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Sagris M, Theofilis P, Mistakidou V, Oikonomou E, Tsioufis K, Tousoulis D. Young and older patients with acute myocardial infarction: differences in risk factors and angiographic characteristics. Hellenic J Cardiol 2024:S1109-9666(24)00112-X. [PMID: 38734305 DOI: 10.1016/j.hjc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/21/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE Although coronary artery disease mainly affects older individuals, the incidence of myocardial infarction (MI) among younger adults (<55 years) has increased during the past decade. Young and older MI patients have different underlying pathophysiologic characteristics, atherosclerotic plaque morphology, and risk factor profiles. METHODS We studied 977 patients (≤55 years old: 322, >55 years old: 655) who were hospitalized for MI in the previous 5 years. Patients' baseline characteristics and daily habits were recorded. Angiographic characteristics and vascular lesions were detected, and further examinations, including flow-mediated dilation (FMD), pulse wave velocity (PWV), and central augmentation index (AIx), were performed. Biomarkers of inflammation (Interleukin-6, Tumor-Necrosis factor-a, Intercellular Adhesion Molecule 1, and Osteopontin) were also tested. RESULTS The median age in the younger age group was 49 years [interquartile range (IQR: 44-53)] and 66 years (IQR: 61-73) in the older age group. Arterial hypertension was less prevalent in the young compared to the elderly with MI (47.4% vs. 76.2%, p < 0.01). The younger counterparts presented significantly lower rates of diabetes mellitus (19.3% vs. 30.6%, p < 0.01), dyslipidemia (59% vs. 70.8%, p < 0.01), and atrial fibrillation (2.6% vs. 9.7%, p < 0.01) and were more casual smokers (49.3% vs. 23.8%, p < 0.01) compared to older patients with MI. In terms of arterial stiffness, lower PWV [7.3 m/s (IQR: 6.5-8.4 m/s) vs. 9 m/s (IQR: 8-10.8 m/s), p < 0.01] and AIx (20.5 ± 10.8 vs. 25.5 ± 7.8, p < 0.01) were recorded in the young compared to the elderly with MI. Concerning angiographic characteristics, younger patients were more likely to have none or single-vessel disease (55.6% vs. 45.8%, p < 0.02), whereas the older participants more frequently had three or more vessel disease (23.5% vs. 13.6% in the young, p < 0.02). Although significant disparities in blood test results were detected during the acute phase, the great majority of young MI patients were undertreated. CONCLUSION Younger patients with MI are more likely to be smokers with impaired PWV measures, present with non-obstructive or single-vessel disease, and often remain undertreated. A better knowledge of the risk factors as well as the anatomic and pathophysiologic processes in young adults will help enhance MI prevention and treatment options in this patient population.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.
| | - Panagiotis Theofilis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Vasiliki Mistakidou
- 3rd Cardiology Department, "Sotiria" Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece; 3rd Cardiology Department, "Sotiria" Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
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Kumar R, Ammar A, Qayyum D, Mujtaba M, Siddiqui MN, Khan MQ, Rahooja K, Rasool M, Samad M, Khan N, Sial JA, Saghir T, Qamar N, Hakeem A, Karim M. Increasing Incidence of ST-Elevation Acute Coronary Syndrome in Young South Asian Population, a Challenge for the World? An Assessment of Clinical and Angiographic Patterns and Hospital Course of Premature Acute Myocardial Infarction. Am J Cardiol 2023; 205:190-197. [PMID: 37611409 DOI: 10.1016/j.amjcard.2023.07.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
The incidence of premature ischemic heart disease (IHD) is increasing because of urbanization, a sedentary lifestyle, and various other unexplored factors, especially in South Asia. This study aimed to assess the distribution of premature ST-elevation acute coronary syndrome (STE-ACS) with its clinical and angiographic pattern along with hospital course in a contemporary cohort of patients who underwent primary percutaneous intervention at a tertiary care center in the South Asian region. We included consecutive patients of either gender diagnosed with STE-ACS and who underwent primary percutaneous intervention. Patients were stratified based on age as ≤40 years (young) and >40 years (old). Clinical characteristics, angiographic patterns, and hospital course were compared between the 2 groups. Of the total of 4,686 patients, 466 (9.9%) were young (≤40 years). Young patients had a lower prevalence of hypertension (40.8% vs 54.5%, p <0.001), diabetes (26.6% vs 36.4%, p <0.001), metabolic syndrome (14.8% vs 24%, p <0.001), history of IHD (5.8% vs 9.3%, p = 0.013) and a higher frequency of smoking (33% vs 24.7%, p <0.001), positive family history (8.2% vs 3.2%, p <0.001), and single-vessel involvement (60.1% vs 33.2%, p <0.001). The composite adverse clinical outcome occurrence was significantly lower in young patients (14.2% vs 19.5%, p = 0.006). On multivariable analysis, history of IHD in young, whereas age, Killip class III/IV, intubated, arrhythmias on arrival, diabetes, history of IHD, pre-procedure left ventricular end-diastolic pressure, ejection fraction <40%, and slow flow/no-reflow during the procedure were found to be the independent predictors of adverse clinical outcome in old patients. In conclusion, we have a substantial burden of premature STE-ACS, mostly in male patients potentially driven by smoking and positive family history. Despite favorable pathophysiology, with mostly single-vessel hospital courses of STE-ACS in the young equally lethal in nature.
