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Pubblicazioni recenti - cardiovascular risk
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Aspirin in primary prevention: the triumph of clinical judgement over complex equations.
Intern Emerg Med2019 Sep;():. doi: 10.1007/s11739-019-02191-4.
Santilli Francesca, Simeone Paola,
Abstract
Aspirin, in 2017, has celebrated its 120th birthday. The efficacy and safety of low-dose aspirin in secondary prevention of cardiovascular disease is well supported by many studies, instead in primary prevention it remains controversial, especially in the aftermath of the publication in 2018 of three novel primary prevention randomized clinical trials, showing that the benefit of low-dose aspirin, although additive to that of statin, is counterbalanced by an excess of (mainly gastrointestinal) bleeding events. The signal for a net benefit seems to be even more controversial in the elderly starting aspirin after the age of 70 years. While international guidelines have promptly downgraded their recommendations to more conservative indications, the practicing clinician is called to make the effort to individualize the treatment, after careful evaluation of the haemorrhagic risk vis-a-vis the risk to develop, in the mid-term and long-term follow-up, major cardiovascular events or cancer. This is a particularly complex task, given the different immediate and long-term impact of diverse outcomes on health, the dynamic nature over time of the benefit/risk balance, prompting periodic re-assessments of its indication, and the interindividual variability in aspirin response. The chemopreventive properties of aspirin, anticipated by a large body of epidemiological and mechanistic evidence, are awaiting their final confirmation by the long-term follow-up of the latest trials specifically designed to assess this endpoint, with the expectation to subvert the delicate benefit/risk balance of aspirin in primary prevention. This review is intended to provide an interpretation of past and current evidence to guide clinical decision making on the contemporary patient.
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Effect of single nucleotide polymorphisms in SEPS1 and SEPP1 on expression in the protein level in metabolic syndrome in subjects with cardiovascular disease.
Mol Biol Rep2019 Sep;():. doi: 10.1007/s11033-019-05000-5.
Gharipour Mojgan, Ouguerram Khadija, Nazih El-Hassane, Salehi Mansoor, Behmanesh Mehrdad, Razavi Rouzbeh, Gharipour Amin, Diantkhah Minoo, Sadeghi Masoumeh,
Abstract
Metabolic syndrome (MetS) results from the interaction between environmental and genetic factors. Several previous studies considered the role of selenium in developing MetS. Two selenoproteins, selenoprotein S (SelS), and the Selenoprotein P (SePP) play an important role in antioxidative defense and therefore susceptibility to MetS. The involvement of SNPs in SEPP1 and SEPS1 have not been studied in MetS subjects. This study aims to investigate the association between the risk of MetS and four polymorphisms SEPS1 (rs28665122, rs4965373), SEPP1 (rs7579, rs3877899) in an Iranian population. The sample of this case-control study consisted of 132 Iranian patients with cardiovascular disease (71 MetS and 65 non-MetS subjects) from December 2015 to March 2016. Demographic data, medical history, and para-clinical were measured, and Taqman probes were used for allelic discrimination. The level of the SelS and the SePP were measured by the ELIZA method. No significant differences were found in the genotype frequencies of SEPS1 (rs4965373, rs28665122), SEPP1 (rs7579, rs3877899) in patients with MetS and the non-MetS group. The mean of SelS in MetS subjects with SEPS1 (rs4965373) GG genotype is significantly lower than the non-MetS group (4496.99?±?3688.5 vs. 6148.6?±?1127.0, P?=?0.009). The mean of SePP in MetS subjects with SEPP1 (rs3877899) GG genotype is significantly lower than the non-MetS group (40.73?±?8.44 vs.83.91?±?21.33, P?=?0.002). The mean of SePP in MetS subjects with SEPP1 (rs7579) GG genotype is lower than the non-MetS group (55.52?±?16.7 vs. 109.48?±?29.78, P?=?0.01). In summary, the results of this study does not indicate significant differences in the SEPP1 (rs7579, rs3877899) and SEPS1 (rs4965373, rs28665122) genotypes between MetS and non-MetS subjects. However, the results show that the mean of expression of SelS and SePP decreased in the subjects with SEPP1 (rs7579) GG and SEPP1 (rs3877899) GG.
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Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease.
