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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1460] [Impact Index Per Article: 1460.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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3
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Kondratieva DS, Afanasiev SA, Muslimova EF. Diabetes mellitus — metabolic preconditioning in protecting the heart from ischemic damage? DIABETES MELLITUS 2022. [DOI: 10.14341/dm12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The negative impact of diabetes mellitus (DM) on the cardiovascular system has been confirmed by numerous clinical studies. However, there are experimental studies that show an increase in the resistance of the heart to ischemic and reperfusion damage in animals with DM. This phenomenon is characterized by a smaller size of the infarct zone, better preservation of the contractile function of the myocardium, and a lower incidence of ischemic and reperfusion arrhythmias. It is assumed that at a certain stage in the development of DM, a “metabolic window” is formed, in which metabolic alterations at the cellular level trigger adaptive mechanisms that increase the viability of cardiomyocytes. Published data confirm that the magnitude of the protective effect induced by DM is comparable to, and in some cases even exceeds, the effect of the preconditioning phenomenon. It is recognized that the mechanisms that protect the heart from ischemic and reperfusion damage against the background of DM are universal and are associated with the modulation of the antioxidant system, apoptosis factors, pro-inflammatory cytokines, and signaling systems that ensure cell survival. The one of the main pathogenic factor in DM is hyperglycemia, but under stress it plays the role of an adaptive mechanism aimed at meeting the increased energy demand in pathological conditions. Probably, at a certain stage of DM, hyperglycemia becomes a trigger for the development of protective effects and activates not only signaling pathways, but also the restructuring of energy metabolism, which makes it possible to maintain ATP production at a sufficient level to maintain the vital activity of heart cells under ischemia/reperfusion conditions. It is possible that an increased level of glucose, accompanied by the activation of insulin-independent mechanisms of its entry into cells, as well as the availability of this energy substrate, will contribute to a better restoration of energy production in heart cells after a infarction, which, in turn, will significantly reduce the degree of myocardial damage and will help preserve the contractile function of the heart. Identification of the conditions and mechanisms of the cardioprotective phenomenon induced by DM will make it possible to simulate the metabolic state in which the protection of cardiomyocytes from damaging factors is realized.
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Affiliation(s)
- D. S. Kondratieva
- Cardiology Research Institute, Tomsk National Research Medical Center
| | - S. A. Afanasiev
- Cardiology Research Institute, Tomsk National Research Medical Center
| | - E. F. Muslimova
- Cardiology Research Institute, Tomsk National Research Medical Center
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Salinero-Fort MA, Mostaza J, Lahoz C, Cárdenas-Valladolid J, Vicente-Díez JI, Gómez-Campelo P, de Miguel-Yanes JM. All-cause mortality and cardiovascular events in a Spanish nonagenarian cohort according to type 2 diabetes mellitus status and established cardiovascular disease. BMC Geriatr 2022; 22:224. [PMID: 35303825 PMCID: PMC8931574 DOI: 10.1186/s12877-022-02893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the progressive aging of the population in industrialized countries, few studies have focused on the natural history of cardiovascular disease in the very old, and recommendations on prevention of cardiovascular disease in this population are lacking. We aimed to analyze all-cause mortality and cardiovascular events according to prevalent type 2 diabetes mellitus and established cardiovascular disease in nonagenarians from a Mediterranean population. Methods We analyzed the primary health records of all nonagenarians living in the Community of Madrid (N = 59,423) and collected data for 4 groups: Group 1, individuals without T2DM or established CVD (T2DM-, CVD-); Group 2, individuals without T2DM but with established CVD (T2DM-, CVD +); Group 3, individuals with T2DM but without established CVD (T2DM + , CVD-); and Group 4, individuals with both T2DM and established CVD (T2DM + , CVD +), taking into account the influence of sex on the outcomes. Follow-up was 2.5 years. The primary outcomes were cumulative incidence and incidence density rates for all-cause mortality, non-fatal myocardial infarction, non-fatal stroke (the first composite primary outcome [CPO1]), combined with heart failure (CPO2). We evaluated the adjusted effect of each group on all-cause mortality (Cox regression). Results Mean age was 93.3 ± 2.8 years (74.2% women). Hypertension, dyslipidemia, heart failure, albuminuria, and estimated glomerular filtration rate < 60 mL/min/1.73 m2 were significantly more prevalent in G4 than in the other groups (all p values < 0.001). We observed significantly higher cumulative incidence rates for all-cause mortality, CPO1, and CPO2 in participants belonging to G4 (all p values ≤ 0.001). People in G2 presented higher rates of all-cause mortality, heart failure, CPO1, and CPO2 than people in G3 (all p values ≤ 0.001). In the fully adjusted model, G4 independently predicted all-cause mortality (HR = 1.48 [95% CI, 1.40 to 1.57] vs reference G1 [p < 0.01]). In addition, significant HRs were recorded for cardiovascular disease alone (G2) and type 2 diabetes mellitus alone (G3) (1.13 and 1.14, respectively; both p values < 0.01). Conclusions In Spanish nonagenarians, established cardiovascular disease and type 2 diabetes mellitus conferred a modest risk of all-cause mortality. However, the simultaneous presence of both conditions conferred the highest risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02893-z.