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Affiliation(s)
- Rajesh Kumar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
| | - Ali Ammar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Danish Qayyum
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Mustajab Mujtaba
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Maria Noor Siddiqui
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Qasim Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Kubbra Rahooja
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Rasool
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Maryam Samad
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Naveedullah Khan
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nadeem Qamar
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Abdul Hakeem
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Musa Karim
- Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Samah N, Ugusman A, Hamid AA, Sulaiman N, Aminuddin A. Role of Matrix Metalloproteinase-2 in the Development of Atherosclerosis among Patients with Coronary Artery Disease. Mediators Inflamm 2023; 2023:9715114. [PMID: 37457745 PMCID: PMC10348858 DOI: 10.1155/2023/9715114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Coronary artery disease (CAD) is a caused by atherosclerotic plaque buildup in the coronary arteries that supply blood and oxygen to the heart. Matrix metalloproteinase (MMP) is a family of zinc-dependent endopeptidase that is involved in various stages of atherosclerosis as demonstrated in in vitro and in vivo studies. MMP-2 is associated with both stable and unstable atherosclerotic plaque formation. The current review aimed to identify the role of MMP-2 in atherosclerosis development among CAD patients. Literature search was conducted through four online databases and only studies that were published from 2018 until February 2023 were included. The risk of bias was assessed by using the Newcastle-Ottawa Scale. A total of 10,622 articles were initially identified, and only eight studies that fulfilled the selection criteria were included in this review. The results showed that MMP-2 levels and activity were higher in patients with unstable CAD than those with stable CAD and healthy subjects. There was a significant association between MMP-2 levels and cardiovascular disease with MMP-14 levels, which is a pro-MMP-2 activator. In addition, two single nucleotide polymorphisms of the MMP-2 gene (rs243865 and rs243866) were significantly associated with the development of atherosclerosis. In conclusion, MMP-2 plays a crucial role in the development of atherosclerosis among patients with CAD and could be a potential target for CAD therapy.
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Affiliation(s)
- Nazirah Samah
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Adila A. Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Nadiah Sulaiman
- Centre for Tissue Engineering & Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia
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Onnis C, Muscogiuri G, Cademartiri F, Fanni D, Faa G, Gerosa C, Mannelli L, Suri JS, Sironi S, Montisci R, Saba L. Non-invasive coronary imaging in elderly population. Eur J Radiol 2023; 162:110794. [PMID: 37001255 DOI: 10.1016/j.ejrad.2023.110794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Age is a non-modifiable cardiovascular risk factor, which leads to development and progression of chronic conditions, such as coronary artery disease, by promoting atherosclerosis. Aging is responsible for morphological structure changes of the coronary arteries and specific atherosclerotic plaque features, which can be studied with non-invasive coronary imaging techniques, particularly coronary CT angiography. The aim of this review is to evaluate current knowledge on this technique applied to the elderly population, and to describe CAD manifestation and plaque features of coronary atherosclerosis in this particular set of patients. We also discuss the clinical implication of frailty assessment and customization of diagnostic strategies in order to shift the approach from disease-centered to patient-centered care.
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Doolub G, Kandoole-Kabwere V, Felekos I. Acute Coronary Syndromes Due to Atherosclerotic Coronary Artery Disease in Young Patients. Cardiol Rev 2022; 30:286-292. [PMID: 34224452 DOI: 10.1097/crd.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Young patients represent about 4-10% of the population presenting with acute coronary syndrome. In this focused mini-review, we highlight the data regarding acute coronary syndromes in young patients with atherosclerotic coronary artery disease. Differences in the underlying pathologies and pathophysiological mechanisms should yield to different clinical management and treatment strategies.
