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Bevan GH, White Solaru KT. Evidence-Based Medical Management of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2020; 40:541-553. [PMID: 31996023 DOI: 10.1161/atvbaha.119.312142] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral artery disease is an atherosclerotic disease of the lower extremities associated with high cardiovascular mortality. Management of this condition may include lifestyle modifications, medical management, endovascular repair, or surgery. The medical approach to peripheral artery disease is multifaceted and includes cholesterol reduction, antiplatelet therapy, anticoagulation, peripheral vasodilators, blood pressure management, exercise therapy, and smoking cessation. Adherence to this regimen can reduce limb-related complications like critical limb ischemia and amputation, as well as systemic complications of atherosclerosis like stroke and myocardial infarction. Relative to coronary artery disease, peripheral artery disease is an undertreated condition. In this article, we explore the evidence behind medical therapies for the management of peripheral artery disease.
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Affiliation(s)
- Graham H Bevan
- From the Department of Medicine (G.H.B., K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Case Western Reserve University School of Medicine, Cleveland, OH (G.H.B., K.T.W.S.)
| | - Khendi T White Solaru
- From the Department of Medicine (G.H.B., K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Harrington Heart and Vascular Institute (K.T.W.S.), University Hospitals Cleveland Medical Center, OH.,Case Western Reserve University School of Medicine, Cleveland, OH (G.H.B., K.T.W.S.)
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52
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Murai Y, Sasase T, Tadaki H, Heitaku S, Imagawa N, Yamada T, Ohta T. Analysis of haemodynamics and angiogenic response to ischaemia in the obese type 2 diabetic model Spontaneously Diabetic Torii
Lepr
fa
(SDT fatty) rats. Clin Exp Pharmacol Physiol 2020; 47:583-590. [DOI: 10.1111/1440-1681.13239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Yasutaka Murai
- Japan Tobacco Inc. Central Pharmaceutical Research Institute Takatsuki Osaka Japan
- Faculty of Agriculture Department of Agrobiology Niigata University Niigata Japan
| | - Tomohiko Sasase
- Japan Tobacco Inc. Central Pharmaceutical Research Institute Takatsuki Osaka Japan
| | - Hironobu Tadaki
- Japan Tobacco Inc. Central Pharmaceutical Research Institute Takatsuki Osaka Japan
| | - Shiro Heitaku
- Japan Tobacco Inc. Central Pharmaceutical Research Institute Takatsuki Osaka Japan
| | - Naoya Imagawa
- Japan Tobacco Inc. Central Pharmaceutical Research Institute Takatsuki Osaka Japan
| | - Takahisa Yamada
- Faculty of Agriculture Department of Agrobiology Niigata University Niigata Japan
| | - Takeshi Ohta
- Laboratory of Animal Physiology and Functional Anatomy Graduate School of Agriculture Kyoto University Kitashirakawa Kyoto Japan
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53
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Matsuoka T, Kobayashi K, Lefor AK, Sasaki J, Shinozaki H. Antithrombotic drugs do not increase intraoperative blood loss in emergency gastrointestinal surgery: a single-institution propensity score analysis. World J Emerg Surg 2019; 14:63. [PMID: 31892938 PMCID: PMC6938014 DOI: 10.1186/s13017-019-0284-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022] Open
Abstract
Background The use of antithrombotic drugs is increasing with the aging population. Prior to elective procedures, antithrombotic drugs are often discontinued. For emergency procedures in patients taking antithrombotic drugs, their effect cannot be attenuated which may lead to an increased risk of hemorrhagic events. However, there are few studies showing increased intraoperative blood loss in patients taking antithrombotic drugs who undergo emergency gastrointestinal surgery. The aim of this study is to determine whether the use of antithrombotic agents increases intraoperative blood loss in emergency gastrointestinal surgery. Methods A retrospective review of patients who underwent emergency abdominal surgery between January 2013 and December 2017 was conducted. The primary outcome measure was intraoperative blood loss. Patients were divided into the antithrombotic drug group and a control group, and a propensity score was developed using multivariate logistic regression. We use 1:1 propensity score matching analysis to compare outcomes between the two groups. Results Of 1555 patients included in this study, 1184 patients, including 170 patients taking antithrombotic drugs, were eligible for propensity score matching analysis. A 1:1 matching yielded 117 well-balanced pairs. There was no statistically significant difference in intraoperative blood loss (antithrombotic drug group vs control group, median (interquartile): 60 (225–10) vs 100 (243–10) ml, p = 0.43). Conclusions This study suggests that antithrombotic drugs do not increase intraoperative blood loss in patients undergoing emergency gastrointestinal surgery. Emergency gastrointestinal surgery for patients currently taking antithrombotic drugs can be performed safely, and the use of antithrombotic drugs is not a reason to delay surgical intervention.
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Affiliation(s)
- Tadashi Matsuoka
- 1Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.,2Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kenji Kobayashi
- 1Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | | | - Junichi Sasaki
- 2Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
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54
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Barbarash OL, Kashtalap VV. [Do the patients with peripheral atherosclerosis need to a medical therapy before the revascularization?]. TERAPEVT ARKH 2019; 91:129-134. [PMID: 32598600 DOI: 10.26442/00403660.2019.12.000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.
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Affiliation(s)
- O L Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases.,Kemerovo State Medical University
| | - V V Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases.,Kemerovo State Medical University
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55
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Zhang D, Song X, Chen Y, Raposeiras-Roubín S, Abu-Assi E, Henriques JPS, D'Ascenzo F, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie S, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Yan Y, Fan J, Ikari Y, Nakahashi T, Sakata K, Yamagishi M, Kalpak O, Kedev S. Outcome of Patients With Prior Stroke/Transient Ischemic Attack and Acute Coronary Syndromes. Angiology 2019; 71:324-332. [PMID: 31793327 DOI: 10.1177/0003319719889524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between prior stroke/transient ischemic attack (TIA) and clinical outcomes in patients with acute coronary syndrome (ACS) has not been well explored. We evaluated the impact of prior stroke/TIA on this specific patient population. We conducted an international multicenter study including 15 401 patients with ACS from the Bleeding Complications in a Multicenter Registry of Patients Discharged With Diagnosis of Acute Coronary Syndrome registry. They were divided into 2 groups: patients with and without prior stroke/TIA. The primary end point was death at 1-year follow-up. Prior stroke/TIA was associated with higher rate of 1-year death (8.7% vs 3.4%; P < .001). It was an independent predictor of 1-year death even after adjustment for confounding variables (odds ratio, 1.705; 95% confidence interval, 1.046-2.778; P = .032). Besides, patients with prior stroke/TIA had significantly increased 1-year reinfarction (5.6% vs 3.8%, P = .015), in-hospital bleeding (8.7% vs 5.8%, P < .001), and 1-year bleeding (5.2% vs 3.0%, P < .001). No difference of antithrombotic therapies or dual antiplatelet therapy (DAPT) types on outcomes was observed in patients with prior stroke/TIA. Prior stroke/TIA was associated with higher 1-year death for patients with ACS who underwent percutaneous coronary intervention. No benefits or harms were observed with different antithrombotic therapies or DAPT types in these patients.
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Affiliation(s)
- Dongfeng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yalei Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | - Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | | | | | | | | | | | | | - Claudio Moretti
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | - Shaoping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | | | | | | | - Neriman Osman
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | - Francesca Giordana
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Xiao Wang
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jingyao Fan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahashi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Oliver Kalpak
- University Clinic of Cardiology, Skopje, Republic of Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Skopje, Republic of Macedonia
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56
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Kazakov YI, Lukin IB, Sokolova NY, Ivanova OV, Bakulina AV. [Outcomes of revascularizing operations on lower-limb arteries in patients with critical ischaemia and multifocal atherosclerosis]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:114-121. [PMID: 31503255 DOI: 10.33529/angio2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).
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Affiliation(s)
- Yu I Kazakov
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - I B Lukin
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - N Yu Sokolova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - O V Ivanova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - A V Bakulina
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
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57
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Darmon A, Sorbets E, Ducrocq G, Elbez Y, Abtan J, Popovic B, Ohman EM, Röther J, Wilson PF, Montalescot G, Zeymer U, Bhatt DL, Steg PG. Association of Multiple Enrichment Criteria With Ischemic and Bleeding Risks Among COMPASS-Eligible Patients. J Am Coll Cardiol 2019; 73:3281-3291. [DOI: 10.1016/j.jacc.2019.04.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
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58
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Sonnenschein K, Tongers J. Optimized cardiovascular risk in peripheral arterial disease – does intensified statin therapy matter? VASA 2019; 48:371-372. [DOI: 10.1024/0301-1526/a000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kristina Sonnenschein
- Medical School of Hannover, Department of Cardiology and Angiology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Jörn Tongers
- Medical School of Hannover, Department of Cardiology and Angiology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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59
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Watanabe I, Saito D, Noike R, Yabe T, Okubo R, Nakanishi R, Amano H, Toda M, Ikeda T. Measurement of left ventricular end-diastolic pressure improves the prognostic utility of the Global Registry of Acute Coronary Events score in patients with ST-segment elevation myocardial infarction. ASIAINTERVENTION 2019; 5:134-140. [PMID: 36483524 PMCID: PMC9706761 DOI: 10.4244/aij-d-18-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 05/02/2019] [Indexed: 06/17/2023]
Abstract
AIMS This study aimed to evaluate the clinical significance of measuring left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS We retrospectively analysed clinical data from 277 patients with STEMI between October 2006 and June 2014. LVEDP and left ventricular ejection fraction (LVEF) were perioperatively measured during percutaneous coronary intervention (PCI). The primary endpoint was a major adverse cardiac event (MACE) such as cardiac death, non-fatal myocardial infarction, or hospitalisation due to heart failure during the observation period. The independent predictors were identified by Cox proportional hazards regression analysis. Continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) were conducted to assess the incremental prognostic value of adding cardiovascular parameters, including LVEDP, to the Global Registry of Acute Coronary Events (GRACE) score. The mean follow-up period was 44±31 months. A MACE occurred in 33 patients (12.0%). In the Cox proportional hazards regression model, after adjusting for confounding factors, LVEDP was an independent predictor of a MACE (hazard ratio [HR] 1.11, 95% confidence interval [CI]: 1.06-1.17, p<0.001). In addition, the predictive value of the GRACE score for a MACE was significantly improved by LVEDP (NRI 0.66, 95% CI: 0.32-1.01, p<0.001; IDI 0.06, 95% CI: 0.02-0.11, p=0.001), but not by LVEF (NRI 0.14, 95% CI: -0.22-0.50, p=0.44; IDI 0.01, 95% CI: 0.00-0.03, p=0.11). CONCLUSIONS The results of this study demonstrated that evaluating LVEDP provides an additive prognostic value over conventional risks estimated by the GRACE score among STEMI patients.