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Affiliation(s)
- M A Salinero-Fort
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Madrid, Spain. .,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Subdirección General de Investigación y Documentación, Consejería de Sanidad, Madrid, Spain.
| | - J Mostaza
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - C Lahoz
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Servicio de Medicina Interna, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - J Cárdenas-Valladolid
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain.,Fundación de Investigación e Innovación Biosanitaria de Atención Primaria, Sistemas de Información, Madrid, Spain.,Universidad Alfonso X El Sabio, Madrid, Spain
| | - J I Vicente-Díez
- Centro de Salud Monóvar, Comunidad de Madrid Servicio Madrileño de Salud, Madrid, Spain
| | - P Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdIPAZ, Madrid, Spain
| | - J M de Miguel-Yanes
- Departamento de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2629] [Impact Index Per Article: 1314.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Comparison of two-year clinical outcomes according to glycemic status and renal function in patients with acute myocardial infarction following implantation of new-generation drug-eluting stents. J Diabetes Complications 2021; 35:108019. [PMID: 34400082 DOI: 10.1016/j.jdiacomp.2021.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/26/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
AIM We compared the 2-year clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) in patients with acute myocardial infarction (AMI) and chronic kidney disease (CKD) after the successful implantation of new-generation drug-eluting stents. METHODS A total of 11,961 AMI patients were classified into group A (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2, n = 2271) and group B (eGFR ≥60 ml/min/1.73 m2, n = 9690). These two groups were sub-classified into normoglycemia, prediabetes, and T2DM. The occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent MI (re-MI), and any repeat revascularization was evaluated. RESULTS In group A, the MACE (p = 0.016 and p = 0.004, respectively) and all-cause death (p = 0.044, and p = 0.031, respectively) rates; in groups B, the MACE, all-cause death, and cardiac death rates, were significantly higher in the prediabetes and T2DM groups than in the normoglycemia group. The re-MI and any repeat revascularization rates were significantly higher in the T2DM group than in the normoglycemia group. The MACE, all-cause death, and cardiac death rates in group A were significantly higher than those in all three glycemic subgroups of group B. Both in group A and B, the major clinical outcomes were not significantly different between the prediabetes and T2DM groups. CONCLUSIONS AMI patients, both with prediabetes and T2DM, showed a higher mortality rate than those with normoglycemia regardless of the degree of eGFR.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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7
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Zhao Y, Malik S, Budoff MJ, Correa A, Ashley KE, Selvin E, Watson KE, Wong ND. Identification and Predictors for Cardiovascular Disease Risk Equivalents among Adults With Diabetes Mellitus. Diabetes Care 2021; 44:dc210431. [PMID: 34380703 DOI: 10.2337/dc21-0431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent based on diabetes severity and other CVD risk factors. RESEARCH DESIGN AND METHODS We pooled 4 US cohorts (ARIC, JHS, MESA, FHS-Offspring) and classified subjects by baseline DM/CVD. CVD risks between DM+/CVD- vs. DM-/CVD+ were examined by diabetes severity and in subgroups of other CVD risk factors. We developed an algorithm to identify subjects with CVD risk equivalent diabetes by comparing the relative CVD risk of being DM+/CVD- vs. DM-/CVD+. RESULTS The pooled cohort included 27,730 subjects (mean age of 58.5 years, 44.6% male). CVD rates per 1000 person-years were 16.5, 33.4, 43.2 and 71.4 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. Compared with those with DM-/CVD+, CVD risks were similar or higher for those with HbA1c ≥ 7%, diabetes duration ≥10 years, or diabetes medication use while those with less severe diabetes had lower risks. Hazard ratios (95%CI) for DM+/CVD- vs. DM-/CVD+ were 0.96(0.86-1.07), 0.97(0.88-1.07), 0.96(0.82-1.13), 1.18(0.98-1.41), 0.93(0.85-1.02) and 1.00(0.89-1.13) among women, white race, age <55 years, triglycerides ≥2.26 mmol/L, hs-CRP ≥ 2 mg/L and eGFR<60 mL/min/1.73m2, respectively. In DM+/CVD- group, 19.1% had CVD risk equivalent diabetes with a lower risk score but a higher observed CVD risk. CONCLUSION Diabetes is a CVD risk equivalent in one-fifth of CVD-free adults living with diabetes. High HbA1c, long diabetes duration, and diabetes medication use were predictors of CVD risk equivalence. Diabetes is a CVD risk equivalent for women, white people, those of younger age, with higher triglycerides or CRP, or reduced kidney function.