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Affiliation(s)
- Gemina Doolub
- From the Bristol Heart Institute, University Hospitals Bristol NHS FT, Bristol, United Kingdom
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Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G, Tsalamandris S, Antoniades C, Brilakis ES, Kaski JC, Tousoulis D. Risk factors profile of young and older patients with myocardial infarction. Cardiovasc Res 2022; 118:2281-2292. [PMID: 34358302 DOI: 10.1093/cvr/cvab264] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/03/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial infarction (MI) among young adults (<45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features, and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidaemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use, and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation, and coagulation are needed.
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Affiliation(s)
- Marios Sagris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Panagiotis Theofilis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Evangelos Oikonomou
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Gerasimos Siasos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sotirios Tsalamandris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Centre of Research Excellence, British Heart Foundation, Oxford, OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, OX3 9DU, UK
| | - Emmanouil S Brilakis
- Division of Cardiovascular Medicine, Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA
| | - Juan C Kaski
- Division of Cardiovascular Medicine, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Dimitris Tousoulis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
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The Effects of Calculated Remnant-Like Particle Cholesterol on Incident Cardiovascular Disease: Insights from a General Chinese Population. J Clin Med 2021; 10:jcm10153388. [PMID: 34362168 PMCID: PMC8348383 DOI: 10.3390/jcm10153388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Growing evidence suggests that remnant cholesterol (RC) contributes to residual atherosclerotic cardiovascular disease (ASCVD) risk. However, the cutoff points to treat RC for reducing ASCVD are still unknown. This study aimed to investigate the relationships between RC and combined cardiovascular diseases (CVDs) in a general China cohort, with 11,956 subjects aged ≥ 35 years. Methods: Baseline RC was estimated with the Friedewald formula for 8782 subjects. The outcome was the incidence of combined CVD, including fatal and nonfatal stroke and coronary heart disease (CHD). The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals. The restricted cubic spline (RCS) model was used to evaluate the dose–response relationship between continuous RC and the natural log of HRs. Results: After a median follow-up of 4.66 years, 431 CVD events occurred. In the Cox proportional models, participants with a high level of categorial RC had a significantly higher risk for combined CVD (HR: 1.37; 95% CI: 1.07–1.74) and CHD (HR: 1.63; 95% CI: 1.06–2.53), compared to those with a medium level of RC. In the stratification analyses, a high level of RC significantly increased combined CVD risk for subgroups females, age < 65 years, noncurrent smokers, noncurrent drinkers, normal weight, renal dysfunction, and no hyperuricemia. The same trends were found for CHD among subgroups males, age < 65 years, overweight, renal dysfunction, and no hyperuricemia; stroke among subgroup females. In RCS models, a significant linear association between RC and combined CVD and a nonlinear association between RC and CHD resulted. The risk of outcomes was relatively flat until 0.84 mmol/L of RC and increased rapidly afterwards, with an HR of 1.308 (1.102 to 1.553) for combined CVD and 1.411 (1.061 to 1.876) for CHD. Stratified analyses showed a significant nonlinear association between RC and CVD outcomes in the subgroup aged < 65 years or the diabetes subgroup. Conclusions: In this large-scale and long-term follow-up cohort study, participants with higher RC levels had a significantly worse prognosis, especially for the subgroup aged 35–65 years or the diabetes mellitus subgroup.
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Vermiglio E, Bortoletto E, Brunelli M, Sipala S, De Leo D. Sudden death in a 39-year-old woman due to three-vessel coronary artery disease: A case report and literature review. MEDICINE, SCIENCE, AND THE LAW 2021; 61:150-154. [PMID: 33591868 DOI: 10.1177/0025802420929210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronary atherosclerosis may be underestimated in previously asymptomatic and apparently healthy young people, although it has been reported in various epidemiological studies. Between 7% and 21% of sudden cardiac deaths in previously asymptomatic people aged <45 years are due to three-vessel coronary artery disease. So, clinical services need to vigilant for this condition. We report a single case of sudden death in a young woman who was affected by three-vessel coronary artery disease. This 39-year-old woman attended an emergency department for non-specific chest pain. After a brief observation period, in the absence of signs of an acute myocardial event, she self-discharged. However, she died suddenly the next day. The subsequent autopsy did not show significant pathological findings, although macroscopic examination of the heart revealed critical three-vessel coronary artery disease. Standard histological examination confirmed an atheromatous plaque obstructing >75% of the lumen of the anterior descending artery, complicated by haemorrhagic phenomena, with diffuse calcified and sub-totally occluded atherosclerotic plaques in the other vascular sections, without ischaemic signs of the cardiomyocytes or fibrosis. When young people present with chest pain, they must be carefully evaluated. Risks need to be clearly explained, particularly when self-discharge is requested.