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Affiliation(s)
- Ippei Watanabe
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Daiga Saito
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ryota Noike
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takayuki Yabe
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ryo Okubo
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideo Amano
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mikihito Toda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
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60
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Wang T, Pan Y, Lin J, Anand R, Wang D, Johnston SC, Meng X, Li H, Zhao X, Liu L, Wang Y, Wang Y. Influence of smoking on
CYP
2C19 genetic variants and clopidogrel efficacy in patients with minor stroke or transient ischaemic attack. Eur J Neurol 2019; 26:1175-1182. [PMID: 30974489 DOI: 10.1111/ene.13962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- T. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Pan
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - J. Lin
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - R. Anand
- Department of Neurosurgery Wayne State University School of Medicine Detroit MIUSA
| | - D. Wang
- INI Stroke Network OSF Healthcare System University of Illinois College of Medicine Peoria ILUSA
| | - S. C. Johnston
- Dell Medical School University of Texas at Austin Austin TX USA
| | - X. Meng
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - H. Li
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - X. Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - L. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University BeijingChina
- China National Clinical Research Center for Neurological Diseases Beijing China
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61
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Patel RS, Tragante V, Schmidt AF, McCubrey RO, Holmes MV, Howe LJ, Direk K, Åkerblom A, Leander K, Virani SS, Kaminski KA, Muehlschlegel JD, Allayee H, Almgren P, Alver M, Baranova EV, Behloui H, Boeckx B, Braund PS, Breitling LP, Delgado G, Duarte NE, Dubé MP, Dufresne L, Eriksson N, Foco L, Scholz M, Gijsberts CM, Glinge C, Gong Y, Hartiala J, Heydarpour M, Hubacek JA, Kleber M, Kofink D, Kotti S, Kuukasjärvi P, Lee VV, Leiherer A, Lenzini PA, Levin D, Lyytikäinen LP, Martinelli N, Mons U, Nelson CP, Nikus K, Pilbrow AP, Ploski R, Sun YV, Tanck MWT, Tang WHW, Trompet S, van der Laan SW, Van Setten J, Vilmundarson RO, Viviani Anselmi C, Vlachopoulou E, Al Ali L, Boerwinkle E, Briguori C, Carlquist JF, Carruthers KF, Casu G, Deanfield J, Deloukas P, Dudbridge F, Engstrøm T, Fitzpatrick N, Fox K, Gigante B, James S, Lokki ML, Lotufo PA, Marziliano N, Mordi IR, Muhlestein JB, Newton-Cheh C, Pitha J, Saely CH, Samman-Tahhan A, Sandesara PB, Teren A, Timmis A, Van de Werf F, Wauters E, Wilde AAM, Ford I, Stott DJ, Algra A, Andreassi MG, Ardissino D, Arsenault BJ, Ballantyne CM, Bergmeijer TO, Bezzina CR, Body SC, Boersma EH, Bogaty P, Bots ML, Brenner H, Brugts JJ, Burkhardt R, Carpeggiani C, Condorelli G, Cooper-DeHoff RM, Cresci S, Danchin N, de Faire U, Doughty RN, Drexel H, Engert JC, Fox KAA, Girelli D, Grobbee DE, Hagström E, Hazen SL, Held C, Hemingway H, Hoefer IE, Hovingh GK, Jabbari R, Johnson JA, Jukema JW, Kaczor MP, Kähönen M, Kettner J, Kiliszek M, Klungel OH, Lagerqvist B, Lambrechts D, Laurikka JO, Lehtimäki T, Lindholm D, Mahmoodi BK, Maitland-van der Zee AH, McPherson R, Melander O, Metspalu A, Niemcunowicz-Janica A, Olivieri O, Opolski G, Palmer CN, Pasterkamp G, Pepine CJ, Pereira AC, Pilote L, Quyyumi AA, Richards AM, Sanak M, Siegbahn A, Simon T, Sinisalo J, Smith JG, Spertus JA, Stender S, Stewart AFR, Szczeklik W, Szpakowicz A, Tardif JC, Ten Berg JM, Tfelt-Hansen J, Thanassoulis G, Thiery J, Torp-Pedersen C, van der Graaf Y, Visseren FLJ, Waltenberger J, Weeke PE, Van der Harst P, Lang CC, Sattar N, Cameron VA, Anderson JL, Brophy JM, Pare G, Horne BD, März W, Wallentin L, Samani NJ, Hingorani AD, Asselbergs FW. Subsequent Event Risk in Individuals With Established Coronary Heart Disease. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e002470. [PMID: 30896328 PMCID: PMC6629546 DOI: 10.1161/circgen.119.002470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Supplemental Digital Content is available in the text. Background: The Genetics of Subsequent Coronary Heart Disease (GENIUS-CHD) consortium was established to facilitate discovery and validation of genetic variants and biomarkers for risk of subsequent CHD events, in individuals with established CHD. Methods: The consortium currently includes 57 studies from 18 countries, recruiting 185 614 participants with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. All studies collected biological samples and followed-up study participants prospectively for subsequent events. Results: Enrollment into the individual studies took place between 1985 to present day with a duration of follow-up ranging from 9 months to 15 years. Within each study, participants with CHD are predominantly of self-reported European descent (38%–100%), mostly male (44%–91%) with mean ages at recruitment ranging from 40 to 75 years. Initial feasibility analyses, using a federated analysis approach, yielded expected associations between age (hazard ratio, 1.15; 95% CI, 1.14–1.16) per 5-year increase, male sex (hazard ratio, 1.17; 95% CI, 1.13–1.21) and smoking (hazard ratio, 1.43; 95% CI, 1.35–1.51) with risk of subsequent CHD death or myocardial infarction and differing associations with other individual and composite cardiovascular endpoints. Conclusions: GENIUS-CHD is a global collaboration seeking to elucidate genetic and nongenetic determinants of subsequent event risk in individuals with established CHD, to improve residual risk prediction and identify novel drug targets for secondary prevention. Initial analyses demonstrate the feasibility and reliability of a federated analysis approach. The consortium now plans to initiate and test novel hypotheses as well as supporting replication and validation analyses for other investigators.
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Affiliation(s)
- Riyaz S Patel
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Vinicius Tragante
- Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Amand F Schmidt
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Raymond O McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H)
| | - Michael V Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Medical Research Council Population Health Research Unit, University of Oxford, United Kingdom (M.V.H).,National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, United Kingdom (M.V.H.)
| | - Laurence J Howe
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Kenan Direk
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.).,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Karol A Kaminski
- Department of Population Medicine and Civilization Disease Prevention (K.A.K.), Medical University of Bialystok, Poland.,Department of Cardiology (K.A.K., A. Szpakowicz), Medical University of Bialystok, Poland
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA (J.D.M., M.H.).,Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B)
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine (H.A., J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Peter Almgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.)
| | - Maris Alver
- Estonian Genome Centre, Department of Biotechnology, Institute of Genomics, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | - Ekaterina V Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.)
| | - Hassan Behloui
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.)
| | - Bram Boeckx
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts), Katholieke Universiteit Leuven, Belgium.,Laboratory for Translational Genetics, VIB Center for Cancer Biology, Belgium (B.B., D. Lambrechts)
| | - Peter S Braund
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Lutz P Breitling
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M.)
| | - Graciela Delgado
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.)
| | - Nubia E Duarte
- Heart Institute, University of Sao Paulo, Brazil (N.E.D., A.C.P.)
| | - Marie-Pierre Dubé
- Montreal Heart Institute, OC, Canada (M.-P.D., J.-C.T.).,Faculty of Medicine, Université de Montréal, QC, Canada (M.-P.D., J.-C.T.)
| | - Line Dufresne
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.)
| | - Niclas Eriksson
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.)
| | - Luisa Foco
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy (L.F.)
| | - Markus Scholz
- Institute for Medical Informatics, Statistics, and Epidemiology (M.S.), University of Leipzig, Germany.,LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany
| | - Crystel M Gijsberts
- Laboratory of Experimental Cardiology (C.M.G.), UMC Utrecht, the Netherlands
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.).,Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.)
| | - Yan Gong
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville
| | - Jaana Hartiala
- Institute for Genetic Medicine (J.H.), Keck School of Medicine of USC, Los Angeles, CA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA (J.D.M., M.H.).,Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B)
| | - Jaroslav A Hubacek
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Marcus Kleber
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.)
| | - Daniel Kofink
- Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), France (S.K.)
| | - Pekka Kuukasjärvi
- Department of Cardio-Thoracic Surgery (P.K.), University of Tampere, Finland
| | - Vei-Vei Lee
- Department of Biostatistics and Epidemiology, Texas Heart Institute, Houston (V.-V.L.)
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Medical Central Laboratories, Feldkirch, Austria (A. Leiherer)
| | - Petra A Lenzini
- Statistical Genomics Division, Department of Genetics (P.A. Lenzini, S.C.), Washington University School of Medicine, Saint Louis, MO
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry (L.-P.L., T.L.), University of Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Nicola Martinelli
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg (L.P.B., U.M.)
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Kjell Nikus
- Department of Cardiology (K.N.), University of Tampere, Finland.,Department of Cardiology, Heart Center (K.N.), Tampere University Hospital, Finland
| | - Anna P Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.)
| | - Rafal Ploski
- Department of Medical Genetics (R. Ploski), Medical University of Warsaw, Poland
| | - Yan V Sun
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA (Y.V.S.).,Department of Biomedical Informatics (Y.V.S.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Michael W T Tanck
- Amsterdam UMC, University of Amsterdam, Clinical Epidemiology and Biostatistics, The Netherlands (M.W.T.T.)
| | - W H Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Heart and Vascular Institute, and Centre for Clinical Genomics, Cleveland Clinic, OH (W.H.W.T.)
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine (S.T.), Leiden University Medical Centre, the Netherlands.,Department of Cardiology (S.T., J.W.J.), Leiden University Medical Centre, the Netherlands
| | - Sander W van der Laan
- Division Laboratories, Pharmacy, and Biomedical Genetics, Laboratory of Clinical Chemistry and Hematology (S.W.v.d.L.), UMC Utrecht, Utrecht University, the Netherlands
| | - Jessica Van Setten
- Division Heart and Lungs, Department of Cardiology, UMC Utrecht, University of Utrecht, the Netherlands (J.V.S.)
| | - Ragnar O Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.), University of Ottawa, ON, Canada
| | - Chiara Viviani Anselmi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Centre, Milan, Italy (C.V.A., G.C.)
| | - Efthymia Vlachopoulou
- Transplantation Laboratory (E.V., M.-L.L.), Helsinki University Hospital and University of Helsinki, Finland
| | - Lawien Al Ali
- University Medical Centre, University of Groningen, the Netherlands (L.A.A., P.V.d.H.)
| | | | | | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | | | - Gavino Casu
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Centre, Milan, Italy (C.V.A., G.C.).,ATS Sardegna, ASSL Nuoro-Ospedale San Francesco, Nuoro, Italy (G.C.).,Department of Biomedical Sciences, Humanitas University, Milan, Italy (G.C.)
| | - John Deanfield
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School (P.D), Queen Mary University of London, United Kingdom.,Centre for Genomic Health (P.D.), Queen Mary University of London, United Kingdom
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, United Kingdom (F.D.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.).,Department of Cardiology, University of Lund, Sweden (T.E.)
| | - Natalie Fitzpatrick
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom
| | - Kim Fox
- National Heart and Lung Institute, Imperial College and Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom (K.F.)
| | - Bruna Gigante
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Stefan James
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Marja-Liisa Lokki
- Transplantation Laboratory (E.V., M.-L.L.), Helsinki University Hospital and University of Helsinki, Finland
| | - Paulo A Lotufo
- Centro de Pesquisa Clinica, Hospital Universitario, Universidade de Sao Paulo, São Paulo, Brazil (P.A. Lotufo, )
| | | | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | - Christopher Newton-Cheh
- Cardiovascular Research Center, Center for Human Genetic Research, Massachusetts General Hospital, Boston (C.N.-C.).,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (C.N.-C.)
| | - Jan Pitha
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.A.H., J.P.)
| | - Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Austria (C.H.S.)
| | - Ayman Samman-Tahhan
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Pratik B Sandesara
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Andrej Teren
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Heart Centre Leipzig, Germany (A. Teren)
| | - Adam Timmis
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom.,Bart's Heart Centre, St Bartholomew's Hospital, London (R.S.P., J.D., A. Timmis)
| | - Frans Van de Werf
- Department of Cardiovascular Sciences (F.V.d.W.), Katholieke Universiteit Leuven, Belgium
| | - Els Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Belgium (E.W.)