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Affiliation(s)
- Yanglu Zhao
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA
- Heart Disease Prevention Program, Department of Medicine, University of California Irvine, Irvine, CA
| | - Shaista Malik
- Heart Disease Prevention Program, Department of Medicine, University of California Irvine, Irvine, CA
| | | | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Kellan E Ashley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Elizabeth Selvin
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Karol E Watson
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Nathan D Wong
- Department of Epidemiology, University of California Los Angeles, Los Angeles, CA
- Heart Disease Prevention Program, Department of Medicine, University of California Irvine, Irvine, CA
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Abstract
Diabetes mellitus is a disease of dysregulated blood glucose homeostasis. The current pandemic of diabetes is a significant driver of patient morbidity and mortality, as well as a major challenge to healthcare systems worldwide. The global increase in the incidence of diabetes has prompted researchers to focus on the different pathogenic processes responsible for type 1 and type 2 diabetes. Similarly, increased morbidity due to diabetic complications has accelerated research to uncover pathological changes causing these secondary complications. Albuminuria, or protein in the urine, is a well-recognised biomarker and risk factor for renal and cardiovascular disease. Albuminuria is a mediator of pathological abnormalities in diabetes-associated conditions such as nephropathy and atherosclerosis. Clinical screening and diagnosis of diabetic nephropathy is chiefly based on the presence of albuminuria. Given the ease in measuring albuminuria, the potential of using albuminuria as a biomarker of cardiovascular diseases is gaining widespread interest. To assess the benefits of albuminuria as a biomarker, it is important to understand the association between albuminuria and cardiovascular disease. This review examines our current understanding of the pathophysiological mechanisms involved in both forms of diabetes, with specific focus on the link between albuminuria and specific vascular complications of diabetes.
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Affiliation(s)
- Pappitha Raja
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Alexander P Maxwell
- Nephrology Research, Centre for Public Health, Queen's University of Belfast, Northern Ireland Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Derek P Brazil
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK.
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9
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Hubbard D, Colantonio LD, Rosenson RS, Brown TM, Jackson EA, Huang L, Orroth KK, Reading S, Woodward M, Bittner V, Gutierrez OM, Safford MM, Farkouh ME, Muntner P. Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease. Cardiovasc Diabetol 2021; 20:58. [PMID: 33648518 PMCID: PMC7923492 DOI: 10.1186/s12933-021-01247-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01247-0.
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Affiliation(s)
- Demetria Hubbard
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Todd M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Lei Huang
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Stephanie Reading
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK.,Department of Epidemiology and Biostatistics, School of Public Health, The George Institute for Global Health, University of New South Wales, Kensington, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Orlando M Gutierrez
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Monika M Safford
- Weill Cornell Medical College, Cornell University, Ithaca, NY, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada
| | - Paul Muntner
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA.
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10
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3176] [Impact Index Per Article: 1058.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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King A, Ringel JB, Safford MM, Riffin C, Adelman R, Roth DL, Sterling MR. Association Between Caregiver Strain and Self-Care Among Caregivers With Diabetes. JAMA Netw Open 2021; 4:e2036676. [PMID: 33570574 PMCID: PMC7879235 DOI: 10.1001/jamanetworkopen.2020.36676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. OBJECTIVE To examine the association between caregiver strain and diabetes self-care among caregivers with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted between July 13, 2018, and June 25, 2020, using data on 795 US caregivers aged 45 years or older with self-reported diabetes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which comprised 30 239 Black and White adults 45 years or older throughout the US enrolled from January 2003 to October 2007. EXPOSURES Caregiver strain, assessed by self-report in response to the question, "How much of a mental or emotional strain is it to provide this care?" Response options were no strain, some strain, or a lot of (high) strain. MAIN OUTCOMES AND MEASURES Diabetes self-care, which was assessed across 4 domains (Mediterranean diet adherence, physical activity, smoking status, and medication adherence), and a composite self-care score summing performance across these domains. The association between caregiver strain and diabetes self-care was examined with multivariable Poisson regression adjusting for demographic, clinical, physical and mental functioning, and caregiving covariates. RESULTS Among the 795 caregivers with diabetes included in the study, the mean (SD) age was 63.7 (8.6) years, 469 (59.0%) were women, and 452 (56.9%) were Black individuals. Overall, 146 caregivers (18.4%) reported high caregiver strain. In unadjusted models, high caregiver strain was associated with less physical activity (prevalence ratio [PR], 0.66; 95% CI, 0.45-0.97), low medication adherence (PR, 0.80; 95% CI, 0.68-0.94), and worse self-care (PR, 0.65; 95% CI, 0.44-0.98). In adjusted models, the association between some and high caregiving strain with low medication adherence remained significant (adjusted PR: some strain, 0.88 [95% CI, 0.78-0.99]; high strain, 0.83 [95% CI, 0.69-0.99]). CONCLUSIONS AND RELEVANCE In this cohort study of US adult caregivers with diabetes, a high level of strain was associated with low medication adherence. Increased awareness of the prevalence of caregiver strain and potential ramifications on caregivers' self-care appears to be warranted among health care professionals and caregivers.
