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Lai M, Cheung CC, Olgin J, Pletcher M, Vittinghoff E, Lin F, Hue T, Lee BK. Risk Factors for Arrhythmic Death, Overall Mortality, and Ventricular Tachyarrhythmias Requiring Shock After Myocardial Infarction. Am J Cardiol 2023; 187:18-25. [PMID: 36459743 DOI: 10.1016/j.amjcard.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
The VEST (Vest Prevention of Early Sudden Death Trial) showed a trend toward decreased sudden death and lower overall mortality with a wearable cardioverter-defibrillator (WCD) in the postmyocardial infarction (post-MI) period. However, it is unclear which patients should receive WCD therapy. We aimed to identify the risk factors for arrhythmic death, all-cause mortality, and ventricular tachyarrhythmias requiring appropriate shock to identify patients most likely to benefit from a WCD. The VEST trial included patients with acute MI with ejection fraction ≤35%. Using logistic regression, 7 risk factors were evaluated for association with arrhythmic death, all-cause mortality, and appropriate shock. Among 2,302 participants, 44 had arrhythmic death (1.9%) and 86 died of any cause (3.7%). Among 1,524 participants randomized to WCD, 20 experienced appropriate shock (1.3%) over 90 days. In the multivariable analyses, lower systolic blood pressure (SBP; odds ratio [OR] 1.64 per 10 mm Hg) and higher heart rate at discharge (OR 1.19 per 10 beats/min) were associated with arrhythmic death. Lower SBP (OR 1.37) and higher heart rate (OR 1.10) were associated with all-cause mortality. Higher heart rate (OR 1.20) was associated with appropriate shock. Patients with both SBP ≤100 and heart rate ≥100 were at increased odds of arrhythmic death (OR 4.82), all-cause mortality (OR 3.10), and appropriate shock (OR 6.13). In patients with acute MI and reduced ejection fraction, lower SBP and higher heart rate at discharge were strongly associated with arrhythmic death and all-cause mortality. In conclusion, these risk factors identify a select group at high risk of adverse events in a setting where WCD therapy is reasonable.
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Affiliation(s)
- Mason Lai
- School of Medicine; Division of Cardiology, Department of Medicine; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Christopher C Cheung
- Division of Cardiology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jeffrey Olgin
- Division of Cardiology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mark Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; and Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Trisha Hue
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Byron K Lee
- Division of Cardiology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
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Huang Z, Chen Z, Wang X, Ding X, Cai Z, Li W, Cai Z, Lan Y, Chen G, Fang W, Wu S, Chen Y. Association of Cardiovascular Health Score Trajectory With Incident Myocardial Infarction in Hypertensive Patients. Hypertension 2022; 79:2622-2630. [PMID: 36082672 DOI: 10.1161/hypertensionaha.122.19633] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The association between changes in cardiovascular health score (CHS) over time and myocardial infarction (MI) risk in hypertensive patients remains unclear. METHOD This was a prospective study comprising 17 374 hypertensive patients from the Kailuan study cohort who underwent 3 surveys and were identified to be free of MI, stroke, or cancer from 2006 to 2010. CHS consisted of 7 cardiovascular health metrics (plasma glucose, total cholesterol, blood pressure, smoking, body mass index, physical activity, salt intake), ranging from 0 (worst) to 13 (best) in the study. CHS trajectories were developed during 2006 to 2010 to predict the MI risk from 2010 to 2020. Additionally, the Cox proportional hazard model was established to calculate the hazard ratio and 95% CI of incident MI in different trajectory groups. RESULT This study identified the 5 CHS trajectories from 2006 to 2010: low-stable (n=1161; range, 4.7-4.5), moderate-decreasing (n=3928; decreased from 6.9 to 6.0), moderate-increasing (n=1014; increased from 5.6 to 7.8), high-stable I (n=7940; range, 8.1-8.2), and high-stable II (n=3331; range, 9.2-9.7). During the median follow-up of 10.04 years, 288 incident MI cases were identified. After adjusting for potential confounders, compared with low-stable group, the hazard ratio and 95% CI of MI were 0.24 (0.15-0.40) for high-stable II, 0.36 (0.24-0.54) for high-stable I, 0.46 (0.25-0.83) for moderate-increasing, and 0.61 (0.41-0.90) for moderate-decreasing, respectively. CONCLUSIONS In hypertensive patients, high-stable CHS or improvement in CHS is associated with a lower risk of incident MI, when compared with low-stable CHS trajectory over time.
