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Papathanasiou KA, Rallidis SL, Armylagos S, Kotrotsios G, Rallidis LS. Gender Differences Among Very Young Patients With Acute Coronary Syndrome: Long-Term Follow-Up of the STAMINA Study. Angiology 2024:33197241232567. [PMID: 38330905 DOI: 10.1177/00033197241232567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The rate of hospitalization for acute coronary syndrome (ACS) among young patients is increasing. Healthcare disparities remain unsolved among female patients. We explored gender differences regarding risk factors, clinical presentation, in-hospital treatment, and long-term outcomes among ACS patients. A total of 445 patients with very early ACS (men ≤ 35 years and women ≤ 40 years of age) were followed for a median of 5 years. Primary clinical endpoint was the composite of cardiac death, non-fatal myocardial infarction, stroke, and coronary revascularization. Women accounted for 16% of cases. Smoking was the most prevalent risk factor, 56% and 60% of the females and males, respectively, continued to smoke after ACS. Chest pain was typical in 85% and 83% of the female and male patients, respectively. In-hospital treatment (pharmacological and reperfusion) as well as the composite clinical endpoint during follow-up did not differ between female and male patients. Lipid-lowering therapy was suboptimal in both genders, and persistence of smoking was the sole predictor for the composite clinical endpoint (hazard ratio: 2.30 [95% CI: 1.26-4.20]; P = .007). In conclusion, in-hospital treatment was similar between male and female patients. However, the majority of them continued smoking, and this was an independent predictor for future adverse outcomes.
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Affiliation(s)
- Konstantinos A Papathanasiou
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Stylianos L Rallidis
- BSc of Biomedical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Stylianos Armylagos
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Georgios Kotrotsios
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - Loukianos S Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Chrissini MK, Panagiotakos DB. Acute Myocardial Infarction in Young Patients and its Correlation with Obesity Status at Pre-adolescent Stage: A Narrative Review. Open Cardiovasc Med J 2022. [DOI: 10.2174/18741924-v16-e2206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Cardiovascular diseases (CVD), especially acute myocardial infarction (AMI), remain a worldwide major cause of premature morbidity and mortality, with considerable health care costs. Metabolic, behavioural, environmental, and social risk factors are significant drivers of AMI, with obesity being a key determinant among them. Childhood obesity constitutes a major health threat that is considered a global epidemic of the 21st century.
Objective:
To assess whether excess weight from the first years of life acts as a predisposing factor in increasing the risk of AMI in young adults.
Methods:
This is a narrative review of the evidence concerning the epidemiology of early AMI and obesity, using PubMed and Google Scholar.
Results:
There is substantial evidence showing that excess weight during childhood multiplies the risk of AMI at an early age.
Conclusion:
Premature AMI seems to have significant drivers related to lifestyle factors, such as childhood obesity. In the era of a childhood obesity epidemic, the aforementioned relationship underlines the need for early prevention and management.
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Wu AD, Lindson N, Hartmann-Boyce J, Wahedi A, Hajizadeh A, Theodoulou A, Thomas ET, Lee C, Aveyard P. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2022; 8:CD014936. [PMID: 35938889 PMCID: PMC9358996 DOI: 10.1002/14651858.cd014936.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking is a leading cause of cardiovascular disease (CVD), particularly coronary heart disease (CHD). However, quitting smoking may prevent secondary CVD events in people already diagnosed with CHD. OBJECTIVES: To examine the impact of smoking cessation on death from CVD and major adverse cardiovascular events (MACE), in people with incident CHD. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the trials registries clinicaltrials.gov and the International Clinical Trials Registry Platform. We ran all searches from database inception to 15 April 2021. SELECTION CRITERIA: We included cohort studies, and both cluster- and individually randomised controlled trials of at least six months' duration. We treated all included studies as cohort studies and analysed them by smoking status at follow-up. Eligible studies had to recruit adults (> 18 years) with diagnosed CHD and who smoked tobacco at diagnosis, and assess whether they quit or continued smoking during the study. Studies had to measure at least one of our included outcomes with at least six months' follow-up. Our primary outcomes were death from CVD and MACE. Secondary outcomes included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, new-onset angina and change in quality of life. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods for screening and data extraction. We assessed the risk of bias for the primary outcomes using the ROBINS-I tool. We compared the incidence of death from CVD and of MACE (primary outcomes) between participants who quit smoking versus those who continued to smoke for each included study that reported these outcomes. We also assessed differences in all-cause mortality, incidence of non-fatal myocardial infarction, incidence of non-fatal stroke and new onset angina. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI). For our outcome, change in quality of life, we calculated the pooled standardised mean difference (SMD) and 95% CI for the difference in change in quality of life from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using the I²statistic. We assessed the certainty of evidence for our primary outcomes using the eight GRADE considerations relevant to non-randomised studies. MAIN RESULTS We included 68 studies, consisting of 80,702 participants. For both primary outcomes, smoking cessation was associated with a decreased risk compared with continuous smoking: CVD death (HR 0.61, 95% CI 0.49 to 0.75; I² = 62%; 18 studies, 17,982 participants; moderate-certainty evidence) and MACE (HR 0.57, 95% CI 0.45 to 0.71; I² = 84%; 15 studies, 20,290 participants; low-certainty evidence). These findings were robust to our planned sensitivity analyses. Through subgroup analysis, for example comparing adjusted versus non-adjusted estimates, we found no evidence of differences in the effect size. While there was substantial heterogeneity, this was primarily in magnitude rather than the direction of the effect estimates. Overall, we judged 11 (16%) studies to be at moderate risk of bias and 18 (26%) at serious risk, primarily due to possible confounding. There was also some evidence of funnel plot asymmetry for MACE outcomes. For these reasons, we rated our certainty in the estimates for CVD death as moderate and MACE as low. For our secondary outcomes, smoking cessation was associated with a decreased risk in all-cause mortality (HR 0.60, 95% CI 0.55 to 0.66; I² = 58%; 48 studies, 59,354 participants), non-fatal myocardial infarction (HR 0.64, 95% CI 0.58 to 0.72; I² = 2%; 24 studies, 23,264 participants) and non-fatal stroke (HR 0.70, 95% CI 0.53 to 0.90; I² = 0%; 9 studies, 11,352 participants). As only one study reported new onset of angina, we did not conduct meta-analysis, but this study reported a lower risk in people who stopped smoking. Quitting smoking was not associated with a worsening of quality of life and suggested improvement in quality of life, with the lower bound of the CI also consistent with no difference (SMD 0.12, 95% CI 0.01 to 0.24; I² = 48%; 8 studies, 3182 participants). AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that smoking cessation is associated with a reduction of approximately one-third in the risk of recurrent cardiovascular disease in people who stop smoking at diagnosis. This association may be causal, based on the link between smoking cessation and restoration of endothelial and platelet function, where dysfunction of both can result in increased likelihood of CVD events. Our results provide evidence that there is a decreased risk of secondary CVD events in those who quit smoking compared with those who continue, and that there is a suggested improvement in quality of life as a result of quitting smoking. Additional studies that account for confounding, such as use of secondary CVD prevention medication, would strengthen the evidence in this area.