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Affiliation(s)
- Alexandra King
- New York Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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12
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Ferreira JP, Fitchett D, Ofstad AP, Kraus BJ, Wanner C, Zwiener I, Zinman B, Lauer S, George JT, Rossignol P, Zannad F. Empagliflozin for Patients With Presumed Resistant Hypertension: A Post Hoc Analysis of the EMPA-REG OUTCOME Trial. Am J Hypertens 2020; 33:1092-1101. [PMID: 32369546 PMCID: PMC7814223 DOI: 10.1093/ajh/hpaa073] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/13/2020] [Accepted: 04/29/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) and resistant hypertension often coexist, greatly increasing risk of target-organ damage and death. We explored the effects of empagliflozin in patients with and without presumed resistant hypertension (prHT) in a post hoc analysis of EMPA-REG OUTCOME (NCT01131676). METHODS Overall, 7,020 patients received empagliflozin 10, 25 mg, or placebo with median follow-up of 3.1 years. We defined baseline prHT as ≥3 classes of antihypertensive drugs including a diuretic and uncontrolled blood pressure (BP; systolic blood pressure (SBP) ≥140 and/or diastolic blood pressure ≥90 mm Hg) or ≥4 classes of antihypertensive, including a diuretic, and controlled BP. We explored the effect of empagliflozin on cardiovascular (CV) death, heart failure (HF) hospitalization, 3-point major adverse cardiac events, all-cause death, and incident/worsening nephropathy by Cox regression and BP over time by a mixed-repeated-measures-model analysis. RESULTS 1,579 (22.5%) patients had prHT. The mean difference in change in SBP from baseline to week 12 vs. placebo was -4.5 (95% confidence interval, -5.9 to -3.1) mm Hg (P < 0.001) in prHT and -3.7 (-4.5, -2.9) mm Hg (P < 0.001) in patients without prHT. SBP was more frequently controlled (<130/80 mm Hg) with empagliflozin than with placebo. Patients with prHT had 1.5- to 2-fold greater risk of HF hospitalization, incident/worsening nephropathy, and CV death compared with those without prHT. Empagliflozin improved all outcomes in patients with and without prHT (interaction P > 0.1 for all outcomes). CONCLUSIONS Empagliflozin induced a clinically relevant reduction in SBP and consistently improved all outcomes regardless of prHT status. Due to these dual effects, empagliflozin should be considered for patients with hypertension and T2D.
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Affiliation(s)
- João Pedro Ferreira
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique Inserm 1433, Nancy, France
- CHRU de Nancy, Inserm U1116, Nancy, France
- FCRIN INI-CRCT, Nancy, France
| | - David Fitchett
- Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Bettina Johanna Kraus
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sabine Lauer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | | | - Patrick Rossignol
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique Inserm 1433, Nancy, France
- CHRU de Nancy, Inserm U1116, Nancy, France
- FCRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique Inserm 1433, Nancy, France
- CHRU de Nancy, Inserm U1116, Nancy, France
- FCRIN INI-CRCT, Nancy, France
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13
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Inzucchi SE, Khunti K, Fitchett DH, Wanner C, Mattheus M, George JT, Ofstad AP, Zinman B. Cardiovascular Benefit of Empagliflozin Across the Spectrum of Cardiovascular Risk Factor Control in the EMPA-REG OUTCOME Trial. J Clin Endocrinol Metab 2020; 105:5850548. [PMID: 32485734 PMCID: PMC7382052 DOI: 10.1210/clinem/dgaa321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/30/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Control of multiple cardiovascular (CV) risk factors reduces CV events in individuals with type 2 diabetes. OBJECTIVE To investigate this association in a contemporary clinical trial population, including how CV risk factor control affects the CV benefits of empagliflozin, a sodium-glucose cotransporter-2 inhibitor. DESIGN Post hoc analysis. SETTING Randomized CV outcome trial (EMPA-REG OUTCOME). PARTICIPANTS Type 2 diabetes patients with established CV disease. INTERVENTION Empagliflozin or placebo. MAIN OUTCOME MEASURES Risk of CV outcomes-including the treatment effect of empagliflozin-by achieving 7 goals for CV risk factor control at baseline: (1) glycated hemoglobin <7.5%, (2) low-density lipoprotein cholesterol <100 mg/dL or statin use, (3) systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg, (4) pharmacological renin-angiotensin-aldosterone system blockade, (5) normoalbuminuria, (6) aspirin use, (7) nonsmoking. RESULTS In the placebo group, the hazard ratio (HR) for CV death was 4.00 (95% CI, 2.26-7.11) and 2.48 (95% CI, 1.52-4.06) for patients achieving only 0-3 or 4-5 risk factor goals at baseline, respectively, compared with those achieving 6-7 goals. Participants achieving 0-3 or 4-5 goals also had increased risk for the composite outcome of hospitalization for heart failure or CV death (excluding fatal stroke) (HR 2.89 [1.82-4.57] and 1.90 [1.31-2.78], respectively) and 3-point major adverse CV events (HR 2.21 [1.53-3.19] and 1.42 [1.06-1.89]). Empagliflozin significantly reduced these outcomes across all risk factor control categories (P > 0.05 for treatment-by-subgroup interactions). CONCLUSIONS Cardiovascular risk in EMPA-REG OUTCOME was inversely associated with baseline CV risk factor control. Empagliflozin's cardioprotective effect was consistent regardless of multiple baseline risk factor control.