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.).,Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.A.M.W.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (I.F.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus and Julius Centre for Health Sciences and Primary Care (A. Algra), UMC Utrecht, Utrecht University, the Netherlands
| | | | - Diego Ardissino
- Cardiology Department, Parma University Hospital, Italy (D.A.)
| | - Benoit J Arsenault
- Centre de recherche de l'Institut Universitaire de cardiologie et de pneumologie de Québec, Canada (B.J.A.).,Department of Medicine, Faculty of Medicine, Université Laval, QC, Canada (B.J.A.)
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V., C.M.B.)
| | - Thomas O Bergmeijer
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Connie R Bezzina
- Amsterdam UMC, University of Amsterdam, Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, AMC Heart Center, the Netherlands (C.G., A.A.M.W., C.R.B.)
| | - Simon C Body
- Harvard Medical School, Boston, MA (J.D.M., M.H., S.C.B).,Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA (S.B.)
| | - Eric H Boersma
- Department of Cardiology, Erasmus MC, Thoraxcenter (E.H.B., J.J.B.).,Cardiovascular Research School, Erasmus Medical Center (COEUR), Rotterdam, the Netherlands(E.H.B.)
| | - Peter Bogaty
- Laval University, Institute universitaire de cardiologie et de pneumologie de Québec, Canada (P.B.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Hermann Brenner
- Network Aging Research (NAR), University of Heidelberg (H.B.)
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, Thoraxcenter (E.H.B., J.J.B.)
| | - Ralph Burkhardt
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Germany (R.B.)
| | | | - Gianluigi Condorelli
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville.,Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | - Sharon Cresci
- Statistical Genomics Division, Department of Genetics (P.A. Lenzini, S.C.), Washington University School of Medicine, Saint Louis, MO.,Cardiovascular Division, Department of Medicine (S.C.), Washington University School of Medicine, Saint Louis, MO
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou & FACT (French Alliance For Cardiovascular Trials), Université Paris Descartes, France (N.D.).,Université Paris-Descartes, France (N.D.)
| | - Ulf de Faire
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden (K.L., B.G., U.d.F.)
| | - Robert N Doughty
- Heart Health Research Group, University of Auckland, New Zealand (R.N.D.)
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria (A. Leiherer, C.H.S., H.D.).,Private University of the Principality of Liechtenstein, Triesen (A. Leiherer, C.H.S., H.D.).,Drexel University College of Medicine, Philadelphia PA (H.D.)
| | - James C Engert
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada (J.C.E.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital, McGill Univ Health Centre, Montreal, QC, Canada (J.C.E., G.T.)
| | - Keith A A Fox
- The University of Edinburgh, United Kingdom (K.A.A.F)
| | - Domenico Girelli
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Emil Hagström
- Department of Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden (E.H.)
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.).,Department of Cardiovascular Medicine, Centre for Microbiome and Human Health, Heart and Vascular Institute, Cleveland Clinic, OH (S.L.H.)
| | - Claes Held
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Harry Hemingway
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Imo E Hoefer
- Department of Clinical Chemistry and Hematology (I.E.H.), UMC Utrecht, the Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam (G.K.H.)
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (C.G., T.E., R.J.)
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, Centre for Pharmacogenomics (Y.G., R.M.C.-D., J.A.J.), University of Florida, Gainesville.,Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | - J Wouter Jukema
- Department of Cardiology (S.T., J.W.J.), Leiden University Medical Centre, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, LUMC, Leiden (J.W.J.).,Interuniversity Cardiology Institute of the Netherlands, Utrecht (J.W.J.)
| | - Marcin P Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Mika Kähönen
- Department of Clinical Physiology (M. Kähönen), University of Tampere, Finland.,Department of Clinical Physiology (M. Kähönen), Tampere University Hospital, Finland
| | - Jiri Kettner
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.)
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland (M. Kiliszek)
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.)
| | - Bo Lagerqvist
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Diether Lambrechts
- Laboratory for Translational Genetics, Department of Human Genetics (B.B., D. Lambrechts), Katholieke Universiteit Leuven, Belgium
| | - Jari O Laurikka
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center, Faculty of Medicine & Life Sciences (J.O.L.), University of Tampere, Finland.,Department of Cardio-Thoracic Surgery, Heart Centre (J.O.L.), Tampere University Hospital, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry (L.-P.L., T.L.), University of Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland (L.-P.L., T.L.)
| | - Daniel Lindholm
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - B K Mahmoodi
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands (E.V.B., O.H.K., A.H.M.-v.d.Z.).,Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam (A.H.M.-v.d.Z.)
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Departments of Medicine and Biochemistry, Microbiology and Immunology(R.M.), University of Ottawa, ON, Canada
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden (P.A., O.M.).,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden (O.M.)
| | - Andres Metspalu
- Estonian Genome Centre, Department of Biotechnology, Institute of Genomics, Institute of Molecular and Cell Biology, University of Tartu, Estonia (M.A., A.M.)
| | | | - Oliviero Olivieri
- Department of Medicine, University of Verona, Italy (N.M., D.G., O.O.)
| | - Grzegorz Opolski
- first Chair and Department of Cardiology (G.O.), Medical University of Warsaw, Poland
| | - Colin N Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee (C.N.P.)
| | - Gerard Pasterkamp
- Department of Clinical Chemistry (G.P.), UMC Utrecht, the Netherlands
| | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine (R.M.C.-D., J.A.J., C.J.P.), University of Florida, Gainesville
| | | | - Louise Pilote
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (L.P., J.M.B.)
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine (A.S.-T., P.B.S., A.A.Q.), Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - A Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.).,Cardiovascular Research Institute, National University of Singapore (A.M.R.)
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Agneta Siegbahn
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Clinical Chemistry, Department of Medical Sciences (A. Siegbahn), Uppsala University, Sweden
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular Trials), Sorbonne Université (T.S.).,Paris-Sorbonne University, UPMC-Site St Antoine, France (T.S.)
| | - Juha Sinisalo
- Heart and Lung Centre (J.S.), Helsinki University Hospital and University of Helsinki, Finland
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital (J.G.S.).,Wallenberg Centre for Molecular Medicine, Lund University Diabetes Centre, Lund University, Sweden (J.G.S.).,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (J.G.S.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (J.A.S.).,Saint Luke's Mid America Heart Insti Kansas City, MO (J.A.S.)
| | - Steen Stender
- Department of Clinical Biochemistry, Copenhagen University Hospital, Gentofte (S.S.)
| | - Alexandre F R Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, ON, Canada (R.O.V., R.M., A.F.R.S.).,Department of Biochemistry, Microbiology and Immunology (R.O.V., A.F.R.S.), University of Ottawa, ON, Canada
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland (M.P.K., M.S., W.S)
| | - Anna Szpakowicz
- Department of Cardiology (K.A.K., A. Szpakowicz), Medical University of Bialystok, Poland
| | - Jean-Claude Tardif
- Montreal Heart Institute, OC, Canada (M.-P.D., J.-C.T.).,Faculty of Medicine, Université de Montréal, QC, Canada (M.-P.D., J.-C.T.)
| | - Jurriën M Ten Berg
- St Antonius Hospital, Department Cardiology, Nieuwegein, the Netherlands (T.O.B., B.K.M., J.M.t.B.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet (J.T.-H.).,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (J.T.-Hansen)
| | - George Thanassoulis
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Preventive and Genomic Cardiology, McGill University Health Centre, Montreal, QC, Canada (L.D., J.C.E., G.T.).,Division of Cardiology, Department of Medicine, Royal Victoria Hospital, McGill Univ Health Centre, Montreal, QC, Canada (J.C.E., G.T.)
| | - Joachim Thiery
- LIFE Research Centre for Civilization Diseases (M.S., A. Teren, R.B., J.T.), University of Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany (J.T.)
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Department of Health Science and Technology, Aalborg University Hospital, Denmark (C.T.-Pedersen)
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care (M.B., D.E.G., Y.v.d.G.), UMC Utrecht, Utrecht University, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine (F.L.J.V), UMC Utrecht, Utrecht University, the Netherlands
| | | | - Peter E Weeke
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark (P.E.W.)
| | - Pim Van der Harst
- University Medical Centre, University of Groningen, the Netherlands (L.A.A., P.V.d.H.)
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Scotland, United Kingdom (D. Levin, I.R.M., C.C.L.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.J.S., N.S.)
| | - Vicky A Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, New Zealand (A.P.P., A.M.R., V.A.C.)
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Cardiology Division, Department of Internal Medicine (J.F.C., J.B.M., J.L.A.), University of Utah, Salt Lake City
| | - James M Brophy
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada (H.B., L.D., L.P., G.T., J.M.B.).,Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (L.P., J.M.B.)
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University (G.P.).,Population Health Research Institute, Hamilton, ON, Canada (G.P.)
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (R.O.M., J.F.C., J.B.M., J.L.A., B.D.H).,Department of Biomedical Informatics (B.D.H.), University of Utah, Salt Lake City
| | - Winfried März
- Fifth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Germany (G.D., M. Kleber, W.M.).,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany (W.M.).,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria (W.M.)
| | - Lars Wallentin
- Uppsala Clinical Research Center, Sweden (A. Åkerblom, N.E., S.J., C.H., B.L., D. Lindholm, A. Siegbahn, L.W.).,Division of Cardiology, Department of Medical Sciences (A. Åkerblom, C.H., D. Lindholm, S.J., B.L., L.W.), Uppsala University, Sweden
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, BHF Cardiovascular Research Centre, University of Leicester, United Kingdom (P.S.B., C.P.N., N.J.S.).,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, United Kingdom (P.S.B., C.P.N., N.J.S.)
| | - Aroon D Hingorani
- Institute of Cardiovascular Science (R.S.P., A.F.S., L.J.H., K.D., J.D., A.D.H., F.W.A), Faculty of Population Health Science, University College London, United Kingdom
| | - Folkert W Asselbergs
- Institute of Health Informatics (N.F., A. Timmis, H.H., F.W.A.), Faculty of Population Health Science, University College London, United Kingdom.,Division of Heart and Lungs, Department of Cardiology (V.T., A.F.S.,D.K.,F.W.A.), UMC Utrecht, the Netherlands.,Durrer Centre of Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (F.W.A.)
