1
|
de Leeuw MJ, Böhmer MN, Leening MJG, Kors JA, Bindels PJE, Oppewal A, Maes-Festen DAM. Feasibility and findings of electrocardiogram recording in older adults with intellectual disabilities: results of the Healthy Ageing and Intellectual Disabilities study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39148342 DOI: 10.1111/jir.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/23/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Older adults with intellectual disabilities (ID) have a high risk of cardiovascular diseases (CVD). At the same time, challenging diagnostic work-up increases the likelihood of underdiagnosis of CVD in this population. To limit this underdiagnosis, it would be beneficial to use objective measures such as the electrocardiogram (ECG). However, little is known about the feasibility of ECG recording and the prevalence of ECG abnormalities in this population. Therefore, the aims of this study were to investigate the feasibility of resting ECG recording, to study the prevalence of ECG abnormalities, and to compare the frequency of ECG abnormalities with medical records in older adults with ID. METHOD A cross-sectional study was performed within a cohort of older adults (≥60 years) with ID as part of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. A resting 12-lead ECG was attempted, and the ECG recording was considered feasible if the recording could be made and if the ECG could be interpreted by a cardiologist and the Modular ECG Analysis System (MEANS). ECGs were assessed for the presence of ECG abnormalities and medical record review was performed. If the cardiologist or MEANS concluded that there was evidence of myocardial infarction, atrial fibrillation or QTc prolongation on the ECG in the absence of this ECG diagnosis in the participant's medical record, this was classified as a previously undiagnosed ECG diagnosis. RESULTS ECG recording was feasible in 134 of the 200 participants (67.0%). Of these 134 participants (70.6 ± 5.8 years; 52.2% female), 103 (76.9%) had one or more ECG abnormality, with the most prevalent being prolonged P-wave duration (27.6%), QTc prolongation (18.7%), minor T-wave abnormalities (17.9%), first degree atrioventricular block (12.7%) and myocardial infarction (6.7%). Eight out of 9 (88.9%) myocardial infarctions and all cases of (significant) QTc prolongation (100%) were previously undiagnosed. CONCLUSIONS This study showed that ECG recording is feasible in the majority of older adults with ID and revealed a substantial underdiagnosis of ECG abnormalities. These results stress the importance of ECG recording and warrant further research into the yield of opportunistic ECG screening in older adults with ID.
Collapse
Affiliation(s)
- M J de Leeuw
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M N Böhmer
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J A Kors
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P J E Bindels
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D A M Maes-Festen
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Dienhart C, Aigner E, Iglseder B, Frey V, Gostner I, Langthaler P, Paulweber B, Trinka E, Wernly B. Investigating the Added Value of Beck's Depression Inventory in Atherosclerosis Prediction: Lessons from Paracelsus 10,000. J Clin Med 2024; 13:4492. [PMID: 39124759 PMCID: PMC11312733 DOI: 10.3390/jcm13154492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Depression is the most common mental illness worldwide and generates an enormous health and economic burden. Furthermore, it is known to be associated with an elevated risk of arteriosclerotic cardiovascular diseases (ASCVD), particularly stroke. However, it is not a factor reflected in many ASCVD risk models, including SCORE2. Thus, we analysed the relationship between depression, ASCVD and SCORE2 in our cohort. Methods: We analysed 9350 subjects from the Paracelsus 10,000 cohort, who underwent both a carotid artery ultrasound and completed a Beck Depression Inventory (BDI) screening. Patients were categorised binomially based on the BDI score. Atherosclerotic carotid plaque or absence was dichotomised for logistic regression modelling. Odds ratios and adjusted relative risks were calculated using Stata. Results: Subjects with an elevated BDI (≥14) had higher odds for carotid plaques compared to subjects with normal BDI, especially after adjusting for classical risk factors included in SCORE2 (1.21; 95%CI 1.03-1.43, p = 0.023). The adjusted relative risk for plaques was also increased (1.09; 95%CI 1.01-1.18, p = 0.021). Subgroup analysis showed an increased odds of plaques with increases in depressive symptoms, particularly in women and patients ≤55 yrs. Conclusions: In our cohort, the BDI score is associated with subclinical atherosclerosis beyond classical risk factors. Thus, depression might be an independent risk factor which may improve risk stratification if considered in ASCVD risk prediction models, such as SCORE2. Furthermore, reminding clinicians to take mental health into consideration to identify individuals at increased atherosclerosis risk may provide added opportunities to address measures which can reduce the risk of ASCVD.
Collapse
Affiliation(s)
- Christiane Dienhart
- Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria; (E.A.); (B.P.)
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria; (E.A.); (B.P.)
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Vanessa Frey
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (V.F.); (I.G.); (P.L.); (E.T.)
| | - Isabella Gostner
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (V.F.); (I.G.); (P.L.); (E.T.)
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (V.F.); (I.G.); (P.L.); (E.T.)
- Department of Artificial Intelligence and Human Interfaces, Paris Lodron University of Salzburg, 5020 Salzburg, Austria
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine I, Paracelsus Medical University, 5020 Salzburg, Austria; (E.A.); (B.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria; (V.F.); (I.G.); (P.L.); (E.T.)
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated Member of the European Reference Network EpiCARE, 5020 Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Bernhard Wernly
- Department of Internal Medicine I, Oberndorf Hospital, 5110 Salzburg, Austria;
- Institute for General and Preventive Medicine, Paracelsus Medical University, 5020 Salzburg, Austria
| |
Collapse
|
3
|
Fernández-Friera L, García-Alvarez A, Oliva B, García-Lunar I, García I, Moreno-Arciniegas A, Gómez-Talavera S, Pérez-Herreras C, Sánchez-González J, de Vega VM, Rossello X, Bueno H, Fernández-Ortiz A, Ibañez B, Sanz J, Fuster V. Association between subclinical atherosclerosis burden and unrecognized myocardial infarction detected by cardiac magnetic resonance in middle-aged low-risk adults. Eur Heart J Cardiovasc Imaging 2024; 25:968-975. [PMID: 38426763 PMCID: PMC11210973 DOI: 10.1093/ehjci/jeae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/13/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS Evidence on the association between subclinical atherosclerosis (SA) and cardiovascular (CV) events in low-risk populations is scant. To study the association between SA burden and an ischaemic scar (IS), identified by cardiac magnetic resonance (CMR), as a surrogate of CV endpoint, in a low-risk population. METHODS AND RESULTS A cohort of 712 asymptomatic middle-aged individuals from the Progression of Early SA (PESA-CNIC-Santander) study (median age 51 years, 84% male, median SCORE2 3.37) were evaluated on enrolment and at 3-year follow-up with 2D/3D vascular ultrasound (VUS) and coronary artery calcification scoring (CACS). A cardiac magnetic study (CMR) was subsequently performed and IS defined as the presence of subendocardial or transmural late gadolinium enhancement (LGE). On CMR, 132 (19.1%) participants had positive LGE, and IS was identified in 20 (2.9%) participants. Individuals with IS had significantly higher SCORE2 at baseline and higher CACS and peripheral SA burden (number of plaques by 2DVUS and plaque volume by 3DVUS) at both SA evaluations. High CACS and peripheral SA (number of plaques) burden were independently associated with the presence of IS, after adjusting for SCORE2 [OR for 3rd tertile, 8.31; 95% confidence interval (CI) 2.85-24.2; P < 0.001; and 2.77; 95% CI, 1.02-7.51; P = 0.045, respectively] and provided significant incremental diagnostic value over SCORE2. CONCLUSION In a low-risk middle-aged population, SA burden (CAC and peripheral plaques) was independently associated with a higher prevalence of IS identified by CMR. These findings reinforce the value of SA evaluation to early implement preventive measures. CLINICAL TRIAL REGISTRATION Progression of Early Subclinical Atherosclerosis (PESA) Study Identifier: NCT01410318.
Collapse
Affiliation(s)
- Leticia Fernández-Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), Hospital Universitario HM Monteprincipe, HM Hospitales, Av. de Montepríncipe, 25, 28660 Boadilla del Monte, Madrid, Spain
- CIBERCV, Madrid, Spain
- Universidad Camilo Jose Cela, Castillo de Alarcón, 49, 28692 Villafranca del Castillo, Madrid, Spain
| | - Ana García-Alvarez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clinic Barcelona-IDIBAPS. Universitat de Barcelona, Barcelona, Spain
| | - Belen Oliva
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Inés García-Lunar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario La Moraleja, Madrid, Spain
| | - Iris García
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Andrea Moreno-Arciniegas
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Sandra Gómez-Talavera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | | | | | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Cardiology Department, Hospital Universitari Son Espases-IDISBA, Palma de Mallorca, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, and i+12 Research Institute, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- CIBERCV, Madrid, Spain
- Cardiology Department, IIS-Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Mount Sinai Fuster Heart Hospital, New York, NY, USA
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain
- Mount Sinai Fuster Heart Hospital, New York, NY, USA
| |
Collapse
|
4
|
Taggart C, Roos A, Kadesjö E, Anand A, Li Z, Doudesis D, Lee KK, Bularga A, Wereski R, Lowry MTH, Chapman AR, Ferry AV, Shah ASV, Gard A, Lindahl B, Edgren G, Mills NL, Kimenai DM. Application of the Universal Definition of Myocardial Infarction in Clinical Practice in Scotland and Sweden. JAMA Netw Open 2024; 7:e245853. [PMID: 38587840 PMCID: PMC11002705 DOI: 10.1001/jamanetworkopen.2024.5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/13/2024] [Indexed: 04/09/2024] Open
Abstract
Importance Whether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown. Objective To evaluate the application of the universal definition of MI in consecutive patients with possible MI across 2 health care systems. Design, Setting, and Participants This cohort study used data from 2 prospective cohorts enrolling consecutive patients with possible MI in Scotland (2013-2016) and Sweden (2011-2014) to assess accuracy of clinical diagnosis of MI recorded in hospital records for patients with an adjudicated diagnosis of type 1 or type 2 MI. Data were analyzed from August 2022 to February 2023. Main Outcomes and Measures The main outcome was the proportion of patients with a clinical diagnosis of MI recorded in the hospital records who had type 1 or type 2 MI, adjudicated by an independent panel according to the universal definition. Characteristics and risk of subsequent MI or cardiovascular death at 1 year were compared. Results A total of 50 356 patients were assessed. The cohort from Scotland included 28 783 (15 562 men [54%]; mean [SD] age, 60 [17] years), and the cohort from Sweden included 21 573 (11 110 men [51%]; mean [SD] age, 56 [17] years) patients. In Scotland, a clinical diagnosis of MI was recorded in 2506 of 3187 patients with an adjudicated diagnosis of type 1 MI (79%) and 122 of 716 patients with an adjudicated diagnosis of type 2 MI (17%). Similar findings were observed in Sweden, with 970 of 1111 patients with adjudicated diagnosis of type 1 MI (87%) and 57 of 251 patients with adjudicated diagnosis of type 2 MI (23%) receiving a clinical diagnosis of MI. Patients with an adjudicated diagnosis of type 1 MI without a clinical diagnosis were more likely to be women (eg, 336 women [49%] vs 909 women [36%] in Scotland; P < .001) and older (mean [SD] age, 71 [14] v 67 [14] years in Scotland, P < .001) and, when adjusting for competing risk from noncardiovascular death, were at similar or increased risk of subsequent MI or cardiovascular death compared with patients with a clinical diagnosis of MI (eg, 29% vs 18% in Scotland; P < .001). Conclusions and Relevance In this cohort study, the universal definition of MI was not consistently applied in clinical practice, with a minority of patients with type 2 MI identified, and type 1 MI underrecognized in women and older persons, suggesting uncertainty remains regarding the diagnostic criteria or value of the classification.