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Affiliation(s)
- Zegui Huang
- Shantou University Medical College, China
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China]
| | - Zekai Chen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands (Z. Chen)
| | - Xianxuan Wang
- Shantou University Medical College, China (Z.H., X.W., Zhiwei Cai, W.F.)
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China (Z.H., X.W., Zefeng Cai, Y.L., W.F., Y.C.)
| | - Xiong Ding
- School of Public Health, Wuhan University, China (X.D.)
| | - Zefeng Cai
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China (Z.H., X.W., Zefeng Cai, Y.L., W.F., Y.C.)
| | - Weijian Li
- Department of Cardiology, Shenzhen Luohu People's Hospital, China (W.L.)
| | - Zhiwei Cai
- Shantou University Medical College, China (Z.H., X.W., Zhiwei Cai, W.F.)
| | - Yulong Lan
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China (Z.H., X.W., Zefeng Cai, Y.L., W.F., Y.C.)
| | - Guanzhi Chen
- China Medical University, Shenyang, China (G.C.)
| | - Wei Fang
- Shantou University Medical College, China (Z.H., X.W., Zhiwei Cai, W.F.)
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China (Z.H., X.W., Zefeng Cai, Y.L., W.F., Y.C.)
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China
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Zhang J, Sun R, Jiang T, Yang G, Chen L. Circadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease. Biomolecules 2021; 11:biom11060868. [PMID: 34207942 PMCID: PMC8230716 DOI: 10.3390/biom11060868] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/21/2022] Open
Abstract
Blood pressure (BP) follows a circadian rhythm, it increases on waking in the morning and decreases during sleeping at night. Disruption of the circadian BP rhythm has been reported to be associated with worsened cardiovascular and renal outcomes, however the underlying molecular mechanisms are still not clear. In this review, we briefly summarized the current understanding of the circadian BP regulation and provided therapeutic overview of the relationship between circadian BP rhythm and cardiovascular and renal health and disease.
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Affiliation(s)
- Jiayang Zhang
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Ruoyu Sun
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Tingting Jiang
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
| | - Guangrui Yang
- School of Bioengineering, Dalian University of Technology, Dalian 116024, China;
| | - Lihong Chen
- Advanced Institute for Medical Sciences, Dalian Medical University, Dalian 116044, China; (J.Z.); (R.S.); (T.J.)
- Correspondence: ; Tel.: +86-411-86118984
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Gameraddin M, Abdalmalik BA, Ibrahim M. The Impact of Khat ( Catha edulis) on Hemodynamics of the Common Carotid Arteries in Regular Khat Chewers: A Case-control Study Using Doppler Ultrasound. J Med Ultrasound 2021; 29:46-49. [PMID: 34084716 PMCID: PMC8081101 DOI: 10.4103/jmu.jmu_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022] Open
Abstract
Background: To evaluate the effect of chewing khat on the hemodynamics of the common carotid arteries (CCAs) using Doppler ultrasound imaging. Methods: This is a cross-sectional case–control study. Fifty volunteers who were chronic regular khat chewers were selected and compared with healthy nonkhat chewers. They were examined using Doppler imaging with a 7–10 MHz linear transducer. The resistivity index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity of the CCAs were determined according to the standard protocol of carotid Doppler ultrasound. Results: The RI and PI of the right and left CCAs were significantly higher in khat chewers compared to controls (P < 0.001). The PSV of the right and left CCAs was considerably higher in khat chewers compared to controls (P < 0.001 and 0.04, respectively). Conclusion: The Doppler values of blood flow velocity, resistivity, and pulsatility were significantly higher in chronic regular khat chewers compared to nonkhat chewers. Khat is a significant contributory factor for increasing the hemodynamics of the CCAs.