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62
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Fitchett D, Inzucchi SE, Cannon CP, McGuire DK, Scirica BM, Johansen OE, Sambevski S, Kaspers S, Pfarr E, George JT, Zinman B. Empagliflozin Reduced Mortality and Hospitalization for Heart Failure Across the Spectrum of Cardiovascular Risk in the EMPA-REG OUTCOME Trial. Circulation 2019; 139:1384-1395. [PMID: 30586757 PMCID: PMC6416009 DOI: 10.1161/circulationaha.118.037778] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the EMPA-REG OUTCOME trial (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease, in comparison with placebo, empagliflozin reduced the risks of 3-point major adverse cardiovascular events (3-point MACE), cardiovascular and all-cause death, and hospitalization for heart failure. We investigated whether these effects varied across the spectrum of baseline cardiovascular risk. METHODS Cardiovascular death, all-cause mortality, 3-point MACE, and hospitalization for heart failure in the pooled empagliflozin and placebo groups were analyzed in subgroups by prior myocardial infarction and stroke at baseline, and by estimated baseline cardiovascular risk based on the 10-point TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Secondary Prevention. RESULTS Of 7020 patients who received the study drug, 65% had a prior myocardial infarction or stroke, and 12%, 40%, 30%, and 18% were at low, intermediate, high, and highest estimated cardiovascular risk according to TIMI Risk Score for Secondary Prevention (≤2, 3, 4, and ≥5 points, respectively). In the placebo group, 3-point MACE occurred during the trial in 7.3%, 9.4%, 12.6%, and 20.6% of patients at low, intermediate, high, and highest estimated baseline risk, respectively. Relative reductions in risk of cardiovascular death, all-cause mortality, 3-point MACE and hospitalization for heart failure with empagliflozin versus placebo were consistent in patients with and without prior myocardial infarction and/or stroke and across subgroups by TIMI Risk Score for Secondary Prevention at baseline ( P>0.05 for randomized group-by-subgroup interactions). CONCLUSIONS Despite all patients having atherosclerotic cardiovascular disease, patients in EMPA-REG OUTCOME demonstrated a broad risk spectrum for cardiovascular events. Reductions in key cardiovascular outcomes and mortality with empagliflozin versus placebo were consistent across the range of cardiovascular risk. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01131676.
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Affiliation(s)
- David Fitchett
- St Michael's Hospital, Division of Cardiology, University of Toronto, Canada (D.F.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.P.C., B.M.S.)
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas (D.K.M.)
| | - Benjamin M Scirica
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA (C.P.C., B.M.S.)
| | | | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Stefan Kaspers
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Egon Pfarr
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Jyothis T George
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (S.S., S.K., E.P., J.T.G.)
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Canada (B.Z.)
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63
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Ammann KR, DeCook KJ, Li M, Slepian MJ. Migration versus proliferation as contributor to in vitro wound healing of vascular endothelial and smooth muscle cells. Exp Cell Res 2019; 376:58-66. [PMID: 30660619 PMCID: PMC6988716 DOI: 10.1016/j.yexcr.2019.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
Wound closure, as a result of collective cell growth, is an essential biological response to injury. In the field of vascular biology, the response of vascular smooth muscle cells (SMCs) and endothelial cells (ECs) to injury and substrate surface is important in therapeutic clinical treatment interventions such as angioplasty and atherectomy. Specifically, the mechanism by which cells close wounds (i.e. proliferation versus migration) in response to injury stimuli is of interest to better modulate recurrent vascular stenosis, prevent thrombus formation, occlusion, and life-threatening cardiovascular events. Here, we examine growth extent and temporal sequence of events following wound or gap introduction to a confluent monolayer of vascular SMCs or ECs. Significant differences in the preferred mechanisms of these cells to close wounds or gaps were observed; after 48 h, 73% of SMC wound closure was observed to be due to proliferation, while 75% of EC wound closure resulted from migration. These mechanisms were further modulated via addition or removal of extracellular matrix substrate and injury, with ECs more responsive to substrate composition and less to injury, in comparison to SMCs. Our results indicate that ECs and SMCs heal wounds differently, and that the time and mode of injury and associated substrate surface all impact this response.
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Affiliation(s)
- Kaitlyn R Ammann
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Katrina J DeCook
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Maxwell Li
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering, College of Engineering, University of Arizona,1127 E James E Rogers Way, PO Box 210020, Tucson, AZ 85721, USA; Department of Medicine, Sarver Heart Center, University of Arizona, 1501 N Campbell Ave, PO Box 245035, Tucson, AZ 85724, USA.
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64
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The Influence of Physical Exercise on Smoking Patients with Peripheral Arterial Disease. CURRENT HEALTH SCIENCES JOURNAL 2019; 44:34-38. [PMID: 30622753 PMCID: PMC6295182 DOI: 10.12865/chsj.44.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/23/2018] [Indexed: 11/18/2022]
Abstract
Smoking should be identified as a major risk factor for Peripheral arterial disease. The purpose of this prospective, randomized, controlled clinical study was to determine whether a rehabilitation program is more efficient than the usual healthcare assistance (medication, hygiene and diet) for improving walking function on the smoking and nonsmoking patients with PAD. For smokers, there were no significant differences after 12 weeks and also 24 weeks, although the 4MWS mean values increased compared to the control. At 24 weeks study time point nonsmokers in the group performed special massage techniques along with the supervised kinesiotherapy had significantly greater improvement in their 4MWS, compared to the group with physical exercises or control. A well-structured rehabilitation program, in terms of intensity, duration and frequency may be of great help for improving the functional status of these patients with peripheral ischemia syndrome.
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65
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Watanabe I, Tatebe J, Fujii T, Noike R, Saito D, Koike H, Yabe T, Okubo R, Nakanishi R, Amano H, Toda M, Ikeda T, Morita T. Prognostic Significance of Serum Indoxyl Sulfate and Albumin for Patients with Cardiovascular Disease. Int Heart J 2018; 60:129-135. [PMID: 30464134 DOI: 10.1536/ihj.18-116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The progression of renal dysfunction reduces serum albumin and deteriorates the binding capacity of protein-bound uremic toxins. We evaluated the prognostic implications of serum indoxyl sulfate (IS) and albumin levels in patients with cardiovascular disease.We prospectively enrolled 351 consecutive patients undergoing percutaneous revascularization for coronary artery disease or peripheral artery disease. The primary endpoint was all-cause mortality. Patients were assigned to four groups according to the median levels of serum IS (0.1 mg/dL) and albumin (3.9 g/dL).During the median follow-up time of 575 days, 16 patients died. The IS level was significantly higher in nonsurvivors (0.33 versus 0.85 mg/dL, P < 0.05). On the Kaplan-Meier curve, the high IS/low albumin group presented the highest mortality rate (log-rank test, P < 0.01). Cox proportional hazard analysis revealed that high IS/low albumin (hazard ratio (HR): 5.33; 95% confidence interval (CI): 1.71-16.5; P < 0.01), diastolic pressure (HR: 0.94; 95% CI: 0.91-0.98; P < 0.01), prior stroke (HR: 4.54; 95% CI: 1.33-15.4; P = 0.01), and left ventricular ejection fraction (LVEF) (HR: 0.92; 95% CI: 0.88-0.96; P < 0.001) were associated with increased mortality. Furthermore, the combination of IS and albumin levels significantly conferred an additive value to LVEF for predicting mortality (C-statistic: 0.69 versus 0.80; P < 0.001; net reclassification improvement: 0.83; P < 0.001; integrated discrimination improvement: 0.02; P = 0.02).A lower albumin level adds potentiating effects on IS as a prognostic factor for cardiovascular disease.
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Affiliation(s)
- Ippei Watanabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Junko Tatebe
- Department of Laboratory Medicine, Toho University Faculty of Medicine
| | - Takahiro Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Ryota Noike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Daiga Saito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Hideki Koike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takayuki Yabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Ryo Okubo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Rine Nakanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Hideo Amano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Mikihito Toda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Toshisuke Morita
- Department of Laboratory Medicine, Toho University Faculty of Medicine
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66
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Affiliation(s)
- Stephen P. Glasser
- University of KentuckyLexingtonKentucky
- University of Birmingham at AlabamaBirminghamAlabama
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67
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Kaasenbrood L, Bhatt DL, Dorresteijn JA, Wilson PW, D'Agostino RB, Massaro JM, van der Graaf Y, Cramer MJ, Kappelle LJ, de Borst GJ, Steg PG, Visseren FLJ. Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART-REACH Model. J Am Heart Assoc 2018; 7:e009217. [PMID: 30369323 PMCID: PMC6201391 DOI: 10.1161/jaha.118.009217] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Background In patients with vascular disease, risk models may support decision making on novel risk reducing interventions, such as proprotein convertase subtilisin/kexin type 9 inhibitors or anti-inflammatory agents. We developed and validated an innovative model to estimate life expectancy without recurrent cardiovascular events for individuals with coronary, cerebrovascular, and/or peripheral artery disease that enables estimation of preventive treatment effect in lifetime gained. Methods and Results Study participants originated from prospective cohort studies: the SMART (Secondary Manifestations of Arterial Disease) cohort and REACH (Reduction of Atherothrombosis for Continued Health) cohorts of 14 259 ( REACH Western Europe), 19 170 ( REACH North America) and 6959 ( SMART , The Netherlands) patients with cardiovascular disease. The SMART-REACH model to estimate life expectancy without recurrent events was developed in REACH Western Europe as a Fine and Gray competing risk model incorporating cardiovascular risk factors. Validation was performed in REACH North America and SMART . Outcomes were (1) cardiovascular events (myocardial infarction, stroke, cardiovascular death) and (2) noncardiovascular death. Predictors were sex, smoking, diabetes mellitus, systolic blood pressure, total cholesterol, creatinine, number of cardiovascular disease locations, atrial fibrillation, and heart failure. Calibration plots showed high agreement between estimated and observed prognosis in SMART and REACH North America. C-statistics were 0.68 (95% confidence interval, 0.67-0.70) in SMART and 0.67 (95% confidence interval, 0.66-0.68) in REACH North America. Performance of the SMART-REACH model was better compared with existing risk scores and adds the possibility of estimating lifetime gained by novel therapies. Conclusions The externally validated SMART-REACH model could be used for estimation of anticipated improvements in life expectancy without recurrent cardiovascular events in individual patients with cardiovascular disease in Western Europe and North America.