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Affiliation(s)
- Angela Difeng Wu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth T Thomas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bruno F, Moirano G, Budano C, Lalloni S, Ciccone G, Verardi R, Andreis A, Montabone A, De Filippo O, Gallone G, Gilardetti M, D'Ascenzo F, De Ferrari GM. Incidence trends and long-term outcomes of myocardial infarction in young adults: Does gender matter? Int J Cardiol 2022; 357:134-139. [PMID: 35301075 DOI: 10.1016/j.ijcard.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/09/2022] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
AIMS Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant. METHODS AND RESULTS Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%). CONCLUSION Among young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovenale Moirano
- Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Stefania Lalloni
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Roberto Verardi
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy; Division of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Emilia-Romagna, Italy
| | - Alessandro Andreis
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy.
| | - Andrea Montabone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Marco Gilardetti
- Clinical Epidemiology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy
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Allagbé I, Le Faou AL, Thomas D, Airagnes G, Limosin F, Chagué F, Zeller M. Tobacco-related cardiovascular risk in women: New issues and therapeutic perspectives. Arch Cardiovasc Dis 2021; 114:694-706. [PMID: 34593343 DOI: 10.1016/j.acvd.2021.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Smoking is the main modifiable risk factor for stroke and myocardial infarction, particularly in women; its prevalence in France is evolving, and new patterns of nicotine consumption have emerged. AIMS To present contemporary data on smoking prevalence and the use of electronic cigarettes, and to describe current knowledge of the cardiovascular risk specificities and the effectiveness of withdrawal methods in women. METHOD We identified studies by searching the MEDLINE bibliographic database between 1995 and 2020, and the Weekly Epidemiological Bulletin (Bulletin Épidémiologique Hebdomadaire) published by the French health authorities. RESULT In recent years, smoking prevalence among French women has decreased overall, except in the oldest age group (aged>55 years). At the same time, the incidence of hospitalization for cardiovascular events has increased worryingly among women smokers aged<65 years. Active smoking in women is associated with an increased risk of premature myocardial infarction, and a risk of stroke that increases with the number of cigarettes consumed per day; it is also responsible for increased cardiovascular events in women taking oestrogen-progestin contraception. Quitting smoking reverses these effects in the long term, and women are just as likely to quit smoking as men. CONCLUSIONS Stopping smoking must be a priority objective for women smokers, for primary and secondary prevention, and they should systematically be offered a validated method of cessation or even electronic cigarettes.
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Affiliation(s)
- Ingrid Allagbé
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France; Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France
| | - Anne-Laurence Le Faou
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Fédération Hospitalo-Universitaire Network of Research in Substance Use Disorder, Ile-de-France, Paris, France
| | - Daniel Thomas
- Institut de Cardiologie, hôpital Pitié-Salpêtrière, AP-HP, Université Paris-VI-Sorbonne, 75013 Paris, France
| | - Guillaume Airagnes
- Outpatient Addiction Centre, Georges Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France; Population-based Epidemiologic Cohorts, UMS 011, Inserm, 94807 Villejuif, France
| | - Frédéric Limosin
- DMU Psychiatry and Addictology, Corentin Celton Hospital, AP-HP, University of Paris, 92130 Issy-les-Moulineaux, France; Psychiatry and Neurosciences Centre, U894, Inserm, 75014 Paris, France
| | - Frédéric Chagué
- Cardiology Department, Dijon University Hospital, 21000 Dijon, France
| | - Marianne Zeller
- Team Physiopathlogy and Epidemiology Cerebro-Cardiovascular (PEC2), EA 7460, University of Burgundy Franche-Comté, Faculté des Sciences de Santé, 7, boulevard Jeanne d'Arc, 21000 Dijon, France.
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Analysis of Some Behavioral Risk Factors in Relation to Acute Coronary Events. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:244-249. [PMID: 33304625 PMCID: PMC7716758 DOI: 10.12865/chsj.46.03.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022]
Abstract
The association of acute coronary events and behavioral risk factors is already known. Of these, smoking and alcohol consumption are the behavioral risk factors with the most intense impact in the occurrence of these events. The correct knowledge of the dynamics and their involvement in the evolution of acute coronary events remains of overwhelming importance in the light of current data. To achieve the purpose of this study data from three family medicine practices from the period November 2018 to May 2019 were corroborated. Anonymous questionnaires were applyed to the subjects. For this study, questions related to the habit of smoking and consuming alcohol were selected. The study aimed to analyze the associative relationships between acute coronary events and two of the most common behavioral risk factors, smoking and alcohol consumption. The highest prevalence of acute coronary events was observed in current smokers and in former smokers. The period of exposure to smoking showed that this is one of the variables most strongly associated with an increased risk of acute coronary events. Moderate consumption of wine or beer seems to have a weak association with acute coronary events, even weaker than those who do not consume at all suggesting a protective effect.
