Distribution of coronary artery disease severity and risk factors in Afro-Caribbeans

Noninvasive prediction of coronary artery disease severity: Comparative analysis of electrocardiographic findings and risk factors with SYNTAX and Gensini score

OBJECTIVE

Coronary artery disease (CAD) remains a significant global health burden, characterized by the narrowing or blockage of coronary arteries. Treatment decisions are often guided by angiography-based scoring systems, such as the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) and Gensini scores, although these require invasive procedures. This study explores the potential of electrocardiography (ECG) as a noninvasive diagnostic tool for predicting CAD severity, alongside traditional risk factors.

METHODS

This retrospective cross-sectional study was conducted on 348 CAD patients who underwent coronary angiography. Demographic data, ECG findings, SYNTAX, and Gensini scores were collected. The association between ECG findings and demographic information with the severity of coronary artery stenosis, as assessed by SYNTAX and Gensini scores, was investigated using SPSS software, version 23.

RESULTS

Significant associations were observed between CAD severity and risk factors such as male gender, diabetes mellitus (DM), and smoking. Additionally, certain ECG indicators, including Q waves and ST depression (STD), showed significant correlations with CAD severity, particularly according to the Gensini score.

CONCLUSION

This study underscores the utility of ECG and clinical factors in identifying severe CAD, offering cost-effective diagnostic alternatives to angiography. Integrating various parameters into a single score is crucial in clinical practice, providing a stronger diagnostic and prognostic tool without increasing costs. Further comprehensive studies are warranted to refine risk prediction models and improve CAD management strategies.

Cardiovascular Disease in the Caribbean: Risk Factor Trends, Care and Outcomes Still Far From Expectations

Cardiovascular diseases (CVD) are a major public health concern in the Caribbean. Cardiovascular care in the Caribbean revealed encouraging improvements but still less than expectations. This study aims to gain insight into CVD and identify gaps in cardiovascular care in the Caribbean compared to high-income countries. More specifically, this review reports on the epidemiology, CVD risk factors, management practices, and patient outcomes (quality of life (QOL) and mortality). A systematic review of peer-reviewed articles was conducted to assess the CVD of individuals in the Caribbean from 1959 to 2022.Using multiple search engines and keywords, a systematic review of relevant peer-reviewed CVD articles was conducted using the necessary inclusion and exclusion criteria. Relevant data of studies were classified by title, publication year, location, type and size of samples, and results. Further analysis grouped patients by epidemiological profile, CVD risk, management, and selected outcomes (quality of life and inpatient mortality).  From the initial review of 1,553 articles, 36 were analyzed from Trinidad and Tobago (20), Barbados (4), Jamaica (7), along with the Bahamas (2), British Virgin Islands (1), Bonaire (1), and one article from a Caribbean study. The social environment of fast food, sedentary jobs, and stress determinants are postulated to be precursors for an increase in CV risks. CVD in the Caribbean reveals a high prevalence of CV risks, suboptimal care, poor compliance, and high inpatient mortality compared with high-income countries. Greater efforts are required to improve CVD care at all stages, including in the social environment.

The relationship of lipid peroxidation and antioxidant status to selected modifiable risk factors in coronary artery disease patients

Background

Coronary artery disease (CAD) is found to be associated with a wide range of modifiable and non-modifiable risk factors.

Aim of the Study

To evaluate the relationship of lipid peroxidation and antioxidant status to selected modifiable risk factors in angiographically proven CAD patients.

Methods

150 angiographically proven CAD patients were categorized into three, based on selected risk factors. Data was collected using proforma and from hospital records. Peroxidation and antioxidant levels in blood samples were assessed using standard procedures.

Results

In category, I, significantly higher level of lipid peroxidation and the lower enzymatic antioxidant level were observed in patients with diabetes, hypertension, and with both diabetes and hypertension, when compared with patients without these clinical characteristics (p < 0.01). Similar results obtained for patients following a non-vegetarian diet when compared with patients following a vegetarian diet (category II). In BMI based group (category III), patients with BMI>25kg/m2 showed a significant increase in peroxidation and low enzymatic and non-enzymatic antioxidant levels than those with normal BMI.

Conclusion

The study confirmed a strong association between selected modifiable risk factors, higher lipid peroxidation, and lower antioxidant levels in angiographically proven CAD patients. This provides leads in the management of cardiovascular events in CAD patients.