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Affiliation(s)
- Lotte Kaasenbrood
- Department of Vascular MedicineUniversity Medical Centre UtrechtThe Netherlands
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular CenterHarvard Medical SchoolBostonMA
| | | | - Peter W.F. Wilson
- Atlanta VAMC Epidemiology and Genomic Medicine and Emory Clinical Cardiovascular Research InstituteAtlantaGA
| | - Ralph B. D'Agostino
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Joseph M. Massaro
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Yolanda van der Graaf
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtThe Netherlands
| | | | - L. Jaap Kappelle
- Department of NeurologyUniversity Medical Centre UtrechtThe Netherlands
| | - Gert J. de Borst
- Department of Vascular SurgeryUniversity Medical Centre UtrechtThe Netherlands
| | - Ph. Gabriel Steg
- FACT, DHU FIREHôpital BichatAP‐HP and INSERM U‐1148Université Paris‐DiderotParisFrance
- NHLI, ICMSImperial CollegeRoyal Brompton HospitalLondonUnited Kingdom
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Armstrong PW, McAlister FA. Searching for Adherence: Can We Fulfill the Promise of Evidence-Based Medicines? J Am Coll Cardiol 2018; 68:802-4. [PMID: 27539171 DOI: 10.1016/j.jacc.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/03/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Paul W Armstrong
- Canadian VIGOUR Centre, Department of Medicine (Cardiology), University of Alberta, Edmonton, Alberta, Canada.
| | - Finlay A McAlister
- Canadian VIGOUR Centre, Department of Medicine (Cardiology), University of Alberta, Edmonton, Alberta, Canada
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van den Berg MJ, Bhatt DL, Kappelle LJ, de Borst GJ, Cramer MJ, van der Graaf Y, Steg PG, Visseren FLJ. Identification of vascular patients at very high risk for recurrent cardiovascular events: validation of the current ACC/AHA very high risk criteria. Eur Heart J 2018; 38:3211-3218. [PMID: 28369481 DOI: 10.1093/eurheartj/ehx102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/14/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To validate and assess performance of the current ACC/AHA very high risk criteria in patients with clinically manifest arterial disease. Methods and results Data were used from the SMART study (n = 7216) and REACH Registry (n = 48 322), two prospective cohorts of patients with manifest atherosclerotic arterial disease. Prevalence and incidence rates of recurrent major adverse cardiovascular events (MACE) were calculated, according to the ACC/AHA VHR criteria (cardiovascular disease combined with diabetes, smoking, dyslipidaemia, and/or recent recurrent coronary events). Performance of the ACC/AHA criteria was compared with single very high risk factors in terms of C-statistics and Net Reclassification Index. All patients were at VHR according to the ESC guidelines (incidence of recurrent MACE in SMART was 2.4/100PY, with 95% CI 2.3-2.5/100PY and in REACH 5.1/100PY with 95% CI 5.0-5.3/100PY). In SMART 57% of the patients were at VHR according to the ACC/AHA criteria (incidence of recurrent MACE 2.7/100PY, 95% CI 2.5-2.9/100PY) and in REACH this was 64% (5.9/100PY, 95% CI 5.7-6.1/100PY). The C-statistic for the ACC/AHA VHR criteria was 0.53 in REACH and 0.54 in SMART. Very high risk factors with comparable or slightly better performance were eGFR < 45, polyvascular disease and age >70 years. Around two third of the patients meeting the ACC/AHA VHR criteria had a predicted 10-year risk of recurrent MACE <30%. Conclusion The ACC/AHA VHR criteria have limited discriminative power. Identifying patients with clinically manifest arterial disease at VHR for recurrent vascular events using eGFR <45, polyvascular disease, or age >70 years performs as well as the ACC/AHA VHR criteria.
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Affiliation(s)
- M Johanneke van den Berg
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, USA
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France.,FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U-1148, Paris, France.,National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, UK
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
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Watanabe I, Tatebe J, Fujii T, Noike R, Saito D, Koike H, Yabe T, Okubo R, Nakanishi R, Amano H, Toda M, Ikeda T, Morita T. Prognostic Utility of Indoxyl Sulfate for Patients with Acute Coronary Syndrome. J Atheroscler Thromb 2018; 26:64-71. [PMID: 29780075 PMCID: PMC6308268 DOI: 10.5551/jat.44149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: We investigated whether indoxyl sulfate (IS), a protein-bound uremic toxin, predicts prognosis after acute coronary syndrome (ACS). Methods: Serum IS level was determined prospectively in 98 patients who underwent successful primary percutaneous coronary intervention for ACS. Patients on hemodialysis were excluded. The endpoint of this study was six-month composite events including death, nonfatal myocardial infarction, heart failure requiring hospitalization, and adverse bleeding events. Results: During the mean follow-up period of 168 days, composite events occurred in 13.3% of cases. Serum IS level was significantly higher in subjects who developed composite events than in those without events (0.14 ± 0.11 mg/dl vs. 0.06 ± 0.04 mg/dl; p < 0.001). After adjusting for confounding factors, a Cox proportional hazard analysis revealed that the IS level (hazard ratio (HR): 10.6; 95% confidence interval (CI): 1.63–69.3, p = 0.01), hemoglobin level (HR: 0.61; 95% CI: 0.43–0.87; p < 0.01), and left ventricular ejection fraction (LVEF) (HR: 0.95; 95% CI: 0.91–0.99; p = 0.03) were independent predictive factors of composite events. Furthermore, IS level significantly conferred additional value to the combined established risks of LVEF and hemoglobin level for predicting the incidence of composite events (area under the curve: 0.82 vs. 0.88, p = 0.01; net reclassification improvement: 0.67, p = 0.01; and integrated discrimination improvement: 0.15, p < 0.01). Conclusions: The assessment of serum IS level has prognostic utility for the management of ACS.
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Affiliation(s)
- Ippei Watanabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Junko Tatebe
- Department of Laboratory Medicine, Toho University Faculty of Medicine
| | - Takahiro Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Ryota Noike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Daiga Saito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Hideki Koike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takayuki Yabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Ryo Okubo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Rine Nakanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Hideo Amano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Mikihito Toda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine
| | - Toshisuke Morita
- Department of Laboratory Medicine, Toho University Faculty of Medicine
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Si S, Golledge J, Norman P, Nelson M, Chew D, Ademi Z, Bhatt DL, Steg GP, Reid CM. Prevalence and Outcomes of Undiagnosed Peripheral Arterial Disease Among High Risk Patients in Australia: An Australian REACH Sub-Study. Heart Lung Circ 2018; 28:939-945. [PMID: 29843973 DOI: 10.1016/j.hlc.2018.04.292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/21/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Compared with other manifestations of cardiovascular disease, peripheral arterial disease (PAD) is under-diagnosed. This study aims to investigate the prevalence, risk profile and cardiovascular outcomes of undiagnosed PAD in Australian general practices. METHOD A sub-study of the Australian Reduction of Atherothrombosis for Continued Health (REACH) Registry, a prospective cohort study of patients at high risk of atherothrombosis recruited from Australian general practices. Eligible patients for this study had no previous clinical diagnosis of PAD and had an ankle-brachial index (ABI) ≤1.4 at recruitment. RESULTS Peripheral arterial disease was undiagnosed in 34% Australian REACH participants, 28% patients had low ABI (ABI<0.9) and 11% had intermittent claudication (IC) based on responses to the Edinburgh Claudication Questionnaire (ECQ). We found no significant differences in risk factor control between patient with or without PAD. Intermittent claudication patients had higher risks of non-fatal cardiovascular events and PAD interventions at one year, whereas all-cause mortality rate was higher among patients with ABI<0.9, especially in those who also reported IC. Finally, an ABI<0.9, together with poorly controlled risk factors were independent predictors of incident IC at one year. CONCLUSIONS This study suggests a high rate of undiagnosed PAD among high risk patients in Australian primary health care. These patients are at high risk of events and therefore would potentially benefit from better secondary prevention measures.
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Affiliation(s)
- Si Si
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, WA, Australia; CCRE Therapeutics, Monash University, Melbourne, Vic, Australia.
| | - Jonathan Golledge
- School of Medicine and Dentistry, James Cook University, Brisbane, Qld, Australia
| | - Paul Norman
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Tas, Australia
| | - Derek Chew
- Flinders University, Adelaide, SA, Australia
| | - Zanfina Ademi
- CCRE Therapeutics, Monash University, Melbourne, Vic, Australia
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, the US
| | | | - Christopher M Reid
- NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, WA, Australia; CCRE Therapeutics, Monash University, Melbourne, Vic, Australia
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72
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Zhao M, Vaartjes I, Klipstein-Grobusch K, Kotseva K, Jennings C, Grobbee DE, Graham I. Quality assurance and the need to evaluate interventions and audit programme outcomes. Eur J Prev Cardiol 2018; 24:123-128. [PMID: 28618906 DOI: 10.1177/2047487317703829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.
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Affiliation(s)
- Min Zhao
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Ilonca Vaartjes
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
| | - Kerstin Klipstein-Grobusch
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,4 Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kornelia Kotseva
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom.,6 Department of Public Health, University of Ghent, Belgium
| | - Catriona Jennings
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Diederick E Grobbee
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
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Abstract
In this seminar, I would like to discuss the recent hybrid operations in patients with peripheral arterial diseases. Hybrid is generally defined as combinations of different types of things. In the surgical community, it is loosely defined as therapy combining open surgery (OS) and endovascular therapy (EVT). In practice, combination surgery of diseased inflow vessels by EVT and outflow vessels by OS is a typical example, namely, the combination therapy of thromboendarterectomy (TEA) for common femoral artery and EVT (PTA and stenting) for iliac artery in patients with PAD (ilio-femoral lesions). Also, there is the potential of various combinations of OS and EVT for complex lesions. Unfortunately, we do not have specific guidelines for hybrid therapy of PAD, but in clinical practices, justified decision-making for surgical indication is strictly required. I emphasize that the cardiovascular surgeon (or vascular specialist) must have the ability of decision-making for suitable combination therapy of OS and EVT which adheres to existing specific guidelines. (This is a translation of Jpn J Vasc Surg 2017; 26: 275-283.).
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Affiliation(s)
- Atsubumi Murakami
- Vascular Surgery, Cardiovascular Center, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan
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74
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Bergmark BA, Bhatt DL, Braunwald E, Morrow DA, Steg PG, Gurmu Y, Cahn A, Mosenzon O, Raz I, Bohula E, Scirica BM. Risk Assessment in Patients With Diabetes With the TIMI Risk Score for Atherothrombotic Disease. Diabetes Care 2018; 41:577-585. [PMID: 29196298 PMCID: PMC5829964 DOI: 10.2337/dc17-1736] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Improved risk assessment for patients with type 2 diabetes and elevated cardiovascular (CV) risk is needed. The Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS 2°P) predicts a gradient of risk in patients with prior myocardial infarction (MI) but has not been evaluated in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS CV event rates were compared by baseline TRS 2°P in 16,488 patients enrolled in SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53) with type 2 diabetes and high CV risk or established CV disease. Calibration was tested in the diabetes cohort from the REACH (REduction of Atherothrombosis for Continued Health) Registry. RESULTS TRS 2°P revealed a robust risk gradient for the composite of CV death, MI, and ischemic stroke in the full trial population, with 2-year event rates of 0.9% in the lowest- and 19.8% in the highest-risk groups (Ptrend < 0.001). A clear risk gradient was present within the subgroups of all coronary artery disease (CAD), CAD without prior MI, CAD with prior MI, peripheral artery disease, and prior stroke (Ptrend < 0.001 for each), with consistent risk relationships across subgroups. The C-statistic (0.71 for CV death and 0.66 for the composite end point) was consistent in each subgroup. There was close calibration with the type 2 diabetes cohort from the REACH Registry (goodness-of-fit P = 0.78). CONCLUSIONS The expanded TRS 2°P provides a practical and well-calibrated risk prediction tool for patients with type 2 diabetes.