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Affiliation(s)
- Elisa Vermiglio
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Elena Bortoletto
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health - Unit of Pathology, University of Verona, Italy
| | - Stefania Sipala
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
| | - Domenico De Leo
- Department of Diagnostics and Public Health - Legal Medicine and Forensic Pathology Unit, University of Verona, Italy
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Delgado GE, Zirlik A, Gruber R, Scheffold T, Krämer BK, März W, Kleber ME. The association of high-normal international-normalized-ratio (INR) with mortality in patients referred for coronary angiography. PLoS One 2019; 14:e0221112. [PMID: 31415634 PMCID: PMC6695160 DOI: 10.1371/journal.pone.0221112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Aims The international-normalized-ratio (INR) is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The aim of our study was to investigate the association of the INR with mortality in coronary artery disease (CAD) patients not on oral anticoagulant therapy. Methods and results Between 1997 to 2000 the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study enrolled 3316 patients of German ancestry that had been referred for coronary angiography. We excluded patients on coumarin therapy (n = 222) and patients with an INR more than 5 standard deviations (SD) away from the mean (n = 30). During a median follow-up of 9.9 years, 884 patients died, 547 patients from cardiovascular causes. After adjustment for cardiovascular risk factors the INR was associated with all-cause mortality in all patients and the CAD positive group with HRs (95% CI) of 1.14(1.07–1.21) and 1.16(1.09–1.23) per 1-SD increase, respectively. Adjustment for NT-proBNP rendered the association insignificant. Conclusion In LURIC, the INR was positively associated with mortality in patients with prevalent CAD not on oral anticoagulant therapy as well as in patients without CAD. Adjustment for NT-proBNP abolished the association suggesting clinical or subclinical heart failure strongly contributing to increased INR and higher mortality.
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Affiliation(s)
- Graciela E. Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Zirlik
- University Heart Centre Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rudolf Gruber
- Hospital of the Order of St.John of God, Central Laboratory, Regensburg, Germany
| | - Thomas Scheffold
- MediClin Medical Care Centre, Department of Cardiology, Lahr, Germany
| | - Bernhard K. Krämer
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- * E-mail:
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Vaideeswar P, Tyagi S, Singaravel S. Pathology of atherosclerotic coronary artery disease in the young Indian population. Forensic Sci Res 2019; 4:241-246. [PMID: 31489389 PMCID: PMC6713168 DOI: 10.1080/20961790.2019.1592315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 02/03/2023] Open
Abstract
Atherosclerotic coronary artery disease (CAD) is of great concern in young adults because of its potential to cause great incapacitation. This arena of cardiology has gained importance in South Asian countries, particularly India due to increased prevalence that is related to traditional risk factors, altered life styles and inherent risk factors. In this study, we sought to evaluate, at autopsy, the pathology of atherosclerotic CAD in young patients with ischemic heart disease (IHD). A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Shashank Tyagi
- Department of Forensic Medicine & Toxicology, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Saranya Singaravel
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, India
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11
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Rahimi R, Singh MKC, Noor NM, Omar E, Noor SM, Mahmood MS, Abdullah N, Nawawi HM. Manifestation of Coronary Atherosclerosis in Klang Valley, Malaysia: An Autopsy Study. J Atheroscler Thromb 2018; 25:405-409. [PMID: 29118310 PMCID: PMC5945553 DOI: 10.5551/jat.39107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aims: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis. Methods: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented. Results: Male and female subjects aged 18–70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD). Conclusion: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.