Med Sci Monit2019 Sep;25():7115-7125. doi: 10.12659/MSM.915830.
Sternberg Michael, Pasini Evasio, Chen-Scarabelli Carol, Corsetti Giovannii, Patel Hemang, Linardi Daniele, Onorati Francesco, Faggian Giuseppe, Scarabelli Tiziano, Saravolatz Louis,
Abstract
In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.
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Fibroblast growth factor 23 expression in human calcified vascular tissues.
Aging (Albany NY)2019 Sep;11():. doi: 10.18632/aging.102297.
Donate-Correa Javier, Martín-Núñez Ernesto, Hernández-Carballo Carolina, Ferri Carla, Tagua Víctor G, Delgado-Molinos Alejandro, López-Castillo Ángel, Rodríguez-Ramos Sergio, Cerro-López Purificación, López-Tarruella Victoria Castro, Felipe-García Raquel, Arévalo-Gomez Miguel A, Pérez-Delgado Nayra, Mora-Fernández Carmen, Navarro-González Juan F,
Abstract
Vascular calcification is a major risk for cardiovascular disease and implies the transformation of smooth muscle cells to an osteoblastic phenotype as a consequence of dysregulation of calcium and phosphate metabolism. Fibroblast growth factor (FGF) 23 is the most potent phosphate regulator. Observational studies suggest that high levels of FGF23 are related to cardiovascular morbidity and mortality. In this work, we determined the levels of both the intact and the carboxi-terminal fragments of circulating FGF23 in 133 patients with established cardiovascular disease, the expression of FGF23, its receptors 1 and 3, and its co-receptor Klotho in vascular fragments of aorta, carotid and femoral in 43 out of this group of patients, and in a control group of 20 organ donors. Patients with atherosclerosis and vascular calcification presented increased levels of FGF23 respect to the control group. Vascular immunoreactivity for FGF23 was also significantly increased in patients with vascular calcification as compared to patients without calcification and to controls. Finally, gene expression of and were also higher and directly related in vascular samples with calcification. Conversely, expression of was reduced in patients with cardiovascular disease when comparing to controls. In conclusion, our findings link the calcification of the vascular tissue with the expression of FGF23 in the vessels and with the elevation of circulating levels this hormone.
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Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis.
BMJ Open2019 Sep;9(9):e030596. doi: 10.1136/bmjopen-2019-030596.
Taylor Kathryn S, Mclellan Julie, Verbakel Jan Y, Aronson Jeffrey K, Lasserson Daniel S, Pidduck Nicola, Roberts Nia, Fleming Susannah, O'Callaghan Christopher A, Bankhead Clare R, Banerjee Amitava, Hobbs Fd Richard, Perera Rafael,
Abstract
OBJECTIVE:
To evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.
DESIGN:
Systematic review and meta-analysis.
METHODS:
Searching MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Clinical Trials Registry Platform, Health Technology Assessment, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index and Clinical Trials Register, from March 1999 to July 2018, we identified randomised controlled trials (RCTs) of drugs for hypertension, lipid modification, glycaemic control and sodium bicarbonate, compared with placebo, no drug or a drug from another class, in ?40 adults with CKD stages 3 and/or 4, with at least 2 years of follow-up and reporting renal function (primary outcome), proteinuria, adverse events, maintenance dialysis, transplantation, cardiovascular events, cardiovascular mortality or all-cause mortality. Two reviewers independently screened citations and extracted data. For continuous outcomes, we used the ratio of means (ROM) at the end of the trial in random-effects meta-analyses. We assessed methodological quality with the Cochrane Risk of Bias Tool and confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS:
We included 35 RCTs and over 51 000 patients. Data were limited, and heterogeneity varied. Final renal function (estimated glomerular filtration rate) was 6% higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10, I=0%, low GRADE confidence) and 4% higher in those taking lipid-modifying drugs (ROM 1.04, 95% CI 1.00 to 1.08, I=88%, very low GRADE confidence). For RCTs of antihypertensive drugs, there were no significant differences in renal function. Treatment with lipid-modifying drugs led to a 36% reduction in cardiovascular disease and 26% reduction in all-cause mortality.
CONCLUSIONS:
Glycaemic control and lipid-modifying drugs may slow the progression of CKD, but we found no pooled evidence of benefit nor harm from antihypertensive drugs. However, given the data limitations, further research is needed to confirm these findings.