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Affiliation(s)
- Brian A Bergmark
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Deepak L Bhatt
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Eugene Braunwald
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David A Morrow
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ph Gabriel Steg
- French Alliance for Cardiovascular Clinical Trials, Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.,Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U-1148, Paris, France.,National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, U.K
| | - Yared Gurmu
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Avivit Cahn
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Itamar Raz
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Erin Bohula
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Benjamin M Scirica
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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75
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Ois A, Zabalza A, Moreira A, Cuadrado-Godia E, Jimenez-Conde J, Giralt-Steinhauer E, Rodríguez-Campello A, Soriano-Tarraga C, Roquer J. Long-term cardiovascular prognosis after transient ischemic attack: Associated predictors. Neurology 2018; 90:e553-e558. [PMID: 29343466 DOI: 10.1212/wnl.0000000000004965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine long-term cardiovascular risk after TIA and to identify the factors associated with increased risk. METHODS This was a prospective observational registry of TIA patients admitted to the emergency room of our tertiary stroke center from June 2006 to January 2016. New vascular events (NVEs) were recorded from 3 months after TIA onset until June 2017, including both stroke and nonstroke events (coronary and peripheral disease). We registered TIA etiology, age, sex, vascular risk factors, radiologic data, and clinical TIA features and analyzed these variables in relation to NVE long-term risk. RESULTS In total, 676 patients 71.7 ± 13.7 years of age were included, with a mean follow-up of 48.8 ± 32.7 months. An NVE was detected in 173 patients (25.6%) without significant differences between event types (p = 0.84). Univariate analysis associated NVEs with etiologic subgroup, male sex, diabetes mellitus, hypertension, previous vascular disease, duration and clinical features of TIA, and signs of acute infarction. Multivariable analysis showed an independent association of NVEs with etiologic TIA subgroup, signs of acute infarction, and duration of TIA symptoms. Large artery atherosclerosis and cardioaortic embolism had the highest NVE risk, with a slightly higher percentage of nonstroke events. The small artery disease subgroup had the lowest NVE risk, with a higher percentage of stroke events. CONCLUSIONS Etiology subgroup was the main factor determining high long-term risk of vascular events in patients with TIA. Large artery atherosclerosis carried the highest vascular risk, both nonstroke and stroke, followed by cardioaortic embolism.
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Affiliation(s)
- Angel Ois
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Ana Zabalza
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Antia Moreira
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Elisa Cuadrado-Godia
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Jordi Jimenez-Conde
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Eva Giralt-Steinhauer
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain.
| | - Ana Rodríguez-Campello
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Carolina Soriano-Tarraga
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
| | - Jaume Roquer
- From the Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques); and Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Spain
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76
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Darmon A, Bhatt DL, Elbez Y, Aboyans V, Anand S, Bosch J, Branch KR, Connolly SJ, Dyal L, Eikelboom JW, Fox KAA, Keltai K, Probstfield J, Yusuf S, Abtan J, Sorbets E, Eagle KA, Ducrocq G, Steg PG. External applicability of the COMPASS trial: an analysis of the reduction of atherothrombosis for continued health (REACH) registry. Eur Heart J 2017; 39:750-757a. [DOI: 10.1093/eurheartj/ehx658] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023] Open
Affiliation(s)
- Arthur Darmon
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
| | - Deepak L Bhatt
- Department of Cardiology, Brigham and Women’s Hospital Heart & Vascular Center, 75 Francis Street, Boston, MA 02115, USA
| | - Yedid Elbez
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
| | - Victor Aboyans
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Department of Cardiology, CHU Dupuytren, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Sonia Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Kelley R Branch
- Department of Cardiology, University of Washington, Seattle, WA 98195, USA
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Leanne Dyal
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Keith A A Fox
- Center for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4T, UK
| | - Katalin Keltai
- Semmelweis University, Budapest, Üllői út 26, 1085, Hungary
| | | | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jérémie Abtan
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
| | - Emmanuel Sorbets
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- Department of Cardiology, Hôpital Avicenne, AP-HP & Université Paris 13, 25 Rue de Stalingrad, 93000 Bobigny, France
| | - Kim A Eagle
- University of Michigan, Ann Arbor, MI 48109, USA
| | - Gregory Ducrocq
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
| | - Philippe Gabriel Steg
- Département Hospitalo-Universitaire FIRE, FACT French Alliance for Cardiovascular Trials, 46 Rue Henri Huchard, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France
- INSERM U1148, Laboratory for Vascular Translationnal Science, 46 Rue Henri Huchard, 75018 Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, 5 rue Thomas Mann, 75013 Paris, France
- Imperial College, Royal Brompton Hospital, London, UK
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Suh DC, Griggs SK, Henderson ER, Lee SM, Park T. Comparative effectiveness of lipid-lowering treatments to reduce cardiovascular disease. Expert Rev Pharmacoecon Outcomes Res 2017; 18:51-69. [DOI: 10.1080/14737167.2018.1407246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Dong-Churl Suh
- Department of Pharmacy, Chung-Ang University College of Pharmacy, Seoul, South Korea
| | - Scott K. Griggs
- St Louis College of Pharmacy, Pharmacy Administration, St. Louis, MO, USA
- St. Louis College of Pharmacy, Center for Outcomes Research and Education, St. Louis, MO, USA
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Emmett R. Henderson
- Saint Louis University, Health Outcomes and Research and Evaluation Sciences, St. Louis, MO, USA
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Seung-Mi Lee
- Department of Pharmacy, Chung-Ang University College of Pharmacy, Seoul, South Korea
| | - Taehwan Park
- St Louis College of Pharmacy, Pharmacy Administration, St. Louis, MO, USA
- St. Louis College of Pharmacy, Center for Outcomes Research and Education, St. Louis, MO, USA
- Saint Louis University Center for Outcomes Research (SLUCOR), St. Louis, MO, USA
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Varshney A, Steg PG, Elbez Y, Sorbets E, Eagle KA, Bhatt DL. Examining the applicability of SPRINT in patients with subclinical or established atherothrombotic disease: A REACH registry analysis. Int J Cardiol 2017; 243:95-97. [DOI: 10.1016/j.ijcard.2017.05.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/28/2022]
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Higashi Y, Miyata T, Shigematsu H, Origasa H, Fujita M, Matsuo H, Naritomi H, Matsuda H, Nakajima M, Awano H. Two-Year Follow-Up of Vascular Events in Peripheral Arterial Disease Treated With Antiplatelet Agents: A Prospective Observational Multicenter Cohort Study (SEASON). Sci Rep 2017; 7:6095. [PMID: 28733607 PMCID: PMC5522420 DOI: 10.1038/s41598-017-06597-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
The present analysis was intended to evaluate the real-world management of peripheral arterial disease (PAD) in Asia, and to explore cardiovascular events in patients with PAD undergoing antiplatelet therapy over 2 years of follow-up. The Surveillance of cardiovascular Events in Antiplatelet-treated arteriosclerosis Obliterans patients in JapaN (SEASON) registry is a prospective observational multicenter study of cardiovascular events in antiplatelet-treated patients with PAD in Japan. The SEASON registry included 11,375 patients who were scheduled to receive treatment for PAD. Two analysis populations were defined: a real-world population (RWP; n = 10,322) and a definite PAD population (DPP; n = 3992) who had ankle-brachial pressure index (ABPI) <0.9 and intermittent claudication, or a history of lower limb revascularization. The primary outcome measure was the rate of the composite of cerebrovascular, cardiovascular, and peripheral vascular events. The composite event rates (95% confidence interval) were 3.28 (3.00-3.57) and 5.71 (5.13-6.34) events per 100 patient-years in the RWP and DPP groups, respectively. Fontaine IV classification and ABPI <0.4 at baseline were both identified as strong risk factors for vascular events. These findings contribute to understanding the situation for real-world patients with PAD receiving antiplatelet therapy.
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Affiliation(s)
- Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Tetsuro Miyata
- Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan
| | - Hiroshi Shigematsu
- Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan
| | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, Toyama, Japan
| | - Masatoshi Fujita
- Department of Cardiovascular Medicine, Uji Hospital, Uji, Kyoto, Japan
| | | | | | | | | | - Hideto Awano
- Mitsubishi Tanabe Pharma Corporation, Osaka, Japan
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Davies GM, Vyas A, Baxter CA. Economic evaluation of ezetimibe treatment in combination with statin therapy in the United States. J Med Econ 2017; 20:723-731. [PMID: 28426345 DOI: 10.1080/13696998.2017.1320559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS This study assessed the cost-effectiveness of ezetimibe with statin therapy vs statin monotherapy from a US payer perspective, assuming the impending patent expiration of ezetimibe. METHODS A Markov-like economic model consisting of 28 distinct health states was used. Model population data were obtained from US linked claims and electronic medical records, with inclusion criteria based on diagnostic guidelines. Inputs came from recent clinical trials, meta-analyses, and cost-effectiveness analyses. The base-case scenario was used to evaluate the cost-effectiveness of adding ezetimibe 10 mg to statin in patients aged 35-74 years with a history of coronary heart disease (CHD) and/or stroke, and with low-density lipoprotein cholesterol (LDL-C) levels ≥70 mg/dL over a lifetime horizon, assuming a 90% price reduction of ezetimibe after 1 year to take into account the impending patent expiration in the second quarter of 2017. Sub-group analyses included patients with LDL-C levels ≥100 mg/dL and patients with diabetes with LDL-C levels ≥70 mg/dL. RESULTS The lifetime discounted incremental cost-effectiveness ratio (ICER) for ezetimibe added to statin was $9,149 per quality-adjusted life year (QALY) for the base-case scenario. For patients with LDL-C levels ≥100 mg/dL, the ICER was $839/QALY; for those with diabetes and LDL-C levels ≥70 mg/dL, it was $560/QALY. One-way sensitivity analyses showed that the model was sensitive to changes in cost of ezetimibe, rate reduction of non-fatal CHD, and utility weight for non-fatal CHD in the base-case and sub-group analyses. LIMITATIONS Indirect costs or treatment discontinuation estimation were not included. CONCLUSIONS Compared with statin monotherapy, ezetimibe with statin therapy was cost-effective for secondary prevention of CHD and stroke and for primary prevention of these conditions in patients whose LDL-C levels are ≥100 mg/dL and in patients with diabetes, taking into account a 90% cost reduction for ezetimibe.
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Affiliation(s)
| | - Ami Vyas
- b Department of Epidemiology , School of Public Health, Rutgers University , Piscataway , NJ , USA
- c Department of Pharmacy Practice , College of Pharmacy, University of Rhode Island , Kingston , RI , USA
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Abtan J, Bhatt DL, Elbez Y, Sorbets E, Eagle K, Reid CM, Baumgartner I, Wu D, Hanson ME, Hannachi H, Singhal PK, Steg PG, Ducrocq G. Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry. Clin Cardiol 2017; 40:710-718. [PMID: 28520087 PMCID: PMC6490387 DOI: 10.1002/clc.22721] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 01/15/2023] Open
Abstract
Background Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. Hypothesis We analyzed baseline characteristics and 4‐year follow‐up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. Methods The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. Results The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%–5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Conclusions Four‐year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality.