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7
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Neves RD, Avila GK, Oliveira FDB, Sampaio JAFD. Impact of Myocardial Revascularization Method on Smoking Cessation: Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention. Braz J Cardiovasc Surg 2018; 32:383-389. [PMID: 29211218 PMCID: PMC5701112 DOI: 10.21470/1678-9741-2017-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/02/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Smoking is a serious public health issue, being a precursor of heart disease
and a predictor of sudden death due to myocardial ischemia. Major events in
the patient's health can lead to radical changes in habits and the choice
for different myocardial revascularization methods might differently impact
smoking cessation and relapse. Objective To study the rate and perpetuation of smoking cessation after myocardial
revascularization comparing coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI). Methods Smokers submitted to myocardial revascularization were divided into CABG and
PCI groups. The research was conducted through interviews at the Hospital
Santa Lucinda outpatient clinic. Patients with smoking cessation longer than
90 days before hospital admission, combined procedures, hospital readmission
before 360 days after discharge, cases of death at any time, and emergency
procedures were excluded from the study. The start of the smoking cessation
period was determined as just after hospital discharge, with a follow-up of
12 months. Results The proportion of patients reporting smoking relapse was significantly lower
in the CABG than in the PCI group at 30 (11.1% vs. 20.8%;
P=0.039) and at 180 days (23.1% vs.
41.5%; P=0.002), but no differences were observed between
the two groups at 360 days after hospital discharge (51.9%
vs. 54.1%; P=0.719). High levels of
nicotine dependence and passive smoking showed to be important predictors of
smoking relapse in the long-term. Conclusion The occurrence of a major surgical procedure seems to have beneficial
psychological effects, representing an interesting setting for smoking
cessation counseling to have higher chances of success.
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Affiliation(s)
- Ricardo das Neves
- Cardiovascular Surgery Department of Hospital Santa Lucinda, Sorocaba, São Paulo, Brazil
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8
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Liu Y, Han T, Gao M, Wang J, Liu F, Zhou S, Chen Y. Clinical characteristics and prognosis of acute myocardial infarction in young smokers and non-smokers (≤ 45 years): a systematic review and meta-analysis. Oncotarget 2017; 8:81195-81203. [PMID: 29113379 PMCID: PMC5655274 DOI: 10.18632/oncotarget.21092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022] Open
Abstract
The effect of smoking on the prognosis of young patients with acute myocardial infarction (AMI) is inconclusive. We enrolled 2188 young AMI patients (≤ 45 years) from the cardiac center of the Chinese PLA General Hospital and Anzhen Hospital and analyzed their clinical characteristics and prognosis. We also searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases for January 2001 to March 2017 and considered for inclusion in a meta-analysis those clinical trials that compared prognoses of young smokers and non-smokers with AMI. The proportion of males and alcohol users was higher in young AMI smokers than in non-smokers; the proportion of hypertension was slightly lower. There was no difference in medical treatment between smokers and non-smokers. No differences were evident between smokers and non-smokers regarding in-hospital cardiac events and major adverse cardiovascular events on follow-up, including incidence of stroke. For young AMI patients, smoking did not lead to poorer prognosisin comparison with not smoking. This “smoker's paradox” needs to be confirmed by more randomized controlled multicenter prospective clinical trials.
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Affiliation(s)
- Yuqi Liu
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Tianwen Han
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Ming Gao
- ICU of The First Phase Beijing Tsinghua Changgeng Hospital, Beijing 100044, China
| | - Jinwen Wang
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Fang Liu
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Shanshan Zhou
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
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9
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Yammine L, Frazier L, Padhye NS, Sanner JE, Burg MM. Two-year prognosis after acute coronary syndrome in younger patients: Association with feeling depressed in the prior year, and BDI-II score and Endothelin-1. J Psychosom Res 2017; 99:8-12. [PMID: 28712433 PMCID: PMC5523834 DOI: 10.1016/j.jpsychores.2017.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the effects of depressive symptoms and Endothelin (ET)-1 on 2-year prognosis in younger patients with acute coronary syndrome (ACS). Depression is associated with poor post-ACS prognosis; however, few investigations have focused on younger patients. Importantly, the studies that did emphasize younger patients suggested that the influence of depression on prognosis could be more robust in younger subgroups. The particular links between depression and poor prognosis in younger patients have yet to be definitively determined. ET-1 is a potent endogenous vasoconstrictor that has been previously linked to adverse post-ACS outcomes. METHODS The sample (n=153) included male (age≤50years) and female (age≤55years) ACS patients. Blood samples for ET-1 assessment were collected within 2-3h of ACS hospital admission. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) II within 2-5days of admission. The primary outcome was defined as a composite of major adverse cardiovascular events (MACE), including recurrent myocardial infarction, emergent coronary revascularization, and all-cause mortality within 2years after index admission. RESULTS During the follow-up period, 23 patients experienced MACE. Neither the BDI-II score nor ET-1 predicted MACE in unadjusted analyses or in analyses adjusted for demographic characteristics, comorbidities and troponin levels. In the supplementary analyses, feeling depressed in the year preceding ACS predicted MACE. CONCLUSIONS In this cohort of younger ACS patients, feeling depressed in the year preceding ACS admission predicted MACE in the 2years after baseline ACS event, while neither the BDI-II score, nor circulating ET-1 level predicted this outcome.
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Affiliation(s)
- Luba Yammine
- University of Texas Health Science Center at Houston, United States.
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10
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Ellis KL, Pang J, Schultz CJ, Watts GF. New data on familial hypercholesterolaemia and acute coronary syndromes: The promise of PCSK9 monoclonal antibodies in the light of recent clinical trials. Eur J Prev Cardiol 2017; 24:1200-1205. [DOI: 10.1177/2047487317708890] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Katrina L Ellis
- School of Medicine, University of Western Australia, Australia
| | - Jing Pang
- School of Medicine, University of Western Australia, Australia
| | - Carl J Schultz
- School of Medicine, University of Western Australia, Australia
- Department of Cardiology, Royal Perth Hospital, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Australia
- Lipid Disorders Clinic, Royal Perth Hospital, Australia
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11
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The fundamental importance of smoking cessation in those with premature ST-segment elevation acute myocardial infarction. Curr Opin Cardiol 2016; 31:531-6. [DOI: 10.1097/hco.0000000000000320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction. Am J Cardiol 2016; 118:319-25. [PMID: 27328956 DOI: 10.1016/j.amjcard.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-matched background population could unmask residual mortality risk in young patients with MI that would otherwise not be apparent when merely comparing the mortality risk of young and older patients with MI. We studied 15,151 patients with AMI from 2000 to 2005, of which 601 patients were ≤40 years (young MI). The relative survival ratio (RSR) was calculated as the ratio of the observed survival of patients with MI divided by the expected survival, estimated from the background population (n = 3,771,700) matched for age, gender, and follow-up year. An RSR of <1.0 or >1.0 indicates poorer or better survival, respectively, than the background population. The 12-year all-cause and cardiovascular mortality of young versus older patients was 12.8% versus 50.7% (p <0.001) and 9.2% versus 34.5% (p <0.001), respectively. The adjusted hazard ratio (95% confidence interval) for all-cause and cardiovascular mortality comparing young with older patients was 0.20 (0.16 to 0.27) and 0.27 (0.20 to 0.36), respectively. The RSR (95% confidence interval) of young and older patients was, respectively, 0.969 (0.950 to 0.980) and 0.804 (0.797 to 0.811) at 1 year, 0.942 (0.918 to 0.960) and 0.716 (0.707 to 0.726) at 5 years, and 0.908 (0.878 to 0.938) and 0.638 (0.620 to 0.654) at 9 years. In conclusion, despite a fivefold lower long-term mortality than older patients with MI, young patients with MI remain at significantly greater risk of long-term mortality than an age-matched background population.