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Affiliation(s)
- Moawia Gameraddin
- Department of Diagnostic Radiologic Technology, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Bushra A Abdalmalik
- Department of Diagnostic Radiology Sciences, Faculty of Applied Medical Sciences, Hail University, Hail, Saudi Arabia
| | - Mohamed Ibrahim
- Faculty of Medicine, University of Hargeisa, Hargeisa, Somaliland
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Martin N, Manoharan K, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2021; 5:CD012721. [PMID: 34022072 PMCID: PMC8140651 DOI: 10.1002/14651858.cd012721.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Beta-blockers and inhibitors of the renin-angiotensin-aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction (LVEF); a review of the evidence is required to determine whether these treatments are beneficial for people with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES To assess the effects of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with HFpEF. SEARCH METHODS We updated searches of CENTRAL, MEDLINE, Embase, and one clinical trial register on 14 May 2020 to identify eligible studies, with no language or date restrictions. We checked references from trial reports and review articles for additional studies. SELECTION CRITERIA: We included randomised controlled trials with a parallel group design, enrolling adults with HFpEF, defined by LVEF greater than 40%. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 41 randomised controlled trials (231 reports), totalling 23,492 participants across all comparisons. The risk of bias was frequently unclear and only five studies had a low risk of bias in all domains. Beta-blockers (BBs) We included 10 studies (3087 participants) investigating BBs. Five studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 30 years to 81 years. A possible reduction in cardiovascular mortality was observed (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.99; number needed to treat for an additional benefit (NNTB) 25; 1046 participants; three studies), however, the certainty of evidence was low. There may be little to no effect on all-cause mortality (RR 0.82, 95% CI 0.67 to 1.00; 1105 participants; four studies; low-certainty evidence). The effects on heart failure hospitalisation, hyperkalaemia, and quality of life remain uncertain. Mineralocorticoid receptor antagonists (MRAs) We included 13 studies (4459 participants) investigating MRA. Eight studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 54.5 to 80 years. Pooled analysis indicated that MRA treatment probably reduces heart failure hospitalisation (RR 0.82, 95% CI 0.69 to 0.98; NNTB = 41; 3714 participants; three studies; moderate-certainty evidence). However, MRA treatment probably has little or no effect on all-cause mortality (RR 0.91, 95% CI 0.78 to 1.06; 4207 participants; five studies; moderate-certainty evidence) and cardiovascular mortality (RR 0.90, 95% CI 0.74 to 1.11; 4070 participants; three studies; moderate-certainty evidence). MRA treatment may have little or no effect on quality of life measures (mean difference (MD) 0.84, 95% CI -2.30 to 3.98; 511 participants; three studies; low-certainty evidence). MRA treatment was associated with a higher risk of hyperkalaemia (RR 2.11, 95% CI 1.77 to 2.51; number needed to treat for an additional harmful outcome (NNTH) = 11; 4291 participants; six studies; high-certainty evidence). Angiotensin-converting enzyme inhibitors (ACEIs) We included eight studies (2061 participants) investigating ACEIs. Three studies used a placebo comparator and in five the comparator was usual care. The mean age of participants ranged from 70 to 82 years. Pooled analyses with moderate-certainty evidence suggest that ACEI treatment likely has little or no effect on cardiovascular mortality (RR 0.93, 95% CI 0.61 to 1.42; 945 participants; two studies), all-cause mortality (RR 1.04, 95% CI 0.75 to 1.45; 1187 participants; five studies) and heart failure hospitalisation (RR 0.86, 95% CI 0.64 to 1.15; 1019 participants; three studies), and may result in little or no effect on the quality of life (MD -0.09, 95% CI -3.66 to 3.48; 154 participants; two studies; low-certainty evidence). The effects on hyperkalaemia remain uncertain. Angiotensin receptor blockers (ARBs) Eight studies (8755 participants) investigating ARBs were included. Five studies used a placebo comparator and in three the comparator was usual care. The mean age of participants ranged from 61 to 75 years. Pooled analyses with high certainty of evidence suggest that ARB treatment has little or no effect on cardiovascular mortality (RR 1.02, 95% 0.90 to 1.14; 7254 participants; three studies), all-cause mortality (RR 1.01, 95% CI 0.92 to 1.11; 7964 participants; four studies), heart failure hospitalisation (RR 0.92, 95% CI 0.83 to 1.02; 7254 participants; three studies), and quality