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Zhang S, Wu Z, Zhuang Y, Sun X, Wang J, Chen S, Guo D, Xu P, Zhang C, Yang J. The metabolic score for insulin resistance in the prediction of major adverse cardiovascular events in patients after coronary artery bypass surgery: a multicenter retrospective cohort study. Diabetol Metab Syndr 2023; 15:157. [PMID: 37461067 PMCID: PMC10351175 DOI: 10.1186/s13098-023-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The metabolic score for insulin resistance (METS-IR) is a simple, convenient, and reliable marker for resistance insulin (IR), which has been regarded as a predictor of cardiovascular disease (CVD) and cardiovascular events. However, few studies examined the relationship between METS-IR and prognosis after coronary artery bypass graft (CABG). This study aimed to investigate the potential value of METS-IR as a prognostic indicator for the major adverse cardiovascular events (MACE) in patients after CABG. METHOD 1100 CABG patients were enrolled in the study, including 760 men (69.1%) and 340 women (30.9%). The METS-IR was calculated as Ln [(2 × FPG (mg/dL) + fasting TG (mg/dL)] × BMI (kg/m2)/Ln [HDL-C (mg/dL)]. The primary endpoint of this study was the occurrence of major adverse cardiovascular events (MACE), including a composite of all-cause death, non-fatal myocardial infarction (MI), coronary artery revascularization, and stroke. RESULT The following-up time of this study was 49-101 months (median, 70 months; interquartile range, 62-78 months). During the follow-up period, there were 243 MACEs (22.1%). The probability of cumulative incidence of MACE increased incrementally across the quartiles of METS-IR (log-rank test, p < 0.001). Multivariate Cox regression analysis demonstrated a hazard ratio (95% CI) of 1.97 (1.36-2.86) for MACE in quartile 4 compared with participants in quartile 1. The addition of the METS-IR to the model with fully adjusting variables significantly improved its predictive value [C-statistic increased from 0.702 to 0.720, p < 0.001, continuous net reclassification improvement (NRI) = 0.305, < 0.001, integrated discrimination improvement (IDI) = 0.021, p < 0.001]. CONCLUSION METS-IR is an independent and favorable risk factor for predicting the occurrence of MACE and can be used as a simple and reliable indicator that can be used for risk stratification and early intervention in patients after CABG.
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Affiliation(s)
- Shuai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Zhenguo Wu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yifan Zhuang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xiangfei Sun
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Juan Wang
- Department of Cardiology, The Second Hospital of Shandong University, Jinan, 250033, Shandong, China
| | - Sha Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Dachuan Guo
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Panpan Xu
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Cheng Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China.
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China.
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Jianmin Yang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, Shandong University, Jinan, 250012, China.
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Shandong University, Jinan, 250012, China.
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
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Piao JJ, Gu Y, Ling Y, Chi L, Chen Y, Wang R. Mediating effect of kinesiophobia between self-efficacy and physical activity levels in post-CABG patients: protocol for a prospective, multicentre, cross-sectional study in China. BMJ Open 2022; 12:e062013. [PMID: 35951463 PMCID: PMC9301793 DOI: 10.1136/bmjopen-2022-062013] [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] [Received: 02/14/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Physical activity (PA) can improve cardiac function, exercise capacity, and quality of life, in addition to reducing mortality by 20%-30% and preventing the recurrence of adverse cardiovascular events in patients following coronary artery bypass graft (CABG). However, PA levels are low in patients after CABG. This study intends to explore the mediating effect of kinesiophobia between self-efficacy and PA levels in patients following CABG. METHODS AND ANALYSIS The proposed study constitutes a prospective, multicentre and cross-sectional study comprising 413 patients. Four teaching hospitals with good reputations in CABG will be included in the study. All of them are located in Beijing, China, and provide medical service to the whole country. This study will assess the following patient-reported outcome measures: demographic information, International Physical Activity Questionnaire-Long, Social Support Rating Scale, Cardiac Exercise Self-Efficacy Instrument, Multidimensional Fatigue Inventory, Hospital Anxiety and Depression Scale, and Tampa Scale for Kinesiophobia Heart. ETHICS AND DISSEMINATION This study conforms to the principles of the Declaration of Helsinki and relevant ethical guidelines. Ethical approval has been obtained from the Ethics Committee of The Sixth Medical Centre of PLA General Hospital (approval number: HZKY-PJ-2022-2). All study participants will provide written informed consent. Findings from this study will be published in Chinese or English for widespread dissemination of the results. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Register, ChiCTR2100054098.