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Pang J, Lansberg PJ, Watts GF. International Developments in the Care of Familial Hypercholesterolemia: Where Now and Where to Next? J Atheroscler Thromb 2016; 23:505-19. [DOI: 10.5551/jat.34108] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jing Pang
- School of Medicine and Pharmacology, University of Western Australia
| | - Peter J Lansberg
- Center for Translational Molecular Medicine - Translational Research Infrastructure (CTMM-TraIT)
- Department of Vascular Medicine, Academic Medical Center
| | - Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital
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Waziri H, Jørgensen E, Kelbæk H, Stagmo M, Pedersen F, Lagerqvist B, James S, Køber L, Wachtell K. Short and long-term survival after primary percutaneous coronary intervention in young patients with ST-elevation myocardial infarction. Int J Cardiol 2015; 203:697-701. [PMID: 26583845 DOI: 10.1016/j.ijcard.2015.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 07/07/2015] [Accepted: 09/08/2015] [Indexed: 12/15/2022]
Abstract
UNLABELLED The long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) aged 45 years or younger and differences according to gender have not been well characterized. METHODS We included 16,685 consecutive STEMI patients from 2003 to 2012 (67,992 patient-years follow-up) from the Eastern Danish Heart Registry and the Swedish Coronary Angiography and Angioplasty Registry who were treated with primary percutaneous coronary intervention (PCI). RESULTS We identified 1026 (6.2%) patients up to 45 years of age (mean age: 40.7 vs. 66.3 years, P<0.001). Patients in the young group were predominantly men (79.7% vs. 71.9%) and smokers (71.2% vs. 44.2%, P<0.001) but with a lower prevalence of hypertension (17.3% vs. 39.3%), hyperlipidemia (18.0% vs. 23.8%), diabetes (9.0% vs. 12.4%) and previous myocardial infarction (6.9% vs. 12.2%, all P<0.001) compared with older patients. Young patients had a 0.8% annual mortality. During the follow-up period 6.3% of young patients died vs. 28.5% of older patients (P<0.001). Both 30-day-mortality (adjusted hazard ratio [HR]=0.26, 95% confidence interval [CI]: 0.12-0.54, P<0.001) and mortality after 30 days and onwards (HR=0.25, CI: 0.17-0.37, P<0.001) were significantly lower in the young group. There was no difference in short-term (HR=0.78, CI: 0.32-1.90, P=0.59) or long-term (HR=0.62, CI: 0.33-1.91, P=0.59) mortality between women and men in the young group (HR=0.79, CI: 0.21-1.80, P=0.39). CONCLUSIONS STEMI patients, aged 45 years or younger, have an excellent prognosis after treatment with primary PCI. Long-term annual survival is more than 99% in these patients. Young women with STEMI do not have a worse long-term prognosis than young men with STEMI.
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Affiliation(s)
- Homa Waziri
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
| | - Erik Jørgensen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Martin Stagmo
- Department of Cardiology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Frants Pedersen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Kristian Wachtell
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden; Glostrup University Hospital, Glostrup, Denmark
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Frequency of familial hypercholesterolemia in patients with early-onset coronary artery disease admitted to a coronary care unit. J Clin Lipidol 2015; 9:703-8. [DOI: 10.1016/j.jacl.2015.07.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/02/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022]
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Watts GF, Pang J, Santos RD. Europe aspires to set the record straight on familial hypercholesterolaemia. Atherosclerosis 2015; 241:769-71. [DOI: 10.1016/j.atherosclerosis.2015.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 01/15/2023]
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Rallidis LS, Sakadakis EA, Tympas K, Varounis C, Zolindaki M, Dagres N, Lekakis J. The impact of smoking on long-term outcome of patients with premature (≤35years) ST-segment elevation acute myocardial infarction. Am Heart J 2015; 169:356-62. [PMID: 25728725 DOI: 10.1016/j.ahj.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are few data regarding the long-term prognosis of young survivors of acute myocardial infarction (AMI). We explored the long-term outcome in individuals who had sustained a premature ST-segment elevation AMI. METHODS We recruited 257 consecutive patients who had survived their first AMI ≤35years of age. Patients were followed up for up to 18years. Clinical end points included all major adverse coronary events (MACE): cardiac death, readmission for acute coronary syndrome, arrhythmias, or coronary revascularization due to clinical deterioration. RESULTS The most prevalent risk factor at presentation was smoking (93.7%). Follow-up data were obtained from 237 patients (32.2±3.7years old). The median follow-up period was 9.1years. During follow-up, 139 (58.6%) patients reported continuation of smoking. Ninety-one (38.4%) patients had recurrent MACE (13 deaths, 59 acute coronary syndromes, 2 arrhythmias, and 17 revascularizations). Multivariable Cox regression analysis showed that persistence of smoking, left ventricular ejection fraction (LVEF), and reperfusion therapy (fibrinolysis or primary coronary angioplasty) were independent predictors of MACE after adjustment for conventional risk factors. Continuation of smoking remained an independent predictor for MACE after additional adjustments for LVEF (hazard ratio 2.154, 95% CI 1.313-3.535, P=.002) or reperfusion treatment (hazard ratio 2.327, 95% CI 1.423-3.804, P=.001). Harrell c statistic showed that the model with persistent smoking had the best discriminatory power compared with models with LVEF or reperfusion treatment. CONCLUSIONS In the era of statins and reperfusion treatment, continuation of smoking is the strongest independent long-term predictor for recurrent MACE in young survivors of premature AMI.