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Affiliation(s)
- Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut
- Correspondence and Reprint Requests: Silvio E. Inzucchi, MD, Section of Endocrinology, Yale University School of Medicine, New Haven, CT 06520. E-mail:
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - David H Fitchett
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christoph Wanner
- Division of Nephrology, Würzburg University Clinic, Würzburg, Germany
| | | | | | | | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Alves-Cabratosa L, Comas-Cufí M, Ponjoan A, Garcia-Gil M, Martí-Lluch R, Blanch J, Elosua-Bayes M, Parramon D, Camós L, Guzmán L, Ramos R. Levels of ankle-brachial index and the risk of diabetes mellitus complications. BMJ Open Diabetes Res Care 2020; 8:8/1/e000977. [PMID: 32144131 PMCID: PMC7059529 DOI: 10.1136/bmjdrc-2019-000977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We sought to compare the association of categorized ankle-brachial index (ABI) with mortality and complications of diabetes in persons with no symptoms of peripheral arterial disease (PAD) and in primary cardiovascular disease prevention. RESEARCH DESIGN AND METHODS This is a retrospective cohort study of persons with type 2 diabetes aged 35-85 years, from 2006 to 2011. Data were obtained from the Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAPQ). Participants had an ABI measurement that was classified into six categories. For each category of ABI, we assessed the incidence of mortality; macrovascular complications of diabetes: acute myocardial infarction (AMI), ischemic stroke, and a composite of these two; and microvascular complications of this metabolic condition: nephropathy, retinopathy, and neuropathy. We also estimated the HRs for these outcomes by ABI category using Cox proportional hazards models. RESULTS Data from 34 689 persons with type 2 diabetes were included. The mean age was 66.2; 51.5% were men; and the median follow-up was 6.0 years. The outcome with the highest incidence was nephropathy, with 24.4 cases per 1000 person-years in the reference category of 1.1≤ABI≤1.3. The incidences in this category for mortality and AMI were 15.4 and 4.1, respectively. In the Cox models, low ABI was associated with increased risk and was significant from ABI lower than 0.9; below this level, the risk kept increasing steeply. High ABI (over 1.3) was also associated with significant increased risk for most outcomes. CONCLUSIONS The studied categories of ABI were associated with different risks of type 2 diabetes complications in persons asymptomatic for PAD, who were in primary cardiovascular prevention. These findings could be useful to optimize preventive interventions according to the ABI category in this population.
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Affiliation(s)
| | | | - Anna Ponjoan
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- IDIBGI, Girona, Catalunya, Spain
| | | | - Ruth Martí-Lluch
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- IDIBGI, Girona, Catalunya, Spain
| | - Jordi Blanch
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
| | | | - Dídac Parramon
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
| | - Lourdes Camós
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
| | - Lidia Guzmán
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
| | - Rafel Ramos
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain
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15
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4939] [Impact Index Per Article: 1234.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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16
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Colantonio LD, Rosenson RS, Deng L, Monda KL, Dai Y, Farkouh ME, Safford MM, Philip K, Mues KE, Muntner P. Adherence to Statin Therapy Among US Adults Between 2007 and 2014. J Am Heart Assoc 2020; 8:e010376. [PMID: 30616455 PMCID: PMC6405715 DOI: 10.1161/jaha.118.010376] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Prior studies suggest that persistence with and adherence to statin therapy is low. Interventions to improve statin persistence and adherence have been developed over the past decade. Methods and Results This was a retrospective cohort study of adults aged ≥21 y with commercial or government health insurance in the MarketScan (Truven Health Analytics) and Medicare databases who initiated statins in 2007–2014 and (1) started treatment after a myocardial infarction (n=201 573), (2) had diabetes mellitus but without coronary heart disease (CHD; n=610 049), or (3) did not have CHD or diabetes mellitus (n=2 244 868). Persistence with (ie, not discontinuing treatment) and high adherence to statin therapy were assessed using pharmacy fills in the year following treatment initiation. In 2007 and 2014, the proportions of patients persistent with statin therapy were 78.1% and 79.1%, respectively, among those initiating treatment following myocardial infarction; 66.5% and 67.3%, respectively, for those with diabetes mellitus but without CHD; and 64.3% and 63.9%, respectively, for those without CHD or diabetes mellitus. Between 2007 and 2014, high adherence to statin therapy increased from 57.9% to 63.8% among patients initiating treatment following myocardial infarction and from 34.9% to 37.6% among those with diabetes mellitus but without CHD (each Ptrend<0.001). Among patients without CHD or diabetes mellitus, high adherence did not improve between 2007 (35.7%) and 2014 (36.8%; Ptrend=0.14). In 2014, statin adherence was lower among younger, black, and Hispanic patients versus white patients and those initiating a high‐intensity statin dosage. Statin adherence was higher among men and patients with cardiologist care following treatment initiation. Conclusions Persistence with and adherence to statin therapy remain low, particularly among those without CHD.