PROSPERO REGISTRATION NUMBER:
CRD42015017501.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
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Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon.
BMJ Open2019 Sep;9(9):e030594. doi: 10.1136/bmjopen-2019-030594.
Nansseu Jobert Richie, Assah Felix, Petnga Saint-Just, Kameni Bibiane Siaheu, Tene Hebert Donald Fosso, Nang Francial Terrenstra, Wouna Dominic Leandry Angong, Noubiap Jean Jacques, Kamgno Joseph,
Abstract
OBJECTIVE:
To describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution.
DESIGN:
A cross-sectional study between May and July 2017.
SETTING:
The University of Yaoundé I, Cameroon.
PARTICIPANTS:
Any university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.
PRIMARY AND SECONDARY OUTCOME MEASURES:
The global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score.
RESULTS:
A total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21-26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7-12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (?=0.08), history of sudden death among biological parents (?=1.28), history of hypertension among brothers/sisters (?=1.33), history of HIV infection (?=4.34), the Alcohol Use Disorder Identification Test-Consumption score (?=0.13), regular exposure to firewood smoke (?=1.29), eating foods/drinks with too much sugar ?1 time/day (?=0.96), eating foods/snacks with too much oil ?3 times/week (?=1.20) and eating dairy products?1 time/day (?=0.61) were the independent factors likely influencing participants' global risk of CVD.
CONCLUSION:
Almost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences.
BMJ Open2019 Sep;9(9):e030344. doi: 10.1136/bmjopen-2019-030344.
Salinero-Fort Miguel Angel, Mostaza-Prieto Jose M, Lahoz-Rallo Carlos, Vicente Díez José Ignacio, Cárdenas-Valladolid Juan,
Abstract
OBJECTIVES:
To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences.
DESIGN AND SETTING:
A cross-sectional population study of 11?645 persons aged ?90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease.
RESULTS:
The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females.
CONCLUSION:
Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ?90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial.
BMJ Open2019 Sep;9(9):e029420. doi: 10.1136/bmjopen-2019-029420.
Kennedy Oliver, Su Fangzhong, Pears Robert, Walmsley Emily, Roderick Paul,
Abstract
OBJECTIVE:
To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC).
DESIGN:
This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015.
SETTING:
151 general practices in Hampshire, England, UK.
PARTICIPANTS:
366?005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC.
INTERVENTION:
NHS HC invitation.
MAIN OUTCOME MEASURES:
HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10%?and >20%, smokers, and total cholesterol (TC) >5.5?mmol/L and >7.5?mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT).
RESULTS:
HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5?mmol/L (4.1%-7.0%, p<0.001) and >7.5?mmol/L (0.3%-0.4%?p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95%?CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5?mmol/L (3.72, 3.57 to 3.89) and >7.5?mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10%?plus statin and >20%?plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation.
CONCLUSIONS:
HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Effectiveness and safety of oral Chinese patent medicines as adjuvant treatment for unstable angina pectoris on the national essential drugs list of China: a protocol for a systematic review and network meta-analysis.
BMJ Open2019 Sep;9(9):e026136. doi: 10.1136/bmjopen-2018-026136.
Hua Zhen, Zhai Feng-Ting, Tian Jinhui, Gao Cheng-Fei, Xu Peng, Zhang Fan, Liu Si-Jia, Dong Kun, Du Xiao-Feng, Zhang Zhe, Yang Guanlin,
Abstract
INTRODUCTION:
Achieving efficacious and safe treatments for unstable angina pectoris (UAP) is still a challenging clinical problem. The availability of different oral Chinese patent medicines frequently poses a practical challenge to clinicians, namely, which one to choose as first-line regimen for treatment. This study aims to examine the comparative effectiveness and safety of oral Chinese patent medicines for UAP on the national essential drugs list of China.