of life (MD 0.41, 95% CI -0.86 to 1.67; 3117 participants; three studies). ARB was associated with a higher risk of hyperkalaemia (RR 1.88, 95% CI 1.07 to 3.33; 7148 participants; two studies; high-certainty evidence). Angiotensin receptor neprilysin inhibitors (ARNIs) Three studies (7702 participants) investigating ARNIs were included. Two studies used ARBs as the comparator and one used standardised medical therapy, based on participants' established treatments at enrolment. The mean age of participants ranged from 71 to 73 years. Results suggest that ARNIs may have little or no effect on cardiovascular mortality (RR 0.96, 95% CI 0.79 to 1.15; 4796 participants; one study; moderate-certainty evidence), all-cause mortality (RR 0.97, 95% CI 0.84 to 1.11; 7663 participants; three studies; high-certainty evidence), or quality of life (high-certainty evidence). However, ARNI treatment may result in a slight reduction in heart failure hospitalisation, compared to usual care (RR 0.89, 95% CI 0.80 to 1.00; 7362 participants; two studies; moderate-certainty evidence). ARNI treatment was associated with a reduced risk of hyperkalaemia compared with valsartan (RR 0.88, 95% CI 0.77 to 1.01; 5054 participants; two studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS There is evidence that MRA and ARNI treatment in HFpEF probably reduces heart failure hospitalisation but probably has little or no effect on cardiovascular mortality and quality of life. BB treatment may reduce the risk of cardiovascular mortality, however, further trials are needed. The current evidence for BBs, ACEIs, and ARBs is limited and does not support their use in HFpEF in the absence of an alternative indication. Although MRAs and ARNIs are probably effective at reducing the risk of heart failure hospitalisation, the treatment effect sizes are modest. There is a need for improved approaches to patient stratification to identify the subgroup of patients who are most likely to benefit from MRAs and ARNIs, as well as for an improved understanding of disease biology, and for new therapeutic approaches.
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Affiliation(s)
- Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Ceri Davies
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - R Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK
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Davis AP, Wiegers TC, Grondin CJ, Johnson RJ, Sciaky D, Wiegers J, Mattingly CJ. Leveraging the Comparative Toxicogenomics Database to Fill in Knowledge Gaps for Environmental Health: A Test Case for Air Pollution-induced Cardiovascular Disease. Toxicol Sci 2020; 177:392-404. [PMID: 32663284 PMCID: PMC7548289 DOI: 10.1093/toxsci/kfaa113] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Environmental health studies relate how exposures (eg, chemicals) affect human health and disease; however, in most cases, the molecular and biological mechanisms connecting an exposure with a disease remain unknown. To help fill in these knowledge gaps, we sought to leverage content from the public Comparative Toxicogenomics Database (CTD) to identify potential intermediary steps. In a proof-of-concept study, we systematically compute the genes, molecular mechanisms, and biological events for the environmental health association linking air pollution toxicants with 2 cardiovascular diseases (myocardial infarction and hypertension) as a test case. Our approach integrates 5 types of curated interactions in CTD to build sets of "CGPD-tetramers," computationally constructed information blocks relating a Chemical- Gene interaction with a Phenotype and Disease. This bioinformatics strategy generates 653 CGPD-tetramers for air pollution-associated myocardial infarction (involving 5 pollutants, 58 genes, and 117 phenotypes) and 701 CGPD-tetramers for air pollution-associated hypertension (involving 3 pollutants, 96 genes, and 142 phenotypes). Collectively, we identify 19 genes and 96 phenotypes shared between these 2 air pollutant-induced outcomes, and suggest important roles for oxidative stress, inflammation, immune responses, cell death, and circulatory system processes. Moreover, CGPD-tetramers can be assembled into extensive chemical-induced disease pathways involving multiple gene products and sequential biological events, and many of these computed intermediary steps are validated in the literature. Our method does not require a priori knowledge of the toxicant, interacting gene, or biological system, and can be used to analyze any environmental chemical-induced disease curated within the public CTD framework. This bioinformatics strategy links and interrelates chemicals, genes, phenotypes, and diseases to fill in knowledge gaps for environmental health studies, as demonstrated for air pollution-associated cardiovascular disease, but can be adapted by researchers for any environmentally influenced disease-of-interest.