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Affiliation(s)
- Lisandro D Colantonio
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Robert S Rosenson
- 2 Mount Sinai Heart Icahn School of Medicine at Mount Sinai New York NY
| | - Luqin Deng
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Keri L Monda
- 3 Center for Observational Research Amgen Inc. Thousand Oaks CA
| | - Yuling Dai
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Michael E Farkouh
- 4 Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre of Excellence University of Toronto Ontario Canada
| | - Monika M Safford
- 5 Department of Medicine Weill Cornell Medical College New York NY
| | | | | | - Paul Muntner
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
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17
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5401] [Impact Index Per Article: 1080.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Rosenson RS, Colantonio LD, Burkholder GA, Chen L, Muntner P. Trends in Utilization of Statin Therapy and Contraindicated Statin Use in HIV--Infected Adults Treated With Antiretroviral Therapy From 2007 Through 2015. J Am Heart Assoc 2019; 7:e010345. [PMID: 30526249 PMCID: PMC6405602 DOI: 10.1161/jaha.118.010345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background HIV is associated with an increased risk for atherosclerotic cardiovascular disease, which may result in many people living with HIV taking a statin. Some statins are contraindicated with certain antiretroviral therapies ( ART ) and other medications commonly used by HIV -infected patients. Methods and Results We analyzed trends in the use of statins, including contraindicated statins, between 2007 and 2015 among HIV -infected patients aged ≥19 years taking ART who had employer-sponsored or Medicare supplemental health insurance in the Marketscan database (n=186 420). Statin use was identified using pharmacy claims. Contraindicated statin use was defined by a pharmacy claim for HIV protease inhibitors, cobicistat, hepatitis C protease inhibitors, anti-infectives, calcium channel blockers, amiodarone, gemfibrozil, or nefazodone followed by a fill for a contraindicated statin type and dosage within 90 days. The percentage of beneficiaries with HIV taking a statin remained unchanged between 2007 (24.6%) and 2015 (24.7%). Among those taking a statin, the percentage taking a contraindicated statin declined from 16.3% in 2007 to 9.0% in 2014 and then increased to 9.8% in 2015. The proportion of contraindicated statin fills attributable to HIV protease inhibitors declined from 63.9% in 2007 to 51.0% in 2015, while those attributable to cobicistat increased from 0% before 2012 to 20.6% in 2015. Conclusions Changes in ART regimens resulted in a decline in contraindicated statin use from 2007 to 2014, but this favorable trend was attenuated in 2015 because of increased use of cobicistat-containing ART regimens.
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Godoy LC, Tavares CAM, Farkouh ME. Weighing Coronary Revascularization Options in Patients With Type 2 Diabetes Mellitus. Can J Diabetes 2019; 44:78-85. [PMID: 31594759 DOI: 10.1016/j.jcjd.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
Abstract
Patients with diabetes mellitus (DM) are at increased risk for developing coronary artery disease. Choosing the optimal revascularization strategy, such as coronary artery bypass grafting or percutaneous coronary intervention (PCI), may be difficult in this population. A large body of evidence suggests that, for patients with DM and stable multivessel ischemic heart disease, coronary artery bypass grafting is usually superior to PCI, leading to lower rates of all-cause mortality, myocardial infarction and repeat revascularization in the long term. In patients with less complex coronary anatomy (2- or single-vessel disease, especially without involvement of the proximal left anterior descendent artery), PCI may be a viable option. Because these anatomic patterns are less frequent in patients with DM, there is less evidence to guide revascularization in these cases. Patients with DM and left main disease and those in the acute coronary syndrome setting are also underrepresented in randomized trials, and the best revascularization strategy for these patients is not clear. Once the revascularization procedure is performed, patients should be kept engaged in controlling the risk factors for progression of cardiovascular disease. Avoidance of smoking, control of cholesterol, blood pressure and glycemic levels; regular practice of physical activity of at least moderate intensity; and a balanced diet are of key importance in the post-revascularization period. In this study, we review the current literature in the management of patients with DM and coronary artery disease undergoing a revascularization procedure.
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Affiliation(s)
- Lucas C Godoy
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Caio A M Tavares
- Instituto do Coracao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, Ontario, Canada.