Collapse
Affiliation(s)
- Caelan Taggart
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas Roos
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Erik Kadesjö
- Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Atul Anand
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ziwen Li
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Dimitrios Doudesis
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kuan Ken Lee
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ryan Wereski
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew T. H. Lowry
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew R. Chapman
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Amy V. Ferry
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Anoop S. V. Shah
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anton Gard
- Department of Cardiology, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Cardiology, Uppsala University, Uppsala, Sweden
| | - Gustaf Edgren
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Nicholas L. Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorien M. Kimenai
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
5
|
Mulder JWCM, Tromp TR, Al-Khnifsawi M, Blom DJ, Chlebus K, Cuchel M, D’Erasmo L, Gallo A, Hovingh GK, Kim NT, Long J, Raal FJ, Schonck WAM, Soran H, Truong TH, Boersma E, Roeters van Lennep JE. Sex Differences in Diagnosis, Treatment, and Cardiovascular Outcomes in Homozygous Familial Hypercholesterolemia. JAMA Cardiol 2024; 9:313-322. [PMID: 38353972 PMCID: PMC10867777 DOI: 10.1001/jamacardio.2023.5597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
Importance Homozygous familial hypercholesterolemia (HoFH) is a rare genetic condition characterized by extremely increased low-density lipoprotein (LDL) cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Heterozygous familial hypercholesterolemia (HeFH) is more common than HoFH, and women with HeFH are diagnosed later and undertreated compared to men; it is unknown whether these sex differences also apply to HoFH. Objective To investigate sex differences in age at diagnosis, risk factors, lipid-lowering treatment, and ASCVD morbidity and mortality in patients with HoFH. Design, Setting, and Participants Sex-specific analyses for this retrospective cohort study were performed using data from the HoFH International Clinical Collaborators (HICC) registry, the largest global dataset of patients with HoFH, spanning 88 institutions across 38 countries. Patients with HoFH who were alive during or after 2010 were eligible for inclusion. Data entry occurred between February 2016 and December 2020. Data were analyzed from June 2022 to June 2023. Main Outcomes and Measures Comparison between women and men with HoFH regarding age at diagnosis, presence of risk factors, lipid-lowering treatment, prevalence, and onset and incidence of ASCVD morbidity (myocardial infarction [MI], aortic stenosis, and combined ASCVD outcomes) and mortality. Results Data from 389 women and 362 men with HoFH from 38 countries were included. Women and men had similar age at diagnosis (median [IQR], 13 [6-26] years vs 11 [5-27] years, respectively), untreated LDL cholesterol levels (mean [SD], 579 [203] vs 596 [186] mg/dL, respectively), and cardiovascular risk factor prevalence, except smoking (38 of 266 women [14.3%] vs 59 of 217 men [27.2%], respectively). Prevalence of MI was lower in women (31 of 389 [8.0%]) than men (59 of 362 [16.3%]), but age at first MI was similar (mean [SD], 39 [13] years in women vs 38 [13] years in men). Treated LDL cholesterol levels and lipid-lowering therapy were similar in both sexes, in particular statins (248 of 276 women [89.9%] vs 235 of 258 men [91.1%]) and lipoprotein apheresis (115 of 317 women [36.3%] vs 118 of 304 men [38.8%]). Sixteen years after HoFH diagnosis, women had statistically significant lower cumulative incidence of MI (5.0% in women vs 13.7% in men; subdistribution hazard ratio [SHR], 0.37; 95% CI, 0.21-0.66) and nonsignificantly lower all-cause mortality (3.0% in women vs 4.1% in men; HR, 0.76; 95% CI, 0.40-1.45) and cardiovascular mortality (2.6% in women vs 4.1% in men; SHR, 0.87; 95% CI, 0.44-1.75). Conclusions and Relevance In this cohort study of individuals with known HoFH, MI was higher in men compared with women yet age at diagnosis and at first ASCVD event were similar. These findings suggest that early diagnosis and treatment are important in attenuating the excessive cardiovascular risk in both sexes.
Collapse
Affiliation(s)
- Janneke W. C. M. Mulder
- Department of Internal Medicine, Erasmus Medical Center Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tycho R. Tromp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Dirk J. Blom
- Department of Medicine, Division of Lipidology and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Krysztof Chlebus
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- National Centre of Familial Hypercholesterolaemia, Gdańsk, Poland
| | - Marina Cuchel
- Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Laura D’Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Gallo
- Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, Sorbonne Université, Institut national de la santé et de la recherche médicale UMR 1166, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpètriêre, Paris, France
| | - G. Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Ngoc Thanh Kim
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Jiang Long
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, The Key Laboratory of Remodeling–Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Frederick J. Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Willemijn A. M. Schonck
- Department of Vascular Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Handrean Soran
- Department of Diabetes, Endocrinology and Metabolism and Manchester National Institute of Health Research/Wellcome Trust Clinical Research Facility, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Thanh-Huong Truong
- Faculty of Medicine, Phenikaa University, Hanoi City, Vietnam
- Vietnam Atherosclerosis Society, Hanoi, Vietnam
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jeanine E. Roeters van Lennep
- Department of Internal Medicine, Erasmus Medical Center Cardiovascular Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
6
|
Hummel B, van Oortmerssen JA, Borst C, Harskamp RE, Galenkamp H, Postema PG, van Valkengoed IG. Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200237. [PMID: 38283611 PMCID: PMC10818071 DOI: 10.1016/j.ijcrp.2024.200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Background Epidemiological studies suggest sex differences in the prevalence and characteristics of unrecognized and recognized myocardial infarction (uMI, rMI). Despite increasingly diverse populations, observations are limited in multiethnic contexts. Gaining better understanding may inform policy makers and healthcare professionals on populations at risk of uMI who could benefit from preventive measures. Methods We used baseline data from the multiethnic population-based HELIUS cohort (2011-2015; Amsterdam, the Netherlands). Using logistic regressions, we studied sex differences in the prevalence and proportion of uMIs across ethnic groups. Next, we studied whether symptoms, clinical parameters, and sociocultural factors were associated with uMIs. Finally, we compared secondary preventive therapies in women and men with a uMI or rMI. We relied on pathological Q-waves on a resting electrocardiogram as the electrocardiographic signature for (past) MI. Results Overall, and in Turkish and Moroccan subgroups, the prevalence of uMIs was higher in men than women. The proportion of uMIs was similar in women (21.0%) and men (18.4%), yet varied by ethnicity. In women and men, symptoms (chest pain, dyspnea) and clinical parameters (hypertension, hypercholesterolemia), and in women also lower educational level and diabetes were associated with lower odds of uMIs. Women (0.0%) and men (3.6%) with uMI were unlikely to receive secondary preventive therapies compared to those with rMI (28.1-40.9%). Conclusions The prevalence of uMIs was higher in men than women, and sex differences in the proportion of uMIs varied somewhat across ethnic groups. People with uMIs did not receive adequate preventative medications, posing a risk for recurrent events.
Collapse
Affiliation(s)
- Bryn Hummel
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - CharlotteS.M. Borst
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ralf E. Harskamp
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
| | - Pieter G. Postema
- Departments of Experimental and Clinical Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| | - Irene G.M. van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - IMPRESS consortium
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Departments of Experimental and Clinical Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Roeters van Lennep JE, Tokgözoğlu LS, Badimon L, Dumanski SM, Gulati M, Hess CN, Holven KB, Kavousi M, Kayıkçıoğlu M, Lutgens E, Michos ED, Prescott E, Stock JK, Tybjaerg-Hansen A, Wermer MJH, Benn M. Women, lipids, and atherosclerotic cardiovascular disease: a call to action from the European Atherosclerosis Society. Eur Heart J 2023; 44:4157-4173. [PMID: 37611089 PMCID: PMC10576616 DOI: 10.1093/eurheartj/ehad472] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women.
Collapse
Affiliation(s)
- Jeanine E Roeters van Lennep
- Department of Internal Medicine, Cardiovascular Institute, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Lina Badimon
- Cardiovascular Science Program-ICCC, IR-Hospital de la Santa Creu I Santa Pau, Ciber CV, Autonomous University of Barcelona, Barcelona, Spain
| | - Sandra M Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, and O’Brien Institute for Public Health, Calgary, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora and CPC Clinical Research Aurora, CO, USA
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, and National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Esther Lutgens
- Cardiovascular Medicine and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jane K Stock
- European Atherosclerosis Society, Mässans Gata 10, SE-412 51 Gothenburg, Sweden
| | - Anne Tybjaerg-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology at University Medical Center Groningen, Groningen, The Netherlands
| | - Marianne Benn
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Hookana I, Holmström L, Eskuri MAE, Pakanen L, Ollila MM, Kiviniemi AM, Kenttä T, Vähätalo J, Tulppo M, Lepojärvi ES, Piltonen T, Perkiömäki J, Tikkanen JT, Huikuri H, Junttila MJ. Characteristics of women with ischemic sudden cardiac death. Ann Med 2023; 55:2258911. [PMID: 37795698 PMCID: PMC10557538 DOI: 10.1080/07853890.2023.2258911] [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: 06/08/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) is a significant mode of death causing 15-20% of all deaths in high-income countries. Coronary artery disease (CAD) is the most common cause of SCD in both sexes, and SCD is often the first manifestation of underlying CAD in women. This case-control study aimed to determine the factors associated with SCD due to CAD in women. METHODS The study group consisted of women with CAD-related SCD (N = 888) derived from the Fingesture study conducted in Northern Finland from 1998 to 2017. All SCDs underwent medicolegal autopsy. The control group consisted of women with angiographically verified CAD without SCD occurring during the 5-year-follow-up (N = 610). To compare these groups, we used medical records, autopsy findings, echocardiograms, and electrocardiograms (ECGs). RESULTS Subjects with SCD were older (73.2 ± 11.3 vs. 68.8 ± 8.0, p < 0.001) and were more likely to be smokers or ex-smokers (37.1% vs. 27.6%, p = 0.045) compared to control patients. The proportion of subjects with prior myocardial infarction (MI) was higher in controls (46.9% vs. 41.4% in SCD subjects, p = 0.037), but in contrast, SCD subjects were more likely to have underlying silent MI (25.6% vs. 2.4% in CAD controls, p < 0.001). Left ventricular hypertrophy (LVH) was more common finding in SCD subjects (70.9% vs. 55.1% in controls, p < 0.001). Various electrocardiographic abnormalities were more common in subjects with SCD, including higher heart rate, atrial fibrillation, prolonged QTc interval, wide or fragmented QRS complex and early repolarization. The prevalence of Q waves and T inversions did not differ between the groups. CONCLUSIONS Underlying LVH and previous MI with myocardial scarring are common and often undiagnosed in women with CAD-related SCD. These results suggest that untreated CAD with concomitant myocardial disease is an important factor in SCD in women.
Collapse
Affiliation(s)
- I. Hookana
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - L. Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M. A. E. Eskuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - L. Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
- Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - M. M. Ollila
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - A. M. Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - T. Kenttä
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - J. Vähätalo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M. Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - E. S. Lepojärvi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - T. Piltonen
- Department of Obstetrics and Gynecology, Research Unit of Clinical Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - J. Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - J. T. Tikkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - H. V. Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M. J. Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu and Biocenter Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| |
Collapse
|
9
|
Zuin M, Rigatelli G, Battisti V, Costola G, Roncon L, Bilato C. Increased risk of acute myocardial infarction after COVID-19 recovery: A systematic review and meta-analysis. Int J Cardiol 2023; 372:138-143. [PMID: 36535564 PMCID: PMC9755219 DOI: 10.1016/j.ijcard.2022.12.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Few studies have analyzed the incidence and the risk of acute myocardial infarction (AMI) during the post-acute phase of COVID-19 infection. OBJECTIVE To assess the incidence and risk of AMI in COVID-19 survivors after SARS-CoV-2 infection by a systematic review and meta-analysis of the available data. METHODS Data were obtained searching MEDLINE and Scopus for all studies published at any time up to September 1, 2022 and reporting the risk of incident AMI in patients recovered from COVID-19 infection. AMI risk was evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins and Thomson I2 statistic. RESULTS Among 2765 articles obtained by our search strategy, four studies fulfilled the inclusion criteria for a total of 20,875,843 patients (mean age 56.1 years, 59.1% males). Of them, 1,244,604 had COVID-19 infection. Over a mean follow-up of 8.5 months, among COVID-19 recovered patients AMI occurred in 3.5 cases per 1.000 individuals compared to 2.02 cases per 1.000 individuals in the control cohort, defined as those who did not experience COVID-19 infection in the same period). COVID-19 patients showed an increased risk of incident AMI (HR: 1.93, 95% CI: 1.65-2.26, p < 0.0001, I2 = 83.5%). Meta-regression analysis demonstrated that the risk of AMI was directly associated with age (p = 0.01) and male gender (p = 0.001), while an indirect relationship was observed when the length of follow-up was utilized as moderator (p < 0.001). CONCLUSION COVID-19 recovered patients had an increased risk of AMI.