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Affiliation(s)
- Jérémie Abtan
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Yedid Elbez
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
| | - Emmanuel Sorbets
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France.,Avicenne Hospital Hôpital, Public Assistance Hospitals of Paris, Paris, France
| | - Kim Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Christopher M Reid
- Monash University, Clayton, Victoria, Australia and Curtin University, Bentley, Perth, Western Australia
| | | | - David Wu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France.,National Heart and Lung Institute, Imperial College School of Medicine, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), French Clinical Research Infrastructure Network, University Hospital Departments-FIRE, Hôpital Bichat, Public Assistance Hospitals of Paris, Paris Diderot University, Sorbonne University Paris Cité, and National Institute of Health and Medical Research, U-1148 Paris, France
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Bavry AA, Elgendy IY, Elbez Y, Mahmoud AN, Sorbets E, Steg PG, Bhatt DL. Aspirin and the risk of cardiovascular events in atherosclerosis patients with and without prior ischemic events. Clin Cardiol 2017; 40:732-739. [PMID: 28520215 DOI: 10.1002/clc.22724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The benefit of aspirin among patients with stable atherosclerosis without a prior ischemic event is not well defined. HYPOTHESIS Aspirin would be of benefit in outpatients with atherosclerosis with prior ischemic events, but not in those without ischemic events. METHODS Subjects from the Reduction of Atherothrombosis for Continued Health registry were divided according to prior ischemic event (n =21 724) vs stable atherosclerosis, but no prior ischemic event (n = 11 872). Analyses were propensity score matched. Aspirin use was updated at each clinic visit and considered as a time-varying covariate. The primary outcome was the first occurrence of cardiovascular death, myocardial infarction, or stroke. RESULTS In the group with a prior ischemic event, aspirin use was associated with a marginally lower risk of the primary outcome at a median of 41 months (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.65-1.01, P = 0.06). In the group without a prior ischemic event, aspirin use was not associated with a lower risk of the primary outcome at a median of 36 months (HR: 1.03, 95% CI: 0.73-1.45, P = 0.86). CONCLUSIONS In this observational analysis of outpatients with stable atherosclerosis, aspirin was marginally beneficial among patients with a prior ischemic event; however, there was no apparent benefit among those with no prior ischemic event.
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Affiliation(s)
- Anthony A Bavry
- Department of Medicine, University of Florida, Gainesville, Florida.,North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Islam Y Elgendy
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Yedid Elbez
- Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France.,FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ahmed N Mahmoud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Emmanuel Sorbets
- Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France.,FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de cardiologie, Hôpital Avicenne, AP-HP, and Université Paris 13, Bobigny, France
| | - Philippe Gabriel Steg
- Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France.,FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.,National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
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83
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The fate of patients with intermittent claudication in the 21st century revisited - results from the CAVASIC Study. Sci Rep 2017; 8:45833. [PMID: 28367968 PMCID: PMC5377933 DOI: 10.1038/srep45833] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/06/2017] [Indexed: 01/09/2023] Open
Abstract
Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.
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84
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Candy N, Ng E, Velu R. Paclitaxel-coated balloon reduces target lesion revascularization compared with standard balloon angioplasty. J Vasc Surg 2017; 65:558-570.e10. [DOI: 10.1016/j.jvs.2016.10.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
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85
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Ovbiagele B, Wang J, Johnston SC, Wang A, Wang D, Wang Y, Zhao X, Wang Y. Effect of Clopidogrel by Smoking Status on Secondary Stroke Prevention. Circulation 2017; 135:315-316. [DOI: 10.1161/circulationaha.116.024957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bruce Ovbiagele
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - Jing Wang
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - S. Claiborne Johnston
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - Anxin Wang
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - David Wang
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - Yongjun Wang
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - Xingquan Zhao
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
| | - Yilong Wang
- From Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.W., A.W., Y.W., X.Z., Y.W.); China National Clinical Research Center for Neurological Diseases, Beijing (J.W., A.W., Y.W., X.Z., Y.W.); Center of Stroke, Beijing Institute for Brain Disorders, China (J.W., A.W., Y.W., X.Z., Y.W.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (J.W., A.W., Y
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86
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Gonzalez L, Helkin A, Gahtan V. Dyslipidemia Part 2: Review of Dyslipidemia Treatment in Patients With Noncoronary Vascular Disease. Vasc Endovascular Surg 2016; 50:119-35. [PMID: 26983668 DOI: 10.1177/1538574416628655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Dyslipidemia is one of the major modifiable risk factors associated with atherosclerotic cardiovascular disease. Appropriate modification of lipid profiles reduces the progression of atherosclerosis in vessel walls across all vascular beds. The management of dyslipidemia has evolved over the last several decades, especially since the discovery of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, also known as statins. Statin use in atherosclerotic heart disease is well described in observational and prospective placebo-controlled studies, citing both lipid-lowering and pleiotropic effects. However, the effect of statins and other lipid-lowering agents on noncoronary arterial beds (the aorta, arteries to the extremities, renal, and carotid arteries) is less understood. This article is part 2 of a 2-part review, with part 1 having focused on lipid metabolism and the downstream effects of lipids on the development of atherosclerosis. The current review (part 2) will discuss trials, retrospective reviews, and observational cohort studies regarding the use of statins and/or other lipid-lowering drugs for primary and secondary prevention of peripheral noncoronary atherosclerotic disease.
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Affiliation(s)
- Lorena Gonzalez
- Department of Veterans Affairs Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alex Helkin
- Department of Veterans Affairs Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Vivian Gahtan
- Department of Veterans Affairs Healthcare Network Upstate New York at Syracuse, Syracuse, NY, USA Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
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87
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Eisen A, Bhatt DL, Steg PG, Eagle KA, Goto S, Guo J, Smith SC, Ohman EM, Scirica BM. Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. J Am Heart Assoc 2016; 5:JAHA.116.004080. [PMID: 27680665 PMCID: PMC5121505 DOI: 10.1161/jaha.116.004080] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated. Methods and Results Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end‐point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11–1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99–1.14, P=0.11), and total primary end‐point events (adjusted risk ratio 1.08, CI 1.01–1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06–1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21–1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13–1.34, P<0.001). Conclusions Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.
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Affiliation(s)
- Alon Eisen
- Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA
| | - P Gabriel Steg
- Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Kim A Eagle
- University of Michigan Health System, Ann Arbor, MI
| | - Shinya Goto
- Department of Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Jianping Guo
- Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA
| | - Sidney C Smith
- Heart and Vascular Center, University of North Carolina at Chapel Hill, NC
| | | | - Benjamin M Scirica
- Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA
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88
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Abtan J, Bhatt DL, Elbez Y, Sorbets E, Eagle K, Ikeda Y, Wu D, Hanson ME, Hannachi H, Singhal PK, Steg PG, Ducrocq G. Residual Ischemic Risk and Its Determinants in Patients With Previous Myocardial Infarction and Without Prior Stroke or TIA: Insights From the REACH Registry. Clin Cardiol 2016; 39:670-677. [PMID: 27588731 DOI: 10.1002/clc.22583] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although the rate of in-hospital ischemic events after myocardial infarction (MI) has dramatically decreased, long-term residual risk may remain substantial. However, most of the information on current residual risk is derived from highly selected randomized trials. HYPOTHESIS In patients with previous MI and no prior ischemic stroke/transient ischemic attack (TIA), residual ischemic risk increases over time. METHODS Using the international Reduction of Atherothrombosis for Continued Health (REACH) registry, we analyzed baseline characteristics and 4-year follow-up of patients with previous MI and no history of stroke/TIA to describe annual rates of recurrent ischemic events globally and by geography. The primary outcome was the composite of cardiovascular death, MI, or stroke. Multivariate analysis identified risk factors associated with recurrent ischemic events. RESULTS Data from 16 770 patients enrolled at 5587 sites in 44 countries were analyzed. The rate of the primary outcome increased annually from 4.7% during year 1 to reach a 4-year rate of 15.1%. Compared with North America, Japan experienced lower ischemic event rates (P < 0.01), whereas Eastern Europe (P < 0.01) and the Middle East (P = 0.01) experienced higher ischemic event rates. The presence of congestive heart failure, polyvascular disease, diabetes, atrial fibrillation or flutter, and older age were associated with increased residual risk (all P < 0.01). Statin use was associated with lower ischemic risk (P < 0.01). CONCLUSIONS In this study, residual ischemic risk after MI accrued progressively up to 4 years of follow-up, emphasizing the value of intensive secondary prevention strategies to minimize residual risk.
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Affiliation(s)
- Jérémie Abtan
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Yedid Elbez
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Emmanuel Sorbets
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
| | - Kim Eagle
- University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Yasuo Ikeda
- Department of Internal Medicine, Graduate School of Medicine Keio University, Tokyo, Japan
| | - David Wu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | | | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France.,National Heart and Lung Institute, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Gregory Ducrocq
- French Alliance for Cardiovascular Clinical Trials (FACT), DHU-FIRE, Hôpital Bichat (Assistance Publique-Hôpitaux de Paris), Université Paris-Diderot, Sorbonne-Paris Cité and INSERM U-1148, Paris, France.,Hôpital Avicenne (Assitance Publique-Hôpitaux de Paris) and Université Paris 13, Bobigny, France
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89
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Chen P, Liu Y, Wang Y, Wang A, Zheng H, Zhao X, Yan A, Wang Y. A Validation of the Essen Stroke Risk Score in Outpatients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2189-95. [PMID: 27289184 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/07/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the predictive accuracy of the Essen Stroke Risk Score (ESRS) for Chinese stroke outpatients. Our goal was to perform an external validation of the ESRS using a large multicenter cohort of outpatients with ischemic stroke (IS). METHODS We estimated the 1-year cumulative event rates for both recurrent stroke and combined vascular events for patients in different ESRS categories using data from a prospective cohort of 3316 outpatients with IS admitted to 18 hospitals in China. In addition, we evaluated the predictive accuracy of the ESRS for both recurrent stroke and combined vascular events using C statistic. RESULTS In the nonatrial fibrillation IS outpatients, the cumulative 1-year event rate was 2.47% (95% confidence interval [CI], 1.97%-3.06%) for recurrent stroke and 4.32% (95% CI, 3.65%-5.06%) for combined vascular events. The event rates were significantly higher in patients in higher ESRS categories. The ESRS had a predictive accuracy of .63 (.57-.69) for recurrent stroke and .63 (.58-.68) for combined vascular events. CONCLUSION Among the Chinese outpatients with IS, the ESRS was able to stratify the risk of both recurrent stroke and combined vascular events equally well. A prediction model suitable for Chinese IS populations is needed.