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20
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Alves-Cabratosa L, Garcia-Gil M, Comas-Cufí M, Blanch J, Ponjoan A, Martí-Lluch R, Elosua-Bayes M, Parramon D, Camós L, Ramos R. Role of Low Ankle-Brachial Index in Cardiovascular and Mortality Risk Compared with Major Risk Conditions. J Clin Med 2019; 8:E870. [PMID: 31216703 PMCID: PMC6617200 DOI: 10.3390/jcm8060870] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular prevention is of particular interest in persons with asymptomatic peripheral arterial disease. We aimed to quantify its association with mortality and cardiovascular outcomes, compared to other indicators of high risk. We performed a retrospective cohort study using the Database of the Catalan primary care system (SIDIAPQ), for 2006-2015, including 35-85-year-old patients with an ankle-brachial index (ABI) measurement, classified according to the presence of diabetes, cardiovascular disease, and low ABI (<0.9). We calculated the incidences and hazard ratios (HRs) for all-cause mortality, acute myocardial infarction, and ischemic stroke. During a median follow-up of 5.9 years, we analyzed 58,118 persons. The mean (SD) age was 66.6 (10.7) years and 53.4% were men. Compared to the reference group with no diabetes, no previous cardiovascular disease, and normal ankle-brachial index, the HR for all-cause mortality was 1.42 (1.25-1.63) in the group with low ABI, 1.35 (1.26-1.45) in those with diabetes, 1.50 (1.34-1.69) in those with previous cardiovascular disease, and 1.84 (1.68-2.01) in those with low ABI and diabetes. In conclusion, participants with low ABI showed increased mortality, acute myocardial infarction, and ischemic stroke incidence in all the subgroups. Patients with low ankle-brachial index plus diabetes presented increased mortality, acute myocardial infarction, and ischemic stroke risk, all at rates similar to those with previous cardiovascular disease.
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Affiliation(s)
- Lia Alves-Cabratosa
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
| | - Maria Garcia-Gil
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
| | - Marc Comas-Cufí
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
| | - Jordi Blanch
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
| | - Anna Ponjoan
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
- Institut d'Investigació Biomèdica de Girona (IDIBGI), 17190 Girona, Spain.
| | - Ruth Martí-Lluch
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
- Institut d'Investigació Biomèdica de Girona (IDIBGI), 17190 Girona, Spain.
| | - Marc Elosua-Bayes
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
| | - Dídac Parramon
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
- Primary Care Services, Girona, Catalan Institute of Health (ICS), 17001 Girona, Spain.
| | - Lourdes Camós
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
- Primary Care Services, Girona, Catalan Institute of Health (ICS), 17001 Girona, Spain.
| | - Rafel Ramos
- Vascular Health Research Group of Girona (ISV-Girona), Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 17002 Girona, Spain.
- Department of Medical Sciences, School of Medicine, University of Girona, 17003 Girona, Spain.
- Institut d'Investigació Biomèdica de Girona (IDIBGI), 17190 Girona, Spain.
- Primary Care Services, Girona, Catalan Institute of Health (ICS), 17001 Girona, Spain.
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Afanasiev SA, Garganeeva AA, Kuzheleva EA, Andriyanova AV, Kondratieva DS, Popov SV. The Impact of Type 2 Diabetes Mellitus on Long-Term Prognosis in Patients of Different Ages with Myocardial Infarction. J Diabetes Res 2018; 2018:1780683. [PMID: 30116733 PMCID: PMC6079422 DOI: 10.1155/2018/1780683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/22/2018] [Accepted: 06/24/2018] [Indexed: 01/01/2023] Open
Abstract
The objective of the study was to assess the impact of DM2 at baseline on long-term mortality after acute myocardial infarction (MI) among different age groups. The data were taken from: "Register of Acute Myocardial Infarction." A total of 862 patients were followed for five years after acute myocardial infarction. The primary endpoint was death from any cause. The patients were categorized into 2 groups based on their ages: group 1-comprised patients older than working age (n = 358) and group 2-comprised employable patients (n = 504). A total of 208 patients were diagnosed with both cardiovascular disease and DM2. Elderly patients with DM2 had worse prognosis and increased five-year mortality compared with patients of the same age group without DM2. Statistically significant differences in long-term outcomes were found in adult patients (p = 0.004) only in group with longer duration of diabetes, unlike the group with DM2 onset. In conclusion, Type 2 DM increased 5-year mortality rate of elderly patients with myocardial infarction. However, younger patients with both myocardial infarction and DM2 had more complications in the early post-MI period compared with patients of the same age group without DM2 but did not show any statistically significant differences in the long-term outcome.