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Affiliation(s)
| | | | | | | | | | | | - Carolyn J Mattingly
- Department of Biological Sciences
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695
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Shan R, Ding J, Weng D, Spaulding EM, Wongvibulsin S, Lee MA, Demo R, Marvel FA, Martin SS. Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology. Am J Prev Cardiol 2020; 3:100089. [PMID: 32964212 PMCID: PMC7497394 DOI: 10.1016/j.ajpc.2020.100089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Objective There is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. Methods In this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. Results Sixty-eight AMI patients (mean age 58 ± 10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 mmHg was 59.6% (95% CI: 54.3–64.9%) and <140/90 mmHg was 83.7% (95% CI: 80.3–87.2%). The percentage of systolic BP <90 mmHg was 1.1% (95% CI: 0.17–2.0%) and the percentage of diastolic BP <60 mmHg was 3.9% (95% CI: 2.6–5.2%). Prior CVD was associated with 12.2 mmHg higher mean daily systolic BP during admission (95% CI: 3.5–20.9 mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. Conclusion The digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health. Digital health reveals home blood pressure trends during early recovery after an event. ~40% of early MI patients had mean daily blood pressure exceeding the guideline goal of <130/80 mmHg. Hypotension occurred rarely over 30 days post-MI. The gap in BP control was especially large in patients in whom MI represented recurrent CVD. There is opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.
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Affiliation(s)
- Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jie Ding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin M. Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
- Corresponding author. Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States.
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Kikuchi N, Ogawa H, Kawada‐Watanabe E, Arashi H, Jujo K, Sekiguchi H, Yamaguchi J, Hagiwara N. Impact of age on clinical outcomes of antihypertensive therapy in patients with hypertension and coronary artery disease: A sub‐analysis of the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease. J Clin Hypertens (Greenwich) 2020; 22:1070-1079. [DOI: 10.1111/jch.13891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Noriko Kikuchi
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Hiroshi Ogawa
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Erisa Kawada‐Watanabe
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Hiroyuki Arashi
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Kentaro Jujo
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Haruki Sekiguchi
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Junichi Yamaguchi
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of CardiologyThe Heart Institute of JapanTokyo Women's Medical University Tokyo Japan
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9
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Which is the worst risk factor for the long-term clinical outcome? Comparison of long-term clinical outcomes between antecedent hypertension and diabetes mellitus in South Korean acute myocardial infarction patients after stent implantation. J Diabetes 2020; 12:119-133. [PMID: 31420948 DOI: 10.1111/1753-0407.12979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypertension and diabetes mellitus (DM) are major risk factors for the cardiovascular disease. In this retrospective cohort study, we compared the long-term clinical outcomes between antecedent hypertension and DM in acute myocardial infarction (AMI) patients after stent implantation. METHODS A total of 32 938 eligible AMI patients were enrolled and divided into the four groups according to the presence or absence of hypertension and DM (hypertension -/DM -[group A, 13 773 patients], hypertension +/DM -[group B, 10 395 patients], hypertension -/DM + [group C, 3050 patients], and hypertension +/DM + [group D, 5720 patients]). The clinical endpoint was the cumulative incidence of major adverse cardiac events (MACEs) defined as all-cause death, recurrent myocardial infarction (Re-MI) and any repeat revascularization during the 2-year follow-up period. RESULTS After adjustment, the cumulative incidence of MACEs (adjusted hazard ratio [aHR], 1.232; 95% confidence interval [CI], 0.982-1.567; P = .071), all-cause death, and e-MI Re-MI were similar between the group B and C. However, the cumulative incidences of any repeat revascularization (aHR, 1.438; 95% CI, 1.062-1.997; P = .007), target lesion revascularization (TLR) (aHR, 2.467; 95% CI, 1.552-3.922; P < .001), and target vessel revascularization (TVR) (aHR, 1.671; 95% CI, 1.256-2.222; P < .001) were significantly higher in group C compared with group B. CONCLUSIONS This large number of a nonrandomized and multicenter cohort study clearly demonstrated the detrimental impacts of the hypertension and diabetes on long-term clinical outcomes. Moreover, higher incidence of repeat revascularization after PCI in diabetic AMI patients a major concern until recently.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Seunghwan Kim