METHODS AND ANALYSIS:
We will conduct a network meta-analysis (NMA) of all randomised controlled trials to evaluate the use of oral Chinese patent medicines as adjuvant for the treatment of UAP. We will explore eight electronic databases from their inception to June 2018 and search for grey literature. Primary outcomes include mortality and the cardiovascular events. Secondary outcomes include: (1) symptom improvement; (2) ECG improvement; (3) frequency of acute angina attack; (4) duration of angina; (5) adverse effects. Two independent authors will screen titles and abstracts, review full texts, extract data, assess the risk of bias using the Cochrane risk of bias tool and assess the quality of evidence and strength of the recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). If adequate data are available, NMA will be performed with Bayesian analysis methods.
ETHICS AND DISSEMINATION:
The NMA will help us to reduce the uncertainty of interventions and help clinicians to make optimal and more accurate therapeutic decisions for adults with UAP. Therefore, we will publish the findings of this study in a peer-reviewed journal. No ethics approval is necessary for this study based on the nature of its design.
TRIAL REGISTRATION NUMBER:
CRD42018092822.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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eradication treatment for gastric carcinoma prevention in asymptomatic or dyspeptic adults: systematic review and Bayesian meta-analysis of randomised controlled trials.
BMJ Open2019 Sep;9(9):e026002. doi: 10.1136/bmjopen-2018-026002.
Terasawa Teruhiko, Hamashima Chisato, Kato Katsuaki, Miyashiro Isao, Yoshikawa Takaki, Takaku Reo, Nishida Hiroshi,
Abstract
OBJECTIVES:
Recent meta-analyses of eradication therapy in -infected adults reported significant reductions in gastric carcinoma risk. However, concerns about supporting unfocused screening and eradication programme in healthy, asymptomatic populations have arisen. We performed a systematic review and Bayesian meta-analysis to provide an accurate interpretation of randomised evidence on the preventive effectiveness of eradication therapy on gastric carcinoma risk.
METHODS:
We searched databases including PubMed, Cochrane Central and Embase for reference and citation tracking without language restrictions, from inception through 31 July 2018. Paired investigators independently selected randomised controlled trials (RCTs) comparing eradication therapy with placebo or no treatment for asymptomatic or dyspeptic -infected adults with no previous gastric carcinoma. The main outcome was gastric carcinoma incidence; secondary outcomes included gastric carcinoma-specific, non-gastric carcinoma and all-cause mortality.
RESULTS:
A total of 5 population-based and 2 outpatient care-based RCTs involving 7303 adults were eligible. Eradication algorithms were heterogeneous, and unsuccessful eradication and reinfection were frequently observed. A Bayesian meta-analysis with competing risk outcomes found low-certainty evidence that eradication therapy might be more likely than control to reduce gastric carcinoma risk (HR=0.65; 95% credible interval (CrI) 0.41 to 1.0; =11%). The CrIs included the null effects across the subgroup and sensitivity analyses, apart from those based on particular models that excluded two RCTs that enrolled subjects with specific histological findings only (HR=0.55; CrI 0.30 to 0.89; =14%). The uncertainty of the average 41% risk reduction in gastric carcinoma-specific mortality included a clinically important mortality risk increase (HR=0.59 favouring eradication therapy; CrI 0.25 to 1.20; =13%; low certainty).
CONCLUSIONS:
There is insufficient evidence to support or refute the effectiveness of eradication therapy in preventing gastric carcinoma in -infected, high-risk populations. Rigorously conducted large RCTs of healthy infected adults only would provide evidence of the true efficacy of successful eradication. CRD42014009245.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Sleep Apnea and Chronic Kidney Disease - A State of the Art Review.
Chest2019 Sep;():. doi: S0012-3692(19)33869-3.
Lin Chou-Han, Lurie Renee C, Lyons Owen D,
Abstract
Patients with chronic kidney disease have increased morbidity and mortality, mainly due to cardiovascular disease. Compared to the general population, patients with chronic kidney disease have an increased prevalence of both obstructive and central sleep apnea, and the presence of sleep apnea in this population has been associated with an increased risk of cardiovascular events and mortality. While obstructive sleep apnea can lead to an increase in the rate of kidney function decline, there is also evidence that the presence of end stage renal disease can lead to worsening of sleep apnea, indicating a bidirectional relationship between sleep apnea and chronic kidney disease. The objective of this review is to describe the epidemiology of sleep apnea in chronic kidney disease, understand the pathophysiological mechanisms by which obstructive sleep apnea can lead to progression of chronic kidney disease, and consider the role of treatment with continuous positive airways pressure in this regard. The review also explores the pathophysiological mechanism by which end stage renal disease can lead to sleep apnea and considers how intensification of renal replacement therapy or extra fluid removal by ultrafiltration may attenuate the degree of sleep apnea severity in this population.