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Affiliation(s)
- S. A. Afanasiev
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
| | - A. A. Garganeeva
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
| | - E. A. Kuzheleva
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
| | - A. V. Andriyanova
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
| | - D. S. Kondratieva
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
| | - S. V. Popov
- Cardiology Research Institute, 111a Kievskaya Street, Tomsk 634012, Russia
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22
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4550] [Impact Index Per Article: 758.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Conway BN, Han X, Munro HM, Gross AL, Shu XO, Hargreaves MK, Zheng W, Powers AC, Blot WJ. The obesity epidemic and rising diabetes incidence in a low-income racially diverse southern US cohort. PLoS One 2018; 13:e0190993. [PMID: 29324894 PMCID: PMC5764338 DOI: 10.1371/journal.pone.0190993] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Obesity is known to be a major risk factor for diabetes, but the magnitude of risk and variation between blacks and whites are less well documented in populations heavily affected by obesity. Herein we assess rates and risks of incident diabetes in a diverse southern population where obesity is common. METHODS A total of 24,000 black and 14,064 white adults aged 40-79 in the Southern Community Cohort Study with no self-reported diabetes at study enrollment during 2002-2009 was followed for up to 10 (median 4.5) years. Incidence rates, odds ratios (OR) and accompanying 95% confidence intervals (CI) for medication-treated incident diabetes were determined according to body mass index (BMI) and other characteristics, including tobacco and alcohol consumption, healthy eating and physical activity indices, and socioeconomic status (SES). RESULTS Risk of incident diabetes rose monotonically with increasing BMI, but the trends differed between blacks and whites (pinteraction < .0001). Adjusted ORs (CIs) for diabetes among those with BMI≥40 vs 20-25 kg/m2 were 11.9 (8.4-16.8) for whites and 4.0 (3.3-4.8) for blacks. Diabetes incidence was more than twice as high among blacks than whites of normal BMI, but the racial difference became attenuated as BMI rose, with estimated 5-year probabilities of developing diabetes approaching 20% for both blacks and whites with BMI≥40 kg/m2. Diabetes risk was also associated with low SES, significantly (pinteraction≤.02) more so for whites, current cigarette smoking, and lower healthy eating and physical activity indices, although high BMI remained the predominant risk factor among both blacks and whites. From baseline prevalence and 20-year projections of the incidence trends, we estimate that the large majority of surviving cohort participants with BMI≥40 kg/m2 will be diagnosed with diabetes. CONCLUSIONS Even using conservative criteria to ascertain diabetes incidence (i.e., requiring diabetes medication use and ignoring undiagnosed cases), rates of obesity-associated diabetes were exceptionally high in this low-income adult population. The findings indicate that effective strategies to halt the rising prevalence of obesity are needed to avoid substantial increases in diabetes in coming years.
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Affiliation(s)
- Baqiyyah N. Conway
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, Tyler, Texas, United States of America
| | - Xijing Han
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Heather M. Munro
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Amy L. Gross
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Margaret K. Hargreaves
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, United States of America
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Alvin C. Powers
- Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - William J. Blot
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Rockville, Maryland, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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24
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Sultan A, Zheng Y, Trainor PJ, Siow Y, Amraotkar AR, Hill BG, DeFilippis AP. Circulating Prolidase Activity in Patients with Myocardial Infarction. Front Cardiovasc Med 2017; 4:50. [PMID: 28824924 PMCID: PMC5535509 DOI: 10.3389/fcvm.2017.00050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/14/2017] [Indexed: 12/20/2022] Open
Abstract
Background Collagen is a major determinant of atherosclerotic plaque stability. Thus, identification of differences in enzymes that regulate collagen integrity could be useful for predicting susceptibility to atherothrombosis or for diagnosing plaque rupture. In this study, we sought to determine whether prolidase, the rate-limiting enzyme of collagen turnover, differs in human subjects with acute myocardial infarction (MI) versus those with stable coronary artery disease (CAD). Methods We measured serum prolidase activity in 15 patients with stable CAD and 49 patients with acute MI, of which a subset had clearly defined thrombotic MI (n = 22) or non-thrombotic MI (n = 12). Prolidase activity was compared across study time points (at cardiac catheterization, T0; 6 h after presentation, T6; and at a quiescent follow-up, Tf/u) in acute MI and stable CAD subjects. We performed subgroup analyses to evaluate prolidase activity in subjects presenting with acute thrombotic versus non-thrombotic MI. Results Although prolidase activity was lower at T0 and T6 versus the quiescent phase in acute MI and stable CAD subjects (p < 0.0001), it was not significantly different between acute MI and stable CAD subjects at any time point (T0, T6, and Tf/u) or between thrombotic and non-thrombotic MI groups. Preliminary data from stratified analyses of a small number of diabetic subjects (n = 8) suggested lower prolidase activity in diabetic acute MI subjects compared with non-diabetic acute MI subjects (p = 0.02). Conclusion Circulating prolidase is not significantly different between patients with acute MI and stable CAD or between patients with thrombotic and non-thrombotic MI. Further studies are required to determine if diabetes significantly affects prolidase activity and how this might relate to the risk of MI.
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Affiliation(s)
- Adnan Sultan
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
| | - Yuting Zheng
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
| | - Patrick J Trainor
- Department of Medicine, Division of Cardiovascular Medicine, and Bioinformatics, University of Louisville, Louisville, KY, United States
| | - Yong Siow
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
| | - Alok R Amraotkar
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
| | - Bradford G Hill
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
| | - Andrew P DeFilippis
- Department of Medicine, Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States.,KentuckyOne, Jewish Hospital, Johns Hopkins University, Baltimore, MD, United States
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