Collapse
Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy; Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Gianluca Rigatelli
- Department of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Padova, Italy
| | | | - Giulia Costola
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| |
Collapse
|
10
|
Minnebaeva EV, Durkina AV, Azarov JE, Bernikova OG. Myocardial Electrophysiological Response to Ischemia and Reperfusion Depends on the Age of Rats. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022070079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
11
|
Zhang H, Merkus D, Zhang P, Zhang H, Wang Y, Du L, Kottu L. Predicting protective gene biomarker of acute coronary syndrome by the circRNA-associated competitive endogenous RNA regulatory network. Front Genet 2022; 13:1030510. [PMID: 36339005 PMCID: PMC9627163 DOI: 10.3389/fgene.2022.1030510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 10/26/2023] Open
Abstract
Background: The mortality and disability rates of acute coronary syndrome (ACS) are quite high. Circular RNA (circRNA) is a competitive endogenous RNA (ceRNA) that plays an important role in the pathophysiology of ACS. Our goal is to screen circRNA-associated ceRNA networks for biomarker genes that are conducive to the diagnosis or exclusion of ACS, and better understand the pathology of the disease through the analysis of immune cells. Materials and methods: RNA expression profiles for circRNAs (GSE197137), miRNAs (GSE31568), and mRNAs (GSE95368) were obtained from the GEO database, and differentially expressed RNAs (DEcircRNAs, DEmiRNAs, and DEmRNAs) were identified. The circRNA-miRNA and miRNA-mRNA regulatory links were retrieved from the CircInteractome database and TargetScan databases, respectively. As a final step, a regulatory network has been designed for ceRNA. On the basis of the ceRNA network, hub mRNAs were verified by quantitative RT-PCR. Hub genes were validated using a third independent mRNA database GSE60993, and ROC curves were used to evaluate their diagnostic values. The correlation between hub genes and immune cells associated with ACS was then analyzed using single sample gene set enrichment analysis (ssGSEA). Results: A total of 17 DEcircRNAs, 229 DEmiRNAs, and 27 DEmRNAs were found, as well as 52 circRNA-miRNA pairings and 10 miRNA-mRNA pairings predicted. The ceRNA regulatory network (circRNA-miRNA-mRNA) was constructed, which included 2 circRNA (hsa_circ_0082319 and hsa_circ_0005654), 4 miRNA (hsa-miR-583, hsa-miR-661, hsa-miR-671-5p, hsa-miR-578), and 5 mRNA (XPNPEP1, UCHL1, DBNL, GPC6, and RAD51). The qRT-PCR analysis result showed that the XPNPEP1, UCHL1, GPC6 and RAD51 genes had a significantly decreased expression in ACS patients. Based on ROC curve analysis, we found that XPNPEP1 has important significance in preventing ACS occurrence and excluding ACS diagnosis. ACS immune infiltration analysis revealed significant correlations between the other 3 hub genes (UCHL1, GPC6, RAD51) and the immune cells (Eosinophils, T folliculars, Type 2 T helper cells, and Imumature dendritic cells). Conclusion: Our study constructed a circRNA-related ceRNA network in ACS. The XPNPEP1 gene could be a protective gene biomarker for ACS. The UCHL1, GPC6 and RAD51 genes were significantly correlated with immune cells in ACS.
Collapse
Affiliation(s)
- Hengliang Zhang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University München, Munich, Germany
| | - Daphne Merkus
- Walter-Brendel-Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University München, Munich, Germany
- Department of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pei Zhang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Huifeng Zhang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yanyu Wang
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Laijing Du
- The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Lakshme Kottu
- Department of Experimental Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
12
|
The coronavirus disease-19 pandemic and acute coronary syndrome: a specific impact in the elderly. J Geriatr Cardiol 2022; 19:325-334. [PMID: 35722030 PMCID: PMC9170908 DOI: 10.11909/j.issn.1671-5411.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
13
|
Steiro OT, Aakre KM, Tjora HL, Bjørneklett RO, Skadberg Ø, Bonarjee VVS, Mjelva ØR, Omland T, Vikenes K, Langørgen J. Association between symptoms and risk of non-ST segment elevation myocardial infarction according to age and sex in patients admitted to the emergency department with suspected acute coronary syndrome: a single-centre retrospective cohort study. BMJ Open 2022; 12:e054185. [PMID: 35551077 PMCID: PMC9109031 DOI: 10.1136/bmjopen-2021-054185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Evaluate the association between symptoms and risk of non-ST segment elevation myocardial infarction (NSTEMI) in patients admitted to an emergency department with suspected acute coronary syndrome based on sex and age. DESIGN Post hoc analysis of a prospective observational study conducted between September 2015 and May 2019. SETTING University hospital in Norway. PARTICIPANTS 1506 participants >18 years of age (39.6% women and 31.0% 70 years of age or older). FINDINGS The OR for NSTEMI was 9.4 if pain radiated to both arms, 3.0 if exertional chest pain was present during the last week and 2.9 if pain occurred during activity. Men had significantly lower OR compared with women if pain was dependent of position, respiration or palpation (OR 0.17 vs 0.53, p value for interaction 0.047). Patients <70 years had higher predictive value than older patients if they reported exertional chest pain the last week (OR 4.08 vs 1.81, 95%, p value for interaction 0.025) and lower if pain radiated to the left arm (OR 0.73 vs 1.67, p value for interaction 0.045). CONCLUSIONS Chest pain with radiation to both arms, exertional chest pain during the last week and pain during activity had the strongest predictive value for NSTEMI. The differences in symptom presentation and risk of NSTEMI between sex and age groups were small. TRIAL REGISTRATION NUMBER WESTCOR study ClinicalTrials.gov (NCT02620202).
Collapse
Affiliation(s)
- Ole-Thomas Steiro
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kristin Moberg Aakre
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - Hilde Lunde Tjora
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Rune Oskar Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Skadberg
- Laboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | | | - Øistein Rønneberg Mjelva
- Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Torbjorn Omland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
14
|
Affiliation(s)
- Ralf E Harskamp
- Department of general practice, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Alexander C Fanaroff
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Sinead Wang Zhen
- Duke-NUS family medicine, SingHealth Polyclinics, Singapore, Singapore
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Ellen J Weber
- Department of Emergency Medicine, University of California, San Francisco, USA
| |
Collapse
|
15
|
Fladseth K, Lindekleiv H, Nielsen C, Øhrn A, Kristensen A, Mannsverk J, Løchen ML, Njølstad I, Wilsgaard T, Mathiesen EB, Stubhaug A, Trovik T, Rotevatn S, Forsdahl S, Schirmer H. Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study. J Am Heart Assoc 2021; 10:e021291. [PMID: 34729991 PMCID: PMC8751909 DOI: 10.1161/jaha.121.021291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.
Collapse
Affiliation(s)
- Kristina Fladseth
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Haakon Lindekleiv
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Christopher Nielsen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Ageing and Health Norwegian Institute of Public Health Oslo Norway.,Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Andrea Øhrn
- Department of Psychology UiT The Arctic University of Norway Tromsø Norway
| | - Andreas Kristensen
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Jan Mannsverk
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Inger Njølstad
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Neurology University Hospital of North Norway Tromsø Norway
| | - Audun Stubhaug
- Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Svein Rotevatn
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Signe Forsdahl
- Department of Radiology University Hospital North Norway Tromsø Norway
| | - Henrik Schirmer
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway.,Department of Cardiology Akershus University Hospital Lørenskog Norway
| |
Collapse
|
16
|
Zhan C, Zhang Y, Liu X, Wu R, Zhang K, Shi W, Shen L, Shen K, Fan X, Ye F, Shen B. MIKB: A manually curated and comprehensive knowledge base for myocardial infarction. Comput Struct Biotechnol J 2021; 19:6098-6107. [PMID: 34900127 PMCID: PMC8626632 DOI: 10.1016/j.csbj.2021.11.011] [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] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023] Open
Abstract
Myocardial infarction knowledge base (MIKB; http://www.sysbio.org.cn/mikb/; latest update: December 31, 2020) is an open-access and manually curated database dedicated to integrating knowledge about MI to improve the efficiency of translational MI research. MIKB is an updated and expanded version of our previous MI Risk Knowledge Base (MIRKB), which integrated MI-related risk factors and risk models for providing help in risk assessment or diagnostic prediction of MI. The updated MIRKB includes 9701 records with 2054 single factors, 209 combined factors, 243 risk models, 37 MI subtypes and 3406 interactions between single factors and MIs collected from 4817 research articles. The expanded functional module, i.e. MIGD, is a database including not only MI associated genetic variants, but also the other multi-omics factors and the annotations for their functional alterations. The goal of MIGD is to provide a multi-omics level understanding of the molecular pathogenesis of MI. MIGD includes 1782 omics factors, 28 MI subtypes and 2347 omics factor-MI interactions as well as 1253 genes and 6 chromosomal alterations collected from 2647 research articles. The functions of MI associated genes and their interaction with drugs were analyzed. MIKB will be continuously updated and optimized to provide precision and comprehensive knowledge for the study of heterogeneous and personalized MI.
Collapse
Affiliation(s)
- Chaoying Zhan
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Yingbo Zhang
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
- Tropical Crops Genetic Resources Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou 571101, China
| | - Xingyun Liu
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Rongrong Wu
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Ke Zhang
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Wenjing Shi
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Li Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Ke Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Xuemeng Fan
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Fei Ye
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| | - Bairong Shen
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Sichuan 610212, China
| |
Collapse
|
17
|
Tripathi B, Tan BEX, Sharma P, Gaddam M, Singh A, Solanki D, Kumar V, Sharma A, Akhtar T, Michos ED, Cheung JW, Deshmukh A, Klein J. Characteristics and Outcomes of Patients Admitted With Type 2 Myocardial Infarction. Am J Cardiol 2021; 157:33-41. [PMID: 34373076 DOI: 10.1016/j.amjcard.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022]
Abstract
Type 2 myocardial infarction (Type 2 MI) is a common problem and carries a high diagnostic uncertainty. Large studies exploring outcomes in type 2 MI are lacking. Nationwide Readmission Database (2017) was queried using the International Classification of Diseases codes (ICD-10-CM) to identify type 2 MI patients. Characteristics, in-hospital outcomes, 30-day readmissions, and predictors of in-hospital mortality as well as 30-day readmissions were explored. We identified 21,738 patients with a diagnosis of type 2 MI. Most common primary diagnosis at presentation included infection/sepsis (27.5%), hypertensive heart disease (15.3%) and pulmonary diseases (8.5%). Overall, in-hospital mortality and 30-day readmission for patients with type 2 MI were 9.0% and 19.1% respectively. On multivariable analysis, significant predictors of increased in-hospital mortality included male gender, coexisting atrial fibrillation/flutter, peripheral vascular disease, coagulopathy, malignancy, and fluid/electrolyte abnormalities. Significant predictors of 30-day readmission were coexisting diabetes mellitus, atrial fibrillation/ flutter, carotid artery stenosis, anemia, COPD, CKD and prior history of myocardial infarction, A primary diagnosis of sepsis, pulmonary issues including respiratory failure, neurological conditions including stroke carried highest risk of mortality however readmission risk was not influenced by primary diagnosis at presentation. In conclusion, approximately 1 in 10 patients admitted for type 2 MI died during admission, and nearly 1 in 5 patients were readmitted at 30 days after discharge. In-hospital mortality varied based on associated primary diagnosis at presentation. Proposed predictive model for mortality and 30-day readmission in our study can help to target high risk patients for post-Type 2 MI care.
Collapse
Affiliation(s)
- Byomesh Tripathi
- The University of Arizona College of Medicine, Phoenix, Arizona.
