Correction: Lipid profile, cardiovascular disease and mortality in a Mediterranean high-risk population: The ESCARVAL-RISK study

[This corrects the article DOI: 10.1371/journal.pone.0186196.].

Clinical impact of mineralocorticoid receptor antagonists treatment after acute coronary syndrome in the real world: A propensity score matching analysis

BACKGROUND

Recent studies suggest that the benefit of mineralocorticoid receptor antagonists in the acute coronary syndrome setting is controversial. The aim of this study was to examine the current long-term prognostic benefit of mineralocorticoid receptor antagonists in patients with acute coronary syndrome.

MATERIAL AND METHODS

We conducted a retrospective cohort study of 8318 consecutive acute coronary syndrome patients. Baseline patient characteristics were examined and a follow-up period was established for registry of death, major cardiovascular adverse events and heart failure re-hospitalization. We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been treated with mineralocorticoid receptor antagonists. The prognostic value of mineralocorticoid receptor antagonists to predict events during follow-up was analysed using Cox regression.

RESULTS

Among the study participants, only 524 patients (6.3%) were discharged on mineralocorticoid receptor antagonists. Patients on mineralocorticoid receptor antagonists had a different clinical and pharmacological profile. These differences disappeared after the propensity score analysis. The median follow-up was 40.7 months. After the propensity score analysis, the cardiovascular mortality and heart failure readmission rates were similar between patients who were discharged on mineralocorticoid receptor antagonists and those whose not. The use of mineralocorticoid receptor antagonists was only associated with a reduction in major cardiovascular adverse events (hazard ratio=0.83, 95% confidence interval 0.69-0.97, p=0.001).

CONCLUSIONS

Our results do not corroborate the long-term benefit of mineralocorticoid receptor antagonists to improve survival after acute coronary syndrome in a large cohort of patients with heart failure or reduced left ventricular ejection fraction and diabetes. Their prescription was associated with a significantly lower incidence of major cardiovascular adverse events during the long-term follow-up without effect on heart failure development.

Three Cases of Canine Dermatomyositis-Like Disease

Background: Dermatomyositis is an idiopathic, inflammatory/immunemediated disease of the skin, muscles and bloodvessels of hereditary nature and unclear pathogenesis. This familial disease has been described in certain breeds, especially collies and Shetland sheep dogs and is of rare occurrence in mongrel dogs. To describe and discuss three clinical cases of dermatomyositis-like disease and provide a brief review of the literature.Cases: Three young mongrel dogs are included in this report. Case 1: Mandarino, a 4-year-old mongrel dog, having a history of skin lesions for at least a year. Showed an underweight patient, skin ulcers, crusts, alopecia, peri-ocular scarring causing severe lagophthalmia and a corneal ulcer. Muscle atrophy was most notable in the head and legs; the dog haddifficulty and pain walking. Treatment was initialised with cephalexin 30 mg/kg BID, pentoxifylline 25 mg/kg BID, and prednisone 2.2 mg/kg SID. The patient was presented after two weeks for follow up; the anaemia and skin condition had improved, the weight had increased by 2 kg, dysphagia and locomotor abnormalities were not present. Case 2: Milagros,a mongrel female dog approximately two years of age, rescued from a shelter. Physical examination showed facial alopecia, erythema and scarring of the periocular skin, crusting and scaling in alopecic areas, pinnae tip necrosis and crusting, ear alopecia, tail tip necrosis and crusting. Also present were distal limb alopecia, crusting and ulcers in areas of trauma in the hock and carpal surfaces; some nails presented onychorhexis and onychoschizia. The patient has been treated for12 months with a good clinical outcome, with pentoxifylline, azathioprine 2.2 mg/kg EOD alternating with prednisone 1 mg/kg EOD. Case 3: Chuchito, an 11-month-old male mongrel rescued dog had been previously hospitalised due to his skin condition. Physical examination showed depigmented and alopecic areas in the nasal planum, perioral and periocular areas, and inflammation of the palpebral tissues. Necrosis of the distal pinnae, alopecia and scales were evident, along with sloughing of scales and ulcers. Skin lesions were also present in the distal limbs, and alopecia, erythema and some crusting and scales in the carpal, tarsal and digital areas. Onychodystrophy was present in several digits. This study describes the physical examination and the clinical pathological findings, including skin scrapings, fungal cultures, and skin biopsies, in three dogs with dermatomyositis-like disease, as well as the clinical outcomes after slightly different treatment protocols were used. The biopsy results of two dogs showed ischaemic dermatopathy.Discussion: The most common initial signs of the disease are erythema, desquamation and alopecia in the facial area, ears, distal limbs and pinnae in young puppies aged between two and six months of age, followed by pigmentary changes. Muscular lesions are uncommon; when present, they represent the most severe form of this disease. Dysphagia is a common sign and mega-oesophagus may be present. Patients with muscular disease can manifest difficulty walking, with a stiff high gait. The immune mediated pathogenesis of dermatomyositis can relate to triggering factors in some dogs, such as drugs, infections, paraneoplasms, or toxins. Other potential inducing stressors include oestrus, whelping and excessive solar exposure. Dermatomyositis-like or familiar dermatomyositis is diagnosed using clinical findings, histopathologyof skin and muscle, and muscle physiology studies. Electromyography, breed predisposition and genetic background can be helpful in some cases. The clinical findings and response to the treatment of all three cases were compatible with dermatomyositis-like disease in mongrel dogs.Keywords: dermatomyositis, dermatopathy, vascular disease, inflammatory myopathies, mongrel dog.