- Division of Cardiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, South Korea
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Tanaka K, Jujo K, Yamaguchi J, Ogawa H, Hagiwara N. Optimal Blood Pressure in Patients With Coronary Artery Disease and Chronic Kidney Disease: HIJ-CREATE Substudy. Am J Med Sci 2019; 358:219-226. [DOI: 10.1016/j.amjms.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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11
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Nordlund D, Engblom H, Bonnet JL, Hansen HS, Atar D, Erlinge D, Ekelund U, Heiberg E, Carlsson M, Arheden H. Gender but not diabetes, hypertension or smoking affects infarct evolution in ST-elevation myocardial infarction patients - data from the CHILL-MI, MITOCARE and SOCCER trials. BMC Cardiovasc Disord 2019; 19:161. [PMID: 31269907 PMCID: PMC6610840 DOI: 10.1186/s12872-019-1139-7] [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: 01/08/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infarct evolution rate and response to acute reperfusion therapy may differ between patients, which is important to consider for accurate management and treatment of patients with ST-elevation myocardial infarction (STEMI). The aim of this study was therefore to investigate the association of infarct size and myocardial salvage with gender, smoking status, presence of diabetes or history of hypertension in a cohort of STEMI-patients. METHODS Patients (n = 301) with first-time STEMI from the three recent multi-center trials (CHILL-MI, MITOCARE and SOCCER) underwent cardiac magnetic resonance (CMR) imaging to determine myocardium at risk (MaR) and infarct size (IS). Myocardial salvage index (MSI) was calculated as MSI = 1-IS/MaR. Pain to balloon time, culprit vessel, trial treatments, age, TIMI grade flow and collateral flow by Rentrop grading were included as explanatory variables in the statistical model. RESULTS Women (n = 66) had significantly smaller MaR (mean difference: 5.0 ± 1.5% of left ventricle (LV), p < 0.01), smaller IS (mean difference: 5.1 ± 1.4% of LV, p = 0.03), and larger MSI (mean difference: 9.6 ± 2.8% of LV, p < 0.01) compared to men (n = 238). These differences remained significant when adjusting for other explanatory variables. There were no significant effects on MaR, IS or MSI for diabetes, hypertension or smoking. CONCLUSIONS Female gender is associated with higher myocardial salvage and smaller infarct size suggesting a pathophysiological difference in infarct evolution between men and women.
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Affiliation(s)
- David Nordlund
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Jean-Louis Bonnet
- Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | | | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Ulf Ekelund
- Department of Emergency Medicine, Clinical Sciences, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden.
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12
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Ofori-Asenso R, Zomer E, Chin KL, Markey P, Si S, Ademi Z, Curtis AJ, Zoungas S, Liew D. Prevalence and impact of non-cardiovascular comorbidities among older adults hospitalized for non-ST segment elevation acute coronary syndrome. Cardiovasc Diagn Ther 2019; 9:250-261. [PMID: 31275815 DOI: 10.21037/cdt.2019.04.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background There is a paucity of information on the prognostic importance of non-cardiovascular comorbidities (NCCs) among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). This study examined the prevalence and impact of NCCs on the length of stay (LOS) and mortality among older adults hospitalized for NSTE-ACS. Methods Among 1,488 older adults (mean age 79.4±8.4 years; 62.0% male) hospitalized for NSTE-ACS at a tertiary hospital in Melbourne, Australia, during 2013-2015, we collected data on comorbidities, LOS, and discharge outcomes. Thirteen NCCs were studied. Negative binomial and Cox proportional regression models were applied to examine the association between NCCs and LOS and in-hospital death, respectively. Results Approximately 53% of the patients had ≥1 NCCs. Diabetes and renal disease as well as anemia and renal disease co-existed more frequently than expected. Compared to having no NCCs, having one NCC was not associated with a significant increase in the likelihood of longer LOS [incidence rate ratio (IRR) 1.07; 95% CI: 0.99-1.15; P=0.085] or in-hospital death [hazard