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Purnima Sharma
- Texas Tech University Health Sciences Center, EL Paso, Texas
| | | | - Aanandita Singh
- The University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | | | - Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | | | | |
Collapse
|
18
|
Fokoua-Maxime CD, Seukep AJ, Bellouche Y, Cheuffa-Karel TE, Nsagha DS, Kaze FF. Prevalence of unrecognized or "silent" myocardial ischemia in chronic kidney disease patients: Protocol for a systematic review and meta-analysis. PLoS One 2021; 16:e0256934. [PMID: 34473787 PMCID: PMC8412314 DOI: 10.1371/journal.pone.0256934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) patients are at an extremely high risk of silent myocardial ischemia (SMI). However, there is a dearth of evidence on the worldwide prevalence of this very lethal and yet unrecognizable complication of CKD. The proposed systematic review and meta-analysis aims to estimate the global prevalence of SMI among CKD patients. METHODS AND ANALYSES This protocol was conceived according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will involve all observational studies and clinical trials published until April 30, 2021, and reporting on the prevalence of SMI in CKD patients. Electronic sources including MEDLINE, Embase, Web of Science, and Cochrane database of systematic reviews will be perused for potentially eligible studies, restricted to only studies published in English or French. Two investigators will independently select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; the I2 will decide if a meta-analysis can be conducted. In case it cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model, depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist. PROSPERO REGISTRATION NUMBER CRD42020211929. STRENGTHS AND LIMITATIONS OF THIS STUDY The intended systematic review and meta-analysis will fill the knowledge gap on the global prevalence of silent myocardial ischemia (SMI) in CKD patients. The eligible studies will be identified through a methodic literature search followed by a rigorous screening process; we will then use robust meta-analysis tools to pool the data and provide reliable estimates of the global prevalence of SMI in CKD patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that some informative patients might have been sidelined by the strict inclusion criteria of these studies; the high probability of type 1 error originating from the important number of subgroup and sensitivity analyses.
Collapse
Affiliation(s)
- Christophe Dongmo Fokoua-Maxime
- University of New York State—University at Albany School of Public Health, Albany, NY, United States of America
- New York State Department of Health, Albany, NY, United States of America
| | | | | | | | | | - François Folefack Kaze
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| |
Collapse
|
19
|
Fokoua-Maxime CD, Lontchi-Yimagou E, Cheuffa-Karel TE, Tchato-Yann TL, Pierre-Choukem S. Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis. PLoS One 2021; 16:e0252511. [PMID: 34111136 PMCID: PMC8191872 DOI: 10.1371/journal.pone.0252511] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/11/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Myocardial ischemia (MI) is a top ranked cause of death among diabetic patients, yet it is mostly asymptomatic or "silent". There is a need for summary epidemiologic measures on this highly lethal and unnoticeable complication of diabetes. The proposed systematic review and meta-analysis aims to estimate of the global prevalence of silent MI among diabetic patients. METHODS AND ANALYSIS This protocol was prepared according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will include all observational studies published until March 23, 2021 and reporting on the prevalence of silent MI in diabetic patients. Electronic sources including MEDLINE(PubMed), Embase, Cochrane Library, and Web of Science will be searched for potentially eligible studies, restricted to only studies published in English. Two investigators will select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; it will decide if a meta-analysis can be conducted. In case a meta-analysis cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will be used to further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist. STRENGTHS AND LIMITATIONS OF THIS STUDY The intended review will provide an up-to-date summary of the global prevalence of silent MI in diabetic patients. We will conduct a thorough literature search for eligible studies, and we will use robust meta-analysis tools to provide reliable estimates of the global prevalence of silent MI in diabetic patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that the strict inclusion criteria of these studies might have excluded other patients; the risk of type 1 error emanating from the high number of subgroup and sensitivity analyses. PROSPERO REGISTRATION NUMBER CRD42019138136.
Collapse
Affiliation(s)
- Christophe Dongmo Fokoua-Maxime
- University of New York State—University at Albany, School of Public Health, Albany, New York, United States of America
- New York State Department of Health, Albany, New York, United States of America
| | - Eric Lontchi-Yimagou
- Global Diabetes Institute, Albert Einstein College of Medicine, New York, New York, United States of America
| | | | | | - Simeon Pierre-Choukem
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Health and Human Development (2HD) Research Network, Douala, Cameroon
| |
Collapse
|
20
|
Kwok CS, Mallen CD. Missed acute myocardial infarction: an underrecognized problem that contributes to poor patient outcomes. Coron Artery Dis 2021; 32:345-349. [PMID: 33196583 DOI: 10.1097/mca.0000000000000975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ischemic heart disease is the number one killer in the world. While improvements in the management of acute myocardial infarction (AMI) have resulted in lower mortality rates, there are still cases where AMI is missed with rates varying depending on the setting where the evaluation took place, the population sample, the definition of missed AMI and timing of evaluation. There is consistent evidence that missed AMI is associated with increased risk of complications and mortality. Many factors contribute to missed AMI which include patient factors, clinician factors and institutional factors. While several studies have been conducted to evaluate missed AMI, there is considerable heterogeneity in methodology, which has resulted in variable rates of missed AMI and the factors associated with missed AMI. In this review, we provide an overview on missed AMI discussing rates reported in the literature, why it is important, reasons why it occurs, some of the challenges in evaluating missed AMI and what could potentially be done to reduce these undesirable outcomes for patients.
Collapse
Affiliation(s)
- Chun Shing Kwok
- School of Medicine, Keele University
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | |
Collapse
|
21
|
Merkler AE, Bartz TM, Kamel H, Soliman EZ, Howard V, Psaty BM, Okin PM, Safford MM, Elkind MSV, Longstreth WT. Silent Myocardial Infarction and Subsequent Ischemic Stroke in the Cardiovascular Health Study. Neurology 2021; 97:e436-e443. [PMID: 34031202 DOI: 10.1212/wnl.0000000000012249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that silent myocardial infarction (MI) is a risk factor for ischemic stroke, we evaluated the association between silent MI and subsequent ischemic stroke in the Cardiovascular Health Study. METHODS The Cardiovascular Health Study prospectively enrolled community-dwelling individuals ≥65 years of age. We included participants without prevalent stroke or baseline evidence of MI. Our exposures were silent and clinically apparent, overt MI. Silent MI was defined as new evidence of Q-wave MI, without clinical symptoms of MI, on ECGs performed during annual study visits from 1989 to 1999. The primary outcome was incident ischemic stroke. Secondary outcomes were ischemic stroke subtypes: nonlacunar, lacunar, and other/unknown. Cox proportional hazards analysis was used to model the association between time-varying MI status (silent, overt, or no MI) and stroke after adjustment for baseline demographics and vascular risk factors. RESULTS Among 4,224 participants, 362 (8.6%) had an incident silent MI, 421 (10.0%) an incident overt MI, and 377 (8.9%) an incident ischemic stroke during a median follow-up of 9.8 years. After adjustment for demographics and comorbidities, silent MI was independently associated with subsequent ischemic stroke (hazard ratio [HR], 1.51; 95% confidence interval [CI], 1.03-2.21). Overt MI was associated with ischemic stroke both in the short term (HR, 80; 95% CI, 53-119) and long term (HR, 1.60; 95% CI, 1.04-2.44). In secondary analyses, the association between silent MI and stroke was limited to nonlacunar ischemic stroke (HR, 2.40; 95% CI, 1.36-4.22). CONCLUSION In a community-based sample, we found an association between silent MI and ischemic stroke.
Collapse
Affiliation(s)
- Alexander E Merkler
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY.
| | - Traci M Bartz
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Hooman Kamel
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Elsayed Z Soliman
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Virginia Howard
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Bruce M Psaty
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Peter M Okin
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Monika M Safford
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - W T Longstreth
- From the Clinical and Translational Neuroscience Unit (A.E.M., H.K.), Feil Family Brain and Mind Research Institute (A.E.M., H.K.), and Departments of Neurology (A.E.M., H.K.) and Medicine (P.M.O., M.M.S.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (B.M.P.), and Departments of Medicine (B.M.P.), Epidemiology (B.M.P., W.T.L.), Health Services (B.M.P.), and Neurology (W.T.L.), University of Washington, Seattle; Epidemiological Cardiology Research Center (E.Z.S.), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Epidemiology (V.H.), School of Public Health, University of Alabama at Birmingham; Kaiser Permanente Washington Health Research Institute (B.M.P.), Seattle; and Department of Neurology, Vagelos College of Physicians and Surgeons (M.S.V.E.), and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
22
|
Chung HE, Chen J, Ghosalkar D, Christensen JL, Chu AJ, Mantsounga CS, Neverson J, Soares C, Shah NR, Wu WC, Choudhary G, Morrison AR. Aortic Valve Calcification Is Associated with Future Cognitive Impairment. J Alzheimers Dis Rep 2021; 5:337-343. [PMID: 34113789 PMCID: PMC8150250 DOI: 10.3233/adr-200253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND While an association between atherosclerosis and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and cognitive impairment (CI). OBJECTIVE We sought to determine whether AVC derived from lung cancer screening CT (LCSCT) was associated with CI in a moderate-to-high atherosclerotic risk cohort. METHODS This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97%male) who underwent quantification of AVC from LCSCT indicated for smoking history. The primary outcome was new diagnosis of CI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Time-to-event analysis was carried out using AVC as a continuous variable. RESULTS Over 5 years, 110 patients (8%) were diagnosed with CI. AVC was associated with new diagnosis of CI using 3 Models for adjustment: 1) age (HR: 1.104; CI: 1.023-1.191; p = 0.011); 2) Model 1 plus hypertension, hyperlipidemia, diabetes, CKD stage 3 or higher (glomerular filtration rate < 60 mL/min) and CAD (HR: 1.097; CI: 1.014-1.186; p = 0.020); and 3) Model 2 plus CVA (HR: 1.094; CI: 1.011-1.182; p = 0.024). Sensitivity analysis demonstrated that the association between AVC and new diagnosis of CI remained significant upon exclusion of severe AVC (HR: 1.100 [1.013-1.194]; p = 0.023). Subgroup analysis demonstrated that this association remained significant when including education in the multivariate analysis (HR: 1.127 [1.030-1.233]; p = 0.009). CONCLUSION This is the first study demonstrating that among mostly male individuals who underwent LCSCT, quantified aortic valve calcification is associated with new diagnosis of CI.
Collapse
Affiliation(s)
- Hojune E. Chung
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jessica Chen
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Dhairyasheel Ghosalkar
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jared L. Christensen
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Alice J. Chu
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Chris S. Mantsounga
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Jade Neverson
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Cullen Soares
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Nishant R. Shah
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Wen-Chih Wu
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Gaurav Choudhary
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| | - Alan R. Morrison
- Department of Internal Medicine (Section of Cardiovascular Medicine), Providence VA Medical Center, Providence, RI, USA
- Department of Internal Medicine (Section of Cardiovascular Medicine), Alpert Medical School at Brown University, Providence, RI, USA
| |
Collapse
|
23
|
Cheng YJ, Jia YH, Yao FJ, Mei WY, Zhai YS, Zhang M, Wu SH. Association Between Silent Myocardial Infarction and Long-Term Risk of Sudden Cardiac Death. J Am Heart Assoc 2020; 10:e017044. [PMID: 33372536 PMCID: PMC7955489 DOI: 10.1161/jaha.120.017044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Although silent myocardial infarction (SMI) is prognostically important, the risk of sudden cardiac death (SCD) among patients with incident SMI is not well established. Methods and Results We examined 2 community-based cohorts: the ARIC (Atherosclerosis Risk in Communities) study (n=13 725) and the CHS (Cardiovascular Health Study) (n=5207). Incident SMI was defined as electrocardiographic evidence of new myocardial infarction during follow-up visits that was not present at the baseline. The primary study end point was physician-adjudicated SCD. In the ARIC study, 513 SMIs, 441 clinically recognized myocardial infarctions (CMIs), and 527 SCD events occurred during a median follow-up of 25.4 years. The multivariable hazard ratios of SMI and CMI for SCD were 5.20 (95% CI, 3.81-7.10) and 3.80 (95% CI, 2.76-5.23), respectively. In the CHS, 1070 SMIs, 632 CMIs, and 526 SCD events occurred during a median follow-up of 12.1 years. The multivariable hazard ratios of SMI and CMI for SCD were 1.70 (95% CI, 1.32-2.19) and 4.08 (95% CI, 3.29-5.06), respectively. The pooled hazard ratios of SMI and CMI for SCD were 2.65 (2.18-3.23) and 3.99 (3.34-4.77), respectively. The risk of SCD associated with SMI is stronger with White individuals, men, and younger age. The population-attributable fraction of SCD was 11.1% for SMI, and SMI was associated with an absolute risk increase of 8.9 SCDs per 1000 person-years. Addition of SMI significantly improved the predictive power for both SCD and non-SCD. Conclusions Incident SMI is independently associated with an increased risk of SCD in the general population. Additional research should address screening for SMI and the role of standard post-myocardial infarction therapy.