Interaction between a haptoglobin genetic variant and coronary artery disease (CAD) risk factors on CAD severity in Singaporean Chinese population

BACKGROUND

Haptoglobin (Hp) is a plasma protein with strong anti-inflammation and antioxidant activities. Its plasma level is known to be inversely associated with many inflammatory diseases, including cardiovascular diseases. However, the association of HP genetic variants with coronary artery disease (CAD) severity/mortality, and how they interact with common CAD risk factors are largely unknown.

METHODS

We conducted the analysis in a Singaporean Chinese CAD population with Gensini severity scores (N = 582) and subsequently evaluated the significant findings in an independent cohort with cardiovascular mortality (excluding stroke) as outcome (917 cases and 19,093 controls). CAD risk factors were ascertained from questionnaires, and stenosis information from medical records. Mortality was identified through linkage with the nationwide registry of births and deaths in Singapore. Linear regression analysis between HP genetic variant (rs217181) and disease outcome were performed. Interaction analyses were performed by introducing an interaction term in the same regression models.

RESULTS

Although rs217181 was not significantly associated with CAD severity and cardiovascular mortality (excluding stroke) in all subjects, when stratified by hypertension status, hypertensive individuals with the minor T allele have more severe CAD (β = 0.073, SE = 0.030, p = 0.015) and non-hypertensive individuals with the T allele have lower risk for mortality (odds ratio = 0.771 (0.607-0.980), p = 0.033).

CONCLUSION

HP genetic variant is not associated with CAD severity and mortality in the general population. However, hypertensive individuals with the rs217181 T allele associated with higher Hp levels had more severe CAD while non-hypertensive individuals with the same allele had lower risk for mortality in the Chinese population.

Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Background

Cardiovascular Disease (CVD) risk prediction models have been useful in estimating if individuals are at low, intermediate, or high risk, of experiencing a CVD event within some established time frame, usually 10 years. Central to this is the concern in Trinidad and Tobago of using pre-existing CVD risk prediction methods, based on populations in the developed world (e.g. ASSIGN, Framingham and QRISK^®2), to establish risk for its multiracial/ethnic Caribbean population. The aim of this study was to determine which pre-existing CVD risk method is best suited for predicting CVD risk for individuals in this population.

Method

A survey was completed by 778 participants, 526 persons with no prior CVD, and 252 who previously reported a CVD event. Lifestyle and biometric data was collected from non-CVD participants, while for CVD participants, medical records were used to collect data at the first instance of CVD. The performances of three CVD risk prediction models (ASSIGN, Framingham and QRISK^®2) were evaluated using their calculated risk scores.

Results

All three models (ASSIGN, Framingham and QRISK^®2) identified less than 62% of cases (CVD participants) with a high proportion of false-positive predictions to true predictions as can be seen by positive predictabilities ranging from 78% (ASSIGN and Framingham) to 87% (QRISK^®2). Further, for all three models, individuals whose scores fell into the misclassification range were 2X more likely to be individuals who had experienced a prior CVD event as opposed to healthy individuals.

Conclusion

The ASSIGN, Framingham and QRISK^®2 models should be utilised with caution on a Trinidad and Tobago population of intermediate and high risk for CVD since these models were found to have underestimated the risk for individuals with CVD up to 2.5 times more often than they overestimated the risk for healthy persons.

Long-term outcomes after percutaneous coronary intervention relative to bypass surgery in diabetic patients with multivessel coronary artery disease according to clinical presentation

BACKGROUND

For diabetic patients with multivessel coronary artery disease (MVD), limited data exist on the long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) according to clinical presentation [stable coronary artery disease (SCAD) or non-ST-elevation acute coronary syndrome (NSTE-ACS)].

PATIENTS AND METHODS

From a Korean multicenter registry, we analyzed 1135 diabetic patients with MVD treated with PCI (n = 660) or CABG (n = 475). After propensity score matching, 8-year major adverse cardiovascular and cerebrovascular events [MACCE; composite of all-cause death, myocardial infarction (MI), or stroke] were compared between PCI and CABG according to clinical presentation.