ratio (HR) 1.11; 95% CI: 0.65-1.90; P=0.707]. However, having ≥2 NCCs was associated with 22% and 79% increased likelihood of longer LOS (IRR 1.22, 95% CI: 1.11-1.33; P<0.001) and in-hospital death (HR 1.79, 95% CI: 1.06-3.03; P=0.029), respectively, compared to not having any NCC. Certain NCC dyads [e.g., chronic pulmonary disease (CPD) + renal disease] exhibited multiplicative effect such that their impact on patients' LOS or survival exceeded the sum of the individual effects of the component NCCs. Conclusions Over half of older patients hospitalized with NSTE-ACS had NCCs. A higher burden of NCCs correlated with increased LOS and lower survival. Contemporary ACS management guidelines need to recognize and incorporate protocols for the treatment of individuals with multiple chronic conditions to reduce the occurrence of adverse outcomes.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken Lee Chin
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Carrick D, Haig C, Maznyczka AM, Carberry J, Mangion K, Ahmed N, Yue May VT, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Davie A, Mahrous A, Mordi I, Ford I, Radjenovic A, Welsh P, Sattar N, Wetherall K, Oldroyd KG, Berry C. Hypertension, Microvascular Pathology, and Prognosis After an Acute Myocardial Infarction. Hypertension 2019; 72:720-730. [PMID: 30012869 PMCID: PMC6080885 DOI: 10.1161/hypertensionaha.117.10786] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The rationale for our study was to investigate the pathophysiology of microvascular injury in patients with acute ST-segment-elevation myocardial infarction in relation to a history of hypertension. We undertook a cohort study using invasive and noninvasive measures of microvascular injury, cardiac magnetic resonance imaging at 2 days and 6 months, and assessed health outcomes in the longer term. Three hundred twenty-four patients with acute myocardial infarction (mean age, 59 [12] years; blood pressure, 135 [25] / 79 [14] mm Hg; 237 [73%] male, 105 [32%] with antecedent hypertension) were prospectively enrolled during emergency percutaneous coronary intervention. Compared with patients without antecedent hypertension, patients with hypertension were older (63 [12] years versus 57 [11] years; P<0.001) and a lower proportion were cigarette smokers (52 [50%] versus 144 [66%]; P=0.007). Coronary blood flow, microvascular resistance within the culprit artery, infarct pathologies, inflammation (C-reactive protein and interleukin-6) were not associated with hypertension. Compared with patients without antecedent hypertension, patients with hypertension had less improvement in left ventricular ejection fraction at 6 months from baseline (5.3 [8.2]% versus 7.4 [7.6]%; P=0.040). Antecedent hypertension was a multivariable associate of incident myocardial hemorrhage 2-day post-MI (1.81 [0.98-3.34]; P=0.059) and all-cause death or heart failure (n=47 events, n=24 with hypertension; 2.53 [1.28-4.98]; P=0.007) postdischarge (median follow-up 4 years). Severe progressive microvascular injury is implicated in the pathophysiology and prognosis of patients with a history of hypertension and acute myocardial infarction. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02072850.
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Affiliation(s)
- David Carrick
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Annette M Maznyczka
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Jaclyn Carberry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Kenneth Mangion
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Nadeem Ahmed
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Vannesa Teng Yue May
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Margaret McEntegart
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mark C Petrie
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Hany Eteiba
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Mitchell Lindsay
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Hood
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Stuart Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Andrew Davie
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ahmed Mahrous
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ify Mordi
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Aleksandra Radjenovic
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Paul Welsh
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Naveed Sattar
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom (C.H., I.F., K.W.)
| | - Keith G Oldroyd
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
| | - Colin Berry
- From the British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., I.M., A.R., P.W., N.S., K.G.O., C.B.).,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom (D.C., A.M.M., J.C., K.M., N.A., V.T.Y.M., M.M., M.C.P., H.E., M.L., S.H., S.W., A.D., A.M., I.M., K.G.O., C.B.)