Collapse
Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Yu-He Jia
- State Key Laboratory of Cardiovascular Disease Cardiac Arrhythmia Center Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Feng-Juan Yao
- Department of Medical Ultrasonics The First Affiliated Hospital of Sun Yat-Sen University Guangzhou China
| | - Wei-Yi Mei
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Yuan-Sheng Zhai
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| | - Ming Zhang
- Department of Cardiology Beijing Anzhen HospitalCapital Medical University Beijing China
| | - Su-Hua Wu
- Department of Cardiology The First Affiliated HospitalSun Yat-Sen University Guangzhou China.,Key Laboratory of Assisted Circulation NHC Guangzhou China
| |
Collapse
|
24
|
van der Ende MY, Juarez-Orozco LE, Waardenburg I, Lipsic E, Schurer RAJ, van der Werf HW, Benjamin EJ, van Veldhuisen DJ, Snieder H, van der Harst P. Sex-Based Differences in Unrecognized Myocardial Infarction. J Am Heart Assoc 2020; 9:e015519. [PMID: 32573316 PMCID: PMC7670510 DOI: 10.1161/jaha.119.015519] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Myocardial infarction is an important cause of morbidity and mortality in both men and women. Atypical or the absence of symptoms, more prevalent among women, may contribute to unrecognized myocardial infarctions and missed opportunities for preventive therapies. The aim of this research is to investigate sex‐based differences of undiagnosed myocardial infarction in the general population. Methods and Results In the Lifelines Cohort Study, all individuals ≥18 years with a normal baseline ECG were followed from baseline visit till first follow‐up visit (≈5 years, n=97 203). Individuals with infarct‐related changes between baseline and follow‐up ECGs were identified. The age‐ and sex‐specific incidence rates were calculated and sex‐specific cardiac symptoms and predictors of unrecognized myocardial infarction were determined. Follow‐up ECG was available after a median of 3.8 (25th and 75th percentile: 3.0–4.6) years. During follow‐up, 198 women experienced myocardial infarction (incidence rate 1.92 per 1000 persons‐years) compared with 365 men (incidence rate 3.30; P<0.001 versus women). In 59 (30%) women, myocardial infarction was unrecognized compared with 60 (16%) men (P<0.001 versus women). Individuals with unrecognized myocardial infarction less often reported specific cardiac symptoms compared with individuals with recognized myocardial infarction. Predictors of unrecognized myocardial infarction were mainly hypertension, smoking, and higher blood glucose level. Conclusions A substantial proportion of myocardial infarctions are unrecognized, especially in women. Opportunities for secondary preventive therapies remain underutilized if myocardial infarction is unrecognized.
Collapse
Affiliation(s)
- M Yldau van der Ende
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | | | - Ingmar Waardenburg
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Erik Lipsic
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Remco A J Schurer
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Hindrik W van der Werf
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Emelia J Benjamin
- Department of Medicine Boston University School of Medicine Boston MA.,Department of Epidemiology Boston University School of Public Health Boston MA
| | - Dirk Jan van Veldhuisen
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands
| | - Harold Snieder
- Department of Epidemiology University Medical Center Groningen University of Groningen The Netherlands
| | - Pim van der Harst
- Department of Cardiology University Medical Center Groningen University of Groningen The Netherlands.,Division of Heart and Lungs Department of Cardiology University Medical Centre Utrecht University of Utrecht The Netherlands
| |
Collapse
|
25
|
Yang Y, Li W, Zhu H, Pan XF, Hu Y, Arnott C, Mai W, Cai X, Huang Y. Prognosis of unrecognised myocardial infarction determined by electrocardiography or cardiac magnetic resonance imaging: systematic review and meta-analysis. BMJ 2020; 369:m1184. [PMID: 32381490 PMCID: PMC7203874 DOI: 10.1136/bmj.m1184] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR). DESIGN Systematic review and meta-analysis of prospective studies. DATA SOURCES Electronic databases, including PubMed, Embase, and Google Scholar. STUDY SELECTION Prospective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction. DATA EXTRACTION AND SYNTHESIS The primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction. RESULTS The meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively. CONCLUSIONS UMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.
Collapse
Affiliation(s)
- Yu Yang
- Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wensheng Li
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Xiong-Fei Pan
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yunzhao Hu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Weiyi Mai
- Department of Cardiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Cai
- Department of Scientific Research and Education, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazhi Road 1, Lunjiao Town, Shunde District, Foshan, 528300, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
26
|
Groepenhoff F, Eikendal ALM, Onland-Moret NC, Bots SH, Menken R, Tulevski II, Somsen AG, Hofstra L, den Ruijter HM. Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics. BMJ Open 2020; 10:e035928. [PMID: 32341045 PMCID: PMC7204862 DOI: 10.1136/bmjopen-2019-035928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To assess the diagnostic value of non-acute chest pain characteristics for coronary artery disease in women and men referred to outpatient cardiology clinics. DESIGN AND SETTING This is an observational study performed at outpatient cardiology centres of the Netherlands. PARTICIPANTS The study population consisted of 1028 patients with non-acute chest pain (505 women). ANALYSIS AND RESULTS Twenty-four women (5%) and 75 men (15%) were diagnosed with coronary artery disease by invasive coronary angiography or CT angiography during regular care follow-up. Elastic net regression was performed to assess which chest pain characteristics and risk factors were of diagnostic value. The overall model selected age, provocation by temperature or stress, relief at rest and functional class as determinants and was accurate in both sexes (area under the curve (AUC) of 0.76 (95% CI 0.68 to 0.85) in women and 0.83 (95% CI 0.78 to 0.88) in men). Both sex-specific models selected age, pressuring nature, radiation, duration, frequency, progress, provocation and relief at rest as determinants. The female model additionally selected dyspnoea, body mass index, hypertension and smoking while the male model additionally selected functional class and diabetes. The sex-specific models performed better than the overall model, but more so in women (AUC: 0.89, 95% CI 0.81 to 0.96) than in men (AUC: 0.84, 95% CI 0.73 to 0.90). CONCLUSIONS In both sexes, the diagnostic value of non-acute chest pain characteristics and risk factors for coronary artery disease was high. Provocation, relief at rest and functional class of chest pain were the most powerful diagnostic predictors in both women and men. When stratified by sex the performance of the model improved, mostly in women.
Collapse
Affiliation(s)
- Floor Groepenhoff
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk L M Eikendal
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - N Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Sophie Heleen Bots
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roxana Menken
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
| | | | - Leonard Hofstra
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
27
|
Pascual I, Hernandez-Vaquero D, Almendarez M, Lorca R, Escalera A, Díaz R, Alperi A, Carnero M, Silva J, Morís C, Avanzas P. Observed and Expected Survival in Men and Women After Suffering a STEMI. J Clin Med 2020; 9:E1174. [PMID: 32325887 PMCID: PMC7230566 DOI: 10.3390/jcm9041174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Mortality caused by ST elevation myocardial infarction (STEMI) has declined because of greater use of primary percutaneous coronary intervention (PCI). It is unknown if patients >75 have similar survival as peers. We aim to know it stratifying by sex and assessing how the sex may impact the survival. METHODS We retrospectively selected all patients >75 who suffered a STEMI treated with primary PCI at our institution. We compared their survival with that of the reference population (general population matched by age, sex, and geographical region). A Cox-regression analysis controlling for clinical factors was performed to know if sex was a risk factor. RESULTS Total of 450 patients were studied. Survival at 1, 3, and 5 years of follow-up for patients who survived the first 30 days was 91.22% (CI95% 87.80-93.72), 79.71% (CI95% 74.58-83.92), and 68.02% (CI95% 60.66-74.3), whereas in the reference population it was 93.11%, 79.10%, and 65.01%, respectively. Sex was not a risk factor, Hazard Ratio = 1.02 (CI95% 0.67-1.53; p = 0.92). CONCLUSIONS Life expectancy of patients suffering a STEMI is nowadays intimately linked to survival in the first 30 days. After one year, the risk of death for both men and women seems similar to that of the general population.
Collapse
Affiliation(s)
- Isaac Pascual
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
- Department of Functional Biology, Physiology Area, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
- Department of Functional Biology, Physiology Area, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (A.E.); (J.S.)
| | - Marcel Almendarez
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
| | - Rebeca Lorca
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
| | - Alain Escalera
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (A.E.); (J.S.)
| | - Rocío Díaz
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (A.E.); (J.S.)
| | - Alberto Alperi
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
| | - Manuel Carnero
- Cardiac Surgery Department, San Carlos Clinic Hospital, 28040 Madrid, Spain;
| | - Jacobo Silva
- Cardiac Surgery Department, Central University Hospital of Asturias, 33011 Oviedo, Spain; (A.E.); (J.S.)
- Department of Surgery, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Cesar Morís
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
- Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| | - Pablo Avanzas
- Department of Cardiology, Central University Hospital of Asturias, 33011 Oviedo, Spain; (I.P.); (M.A.); (R.L.); (A.A.); (C.M.); (P.A.)
- Research Institute of the Principado de Asturias, 33011 Oviedo, Spain;
- Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
| |
Collapse
|
28
|
Yavelov IS. [Rivaroxaban in prevention of stroke in elderly patients with non-valvular atrial fibrillation]. ACTA ACUST UNITED AC 2019; 59:4-11. [PMID: 31995720 DOI: 10.18087/cardio.n892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/17/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
Data regarding efficacy and safety of direct oral anticoagulant rivaroxaban in prevention of stroke in elderly polymorbid patients with non-valvular atrial fibrillation are presented. In this aspect results of randomized clinical trial in direct comparison of rivaroxaban and warfarin in patients with non-valvular atrial fibrillation ROCKET-AF are discussed. Results of rivaroxaban use in elderly patients in real medical practice are also considered.
Collapse
Affiliation(s)
- I S Yavelov
- National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation
| |
Collapse
|
29
|
Pong JZ, Ho AFW, Tan TXZ, Zheng H, Pek PP, Sia CH, Hausenloy DJ, Ong MEH. ST-segment elevation myocardial infarction with non-chest pain presentation at the Emergency Department: Insights from the Singapore Myocardial Infarction Registry. Intern Emerg Med 2019; 14:989-997. [PMID: 31165979 DOI: 10.1007/s11739-019-02122-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) often presents acutely at the Emergency Department (ED). Although chest pain is a classical symptom, a significant proportion of patients do not present with chest pain. The impact of a non-chest pain (NCP) presentation on ED processes-of-care and outcomes is not fully understood. We utilised a national registry to characterise predictors, processes-of-care, and outcomes of NCP STEMI presentations. Retrospective data for all STEMI cases occurring between 2010 and 2012 were analysed from the Singapore Myocardial Infarction Registry. Cases of inpatient onset, inter-facility transfers, and out-of-hospital cardiac arrests were excluded. Univariable analysis of demographic, clinical, processes-of-care, and outcome variables was conducted. Multivariable logistic regression ascertained independent predictors of a NCP presentation and 28-day mortality. Of 4667 STEMI cases, 12.9% presented without chest pain. Patients with NCP presentation were older (median, years = 74 vs. 58; p < 0.001), more likely to be female (39.1% vs. 15.7%; p < 0.001), of the Chinese race (72.5% vs. 62.7%; p < 0.001), and with diabetes (48.6% vs. 36.7%; p < 0.001). These patients were more likely to present with syncope (6.0% vs. 1.9%; p < 0.001) or epigastric pain (10.6% vs. 4.9%; p < 0.001). Patients with NCP presentation were less likely to receive percutaneous coronary intervention (27.0% vs. 75.6%; p < 0.001), had longer door-to-balloon time (median, minutes = 83 vs. 63; p < 0.001), and experienced greater mortality at 28 days (31.2% vs. 4.5%; p < 0.001). On multivariable logistic regression, independent predictors of a NCP presentation included age (adjusted odds ratio [aOR] = 1.05, 95% confidence interval [CI] 1.04-1.07), diabetes (aOR = 1.76, 95% CI 1.40-2.19), BMI (aOR = 0.93, 95% CI 0.91-0.96), and dyslipidemia (aOR = 0.73, 95% CI 0.58-0.91). Absence of chest pain was an independent predictor for 28-day mortality (aOR = 3.46, 95% CI 2.64-4.52). Patients who presented with a NCP STEMI had a distinct clinical profile and experienced poorer outcomes. Routine triage ECG could be considered for patients with high-risk factors and non-classical symptoms.