RESULTS

After matching, MACCE was not different between PCI and CABG for SCAD patients [15.6 vs. 17.2%, hazard ratio (HR)  = 0.94, 95% confidence interval (CI)  = 0.55-1.63, P = 0.837], whereas it was higher in PCI than in CABG for NSTE-ACS patients (31.1 vs. 22.4%, HR = 1.63, 95% CI = 1.03-2.59, P = 0.036), mainly driven by the higher MI occurrence (HR = 2.18, 95% CI = 1.04-4.59, P = 0.035). A significant interaction between revascularization strategy and clinical presentation was observed for MACCE (P-interaction = 0.022). However, when PCI was further classified according to revascularization completeness, the treatment gap between PCI and CABG with respect to MI in NSTE-ACS patients was improved by complete-revascularization PCI.

CONCLUSION

Among diabetic patients with MVD, the long-term outcomes of PCI versus CABG differed according to clinical presentation. CABG may be more beneficial for NSTE-ACS patients with MVD in reducing MACCE and MI, whereas PCI was as effective as CABG for SCAD patients with MVD. Therefore, clinical presentation must be considered when choosing revascularization strategies in these patients.

Classification of Real Imbalanced Cardiovascular Data Using Feature Selection and Sampling Methods: A Case Study with Neural Networks and Logistic Regression

Coronary Artery Disease (CAD) is very common among the major types of cardiovascular diseases, and there are several studies created with different features including data that is collected from patients for timely diagnosis of CAD.

In this study, a dataset with 21 features have been used, and a risk score prediction system has been proposed. The patients were divided into four groups. To determine the effective features of CAD dataset; t-test and Relief-f methods on Logistic Regression Analysis (LRA); Relief-f on Neural Network (NN) feature selection methods were utilized.

Sampling methods were used to improve imbalanced form of 4-classed dataset, and the effects of sampling methods were evaluated. Using NN with oversampling and Relief-f feature selection method; the results before the preprocess operations were detected as follows; 72.3% accuracy; after the operations, 84.1% accuracy were achieved with 0.84 sensitivity 0.94 specificity. These statistics obtained from the experiment, by detailed analysis, are the best ones for the CAD data set in this study.

Using the feature selection and the sampling methods with the NN substantially improve the prediction accuracy as well as the other metrics. This suggests that these preprocessing methods and the NN may be used together to construct for prediction of the 4-classed imbalanced medical datasets.

[Health status of populations living in French overseas territories in 2012, compared with metropolitan France: An analysis of the national health insurance database]

BACKGROUND

This study uses healthcare consumption to compare the health status of beneficiaries of the French national health insurance general scheme between individuals living in French overseas territories (FOT) and those living in metropolitan France.

METHODS

Data were extracted from the French national health insurance database (Sniiram) for 2012, using algorithms, 56 groups of diseases and 27 groups of hospital activity were isolated. Standardized morbidity ratio for age and sex (SMR) were used to compare FOT to mainland France.

RESULTS

Compared with mainland France, people living in the four FOT had high SMR for diabetes care (Guadeloupe 1.9; Martinique 1.7; Guyane 1.9; La Réunion 2.3), dialysis (2.7; 2.4; 3.8; 4.4), stroke (1.2; 1.1; 2.0; 1.5), and hospitalization for infectious diseases (1.9; 2.5; 2.4; 1.4) and obstetrics (1.4; 1.2; 1.9; 1.2). Care for inflammatory bowel disease or cancer were less frequent except for prostate in Martinique and Guadeloupe (2.3). People living in Martinique, Guadeloupe and la Reunion had more frequently care for psychotic disorders (2.0; 1.7; 1.2), dementia (1.1; 1.3; 11), epileptic seizures (1.4; 1.4; 16) and hospitalizations for burns (2.6; 1.7; 2.9). In la Reunion, people had more frequently coronary syndrome (1.3), cardiac heart failure (1.6), chronic respiratory diseases except cystic fibrosis (1.5), drug addiction (1.4) and hospitalizations for cardiovascular catheterization (1.4) and toxicology, poisoning, alcohol (1.7). Other differences were observed by gender: HIV infection, peripheral arterial disease, some chronic inflammatory disease (lupus) were more frequent in women living in Martinique or Guadeloupe, compared to women from mainland France and psychotic disorders for men. From la Reunion, men had more frequently liver and pancreatic diseases and hospitalisation for toxicology, poisoning, alcohol than men from mainland France.

CONCLUSION

This study highlights the utility of administrative database to compare and follow population health status considering healthcare use. Specific Public Health policies are justified for FOT, taking into account the specific context of each FOT, the necessity of prevention initiatives and screening to reduce the frequency of the chronic diseases.