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Wald DS, Bangash FA, Bestwick JP. Prevalence of DNA-confirmed familial hypercholesterolaemia in young patients with myocardial infarction. Eur J Intern Med 2015; 26:127-30. [PMID: 25682442 DOI: 10.1016/j.ejim.2015.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/01/2014] [Accepted: 01/25/2015] [Indexed: 02/01/2023]
Abstract
PURPOSE To report the prevalence of DNA-confirmed Familial Hypercholesterolaemia (FH) in young patients with acute myocardial infarction, the relative contribution of smoking and diabetes and to compare these rates with those in the general population. METHODS A pilot clinical service was established to diagnose FH in young patients (≤50 years) with myocardial infarction at a London hospital. Over 23 months, 231 such patients, underwent testing for 48 common FH-mutations and whole exon LDLR gene deletions and duplications. Patients with total cholesterol levels ≥7.0 mmol/L, additionally, underwent full sequencing of the LDLR gene. Smoking and diabetes history were recorded. The prevalence of FH, smoking and diabetes were determined and compared with the prevalence in age and sex matched controls from published surveys. RESULTS The prevalence of DNA-confirmed FH was 1.3% (95% confidence interval 0.3%-3.8%) compared with 0.2% (0.17%-0.23%) in the general population (p=0.012). Observed prevalence rates for smoking and diabetes were 57% (50.3%-63.6%) and 13.4% (9.2%-18.6%) respectively in patients, compared with expected rates of 25% (23.9%-26.2%) and 4.6% (4.1%-5.2%) in the general population (p<0.001 for both comparisons). CONCLUSION FH is an important cause of premature myocardial infarction but it accounts for only a small proportion of all such events. The endemic risk factors, smoking and diabetes, far exceed FH in patients with acute myocardial infarction aged 50 or less. Consideration should be given to extending the use of statins and blood pressure drugs to a younger group of smokers and diabetics, who are excluded from treatment by conventional prevention strategies.
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Affiliation(s)
- David S Wald
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom.
| | - Fatima A Bangash
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
| | - Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom.
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Orenes-Piñero E, Pineda J, Roldán V, Hernández-Romero D, Marco P, Tello-Montoliu A, Sogorb F, Valdés M, Lip GYH, Marín F. Effects of Body Mass Index on the Lipid Profile and Biomarkers of Inflammation and a Fibrinolytic and Prothrombotic State. J Atheroscler Thromb 2014; 22:610-7. [PMID: 25737193 DOI: 10.5551/jat.26161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Both an overweight status and obesity are associated with high cardiovascular morbidity and mortality. The aim of this study was to examine the effects of obesity on different underlying mechanisms, i.e. inflammation, fibrinolysis and a prothrombotic state, in a young high-risk population in the Mediterranean area. METHODS The study population included 237 subjects (median age: 44 years). We recorded the presence of cardiovascular risk factors and premature ischaemic heart disease and performed weight stratification using the body mass index (BMI) according to the established World Health Organization (WHO) criteria. We also measured the serum/plasma lipid, fibrinogen, D-dimer, von Willebrand factor, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor-1 antigen (PAI-1) and high-sensitivity C-reactive protein (CRP-hs) levels in samples of peripheral blood. RESULTS The subjects with premature ischaemic heart disease and hypertension had higher BMI values (p<0.01), and the subjects with an increased weight showed an unadjusted detrimental lipid profile, with a proinflammatory, prothrombotic state and abnormal fibrinolytic parameters. According to a multivariate analysis, the HDL-cholesterol (r(2)=0.176; p<0.001), t-PA antigen (r(2)=0.235; p<0.001), PAI-1 antigen (r(2)=0.164; p<0.001) and CRP-hs (r(2)=0.096; p=0.019) levels were significantly related to the weight stratification. CONCLUSIONS A high BMI is a common finding in young populations at high risk of cardiovascular disease. In the current study, the patients with an increased BMI demonstrated an unhealthy lipid profile, as well as a proinflammatory and prothrombotic state and abnormal fibrinolytic parameters.
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Affiliation(s)
- Esteban Orenes-Piñero
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Universidad de Murcia
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Esteban MR, Montero SM, Sánchez JJA, Hernández HP, Pérez JJG, Afonso JH, Pérez DCR, Díaz BB, de León AC. Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J 2014; 8:61-7. [PMID: 25152777 PMCID: PMC4141177 DOI: 10.2174/1874192401408010061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022] Open
Abstract
Background: To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis. Methods: Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome. Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.
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Affiliation(s)
| | - Sara M Montero
- Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José J A Sánchez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Del C R Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Buenaventura B Díaz
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio C de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain ; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Sniderman AD, Tsimikas S, Fazio S. The severe hypercholesterolemia phenotype: clinical diagnosis, management, and emerging therapies. J Am Coll Cardiol 2014; 63:1935-47. [PMID: 24632267 DOI: 10.1016/j.jacc.2014.01.060] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/05/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
The severe hypercholesterolemia phenotype includes all patients with marked elevation of low-density lipoprotein cholesterol (LDL-C) levels. The most common cause is autosomal dominant hypercholesterolemia, an inherited disorder caused by mutations either in LDL receptor, apolipoprotein B (APOB), or proprotein convertase subtilisin kexin type 9 (PCSK9) genes. However, it is now known that many subjects with severe inherited hypercholesterolemia have no defects in these genes. These cases are caused either by mutations in genes yet to be identified or are consequences of polygenic, epigenetic, or acquired defects. Because the clinical consequences of extreme hypercholesterolemia are the same no matter the cause, the focus should be on the identification of subjects with severe hypercholesterolemia, followed by phenotypic screening of family members. Genetic screening is not necessary to diagnose or initiate treatment for the severe hypercholesterolemia phenotype. Management of severe hypercholesterolemia is based on risk factor modification and use of multiple lipid-lowering medications. Lipoprotein apheresis is indicated for coronary artery disease (CAD) patients taking maximally tolerated therapy and with LDL-C levels >200 mg/dl (>300 mg/dl if without CAD). A microsomal triglyceride transfer protein inhibitor and an antisense oligonucleotide against APOB have recently been approved for use in subjects with clinically diagnosed homozygous familial hypercholesterolemia. PCSK9 inhibitors, currently in phase II and III trials, lower LDL-C up to an additional 70% in the setting of maximally tolerated medical therapy and have the potential to reduce LDL-C to <70 mg/dl in most patients. Early identification of affected individuals and aggressive treatment should significantly reduce the burden of cardiovascular disease in society.