Collapse
Affiliation(s)
- Jeremy Zhenwen Pong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | | | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Derek John Hausenloy
- Signature Programme in Cardiovascular and Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research and Development, London, UK
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo León, Mexico
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
- Health Service Research Centre, Singapore Health Services, Academia, 20 College Road, Singapore, 169856, Singapore.
| |
Collapse
|
30
|
Merkler AE, Sigurdsson S, Eiriksdottir G, Safford MM, Phillips CL, Iadecola C, Gudnason V, Weinsaft JW, Kamel H, Arai AE, Launer LJ. Association Between Unrecognized Myocardial Infarction and Cerebral Infarction on Magnetic Resonance Imaging. JAMA Neurol 2019; 76:956-961. [PMID: 31107514 DOI: 10.1001/jamaneurol.2019.1226] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance It is uncertain whether unrecognized myocardial infarction (MI) is a risk factor for cerebral infarction. Objective To determine whether unrecognized MI detected by cardiac magnetic resonance imaging (MRI) is associated with cerebral infarction. Design, Setting, and Participants This is a cross-sectional study of ICELAND MI, a cohort substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study conducted in Iceland. Enrollment occurred from January 2004 to January 2007 from a community-dwelling cohort of older Icelandic individuals. Participants aged 67 to 93 years who underwent both brain MRI and late gadolinium enhancement cardiac MRI were included. Data analysis was performed from September 2018 to March 2019. Exposures Unrecognized MI identified by cardiac MRI. Main Outcomes and Measures Unrecognized MI was defined as cardiac MRI evidence of MI without a history of clinically evident MI. Recognized MI was defined as cardiac MRI evidence of MI with a history of clinically evident MI. Cerebral infarctions on brain MRI were included regardless of associated symptoms. Multiple logistic regression was used to evaluate the association between MI status (no MI, unrecognized MI, or recognized MI) and cerebral infarction after adjustment for demographic factors and vascular risk factors. In addition, we evaluated the association between unrecognized MI and embolic infarcts of undetermined source. Results Five enrolled participants had nondiagnostic brain MRI studies and were excluded. Among 925 participants, 480 (51.9%) were women; the mean (SD) age was 75.9 (5.3) years. There were 221 participants (23.9%) with cardiac MRI evidence of MI, of whom 68 had recognized MI and 153 unrecognized MI. There were 308 participants (33.3%) with brain MRI evidence of cerebral infarction; 93 (10.0%) had embolic infarcts of undetermined source. After adjustment for demographic factors and vascular risk factors, the likelihood (odds ratio) of having cerebral infarction was 2.0 (95% CI, 1.2-3.4; P = .01) for recognized MI and 1.5 (95% CI, 1.02-2.2; P = .04) for unrecognized MI. After adjustment for demographics and vascular risk factors, unrecognized MI was also associated with embolic infarcts of undetermined source (odds ratio, 2.0 [95% CI, 1.1-3.5]; P = .02). Conclusions and Relevance In a population-based sample, we found an association between unrecognized MI and cerebral infarction. These findings suggest that unrecognized MI may be a novel risk factor for cardiac embolism and cerebral infarction.
Collapse
Affiliation(s)
- Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.,Department of Neurology, Weill Cornell Medical College, New York, New York
| | | | | | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Caroline L Phillips
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Vilmundur Gudnason
- The Icelandic Heart Association, Kopavogur, Iceland.,The University of Iceland, Reykjavik, Iceland
| | | | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| |
Collapse
|
31
|
Harwin B, Formanek B, Spoonamore M, Robertson D, Buser Z, Wang JC. The incidence of myocardial infarction after lumbar spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2070-2076. [DOI: 10.1007/s00586-019-06072-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/29/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022]
|
32
|
Ahmad MI, Dutta A, Anees MA, Soliman EZ. Interrelations Between Serum Uric Acid, Silent Myocardial Infarction, and Mortality in the General Population. Am J Cardiol 2019; 123:882-888. [PMID: 30617009 DOI: 10.1016/j.amjcard.2018.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/02/2018] [Accepted: 12/07/2018] [Indexed: 02/04/2023]
Abstract
Whether elevated uric acid (UA) is associated with silent myocardial infarction (SMI) or whether their joint association predicts an increased risk of mortality has not been explored. This analysis included 6,323 participants (58.4 ± 13.1 years, 53.9% women, and 49.7% Non-Hispanic whites) without clinical cardiovascular disease (CVD) from third National Health and Nutrition Examination Survey. SMI was defined as electrocardiographic evidence of myocardial infarction (MI) without a history of MI. Multivariable logistic regression model was used to examine the cross-sectional association between baseline UA and SMI. Cox-proportional hazard analysis was used to calculate hazard ratio (HR) with 95% confidence interval (CI) for the risk of all-cause and CVD mortality with UA in the absence and presence of SMI. The higher baseline level of UA was associated with higher odds of baseline SMI. The prevalence of SMI was 0.79%, 1.18%, 1.59%, and 2.27% across the UA quartiles respectively; multivariable-adjusted odds ratio (95% CI): 2.37 (1.11 to 5.08) comparing the upper with lower quartile. During a median follow up of 14 years, there were 1916 all-cause death of whom 774 were CVD deaths. Compared with participants with the lowest UA quartile values and without SMI, those with highest UA had a 29% increased the risk of all-cause mortality (multivariable-adjusted HR: [95% CI]: 1.29 [1.10 to 1.51]). This risk increased by 107% in the presence of SMI (multivariable-adjusted HR (95% CI): 2.07 (1.38 to 3.10)). Similar results were observed for CVD mortality. SMI carried an increased risk of all-cause and CVD mortality only in higher quartiles of UA. In conclusion, the strong association of UA with SMI and the additive effect of UA and SMI on mortality further support the potential role of UA as a marker of poor outcomes.
Collapse
Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Abhishek Dutta
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Elsayed Z Soliman
- Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina; Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
33
|
Tamosiunas A, Petkeviciene J, Radisauskas R, Bernotiene G, Luksiene D, Kavaliauskas M, Milvidaitė I, Virviciute D. Trends in electrocardiographic abnormalities and risk of cardiovascular mortality in Lithuania, 1986-2015. BMC Cardiovasc Disord 2019; 19:30. [PMID: 30700252 PMCID: PMC6354422 DOI: 10.1186/s12872-019-1009-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/23/2019] [Indexed: 01/15/2023] Open
Abstract
Background This study aimed to assess the trends in the prevalence of electrocardiographic (ECG) abnormalities from 1986 to 2015 and impact of ECG abnormalities on risk of death from cardiovascular diseases (CVD) in the Lithuanian population aged 40–64 years. Methods Data from four surveys carried out in Kaunas city and five randomly selected municipalities of Lithuania were analysed. A resting ECG was recorded and CVD risk factors were measured in each survey. ECG abnormalities were evaluated using Minnesota Code (MC). Trends in age-standardized prevalence of ECG abnormalities were estimated for both sexes. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) for coronary heart disease (CHD) and CVD mortality. Net reclassification index (NRI), integrated discrimination improvement and other indices were used for evaluation of improvement in the prediction of CVD and CHD mortality risk after addition of ECG abnormalities variable to Cox models. Results From1986 to 2008, the decrease in the prevalence of Q-QS MC was observed in both genders. The prevalence of high R waves increased in men, while the prevalence of ST segment and T wave abnormalities as well as arrhythmias decreased in women. Ischemic changes and possible MI were associated with a 2.5-fold and 4.4-fold higher risk of death from CVD in men and 1.51-fold and 2.56-fold higher mortality risk from CVD in women as compared to individuals with marginal or no ECG abnormalities. The addition of ECG abnormalities to traditional CVD risk factors improved Cox regression models performance. According to NRI, 18.6% of men were correctly reclassified in CVD mortality prediction model and 25.2% of men - in CHD mortality prediction model. Conclusions the decreasing trends in the prevalence of ischemia on ECG in women and increasing trends in the prevalence of left VH in men were observed. ECG abnormalities were associated with higher risk of CVD mortality. The addition of ECG abnormalities to the prediction models modestly improved the prediction of CVD mortality beyond traditional CVD risk factors. The use of ECG as routine screening to identify high risk individuals for more intensive preventive interventions warrants further research.
Collapse
Affiliation(s)
- Abdonas Tamosiunas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania. .,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Janina Petkeviciene
- Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gailute Bernotiene
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Dalia Luksiene
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania.,Faculty of Public Health, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kavaliauskas
- Faculty of Mathematics and Natural Sciences, Kaunas University of Technology, Kaunas, Lithuania
| | - Irena Milvidaitė
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Dalia Virviciute
- Institute of Cardiology, Academy of Medicine, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| |
Collapse
|
34
|
Hof D, von Eckardstein A. High-Sensitivity Troponin Assays in Clinical Diagnostics of Acute Coronary Syndrome. Methods Mol Biol 2019; 1929:645-662. [PMID: 30710302 DOI: 10.1007/978-1-4939-9030-6_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Nowadays, measurement of cardiac troponins (cTn) in patient plasma is central for diagnosis of patients with acute coronary syndrome (ACS). High-sensitivity (hs) immunoassays have been developed that can very precisely record slightly elevated and rising plasma concentrations of cTn very early after onset of clinical symptoms. Algorithms integrate measurements of hs-cTn at onset of clinical symptoms of acute myocardial infarction (AMI), and 1 or 3 h after onset, to rule-in and rule-out AMI patients. More and more point-of-care (POC) cTn assays conquer the diagnostic market, but thorough clinical validation studies are required before potential implementation of such POC tests into hospital settings. This review provides an overview of the technical aspects, as well as diagnostic and prognostic use of cardiac troponins in AMI patients and in the healthy population.
Collapse
|
35
|
Kim MY, Kim K, Hong CH, Lee SY, Jung YS. Sex Differences in Cardiovascular Risk Factors for Dementia. Biomol Ther (Seoul) 2018; 26:521-532. [PMID: 30464071 PMCID: PMC6254640 DOI: 10.4062/biomolther.2018.159] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 10/06/2018] [Indexed: 12/16/2022] Open
Abstract
Dementia, characterized by a progressive cognitive decline and a cumulative inability to behave independently, is highly associated with other diseases. Various cardiovascular disorders, such as coronary artery disease and atrial fibrillation, are well-known risk factors for dementia. Currently, increasing evidence suggests that sex factors may play an important role in the pathogenesis of diseases, including cardiovascular disease and dementia. Recent studies show that nearly two-thirds of patients diagnosed with Alzheimer’s disease are women; however, the incidence difference between men and women remains vague. Therefore, studies are needed to investigate sex-specific differences, which can help understand the pathophysiology of dementia and identify potential therapeutic targets for both sexes. In the present review, we summarize sex differences in the prevalence and incidence of dementia by subtypes. This review also describes sex differences in the risk factors of dementia and examines the impact of risk factors on the incidence of dementia in both sexes.