Copyright © 2019. Published by Elsevier Inc.
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Prognostic effect of troponin elevation in patients undergoing carotid endarterectomy with regional anesthesia - A prospective study.
Int J Surg2019 Sep;():. doi: S1743-9191(19)30246-8.
Pereira-Macedo Juliana, Rocha-Neves João P, Dias-Neto Marina F, Andrade José Paulo V,
Abstract
BACKGROUND:
Myocardial injury after noncardiac surgery (MINS) occurs in 15% of patients undergoing carotid endarterectomy (CEA) with general anesthesia. Short and long-term risk of myocardial infarction (MI) and stroke have been strongly associated with the presence of MINS, with an associated mortality rate superior to 10% in the first year. Due to the absence of studies concerning CEA with regional anesthesia (RA), the present study aimed to evaluate the incidence of MINS in patients with RA and its prognostic value on cardiovascular events or death.
MATERIALS AND METHODS:
From January 2009 to January 2018, 156 patients from a Portuguese tertiary care medical center who underwent CEA under RA were retrieved from a prospectively gathered database. Troponin I or high-sensitive troponin I values were systematically measured in the postoperative period and studied as a binary outcome in a logistic regression model. Survival analysis was used to study the impact of MINS in time-dependent clinical outcomes such as stroke and MI.
RESULTS:
The incidence of MINS after CEA was 15.3%. Multivariate analysis confirmed that chronic heart failure was strongly associated with MINS (OR: 4.458, 95% CI: 1,689 - 11.708, P < 0.001). A previously diagnosed MINS was associated with the long-term risk of MI and major adverse cardiovascular events (MACE) with hazard ratios (HR) of 3.318 (95% CI: 0.97-13.928, Breslow: P = 0.025) and 1.955 (95% CI: 1.01 - 4.132, Breslow: P = 0.046), respectively.
CONCLUSIONS:
MINS is a long-term predictor of MI and MACE. Troponin assessment after CEA should be routinely monitored in patients with a cardiovascular risk superior to 5%. Further studies concerning prophylaxis and management of MINS should be carried on, focusing on the effect of anesthetic procedure in postoperative troponin elevation.
Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
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The Risk of Cardiovascular Events on Cannabis' Highest Day.
Can J Cardiol2019 May;():. doi: S0828-282X(19)30356-3.
Singh Sheldon M, Koh Maria, Fang Jiming, Ko Dennis T,
Abstract
Knowledge of the acute cardiovascular effects of cannabis consumption remains largely unknown and is important given the changing landscape of legalization of recreational cannabis use. "4/20" is an annual event where many individuals gather to consume cannabis. An increased risk of adverse health events such as motor vehicle accidents has previously been reported to occur on "4/20." In this study, population-based administrative databases in Ontario, Canada, were used to evaluate the association between "4/20" and cardiovascular events. An increased risk of cardiovascular events on a population level was not observed on "4/20." Additional research into the changes in the prevalence of the use of cannabis with recreational legalization and acute and chronic risk with cannabis use is suggested.
Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Routine Glycoprotein IIb/IIIa Inhibitor Therapy in ST-Segment Elevation Myocardial Infarction: A Meta-analysis.
Can J Cardiol2019 May;():. doi: S0828-282X(19)30302-2.
Karathanos Athanasios, Lin Yingfeng, Dannenberg Lisa, Parco Claudio, Schulze Volker, Brockmeyer Maximilian, Jung Christian, Heinen Yvonne, Perings Stefan, Zeymer Uwe, Kelm Malte, Polzin Amin, Wolff Georg,
Abstract
BACKGROUND:
Guidelines recommend adjunct glycoprotein IIb/IIIa inhibitors (GPIs) only in selected patients with acute ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate routine GPI use in STEMI treated with primary percutaneous coronary intervention.