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Affiliation(s)
- Allan D Sniderman
- Division of Cardiology, Department of Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Sotirios Tsimikas
- Department of Medicine, University of California San Diego, La Jolla, California.
| | - Sergio Fazio
- Section of Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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Konishi H, Miyauchi K, Kasai T, Tsuboi S, Ogita M, Naito R, Katoh Y, Okai I, Tamura H, Okazaki S, Daida H. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention. J Cardiol 2014; 64:171-4. [PMID: 24495504 DOI: 10.1016/j.jjcc.2013.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/27/2013] [Accepted: 12/12/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. METHODS AND RESULTS Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. CONCLUSION Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese.
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Affiliation(s)
- Hirokazu Konishi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takatoshi Kasai
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiteru Katoh
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Tamura
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Comparison of clinical features and outcomes of patients with acute myocardial infarction younger than 35 years with those older than 65 years. Am J Med Sci 2013; 346:52-5. [PMID: 23328834 DOI: 10.1097/maj.0b013e318265e33e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The objective of this study was to analyze the clinical characteristics of patients younger than 35 years with acute myocardial infarction (AMI). METHODS A total of 117 patients younger than 35 years with AMI admitted to the hospital during the recent 10 years were chosen, and 355 patients older than 65 years with AMI served as a control group. The case history, clinical data, coronary angiography and prognosis of the patients were analyzed and compared. RESULTS Among the younger patients with AMI, men (96.6%) and those smoking cigarettes (66.7%) account for the majority. ST-segment elevation (69.2%) and anterior wall infarction (43.6%) were more prevalent in the younger patients than in the older patients. Compared with the older patients, the younger patients had a higher level of low-density lipoprotein cholesterol (2.93 ± 1.48 versus 2.35 ± 1.21, P = 0.0428) and higher left ventricular ejection fraction (59.82 ± 10.86 versus 48.31 ± 12.48, P = 0.0396). Coronary angiography data showed that most of the younger patients were characteristic of having single-vessel lesion (66.7%), left anterior descending artery lesion (69.3%) and coronary artery spasm more than the older patients (6.8% versus 0.56%, P = 0.0001). In addition, the in-hospital mortality, and the prognosis after 1 and 12 months in the younger patients were comparatively better. CONCLUSIONS The main risk factors for young adults aged <35 years with AMI include cigarette smoking, hyperlipidemia and family history of coronary artery disease, and smoking cessation and lifestyle improvement are important considerations for the prevention of this disease in this population.
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Al Suwaidi J, Zubaid M, El-Menyar AA, Singh R, Asaad N, Sulaiman K, Al Mahmeed W, Al-Shereiqi S, Akbar M, Al Binali HA. Prevalence and outcome of cigarette and waterpipe smoking among patients with acute coronary syndrome in six Middle-Eastern countries. Eur J Prev Cardiol 2012; 19:118-25. [PMID: 21450616 DOI: 10.1177/1741826710393992] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
OBJECTIVE We evaluated the prevalence and effect of cigarette smoking (CS) and waterpipe (WP) smoking on patients with acute coronary syndrome (ACS) in six Middle-Eastern countries. METHODS Analysis of the Gulf Registry of Acute Coronary Events (Gulf RACE) survey, which included 6704 consecutive patients hospitalized with ACS, was made and patients were divided into four groups depending on whether they were smokers - cigarette-CS, waterpipe-WS, combined cigarette and waterpipe (CW) - or non-smokers (NS). RESULTS Overall 38% of patients were smokers; 4.4% of patients were waterpipe smokers (1.4% WS and 3% CW). When compared to the three smokers' groups, non-smokers were older. Overall, smokers had fewer cardiovascular risk factors when compared to NS. ST-segment elevation myocardial infarction was more common among nicotine smokers (CS 54.4%, WS 57.3%, 47.3% CW vs 30% NS, p = 0.001) while NS were more likely to have non-ST elevation ACS. Cigarette (and not waterpipe) smokers were more likely to present early and with typical symptoms when compared to NS and WS. Admission heart rate and blood pressures were higher in the non-smoker group and WS. Non-smokers and WS were also more likely to present with Killip class >1. After adjustment for baseline variables, smoking was not an independent predictor of adverse cardiac events. CONCLUSION Cigarette smoking is prevalent among Middle-Eastern patients presenting with acute coronary syndrome. Waterpipe smoking use is low; however it is relatively more frequent in women when compared to cigarette smoking. The current study underscores the need for further studies into the effects of different forms of nicotine smoking.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation, Qatar and Weill Cornell Medical College, Qatar.
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Smoking cessation and outcome in stable outpatients with coronary, cerebrovascular, or peripheral artery disease. Eur J Prev Cardiol 2011; 20:486-95. [DOI: 10.1177/1741826711426090] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Bähler C, Gutzwiller F, Erne P, Radovanovic D. Lower age at first myocardial infarction in female compared to male smokers. Eur J Prev Cardiol 2011; 19:1184-93. [DOI: 10.1177/1741826711422764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Bähler
- AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
| | - Felix Gutzwiller
- Institute of Social and Preventive Medicine, University of Zurich, Switzerland
| | - Paul Erne
- Division of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Switzerland
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Godtfredsen NS, Prescott E. Benefits of smoking cessation with focus on cardiovascular and respiratory comorbidities. CLINICAL RESPIRATORY JOURNAL 2011; 5:187-94. [PMID: 21689381 DOI: 10.1111/j.1752-699x.2011.00262.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Smoking cessation is crucial in preventing premature morbidity, disability and mortality worldwide. The effectiveness of quitting tobacco use surpasses any other intervention to minimise the risk for chronic cardiac and respiratory conditions. The overall health benefits of smoking cessation have been recognised for decades but as tobacco legislation has been changing in recent years, new evidence particularly concerning the effect of less smoke exposure on the vascular system has emerged. Recently, much research in chronic obstructive pulmonary disease (COPD) has concerned the ongoing inflammation - also in former smokers - and disease heterogeneity, which provides new knowledge regarding current and ex-smokers with COPD. Many other cardiovascular and respiratory diseases are associated with smoking, and the course of these diseases is not always studied in the context of smoking cessation versus continued smoking. This review summarises the latest available data on health benefits of smoking cessation with focus on both common and infrequent cardiovascular and respiratory diseases.