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Affiliation(s)
- Pan Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aoshuang Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med 2016; 42:1398-407. [DOI: 10.1007/s00134-016-4358-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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91
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Hajage D, Tubach F, Steg PG, Bhatt DL, De Rycke Y. On the use of propensity scores in case of rare exposure. BMC Med Res Methodol 2016; 16:38. [PMID: 27036963 PMCID: PMC4815252 DOI: 10.1186/s12874-016-0135-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 03/15/2016] [Indexed: 12/03/2022] Open
Abstract
Background Observational post-marketing assessment studies often involve evaluating the effect of a rare treatment on a time-to-event outcome, through the estimation of a marginal hazard ratio. Propensity score (PS) methods are the most used methods to estimate marginal effect of an exposure in observational studies. However there is paucity of data concerning their performance in a context of low prevalence of exposure. Methods We conducted an extensive series of Monte Carlo simulations to examine the performance of the two preferred PS methods, known as PS-matching and PS-weighting to estimate marginal hazard ratios, through various scenarios. Results We found that both PS-weighting and PS-matching could be biased when estimating the marginal effect of rare exposure. The less biased results were obtained with estimators of average treatment effect in the treated population (ATT), in comparison with estimators of average treatment effect in the overall population (ATE). Among ATT estimators, PS-weighting using ATT weights outperformed PS-matching. These results are illustrated using a real observational study. Conclusions When clinical objectives are focused on the treated population, applied researchers are encouraged to estimate ATT with PS-weighting for studying the relative effect of a rare treatment on time-to-event outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0135-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Hajage
- APHP, Hôpital Louis Mourier, Département d'Epidémiologie et Recherche Clinique, 178 Rue des Renouillers, Colombes, 92700, France. .,APHP, Hôpital Bichat, Centre de Pharmacoépidémiologie (Cephepi), 46 Rue Henri Huchard, Paris, F-75018, France. .,Univ Paris Diderot, Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, F-75018, France. .,INSERM, UMR 1123 ECEVE, Paris, F-75018, France. .,INSERM, CIE-1425, Paris, F-75018, France.
| | - Florence Tubach
- APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, 46 Rue Henri Huchard, Paris, F-75018, France.,APHP, Hôpital Bichat, Centre de Pharmacoépidémiologie (Cephepi), 46 Rue Henri Huchard, Paris, F-75018, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, F-75018, France.,INSERM, UMR 1123 ECEVE, Paris, F-75018, France.,INSERM, CIE-1425, Paris, F-75018, France
| | - Philippe Gabriel Steg
- FACT, DHU FIRE, Univ Paris-Diderot, Sorbonne Paris-Cité, Paris, F-75018, France.,LVTS, INSERM U-1148, Hôpital Bichat, HUPNVS, AP-HP, Paris, F-75018, France.,NHLI, Imperial College, Royal Brompton Hospital, London, UK
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yann De Rycke
- APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, 46 Rue Henri Huchard, Paris, F-75018, France.,APHP, Hôpital Bichat, Centre de Pharmacoépidémiologie (Cephepi), 46 Rue Henri Huchard, Paris, F-75018, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, F-75018, France.,INSERM, UMR 1123 ECEVE, Paris, F-75018, France.,INSERM, CIE-1425, Paris, F-75018, France
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92
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Ruwanpathirana T, Owen A, Renzaho AMN, Zomer E, Gambhir M, Reid CM. Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling. Clin Exp Pharmacol Physiol 2016; 42:596-601. [PMID: 25854647 DOI: 10.1111/1440-1681.12399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 01/08/2023]
Abstract
The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations.
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Affiliation(s)
| | - Alice Owen
- CCRE Therapeutics, The Alfred Centre, Melbourne, Vic., Australia
| | - Andre M N Renzaho
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, The Alfred Centre, Melbourne, Vic., Australia
| | - Ella Zomer
- Centre for International Health, Department of Epidemiology and Preventive Medicine, Burnet Institute, Monash University, Melbourne, Vic., Australia
| | - Manoj Gambhir
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Christopher M Reid
- CCRE Therapeutics, The Alfred Centre, Melbourne, Vic., Australia.,Priment, UCL, London, UK
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93
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Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis. J Am Coll Cardiol 2016; 67:392-403. [DOI: 10.1016/j.jacc.2015.10.084] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/27/2015] [Indexed: 11/18/2022]
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94
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7<sup>th</sup> Asian PAD Workshop. Ann Vasc Dis 2016; 9:135-47. [DOI: 10.3400/avd.pad.16-01000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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95
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Higashi Y, Miyata T, Shigematsu H, Origasa H, Fujita M, Matsuo H, Naritomi H, Matsuda H, Nakajima M. Baseline Characterization of Japanese Peripheral Arterial Disease Patients – Analysis of Surveillance of Cardiovascular Events in Antiplatelet-Treated Arteriosclerosis Obliterans Patients in Japan (SEASON) –. Circ J 2016; 80:712-21. [DOI: 10.1253/circj.cj-15-1048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Tetsuro Miyata
- Sanno Medical Center, International University of Health and Welfare
| | | | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine
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96
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Beckmann M, Jacomella V, Kohler M, Lachat M, Salem A, Amann-Vesti B, Husmann M. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index. PLoS One 2015; 10:e0139887. [PMID: 26452151 PMCID: PMC4599890 DOI: 10.1371/journal.pone.0139887] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/19/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. AIM To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). METHODS cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. RESULTS In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). CONCLUSION Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease.
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Affiliation(s)
- Marianne Beckmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Angiology Division, Department of Internal Medicine, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Vincenzo Jacomella
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Malcom Kohler
- Clinic for Pneumology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Amr Salem
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Beatrice Amann-Vesti
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marc Husmann
- Clinic for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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97
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Guo Y, Wang H, Tian Y, Wang Y, Lip GYH. Time Trends of Aspirin and Warfarin Use on Stroke and Bleeding Events in Chinese Patients With New-Onset Atrial Fibrillation. Chest 2015; 148:62-72. [PMID: 25501045 DOI: 10.1378/chest.14-2018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Much of the clinical epidemiology and treatment patterns for patients with atrial fibrillation (AF) are derived from Western populations. Limited data are available on antithrombotic therapy use over time and its impact on the stroke or bleeding events in newly diagnosed Chinese patients with AF. The present study investigates time trends in warfarin and aspirin use in China in relation to stroke and bleeding events in a Chinese population. METHODS We used a medical insurance database involving > 10 million individuals for the years 2001 to 2012 in Yunnan, a southwestern province of China, and performed time-trend analysis on those with newly diagnosed AF. Cox proportional hazards time-varying exposures were used to determine the risk of stroke or bleeding events associated with antithrombotic therapy among patients with AF. RESULTS Among the randomly sampled 471,446 participants, there were 1,237 patients with AF, including 921 newly diagnosed with AF, thus providing 4,859 person-years of experience (62% men; mean attained age, 70 years). The overall rate of antithrombotic therapy was 37.7% (347 of 921 patients), with 4.1% (38 of 921) on warfarin and 32.3% (298 of 921) on aspirin. Antithrombotic therapy was not related to stroke/bleeding risk scores (CHADS2 [congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke (doubled)] score, P = .522; CHA2DS2-VASc [congestive heart failure, hypertension, age ≥ 75 years (doubled), diabetes mellitus, stroke or transient ischemic attack (doubled), vascular disease, age 65 to 74 years, and female sex] score, P = .957; HAS-BLED [hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (> 65 years), drugs/alcohol concomitantly] score, P = .095). The use of antithrombotic drugs (mainly aspirin) increased in both women and men over time, with the rate of aspirin increasing from 4.0% in 2007 to 46.1% in 2012 in the former, and from 7.7% in 2007 to 61.9% in 2012 in the latter (P for trend for both, < .005). In the overall cohort, the annual stroke rate was approximately 6% and the annual major bleeding rate was about 1%. Compared with nonantithrombotic therapy, the hazard ratio for ischemic stroke was 0.68 (95% CI, 0.39-1.18) for aspirin and 1.39 (0.54-3.59) for warfarin. CONCLUSIONS Aspirin use increased among Chinese patients newly diagnosed with AF, with no relationship to the patient's stroke or bleeding risk. Warfarin use was very low. Given the health-care burden of AF and its complications, our study has major implications for health-care systems in non-Western countries, given the global burden of this common arrhythmia.
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Affiliation(s)
- Yutao Guo
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hao Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China; Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yingchun Tian
- Department of Gerontology (Drs Tian and Lip), Second People's Hospital, Yunnan Province, China
| | - Yutang Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Department of Gerontology (Drs Tian and Lip), Second People's Hospital, Yunnan Province, China; University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
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98
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Elbez Y, Cheong AP, Fassa AA, Cohen E, Reid CM, Babarskiene R, Bhatt DL, Steg PG. Clinical outcomes in patients with stable coronary artery disease with vs. without a history of myocardial revascularization. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 2:23-32. [PMID: 29474584 DOI: 10.1093/ehjqcco/qcv017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Indexed: 11/12/2022]
Abstract
Aims The aim was to describe outcomes among patients with stable coronary artery disease (CAD) with or without a history of myocardial revascularization in a large contemporary cohort. Methods and results Patients with stable CAD were selected from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The cohort was divided into patients with ( n = 25 583) and without ( n = 13 133) a history of myocardial revascularization. Crude outcomes were described according to the use and type of revascularization: percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The primary outcome was cardiovascular (CV) death. At baseline, the non-revascularized group was older and had more CV risk factors. At 36-month median follow-up, previous revascularization was associated with a lower risk of CV death [crude incidence rate (CIR): 6.82 vs. 9.08%, hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.66-0.80]; P < 0.01]. This association was seen for patients with a history of PCI (CIR 5.78 vs. 8.88%, HR 0.64 [0.58-0.71]; P ≤ 0.01), but not with CABG (HR 1.26 [1.14-1.49]; P < 0.01), and was consistent regardless of prior MI and the timing of prior revascularization. Conclusion Among patients with stable CAD, a history of myocardial revascularization was associated with lower CV mortality, particularly when PCI was the mode of revascularization. Coronary artery disease patients managed non-invasively represent a high-risk group.
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Affiliation(s)
- Yedid Elbez
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Adrian P Cheong
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Amir-Ali Fassa
- FACT, Département Hospitalo-Universitaire FIRE , AP-HP, Hôpital Bichat , 46 rue Henri Huchard, 75877 Paris Cedex 18 , France
| | - Eric Cohen
- Sunnybrook and Women's College Health Sciences Center , Toronto, ON , Canada
| | | | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School , Boston, MA , USA
| | - Philippe Gabriel Steg
- FACT, Département Hospitalo-Universitaire FIRE, AP-HP, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.,Univ Paris-Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U-1148, F-75018 Paris, France.,NHLI, Imperial College, Royal Brompton Hospital, London, UK
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99
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Hansel B, Roussel R, Elbez Y, Marre M, Krempf M, Ikeda Y, Eagle KA, Elisaf M, Bhatt DL, Steg PG. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Eur Heart J 2015; 36:2716-28. [DOI: 10.1093/eurheartj/ehv347] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 07/06/2015] [Indexed: 12/29/2022] Open
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100
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Akao M, Beyer-Westendorf J, Goto S, Peterson E. Stroke prevention in atrial fibrillation: evidence from real-life studies: Table 1. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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