METHODS:
Online databases were searched for randomized controlled trials of routine GPI vs control therapy in STEMI. Data from retrieved studies were abstracted and evaluated in a comprehensive meta-analysis. Twenty-one randomized controlled trials with 8585 patients were included: 10 trials randomized tirofiban, 9 abciximab, 1 trial eptifibatide, and 1 trial used abciximab+tirofiban; only 1 trial used dual antiplatelet therapy with prasugrel/ticagrelor.
RESULTS:
Routine GPI use was associated with a significant reduction in all-cause mortality at 30 days (2.4% [GPI] vs 3.2%; risk ratio [RR], 0.72; P = 0.01) and 6 months (3.7% vs 4.8%; RR, 0.76; P = 0.02), and a reduction in recurrent myocardial infarction (1.1% vs 2.1%; RR, 0.55; P = 0.0006), repeat revascularization (2.5% vs 4.1%; RR, 0.63; P = 0.0001), thrombolysis in myocardial infarction flow <3 after percutaneous coronary intervention (5.4% vs 8.2%; RR, 0.61; P < 0.0001), and ischemic stroke (RR, 0.42; P = 0.04). Major (4.7% vs 3.4%; RR, 1.35; P = 0.005) and minor bleedings (7.2% vs 5.1%; RR, 1.39; P = 0.006) but not intracranial bleedings (0.1% vs 0%; RR, 2.7; P = 0.37) were significantly increased under routine GPI.
CONCLUSIONS:
Routine GPI administration in STEMI resulted in a reduction in mortality, driven by reductions in recurrent ischemic events-however predominantly in pre-prasugrel/ticagrelor trials. Trials with contemporary STEMI management are needed to confirm these findings.
Copyright © 2019. Published by Elsevier Inc.
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Arrhythmias in Patients on Maintenance Dialysis: A Cross-sectional Study.
Am J Kidney Dis2019 Sep;():. doi: S0272-6386(19)30888-1.
Rantanen Jesper Moesgaard, Riahi Sam, Schmidt Erik Berg, Johansen Martin Berg, Søgaard Peter, Christensen Jeppe Hagstrup,
Abstract
RATIONALE & OBJECTIVE:
Patients with kidney failure treated with maintenance dialysis experience a high rate of mortality, in part due to sudden cardiac death caused by arrhythmias. The prevalence of arrhythmias, including the subset that are clinically significant, is not well known. This study sought to estimate the prevalence of arrhythmias, characterize the pattern of arrhythmic events in relation to dialysis treatments, and identify associated clinical characteristics.
STUDY DESIGN:
Cross-sectional study.
SETTING & PARTICIPANTS:
152 patients with kidney failure treated with maintenance dialysis in Denmark.
EXPOSURES:
Dialysis treatment; clinical characteristics; cardiac output and preload defined using echocardiography.
OUTCOMES:
Prevalence and pattern of arrhythmias on 48-hour Holter monitoring; odds ratios for arrhythmias.
ANALYTICAL APPROACH:
Descriptive analysis of the prevalence of arrhythmias. Pattern of arrhythmias described using a repeated-measures negative binomial regression model. Associations between clinical characteristics and echocardiographic findings with arrhythmias were assessed using logistic regression.
RESULTS:
Among the 152 patients studied, 83.6% were treated with in-center dialysis; 10.5%, with home hemodialysis; and 5.9%, with peritoneal dialysis. Premature atrial and ventricular complexes were seen in nearly all patients and 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation observed among 8.6% of patients, paroxysmal atrial fibrillation among 3.9%, nonsustained ventricular tachycardia among 19.7%, bradycardia among 4.6%, advanced second-degree atrioventricular block among 1.3%, and third-degree atrioventricular block among 2.6%. Premature ventricular complexes were more common on dialysis days, while tachyarrhythmias were more often observed during dialysis and in the immediate postdialytic period. Older age (OR per 10 years older, 1.53; 95% CI, 1.15-2.03; P=0.003), elevated preload (OR, 4.02; 95% CI, 1.05-15.35; P=0.04), and lower cardiac output (OR per 1L/min greater, 0.66; 95% CI, 0.44-1.00; P=0.05) were independently associated with clinically significant arrhythmias.
LIMITATIONS:
Arrhythmia monitoring limited to 48 hours; small sample size; heterogeneous nature of the population, risk for residual confounding.