Collapse
Affiliation(s)
- Mi-Young Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Kyeongjin Kim
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon 16499, Republic of Korea.,Institute on Aging, Ajou University Medical Center, Suwon 16499, Republic of Korea
| | - Sang Yoon Lee
- Department of Biomedical Sciences, Chronic Inflammatory Disease Research Center, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Yi-Sook Jung
- College of Pharmacy, Ajou University, Suwon 16499, Republic of Korea.,Research Institute of Pharmaceutical Sciences and Technology, Ajou University, Suwon 16499, Republic of Korea
| |
Collapse
|
36
|
Øhrn AM, Schirmer H, von Hanno T, Mathiesen EB, Arntzen KA, Bertelsen G, Njølstad I, Løchen ML, Wilsgaard T, Bairey Merz CN, Lindekleiv H. Small and large vessel disease in persons with unrecognized compared to recognized myocardial infarction: The Tromsø Study 2007-2008. Int J Cardiol 2018; 253:14-19. [PMID: 29306455 DOI: 10.1016/j.ijcard.2017.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. METHODS 6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. RESULTS Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05-2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35-0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37-0.69). No significant sex interaction was present. CONCLUSIONS Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.
Collapse
Affiliation(s)
- Andrea Milde Øhrn
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway.
| | - Henrik Schirmer
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Therese von Hanno
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Bodø, Norway
| | - Ellisiv B Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Geir Bertelsen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Epidemiology of Chronic Diseases Research Group, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - C Noel Bairey Merz
- NBM Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Haakon Lindekleiv
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
37
|
Kimenai DM, Janssen EBNJ, Eggers KM, Lindahl B, den Ruijter HM, Bekers O, Appelman Y, Meex SJR. Sex-Specific Versus Overall Clinical Decision Limits for Cardiac Troponin I and T for the Diagnosis of Acute Myocardial Infarction: A Systematic Review. Clin Chem 2018; 64:1034-1043. [PMID: 29844245 DOI: 10.1373/clinchem.2018.286781] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The overall clinical decision limits of high-sensitivity cardiac troponin I (hs-cTnI; 26 ng/L) and T (hs-cTnT; 14 ng/L) may contribute to underdiagnosis of acute myocardial infarction in women. We performed a systematic review to investigate sex-specific and overall 99th percentiles of hs-cTnI and hs-cTnT derived from healthy reference populations. CONTENT We searched in PubMed and EMBASE for original studies, and by screening reference lists. Reference populations designed to establish 99th percentiles of hs-cTnI (Abbott) and/or hs-cTnT (Roche), published between January 2009 and October 2017, were included. Sex-specific and overall 99th percentile values of hs-cTnI and hs-cTnT were compared with overall clinical decision ranges (hs-cTnI, 23-30 ng/L; hs-cTnT, 13-25 ng/L). Twenty-eight studies were included in the systematic review. Of 16 hs-cTnI and 18 hs-cTnT studies, 14 (87.5%) and 11 (61.1%) studies reported lower female-specific hs-cTn cutoffs than overall clinical decision ranges, respectively. Conversely, male-specific thresholds of both hs-cTnI and hs-cTnT were in line with currently used overall thresholds, particularly hs-cTnT (90% concordance). The variation of estimated overall 99th percentiles was much higher for hs-cTnI than hs-cTnT (29.4% vs 80.0% of hs-cTnI and hs-cTnT studies reported values within the current overall clinical decision range, respectively). SUMMARY Our data show substantially lower female-specific upper reference limits of hs-cTnI and hs-cTnT than overall clinical decision limits of 26 ng/L and 14 ng/L, respectively. The statistical approach strongly affects the hs-cTnI threshold. Downward adjustment of hs-cTn thresholds in women may be warranted to reduce underdiagnosis of acute myocardial infarction in women.
Collapse
Affiliation(s)
- Dorien M Kimenai
- Department of Central Diagnostic Laboratory, Clinical Chemistry, Maastricht University Medical Center, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Emma B N J Janssen
- Department of Central Diagnostic Laboratory, Clinical Chemistry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kai M Eggers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Otto Bekers
- Department of Central Diagnostic Laboratory, Clinical Chemistry, Maastricht University Medical Center, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Yolande Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Steven J R Meex
- Department of Central Diagnostic Laboratory, Clinical Chemistry, Maastricht University Medical Center, Maastricht, the Netherlands; .,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
38
|
Myocardial Infarction Secondary to Blunt Chest Trauma. Am J Med Sci 2018; 355:88-93. [DOI: 10.1016/j.amjms.2016.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
|
39
|
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P. [2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.]. Eur Heart J 2018; 39:119-177. [PMID: 29457615 DOI: 10.1093/eurheartj/ehx393] [Citation(s) in RCA: 6163] [Impact Index Per Article: 1027.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Borja Ibanez
- Department of Cardiology, IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Mingels AMA, Kimenai DM. Sex-Related Aspects of Biomarkers in Cardiac Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:545-564. [PMID: 30051406 DOI: 10.1007/978-3-319-77932-4_33] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biomarkers play an important role in the clinical management of cardiac care. In particular, cardiac troponins (cTn) and natriuretic peptides are the cornerstones for the diagnosis of acute myocardial infarction (AMI) and for the diagnosis of heart failure (HF), respectively. Current guidelines do not make a distinction between women and men. However, the commonly used "one size fits all" algorithms are topic of debate to improve assessment of prognosis, particularly in women. Due to the high-sensitivity assays (hs-cTn), lower cTn levels (and 99th percentile upper reference limits) were observed in women as compared with men. Sex-specific diagnostic thresholds may improve the diagnosis of AMI in women, though clinical relevance remains controversial and more trials are needed. Also other diagnostic aspects are under investigation, like combined biomarkers approach and rapid measurement strategies. For the natriuretic peptides, previous studies observed higher concentrations in women than in men, especially in premenopausal women who might benefit from the cardioprotective actions. Contrary to hs-cTn, natriuretic peptides are particularly incorporated in the ruling-out algorithms for the diagnosis of HF and not ruling-in. Clinical relevance of sex differences here seems marginal, as clinical research has shown that negative predictive values for ruling-out HF were hardly effected when applying a universal diagnostic threshold that is independent from sex or other risk factors. Apart from the diagnostic issues of AMI in women, we believe that in the future most sex-specific benefits of cardiac biomarkers can be obtained in patient follow-up (guiding therapy) and prognostic applications, fitting modern ideas on preventive and personalized medicine.
Collapse
Affiliation(s)
- Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Dorien M Kimenai
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
41
|
Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
Collapse
Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
| |
Collapse
|
42
|
Alberty R, Studenčan M, Kovář F. Prevalence of Conventional Cardiovascular Risk Factors in Patients with Acute Coronary Syndromes in Slovakia. Cent Eur J Public Health 2017; 25:77-84. [PMID: 28399360 DOI: 10.21101/cejph.a4351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a major health problem and the leading cause of death and disability in Slovakia. This is the first study to describe the prevalence rate of conventional cardiovascular risk factors in patients hospitalized for ACS. METHODS Hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking were documented in 1,567 cases (mean age, SD: 66.1±12.0 years, 34.8% of females) enrolled in the SLOVAKS registry from August 2011 through September 2011. RESULTS Overall, 83.5% (95% CI, 81.6-85.2%) of the patients with ACS had hypertension, 65.0% (62.5-67.2%) had a hyperlipidemic profile, 32.6% (30.3-34.9%) were diagnosed with diabetes, and 27.6% (25.1-29.8%) were smokers at the time of a heart-related event. Only 5% of patients with ACS lacked any of the 4 conventional risk factors. Higher prevalence rates of all major risk factors, except smoking, were detected in women than in men, in older (≥65 years of age) than younger patients, and in rural (<2,000 inhabitants) than in urban areas. Premature ACS (<45 years of age) was associated with smoking in men, and smoking and hypertension in women. Smoking, in all risk factor combinations, reduced the age at the time of a heart-related event, on average, by 10.0 years in men and by 12.4 years in women. CONCLUSION The results of this study suggest an appreciable burden of major cardiovascular risk factors and also highlight differences that may aid the targeting of public health interventions.
Collapse
Affiliation(s)
- Roman Alberty
- Department of Biology and Ecology, Faculty of Natural Sciences, Matej Bel University, Banská Bystrica, Slovakia
| | | | | |
Collapse
|
43
|
Zhang ZM, Rautaharju PM, Prineas RJ, Tereshchenko L, Soliman EZ. Electrocardiographic QRS-T angle and the risk of incident silent myocardial infarction in the Atherosclerosis Risk in Communities study. J Electrocardiol 2017; 50:661-666. [PMID: 28515002 DOI: 10.1016/j.jelectrocard.2017.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Silent myocardial infarction (SMI) accounts for about half of the total number of MIs, and is associated with poor prognosis as is clinically documented MI (CMI). The electrocardiographic (ECG) spatial QRS/T angle has been a strong predictor of cardiovascular outcomes. Whether spatial QRS/T angle also is predictive of SMI, and the easy-to-obtain frontal QRS/T angle will show similar association are currently unknown. METHODS We examined the association between the spatial and frontal QRS/T angles, separately, with incident SMI among 9498 participants (mean age 54years, 57% women, and 20% African-American), who were free of cardiovascular disease at baseline (visit 1, 1987-1989) from the Atherosclerosis Risk in Communities (ARIC) study. Incident SMI was defined as MI occurring after the baseline until visit 4 (1996-1998) without CMI. The frontal plane QRS/T angle was defined as the absolute difference between QRS axis and T axis. Values greater than the sex-specific 95th percentiles of the QRS/T angles were considered wide (abnormal). RESULTS A total of 317 (3.3%) incident SMIs occurred during a 9-year median follow-up. In a model adjusted for demographics, cardiovascular risk factors and potential confounders, both abnormal frontal (HR 2.28, 95% CI 1.58-3.29) and spatial (HR 2.10, 95% CI 1.44-3.06) QRS/T angles were associated with an over 2-fold increased risk of incident SMI. Similar patterns of associations were observed when the results were stratified by sex. CONCLUSIONS Both frontal and spatial QRS/T angles are predicative of SMI suggesting a potential use for these markers in identifying individuals at risk.
Collapse
Affiliation(s)
- Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Pentti M Rautaharju
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ronald J Prineas
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Larisa Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
44
|
de Kat AC, Verschuren WM, Eijkemans MJC, Broekmans FJM, van der Schouw YT. Anti-Müllerian Hormone Trajectories Are Associated With Cardiovascular Disease in Women: Results From the Doetinchem Cohort Study. Circulation 2017; 135:556-565. [PMID: 28153992 DOI: 10.1161/circulationaha.116.025968] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/22/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Earlier age at menopause is widely considered to be associated with an increased risk of cardiovascular disease. However, the underlying mechanisms of this relationship remain undetermined. Indications suggest that anti-Müllerian hormone (AMH), an ovarian reserve marker, plays a physiological role outside of the reproductive system. Therefore, we investigated whether longitudinal AMH decline trajectories are associated with an increased risk of cardiovascular disease (CVD) occurrence. METHODS This study included 3108 female participants between 20 and 60 years of age at baseline of the population-based Doetinchem Cohort. Participants completed ≥1 of 5 consecutive quinquennial visits between 1987 and 2010, resulting in a total follow-up time of 20 years. AMH was measured in 8507 stored plasma samples. Information on total CVD, stroke, and coronary heart disease was obtained through a hospital discharge registry linkage. The association of AMH trajectories with CVD was quantified with joint modeling, with adjustment for age, smoking, oral contraceptive use, body mass index, menopausal status, postmenopausal hormone therapy use, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and glucose levels. RESULTS By the end of follow-up, 8.2% of the women had suffered from CVD, 4.9% had suffered from coronary heart disease, and 2.6% had experienced a stroke. After adjustment, each ng/mL lower logAMH level was associated with a 21% higher risk of CVD (hazard ratio, 1.21; 95% confidence interval, 1.07-1.36) and a 26% higher risk of coronary heart disease (hazard ratio, 1.25; 95% confidence interval, 1.08-1.46). Each additional ng/mL/year decrease of logAMH was associated with a significantly higher risk of CVD (hazard ratio, 1.46; 95% confidence interval, 1.14-1.87) and coronary heart disease (hazard ratio, 1.56; 95% confidence interval, 1.15-2.12). No association between AMH and stroke was found. CONCLUSIONS These results indicate that AMH trajectories in women are independently associated with CVD risk. Therefore, we postulate that the decline of circulating AMH levels may be part of the pathophysiology of the increased cardiovascular risk of earlier menopause. Confirmation of this association and elucidation of its underlying mechanisms are needed to place these results in a clinical perspective.