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Affiliation(s)
- Nina Skavlan Godtfredsen
- Departments of Pulmonary Medicine Cardiology, Bispebjerg University Hospital, Copenhagen, NV, Denmark.
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Panduranga P, Sulaiman K, Al-Zakwani I, Abdelrahman S. Acute coronary syndrome in young adults from oman: results from the gulf registry of acute coronary events. Heart Views 2011; 11:93-8. [PMID: 21577375 PMCID: PMC3089825 DOI: 10.4103/1995-705x.76799] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence, risk factors, presenting features, and in-hospital outcomes of acute coronary syndrome (ACS) patients ≤40 years of age from Oman. METHODS Data were analyzed from 1579 consecutive ACS patients from Oman during May, 2006 to June, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). ACS patients ≤40 years of age were compared with patients >40 years of age. RESULTS A total of 121 (7.6%) patients were ≤40 years of age with mean age of 36 ± 4 vs. 61 ± 11 years in young and old adults, respectively (P<0.001). More men were seen in the younger age group (81 vs. 60%; P<0.001). Among all the coronary risk factors, young patients had more history of smoking (47 vs. 15%; P<0.001), obesity (72 vs. 58%; P = 0.009), and family history of coronary artery disease (CAD) (16 vs. 7%; P = 0.001). Both groups received aspirin, statins, thrombolytic therapy, and anticoagulants equally; however, younger patients received clopidogrel, glycoprotein IIb/IIIa inhibitors, β-blockers, and in-hospital coronary angiogram more. Younger patients experienced less heart failure (6 vs. 27%; P<0.001) and in-hospital mortality, especially among STEMI patients (0 vs. 10%; P = 0.037). CONCLUSIONS Young ACS patients from Oman have different risk profile. They were treated more aggressively and their outcome was better, which is similar to other populations. However, smoking, along with obesity and family history of CAD were strong risk factors in the young Omani ACS patients. There is a need for prevention programmes to control smoking and obesity epidemic by targeting young adults in the population.
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Familial hypercholesterolemias: prevalence, genetics, diagnosis and screening recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. J Clin Lipidol 2011; 5:S9-17. [PMID: 21600530 DOI: 10.1016/j.jacl.2011.03.452] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 11/20/2022]
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Long-term predictors of smoking cessation in a cohort of myocardial infarction survivors: a longitudinal study. ACTA ACUST UNITED AC 2011; 18:533-41. [DOI: 10.1177/1741826710389371] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Assiri AS. Gender differences in clinical presentation and management of patients with acute coronary syndrome in Southwest of Saudi Arabia. J Saudi Heart Assoc 2011; 23:135-41. [PMID: 24146527 DOI: 10.1016/j.jsha.2011.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/02/2011] [Accepted: 01/03/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Gender differences in the clinical presentation and management of patients with acute coronary syndrome (ACS) have been reported in different parts of the world with contradicting results. We aimed at investigating the presence of gender bias in patients admitted with ACS to Aseer Central Hospital (ACH). METHODS A retrospective cohort of all consecutive patients admitted to ACH with the diagnosis of ACS, during the period between the 1st of June 2007 and the 31st of May 2009 was studied. Data on demographic and clinical profiles, management and outcomes of ACS patients were collected and compared for both genders. RESULTS The present study included 148 females and 397 males. Females were significantly older than males (62.9 ± 14.2 vs. 60 ± 13.4, respectively, P < 0.03), were less likely ever to have smoked (0.7% vs. 26.2%, respectively, P < 0.001), less likely to have had a history of hyperlipidemia (10.8% vs. 22.2%, respectively, P < 0.003) or family history of ischemic heart disease (10.1% vs. 18.9%, respectively, P < 0.014). Female patients presented more with atypical presentation (42.6% vs. 28.9%, respectively, P < 0.003), more with unstable angina (72.3% vs. 50.4%, respectively, P < 0.001), and less with ST-elevation myocardial infarction (18.9% vs. 40.8%, respectively, P < 0.001). Furthermore, they had significantly lower levels of hemoglobin compared to males (12.9 ± 2.3 vs. 14.5 ± 2.2 g/L, respectively, P < 0.001), and higher levels of high density lipoprotein (1.1 ± 0.4 vs. 0.98 ± 0.4 mmol/L, respectively, P < 0.008). Left ventricular ejection fraction was significantly higher in female patients compared to males (50.9 ± 14 vs. 45.8 ± 14, respectively, P < 0.003). Coronary angiography showed a higher rate of normal findings (29.3% vs. 8.9%, respectively, P < 0.001) and less severe disease (46.7% vs. 60.3%, respectively, P < 0.027) in women, however, they were less likely to undergo invasive revascularization procedures (31% vs. 42.8%, respectively, P < 0.013). No significant differences were found between both sexes regarding in-hospital mortality or re-infarction rates. CONCLUSION We documented gender differences in both clinical presentation as well as management of patients admitted with ACS to ACH. However, there were no significant differences between both genders regarding the clinical in-hospital outcomes. Emphasis should be made to avoid such bias in the future.