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Affiliation(s)
- Jing Jing Piao
- Faculty of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanmei Gu
- Faculty of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yunpeng Ling
- Department of Adult Cardiovascular Surgery, Peking University Third Hospital, Beijing, China
| | - Liqun Chi
- Department of Adult Cardiovascular Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing, China
| | - Yu Chen
- Department of Adult Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Rong Wang
- Department of Adult Cardiovascular Surgery, Sixth Medical Center of PLA General Hospital, Beijing, China
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Verma S, Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Dhingra NK, Ketchum SB, Juliano RA, Jiao L, Doyle RT, Granowitz C, Gibson CM, Pinto D, Giugliano RP, Budoff MJ, Mason RP, Tardif JC, Ballantyne CM. Icosapent Ethyl Reduces Ischemic Events in Patients With a History of Previous Coronary Artery Bypass Grafting: REDUCE-IT CABG. Circulation 2021; 144:1845-1855. [PMID: 34710343 DOI: 10.1161/circulationaha.121.056290] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite advances in surgery and pharmacotherapy, there remains significant residual ischemic risk after coronary artery bypass grafting surgery. METHODS In REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial), a multicenter, placebo-controlled, double-blind trial, statin-treated patients with controlled low-density lipoprotein cholesterol and mild to moderate hypertriglyceridemia were randomized to 4 g daily of icosapent ethyl or placebo. They experienced a 25% reduction in risk of a primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina) and a 26% reduction in risk of a key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) when compared with placebo. The current analysis reports on the subgroup of patients from the trial with a history of coronary artery bypass grafting. RESULTS Of the 8179 patients randomized in REDUCE-IT, a total of 1837 (22.5%) had a history of coronary artery bypass grafting, with 897 patients randomized to icosapent ethyl and 940 to placebo. Baseline characteristics were similar between treatment groups. Randomization to icosapent ethyl was associated with a significant reduction in the primary end point (hazard ratio [HR], 0.76 [95% CI, 0.63-0.92]; P=0.004), in the key secondary end point (HR, 0.69 [95% CI, 0.56-0.87]; P=0.001), and in total (first plus subsequent or recurrent) ischemic events (rate ratio, 0.64 [95% CI, 0.50-0.81]; P=0.0002) compared with placebo. This yielded an absolute risk reduction of 6.2% (95% CI, 2.3%-10.2%) in first events, with a number needed to treat of 16 (95% CI, 10-44) during a median follow-up time of 4.8 years. Safety findings were similar to the overall study: beyond an increased rate of atrial fibrillation/flutter requiring hospitalization for at least 24 hours (5.0% vs 3.1%; P=0.03) and a nonsignificant increase in bleeding, occurrences of adverse events were comparable between groups. CONCLUSIONS In REDUCE-IT patients with a history of coronary artery bypass grafting, treatment with icosapent ethyl was associated with significant reductions in first and recurrent ischemic events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01492361.
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Affiliation(s)
- Subodh Verma
- Montreal Heart Institute, Université de Montréal, Quebec, Canada (J-C.T.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B., R.P.G.)
| | - Ph Gabriel Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, French Alliance for Cardiovascular Trials, and Institut National de la Santé et de la Recherche Médicale U-1148, Paris, France (P.G.S.)
| | - Michael Miller
- Department of Medicine, University of Maryland School of Medicine, Baltimore (M.M.)
| | | | - Terry A Jacobson
- Office of Health Promotion and Disease Prevention, Department of Medicine, Emory University School of Medicine, Atlanta, GA (T.A.J.)
| | - Nitish K Dhingra
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, ON, Canada (S.V., N.K.D.)
| | - Steven B Ketchum
- Amarin Pharma Inc, Bridgewater, NJ (S.B.K., R.A.J., L.J., R.T.D., C.G.)
| | - Rebecca A Juliano
- Amarin Pharma Inc, Bridgewater, NJ (S.B.K., R.A.J., L.J., R.T.D., C.G.)
| | - Lixia Jiao
- Amarin Pharma Inc, Bridgewater, NJ (S.B.K., R.A.J., L.J., R.T.D., C.G.)
| | - Ralph T Doyle
- Amarin Pharma Inc, Bridgewater, NJ (S.B.K., R.A.J., L.J., R.T.D., C.G.)
| | - Craig Granowitz
- Amarin Pharma Inc, Bridgewater, NJ (S.B.K., R.A.J., L.J., R.T.D., C.G.)
| | | | - Duane Pinto
- Baim Clinical Research Institute, Boston, MA (C.M.G., D.P.)
| | - Robert P Giugliano
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B., R.P.G.)
| | - Matthew J Budoff
- David Geffen School of Medicine, Lundquist Institute, Torrance, CA (M.J.B.)
| | | | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Quebec, Canada (J-C.T.)
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.)
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