CONCLUSIONS:
Arrhythmias, including clinically significant abnormal rhythms, were common. Tachyarrhythmias were more frequent during dialysis and the immediate postdialytic period. The relevance of these findings to clinical outcomes requires additional study.
Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults.
Soc Sci Med2019 Aug;239():112514. doi: S0277-9536(19)30508-8.
Jung Lara, De Neve Jan-Walter, Chen Simiao, Manne-Goehler Jennifer, Jaacks Lindsay M, Corsi Daniel J, Awasthi Ashish, Subramanian S V, Vollmer Sebastian, Bärnighausen Till, Geldsetzer Pascal,
Abstract
BACKGROUND:
Diabetes, hypertension, and obesity tend to be positively associated with socio-economic status in low- and middle-income countries (LMICs). It has been hypothesized that these positive socio-economic gradients will reverse as LMICs continue to undergo economic development. We use population-based cross-sectional data in India to examine how a district's economic development is associated with socio-economic differences in cardiovascular disease (CVD) risk factor prevalence between individuals.
METHODS:
We separately analyzed two nationally representative household survey datasets - the NFHS-4 and the DLHS-4/AHS - that are representative at the district level in India. Diabetes was defined based on a capillary blood glucose measurement, hypertension on blood pressure measurements, obesity on measurements of height and weight, and current smoking on self-report. Five different measures of a district's economic development were used. We analyzed the data using district-level regressions (plotting the coefficient comparing high to low socio-economic status against district-level economic development) and multilevel modeling.
RESULTS:
757,655 and 1,618,844 adults participated in the NFHS-4 and DLHS-4/AHS, respectively. Higher education and household wealth were associated with a higher probability of having diabetes, hypertension, and obesity, and a lower probability of being a current smoker. For diabetes, hypertension, and obesity, we found that a higher economic development of a district was associated with a less positive (or even negative) association between the CVD risk factor and education. For smoking, the association with education tended to become less negative as districts had a higher level of economic development. In general, these associations did not show clear trends when household wealth quintile was used as the measure of socio-economic status instead of education.
CONCLUSIONS:
While this study provides some evidence for the "reversal hypothesis", large-scale longitudinal studies are needed to determine whether LMICs should expect a likely reversal of current positive socioeconomic gradients in diabetes, hypertension, and obesity as their countries continue to develop economically.
Copyright © 2019 Elsevier Ltd. All rights reserved.
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Non-linear associations of 25-hydroxyvitamin D concentrations with risk of cardiovascular disease and all-cause mortality: results from The Health Improvement Network (THIN) database.
J Steroid Biochem Mol Biol2019 Sep;():105480. doi: S0960-0760(19)30363-2.
Crowe Francesca L, Thayakaran Rasiah, Gittoes Neil, Hewison Martin, Thomas G Neil, Scragg Robert, Nirantharakumar Krishnarajah,
Abstract
BACKGROUND:
There is increasing evidence that vitamin D supplementation may only be beneficial in people with vitamin D deficiency, and the lack of sufficient people with very low vitamin D levels could explain the lack of protection against cardiovascular disease (CVD) reported in recent clinical trials of vitamin D supplementation. The aim of this study was to assess associations of low to moderate circulating concentrations of 25-hydroxyvitamin D (25(OH)D with risk of incident CVD and all-cause mortality, as well as the risk of ischaemic heart disease (IHD), cerebrovascular disease, and heart failure separately.
METHODS AND RESULTS:
Longitudinal analysis of electronic health records in The Health Improvement Network (THIN), a UK primary care database. The analysis included 180,263 patients age 18 years and older without a history of CVD and with circulating concentrations of 25(OH)D. After a mean follow-up of 2.2 (SD 1.7) years, there were 3,747 patients diagnosed with CVD and 3,912 patients died. Compared to patients in the highest quintile of 25(OHD) (? 67.5?nmol/L), those in the lowest 25(OH)D quintile (<23.1?nmol/L) had a hazard ratio (HR) of 1.24 (95% CI 1.12-1.38, P?
CONCLUSION:
Low 25(OH)D are associated with highest risk of CVD and mortality, and are consistent with accumulating evidence that increased risk of these diseases occurs primarily in people with vitamin D deficiency.
Copyright © 2019. Published by Elsevier Ltd.
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An In-hospital Mortality Risk Model for Patients Undergoing Coronary Artery Bypass Grafting in China.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31404-3.