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Affiliation(s)
- Abdullah S Assiri
- King Khalid University, Interventional Cardiology Consultant, College of Medicine, P.O. Box 641, 61421 Abha, Saudi Arabia
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Pineda J, Marín F, Marco P, Roldán V, Valencia J, Ruiz-Nodar JM, Romero DH, Sogorb F, Lip GY. The prognostic value of biomarkers after a premature myocardial infarction. Int J Cardiol 2010; 143:249-54. [DOI: 10.1016/j.ijcard.2009.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/14/2009] [Accepted: 02/19/2009] [Indexed: 11/28/2022]
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Chrysohoou C, Panagiotakos DB, Aggelopoulos P, Kastorini CM, Kehagia I, Pitsavos C, Stefanadis C. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. Am J Clin Nutr 2010; 92:47-54. [PMID: 20484450 DOI: 10.3945/ajcn.2009.28982] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of the cardioprotective Mediterranean diet on the development of cardiac abnormalities and prognosis of cardiac patients has rarely been investigated. OBJECTIVE We sought to evaluate the relation between the Mediterranean diet, the development of left ventricular systolic dysfunction (LVSD) at hospitalization, and the 2-y prognosis of patients who have had an acute coronary syndrome (ACS). DESIGN During 2006-2009, 1000 consecutive patients with ACS were enrolled; of these patients, 459 had LVSD (ejection fraction <40%) at hospitalization [367 men with a mean (+/-SD) age of 64 +/- 14 y, and 92 women aged 71 +/- 12 y], whereas 541 had preserved left ventricular systolic function (421 men aged 62 +/- 12 y, and 120 women aged 67 +/- 12 y). Adherence to the Mediterranean diet was assessed by the validated Mediterranean Diet Score (MedDietScore; theoretical range: 0-55). RESULTS The MedDietScore was associated with less likelihood of developing LVSD at hospitalization [odds ratio (OR) per 1/55 unit: 0.93; 95% CI: 0.88, 0.99; P = 0.04], less likelihood of remodeling (ie, ejection fraction <50% at 3 mo follow-up; OR: 0.90; 95% CI: 0.78, 1.03: P = 0.06), and less likelihood of recurrent cardiovascular disease events during the 2 y of follow-up (OR: 0.88; 95% CI: 0.80, 0.98; P = 0.04), after adjustment for various confounders. CONCLUSIONS Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an ACS.
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Hopkins PN. Encouraging appropriate treatment for familial hypercholesterolemia. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.10.22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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L J, N B, O R, J-Y W, R LB, J L, J-P M. [Acute myocardial infarction in young smokers treated by coronary angioplasty. In-hospital prognosis and long-term outcome in a consecutive series of 93 patients]. Ann Cardiol Angeiol (Paris) 2010; 59:119-24. [PMID: 20511119 DOI: 10.1016/j.ancard.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 04/06/2010] [Indexed: 11/16/2022]
Abstract
AIMS OF THE STUDY The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty. PATIENTS AND METHOD This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008. RESULTS We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5+/-3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0+/-15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers. CONCLUSION Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation.
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Affiliation(s)
- Jacquemin L
- Service de cardiologie, centre hospitalier Emile-Muller, 20, rue du Docteur Laennec, Mulhouse, France.
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Barrios V, Escobar C, Murga N, Quijano JJ. Clinical profile and management of patients with chronic ischemic heart disease according to age in the population daily attended by cardiologists in Spain The ELDERCIC study. Eur J Intern Med 2010; 21:180-4. [PMID: 20493419 DOI: 10.1016/j.ejim.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/10/2009] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study was aimed to evaluate the differences according to age in the clinical profile and management of outpatients with chronic ischemic heart disease attended by cardiologists in Spain. METHODS Patients with an established diagnosis of chronic ischemic heart disease were included in this cross-sectional multicenter study. The age of 65 years was considered as the cut-off point for the present analysis. RESULTS A total of 1038 subjects were included, 524 of them (50.5%) >65 years. Patients >65 years had a lesser prevalence of smoking, a longer history of hypertension, a worse left ventricular ejection fraction and a higher prevalence of heart failure and renal insufficiency than younger subjects. The number of prescribed drugs was higher in patients >65 years (6.1+/-1.9 vs 5.7+/-2.1, p=0.004). Blood pressure control rate was lower in older patients (38.1% vs 46.5%, p=0.008). No significant differences were found either in LDL-cholesterol (42.4% vs 46.5%), or glycemic control rates (42.4% vs 41.4%), both p=NS. Diagnostic and therapeutic procedures were also compared in >65 vs < or =65 years, exercise test was performed in 51.5% vs 62.8% (p<0.0001); stress echocardiography in 18.3% vs 13.2% (p=0.027); coronary angiography in 38.6% vs 53.5% (p<0.0001); and coronary revascularization in 37.2% vs 46.9% (p=0.002), without significant differences in electrocardiogram, echocardiogram, or isotopic exams. CONCLUSIONS Older patients exhibited a worse clinical profile and a worse blood pressure control rate than the younger. However, diagnostic and therapeutic procedures appear to be frequently underused in the old patients.
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Affiliation(s)
- Vivencio Barrios
- Vivencio Barrios, Dept. of Cardiology, Hospital Ramón y Cajal, Ctra. Colmenar km 9.100, 28034 Madrid, Spain.
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Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Niedermaier G, Keller PF, Gutzwiller F, Erne P. Acute coronary syndromes in young patients: presentation, treatment and outcome. Int J Cardiol 2009; 148:300-4. [PMID: 19942306 DOI: 10.1016/j.ijcard.2009.11.009] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 10/26/2009] [Accepted: 11/15/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Acute coronary syndromes (ACS) in very young patients have been poorly described. We therefore evaluate ACS in patients aged 35 years and younger. METHODS In this prospective cohort study, 76 hospitals treating ACS in Switzerland enrolled 28,778 patients with ACS between January 1, 1997, and October 1, 2008. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). RESULTS 195 patients (0.7%) were 35 years old or younger. Compared to patients>35 years, these patients were more likely to present with chest pain (91.6% vs. 83.7%; P=0.003) and less likely to have heart failure (Killip class II to IV in 5.2% vs. 23.0%; P<0.001). STEMI was more prevalent in younger than in older patients (73.1% vs. 58.3%; P<0.001). Smoking, family history of CAD, and/or dyslipidemia were important cardiovascular risk factors in young patients (prevalence 77.2%, 55.0%, and 44.0%). The prevalence of overweight among young patients with ACS was high (57.8%). Cocaine abuse was associated with ACS in some young patients. Compared to older patients, young patients were more likely to receive early percutaneous coronary interventions and had better outcome with fewer major adverse cardiac events. CONCLUSIONS Young patients with ACS differed from older patients in that the younger often presented with STEMI, received early aggressive treatment, and had favourable outcomes. Primary prevention of smoking, dyslipidemia and overweight should be more aggressively promoted in adolescence.
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Affiliation(s)
- Andreas W Schoenenberger
- Department of Geriatrics and General Internal Medicine, University of Berne Hospital Inselspital, Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland
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