Collapse
Affiliation(s)
- Annelien C de Kat
- From Department of Reproductive Medicine and Gynecology (A.C.d.K., F.J.M.B.), Julius Center for Health Sciences and Primary Care (A.C.d.K., W.M.V., M.J.C.E., Y.T.V.D.S.), University Medical Center Utrecht, The Netherlands; and National Institute for Public Health and the Environment, Bilthoven, The Netherlands (W.M.V.).
| | - W Monique Verschuren
- From Department of Reproductive Medicine and Gynecology (A.C.d.K., F.J.M.B.), Julius Center for Health Sciences and Primary Care (A.C.d.K., W.M.V., M.J.C.E., Y.T.V.D.S.), University Medical Center Utrecht, The Netherlands; and National Institute for Public Health and the Environment, Bilthoven, The Netherlands (W.M.V.)
| | - Marinus J C Eijkemans
- From Department of Reproductive Medicine and Gynecology (A.C.d.K., F.J.M.B.), Julius Center for Health Sciences and Primary Care (A.C.d.K., W.M.V., M.J.C.E., Y.T.V.D.S.), University Medical Center Utrecht, The Netherlands; and National Institute for Public Health and the Environment, Bilthoven, The Netherlands (W.M.V.)
| | - Frank J M Broekmans
- From Department of Reproductive Medicine and Gynecology (A.C.d.K., F.J.M.B.), Julius Center for Health Sciences and Primary Care (A.C.d.K., W.M.V., M.J.C.E., Y.T.V.D.S.), University Medical Center Utrecht, The Netherlands; and National Institute for Public Health and the Environment, Bilthoven, The Netherlands (W.M.V.)
| | - Yvonne T van der Schouw
- From Department of Reproductive Medicine and Gynecology (A.C.d.K., F.J.M.B.), Julius Center for Health Sciences and Primary Care (A.C.d.K., W.M.V., M.J.C.E., Y.T.V.D.S.), University Medical Center Utrecht, The Netherlands; and National Institute for Public Health and the Environment, Bilthoven, The Netherlands (W.M.V.)
| |
Collapse
|
45
|
Øhrn AM, Nielsen CS, Schirmer H, Stubhaug A, Wilsgaard T, Lindekleiv H. Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population-Based, Cross-Sectional Study. J Am Heart Assoc 2016; 5:e003846. [PMID: 28003255 PMCID: PMC5210406 DOI: 10.1161/jaha.116.003846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI. METHODS AND RESULTS We conducted a population-based cross-sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47-0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14). CONCLUSIONS Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.
Collapse
Affiliation(s)
- Andrea Milde Øhrn
- Faculty of Health Sciences, University of Tromsø, Norway
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Schirmer
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Tom Wilsgaard
- Faculty of Health Sciences, University of Tromsø, Norway
| | - Haakon Lindekleiv
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
46
|
Ramos R, Albert X, Sala J, Garcia-Gil M, Elosua R, Marrugat J, Ponjoan A, Grau M, Morales M, Rubió A, Ortuño P, Alves-Cabratosa L, Martí-Lluch R. Prevalence and incidence of Q-wave unrecognized myocardial infarction in general population: Diagnostic value of the electrocardiogram. The REGICOR study. Int J Cardiol 2016; 225:300-305. [PMID: 27744207 DOI: 10.1016/j.ijcard.2016.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diagnosis of unrecognized myocardial infarction (UMI) remains an open question in epidemiological and clinical studies, inhibiting effective secondary prevention of myocardial infarction. We aimed to determine the prevalence and incidence of Q-wave UMI in asymptomatic individuals aged 35 to 74years, and to ascertain the positive predictive value (PPV) of asymptomatic Q-wave to diagnose UMI. METHODS Two population-based cross-sectional studies were conducted, in 2000 (with 10-year follow-up) and in 2005. A baseline electrocardiogram was obtained for each participant. Imaging techniques (echocardiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computerized tomography) were used to confirm UMI in patients with asymptomatic Q-wave. RESULTS The prevalence of confirmed Q-wave UMI in the 5580 participants was 0.18% (95% confidence interval [CI]: 0.10-0.33) and the incidence rate was 27.1 Q-wave UMI per 100,000person-years. The proportion of confirmed Q-wave UMI with respect to all prevalent MI was 8.1% (95% CI: 4.4-14.2). The PPV of asymptomatic Q-wave to diagnose Q-wave UMI was 29.2% (95% CI: 18.2-43.2%) overall, but much higher (75%, 95% CI: 40.9-92.9%) in participants with 10-year CHD risk ≥10%, compared to lower-risk participants. CONCLUSION Opportunistic identification of asymptomatic Q-waves by routine electrocardiogram overestimates actual Q-wave UMI, which represents 8% to 13% of all myocardial infarction in the population aged 35 to 74years. This overestimation is particularly high in the population at low cardiovascular risk. In epidemiological studies and in clinical practice, diagnosis of a pathologic Q-wave in asymptomatic patients requires detailed analysis of imaging tests to confirm or rule out myocardial necrosis.
Collapse
Affiliation(s)
- Rafel Ramos
- ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain.
| | - Xavier Albert
- Department of Medical Sciences, School of Medicine, University of Girona, Spain; Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain; Doctoral Program in Public Health and Biomedical Research Methods, Autonomous University of Barcelona, Spain
| | - Joan Sala
- Department of Medical Sciences, School of Medicine, University of Girona, Spain; Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain
| | - Maria Garcia-Gil
- ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain
| | - Roberto Elosua
- Registre Gironí del COR (REGICOR) Group, Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - Jaume Marrugat
- Registre Gironí del COR (REGICOR) Group, Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - Anna Ponjoan
- ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain
| | - María Grau
- Registre Gironí del COR (REGICOR) Group, Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Municipal Institute for Medical Research (IMIM), Barcelona, Spain
| | - Manel Morales
- Coronary Unit and Cardiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain
| | - Antoni Rubió
- Department of Nuclear Medicine, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain
| | - Pedro Ortuño
- Department of Diagnostic Radiology, Hospital Josep Trueta, Girona, Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain
| | - Lia Alves-Cabratosa
- ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain
| | - Ruth Martí-Lluch
- ISV Research Group, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), Catalan Institute of Health (ICS), Girona, Spain
| | | |
Collapse
|
47
|
Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:256. [PMID: 27500157 DOI: 10.21037/atm.2016.06.33] [Citation(s) in RCA: 651] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.
Collapse
Affiliation(s)
| | - Carme Perez-Quilis
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain;; European University of Madrid, Madrid, Spain
| |
Collapse
|
48
|
Jovanova O, Luik AI, Leening MJG, Noordam R, Aarts N, Hofman A, Franco OH, Dehghan A, Tiemeier H. The long-term risk of recognized and unrecognized myocardial infarction for depression in older men. Psychol Med 2016; 46:1951-1960. [PMID: 26996221 DOI: 10.1017/s0033291716000544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between myocardial infarction (MI) and depression is well described. Yet, the underlying mechanisms are unclear and the contribution of psychological factors is uncertain. We aimed to determine the risk of recognized (RMI) and unrecognized (UMI) myocardial infections on depression, as both have a similar impact on cardiovascular health but differ in psychological epiphenomena. METHOD Participants of the Rotterdam Study, 1823 men aged ⩾55 years, were followed for the occurrence of depression. RMI and UMI were ascertained using electrocardiography and medical history at baseline. We determined the strength of the association of RMI and UMI with mortality, and we studied the relationship of RMI and UMI with depressive symptoms and the occurrence of major depression. RESULTS The risk of mortality was similar in men with RMI [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI) 1.45-2.03] and UMI (aHR 1.58, 95% CI 1.27-1.97). Men with RMI had on average [unstandardized regression coefficient (B) 1.14, 95% CI 0.07-2.21] higher scores for depressive symptoms. By contrast, we found no clear association between UMI and depressive symptoms (B 0.55, 95% CI -0.51 to 1.62) in men. Analysis including occurrence of major depression as the outcome were consistent with the pattern of association. CONCLUSION The discrepant association of RMI and UMI with mortality compared to depression suggests that the psychological burden of having experienced an MI contributes to the long-term risk of depression.
Collapse
Affiliation(s)
- O Jovanova
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A I Luik
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - M J G Leening
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - R Noordam
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - N Aarts
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - O H Franco
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Dehghan
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| |
Collapse
|
49
|
Themudo R, Johansson L, Ebeling-Barbier C, Lind L, Ahlström H, Bjerner T. The number of unrecognized myocardial infarction scars detected at DE-MRI increases during a 5-year follow-up. Eur Radiol 2016; 27:715-722. [DOI: 10.1007/s00330-016-4439-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/15/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
|
50
|
Zhang ZM, Rautaharju PM, Prineas RJ, Rodriguez CJ, Loehr L, Rosamond WD, Kitzman D, Couper D, Soliman EZ. Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2016; 133:2141-8. [PMID: 27185168 PMCID: PMC4889519 DOI: 10.1161/circulationaha.115.021177] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Race and sex differences in silent myocardial infarction (SMI) are not well established. METHODS AND RESULTS The analysis included 9498 participants from the Atherosclerosis Risk in Communities (ARIC) study who were free of cardiovascular disease at baseline (visit 1, 1987-1989). Incident SMI was defined as ECG evidence of MI without clinically documented MI (CMI) after the baseline until ARIC visit 4 (1996-1998). Coronary heart disease and all-cause deaths were ascertained starting from ARIC visit 4 until 2010. During a median follow-up of 8.9 years, 317 participants (3.3%) developed SMI and 386 (4.1%) developed CMI. The incidence rates of both SMI and CMI were higher in men (5.08 and 7.96 per 1000-person years, respectively) than in women (2.93 and 2.25 per 1000-person years, respectively; P<0.0001 for both). Blacks had a nonsignificantly higher rate of SMI than whites (4.45 versus 3.69 per 1000-person years; P=0.217), but whites had higher rate of CMI than blacks (5.04 versus 3.24 per 1000-person years; P=0.002). SMI and CMI (compared with no MI) were associated with increased risk of coronary heart disease death (hazard ratio, 3.06 [95% confidence interval, 1.88-4.99] and 4.74 [95% confidence interval, 3.26-6.90], respectively) and all-cause mortality (hazard ratio, 1.34 [95% confidence interval, 1.09-1.65] and 1.55 [95% confidence interval, 1.30-1.85], respectively). However, SMI and CMI were associated with increased mortality among both men and women, with potentially greater increased risk among women (interaction P=0.089 and 0.051, respectively). No significant interactions by race were detected. CONCLUSIONS SMI represents >45% of incident MIs and is associated with poor prognosis. Race and sex differences in the incidence and prognostic significance of SMI exist that may warrant considering SMI in personalized assessments of coronary heart disease risk.
Collapse
Affiliation(s)
- Zhu-Ming Zhang
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill.
| | - Pentti M Rautaharju
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Ronald J Prineas
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Carlos J Rodriguez
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Laura Loehr
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Wayne D Rosamond
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Dalane Kitzman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - David Couper
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| | - Elsayed Z Soliman
- From Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences(Z.M.Z., P.M.R., R.J.P., E.Z.S.), Department of Internal Medicine, Section of Cardiology(C.J.R., D.K., E.Z.S.), and Department of Epidemiology and Prevention, Division of Public Health Sciences(C.J.R.), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Gillings School of Global Public Health(L.L., W.D.R.) and Gillings School of Global Public Health (D.C.), University of North Carolina at Chapel Hill
| |
Collapse
|