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Affiliation(s)
- Razuin Rahimi
- The Centre for Pathology Diagnostic and Research Laboratories (CPDRL), Faculty of Medicine, Universiti Teknologi MARA.,Department of Forensic Medicine, Hospital Sungai Buloh
| | - Mansharan Kaur Chainchel Singh
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA.,National Institute of Forensic Medicine, Hospital Kuala Lumpur
| | - Norizal Mohd Noor
- The Centre for Pathology Diagnostic and Research Laboratories (CPDRL), Faculty of Medicine, Universiti Teknologi MARA
| | - Effat Omar
- The Centre for Pathology Diagnostic and Research Laboratories (CPDRL), Faculty of Medicine, Universiti Teknologi MARA
| | | | | | | | - Hapizah Mohd Nawawi
- The Centre for Pathology Diagnostic and Research Laboratories (CPDRL), Faculty of Medicine, Universiti Teknologi MARA.,Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA
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Abstract
The Women's Health Initiative studies and others have suggested that menopausal hormone therapy may enhance the risk of new cardiovascular (CV) events in older women and diminish the development of coronary atherosclerosis in younger women. The underlying mechanisms to explain these findings are encapsulated in the term "Timing Hypothesis." Extensive pathophysiologic studies have provided mechanistic evidence for the dichotomous effects of estrogen on coronary artery vasculature. Early in the atherosclerotic disease process, estrogen exerts protective effects on the endothelium and retards plaque formation. Late in the process, estrogen causes plaque erosion or rupture with subsequent thrombosis and acute coronary events. Analysis of the Timing Hypothesis in women examined in the Women's Health Initiative primarily used chronologic age to assess divergent effects of estrogen. The complexity of the data underlying coronary pathophysiology has resulted in controversy whether MHT can be used in older women or those with prior CV disease. In a debate of this issue at a recent International Menopause Society meeting, the concept of using CV age rather than chronologic age was discussed as a practical method of resolving this issue and facilitating therapeutic decisions in older women. This "Personal Perspective" will review the concepts underlying CV age, describe how it is determined, provide support for its utility, and propose future studies using this parameter.
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Trakarnwijitr I, Li B, Adams H, Layland J, Garlick J, Wilson A. Age modulates the relationship between platelet-to-lymphocyte ratio and coronary artery disease. Int J Cardiol 2017; 248:349-354. [DOI: 10.1016/j.ijcard.2017.06.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 01/31/2023]
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van den Berg MJ, Westerink J, van der Graaf Y, Kappelle LJ, de Borst GJ, Cramer MJM, Visseren FLJ. Risk Factors for Recurrent Cardiovascular Events Before Age 65 Years or Within 2.5 Years of a Recent First Cardiovascular Event. Am J Cardiol 2017; 120:167-173. [PMID: 28532782 DOI: 10.1016/j.amjcard.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 01/14/2023]
Abstract
The aim of this study was to quantify the relation between classical risk factors (smoking, diabetes, BMI, waist circumference, blood pressure, and lipids), risk factor targets, and risk of recurrent major atherosclerotic cardiovascular events (MACE). This was first done for recurrent MACE ≤65 years in patients aged <60 years and second for recurrent MACE ≤2.5 years after a first cardiovascular event. Data were used from the Second Manifestations of Arterial Disease study (n = 5,115), a prospective cohort of patients with a recent (≤1 year) first cardiovascular event. During follow-up, 746 recurrent MACE occurred. Smoking (hazard ratio [HR] 1.43, 95% CI 1.11 to 1.84), diabetes (HR 1.83, 95% CI 1.11 to 1.84), diastolic blood pressure (>90 vs 70 to 90 mm Hg, HR 1.54, 95% CI 1.15 to 2.07), and high-density lipoprotein cholesterol (≤1.0 vs >1.0 mmol/L, HR 1.34, 95% CI 1.03 to 1.76) were related to increased risk of recurrent MACE ≤65 years in patients aged <60 years. Smoking (HR 1.65, 95% CI 1.23 to 2.22), physical inactivity (highest vs lowest tertile, HR 1.48, 95% CI 1.05 to 2.09), body mass index (per kg/m2, HR 1.04, 95% CI 1.00 to 1.08), diastolic blood pressure (>90 vs 70 to 90 mm Hg, HR 1.61, 95% CI 1.17 to 2.21), low-density lipoprotein cholesterol (per mmol/L, HR 1.18, 95% CI 1.02 to 1.37), and non-high-density lipoprotein cholesterol (per mmol/L, HR 1.15, 95% CI 1.03 to 1.28) were related to recurrent MACE ≤2.5 years of follow-up. In conclusion, in patients with a recent cardiovascular event, smoking, blood pressure, and lipids are related to increased risk of recurrent cardiovascular events at young age or within a short time span, and intensive treatment of modifiable risk factors may contribute to prevent recurrent MACE in these patients.
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Affiliation(s)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten-Jan M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
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