Hu Zhan, Chen Sipeng, Du Junzhe, Gu Dachuan, Wang Yun, Hu Shengshou, Zheng Zhe,
Abstract
BACKGROUND:
To meet the demand of increasing surgical volume and changing of patient's risk profiles of coronary artery bypass grafting in China, we develop a new risk model that predicts in-hospital mortality.
METHODS:
The analysis included patients who underwent coronary artery bypass grafting between January 2013 and December 2016 at 87 hospitals in the Chinese Cardiac Surgery Registry. Patients in years 2013-2015 were randomly divided into training (n=31297, 75%) and test (n=10432, 25%) samples; 2016 patients (n=15047) comprised the validation sample. Demographic and clinical risk factors were identified . Harrell's C-statistic was used to evaluate model discrimination, and the Hosmer-Lemeshow goodness-of-fit test was used to assess calibration.
RESULTS:
The 56776 patients had a mean age of 61.8 (standard deviation 8.8) years, and 24.6% were female. Overall, in-hospital mortality was 2.1%. The final model included 21 risk factors represented by 16 unique variables. The model achieved good discrimination, with a C-statistic of 0.79 (95% CI 0.77-0.80) in the training sample, 0.79 (95% CI 0.76-0.82) in the test sample, and0.78 (95% CI 0.76-0.81) in the validation sample. Model calibration was good according to the Hosmer-Lemeshow test (P>0.05 in the three samples). When compared with the SinoSCORE and EuroSCORE II, the model had better discrimination and calibration.
CONCLUSIONS:
We developed and evaluated a model with 16 risk factors that predicted in-hospital mortality risk after coronary artery bypass grafting in China. This updated model may help surgeons and hospitals better identify high-risk patient.
Copyright © 2019. Published by Elsevier Inc.
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An update on efficacy and safety of SGLT2 inhibitors in Asians and non-Asians.
J Diabetes Investig2019 Sep;():. doi: 10.1111/jdi.13150.
Fujita Yoshihito, Inagaki Nobuya,
Abstract
Recent topics about SGLT2 inhibitor mainly focus on clinical studies, briefly mentioning its efficacy and safety in Asian and non-Asian type 2 diabetes patients. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of anti-diabetic drugs for treatment of diabetes; they reduce plasma glucose concentrations and body?weight by inhibiting glucose reabsorption in the kidney (1). As the action of the drug is unique, it has been receiving attention regarding its efficacy and safety from well before its launch. In clinical use, further insights on efficacy and cautions on safety of SGLT2 inhibitors have been accumulating. Meta-analysis suggests that SGLT2 inhibitors as well as glucagon-like peptide 1 (GLP-1) analogs lead to comparable bodyweight decreases in type 2 diabetes patients (2). Body weight loss is a major target for treatment of patients with type 2 diabetes, especially because overweight is associated with insulin resistance and cardiovascular risk factors.
© 2019 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.
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Comparison of Lacrosse Non-Slip Elements and Cutting Balloons in Treating Calcified Coronary Lesions: a Retrospective, Single-Blind Randomized Controlled Study.
Adv Ther2019 Sep;():. doi: 10.1007/s12325-019-01072-8.
Zhang Xin-Yong, Tang Zhe, Zeng Ya-Ping, Nie Shao-Ping,
Abstract
INTRODUCTION:
The present study aimed to compare Lacrosse non-slip elements (NSE) and cutting balloons in treating calcified coronary lesions.
METHODS:
A retrospective analysis was performed in 79 patients, who were diagnosed with moderate to severe calcified coronary lesions by coronary angiography, and underwent interventional therapy from January to December 2017. Lacrosse NSEs were used in 41 patients, while cutting balloons were used in 38 patients. The basic clinical characteristics, angiographic images, perioperative parameters, operation durations, interventional complications and incidence of major adverse cardiovascular events were compared.
RESULTS:
There was no significant difference in age, gender and risk factors between the two groups (P?>?0.05). Furthermore, there was no significant difference in operation duration, and perioperative and postoperative complications between the two groups (P?>?0.05).
CONCLUSION:
Compared with cutting balloons, the Lacrosse NSE has a similar effect in treating moderate to severe calcified coronary lesions.
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