Prognosis and lipid profile improvement by a specialized outpatient clinic for acute coronary syndrome patients

BACKGROUND AND AIMS

Prognosis variations in patients discharged after an acute coronary syndrome (ACS) according to the professionals involved has not been clearly outlined. The aim of our study was to assess the impact on a specific outpatient clinic (SOC).

METHODS

We included all consecutive patients admitted for an ACS in a single center. We performed a propensity score matching with all patients discharged from hospital according to whether they were referred to the SOC or not.

RESULTS

From the 1822 patients discharged, 260 couples of well-balanced ACS patients were obtained after propensity score matching. Median follow-up was 43.3 months and cardiovascular mortality rate was 10.4%, all-cause mortality was 13.9% and any MACE 38.2%. Patients attended the SOC had significantly lower rates at all three endpoints. Multivariate analysis results showed how the follow-up in the SOC was associated with significantly lower risk at all endpoints. SOC patients also had significantly lower rate at hospital readmissions and the multivariate analysis identified a negative association between the first cardiovascular readmission and SOC (sHR: 0.26 95%CI 0.18-0.367; p < 0.01). Mean LDLc levels at the time of ACS admission was 99.0 (36.7) mg/dl and no difference was observed in patients referred to SOC vs. non-referred. Patients followed at the SOC achieved significantly lower LDLc and higher percentage of LDLc <70 mg/dl (56.7% vs. 36.7%; p < 0.01). SOC follow-up was associated with 44% higher probability of final LDLc <70 mg/dl.

CONCLUSIONS

An SOC for ACS patients was independently associated with higher LDLc control and long-term survival.

Clinical profile and outcomes in octogenarians with atrial fibrillation: A community-based study in a specific European health care area

BACKGROUND

Age increases risk of stroke and bleeding. Clinical trial data have had relatively low proportions of elderly subjects. We sought to study a Spanish population of octogenarians with atrial fibrillation (AF) by combining different sources of electronic clinical records from an area where all medical centres utilized electronic health record systems.

METHODS

Data was derived from the Galician Healthcare Service information system.

RESULTS

From 383,000 subjects, AF was coded in 7990 (2.08%), 3640 (45.6%) of whom were ≥80 and 4350 (54.4%)<80. All CHA2DS2-VASc's components were more prevalent in the elderly except for diabetes. Of those ≥80, 2178 (59.8%) were women. Mean CHA₂DS₂-VASc was 4.2±1.1. Distribution of CHA₂DS₂-VASc components varied between genders. 2600 (71.4%) were on oral anticoagulant (OA). During a median follow up of 696days (124.23), all-cause mortality was higher in ≥80 (1011/3640 (27.8%) vs 350/4350 (8.05%) (p<0.001). There were differences in rate of thromboembolic (TE) and haemorrhagic events (2.3% vs 0.9%, p<0.01 and 2.5% vs 1.7%, p=0.01 respectively). In octogenarian, differences between genders were observed with regard to TE, but not in haemorrhagic or all-cause mortality rates. Age, heart failure, non-valvular AF, dementia, and OA were independent predictors of all-cause mortality. In regard to TE, female gender, hypertension, previous TE and OA were independent predictive factors.

CONCLUSIONS

Octogenarians with AF had very different characteristics and outcomes from their younger counterparts. These results also provide reassurance about the effectiveness of OA in preventing TE events and maintaining a reasonable haemorrhagic event rate in the extremely elderly.

Association analysis between hyperuricemia and long term mortality after acute coronary syndrome in three subgroups of patients

These data are linked to the research article, entitled Hyperuricemia as a prognostic factor after acute coronary syndrome published in Atherosclerosis. Data from patients admitted for acute coronary syndrome between 2008 and 2013 were collected during the hospitalization, and a follow-up until endpoint or end of study was carried out. Multivariate analysis of variables associated with long term mortality after acute coronary syndrome in patients stratified by the presence of diabetes, hypertension or kidney failure is provided in this article.

Nutrients restriction upregulates adiponectin in epicardial or subcutaneous adipose tissue: impact in de novo heart failure patients

Background: Hyperadiponectinemia is an indicator of worse outcomes in advanced heart failure (HF), its role in de novo HF is less clear. Objective: Because this protein is a hormone with starvation properties, we wanted to know its association with nutritional state and its regulator factors in de novo HF. Methods: Adiponectin circulating levels were determined by ELISA at discharge in patients admitted for de novo HF (n=74). Nutritional status was determined by CONUT score. Univariate and multivariate Cox regression analyses were employed to calculate the estimated hazard ratio (HR) with 95% confidence interval (CI) for death or all-cause readmission. Stromal vascular cells (SVC) of EAT and subcutaneous adipose tissue (SAT) from patients (n=5) underwent heart surgery were induced to adipogenesis for 18 days. Then, cells were cultured with complete or starved medium for 8 hours. At the end, adiponectin expression levels were analysed by real time polymerase chain reaction. Results: Patients were grouped regarding nutritional status. There was a strong association between high adiponectin levels and failing nutritional status. Those patients with worse nutritional state had the highest adiponectin and proBNP levels at discharge (p<0.01). Both proteins were slightly correlated (p<0.05). However, only high adiponectin levels were independently associated with death or all-cause readmission. Nutrients starvation upregulated adiponectin expression levels in adipogenesis-induced SVC from EAT or SAT. Conclusions: Worse nutritional state in de novo HF patients is associated with higher adiponectin plasma levels. Their levels were upregulated in adipose cells after being nutrients-starved. These results may help us to understand the adiponectin paradox in HF.