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Bikou O, Miyashita S, Ishikawa K. Pig Model of Increased Cardiac Afterload Induced by Ascending Aortic Banding. Methods Mol Biol 2019; 1816:337-342. [PMID: 29987832 DOI: 10.1007/978-1-4939-8597-5_26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Increase in cardiac afterload as represented by hypertension is an established risk factor for cardiovascular diseases. Animal models of increased cardiac afterload offer studies aiming at identifying key molecular mechanisms and developing new therapeutic approaches. We have reported that banding of the ascending aorta in pigs results in significant cardiac hypertrophy and increased myocardial fibrosis at the chronic stages. These changes were accompanied by increased stiffness of the heart, but not by systolic dysfunction. In this chapter, we describe methods to surgically band the ascending aorta in pigs. After 3 months, animals develop systolic left ventricular pressure of >200 mmHg with above described changes in the heart.
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Affiliation(s)
- Olympia Bikou
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satoshi Miyashita
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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15
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[Target blood pressure level in older patients with hypertension]. Nihon Ronen Igakkai Zasshi 2018; 55:539-546. [PMID: 30542017 DOI: 10.3143/geriatrics.55.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Martin N, Manoharan K, Thomas J, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2018; 6:CD012721. [PMID: 29952095 PMCID: PMC6513293 DOI: 10.1002/14651858.cd012721.pub2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Beta-blockers and inhibitors of the renin-angiotensin aldosterone system improve survival and reduce morbidity in people with heart failure with reduced left ventricular ejection fraction. There is uncertainty whether these treatments are beneficial for people with heart failure with preserved ejection fraction and a comprehensive review of the evidence is required. OBJECTIVES To assess the effects of beta-blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and mineralocorticoid receptor antagonists in people with heart failure with preserved ejection fraction. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trial registries on 25 July 2017 to identify eligible studies. Reference lists from primary studies and review articles were checked for additional studies. There were no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials with a parallel group design enrolling adult participants with heart failure with preserved ejection fraction, defined by a left ventricular ejection fraction of greater than 40 percent. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion and extracted data. The outcomes assessed included cardiovascular mortality, heart failure hospitalisation, hyperkalaemia, all-cause mortality and quality of life. Risk ratios (RR) and, where possible, hazard ratios (HR) were calculated for dichotomous outcomes. For continuous data, mean difference (MD) or standardised mean difference (SMD) were calculated. We contacted trialists where neccessary to obtain missing data. MAIN RESULTS 37 randomised controlled trials (207 reports) were included across all comparisons with a total of 18,311 participants.Ten studies (3087 participants) investigating beta-blockers (BB) were included. A pooled analysis indicated a reduction in cardiovascular mortality (15% of participants in the intervention arm versus 19% in the control arm; RR 0.78; 95% confidence interval (CI) 0.62 to 0.99; number needed to treat to benefit (NNTB) 25; 1046 participants; 3 studies). However, the quality of evidence was low and no effect on cardiovascular mortality was observed when the analysis was limited to studies with a low risk of bias (RR 0.81; 95% CI 0.50 to 1.29; 643 participants; 1 study). There was no effect on all-cause mortality, heart failure hospitalisation or quality of life measures, however there is uncertainty about these effects given the limited evidence available.12 studies (4408 participants) investigating mineralocorticoid receptor antagonists (MRA) were included with the quality of evidence assessed as moderate. MRA treatment reduced heart failure hospitalisation (11% of participants in the intervention arm versus 14% in the control arm; RR 0.82; 95% CI 0.69 to 0.98; NNTB 41; 3714 participants; 3 studies; moderate-quality evidence) however, little or no effect on all-cause and cardiovascular mortality and quality of life measures was observed. MRA treatment was associated with a greater risk of hyperkalaemia (16% of participants in the intervention group versus 8% in the control group; RR 2.11; 95% CI 1.77 to 2.51; 4291 participants; 6 studies; high-quality evidence).Eight studies (2061 participants) investigating angiotensin converting enzyme inhibitors (ACEI) were included with the overall quality of evidence assessed as moderate. The evidence suggested that ACEI treatment likely has little or no effect on cardiovascular mortality, all-cause mortality, heart failure hospitalisation, or quality of life. Data for the effect of ACEI on hyperkalaemia were only available from one of the included studies.Eight studies (8755 participants) investigating angiotensin receptor blockers (ARB) were included with the overall quality of evidence assessed as high. The evidence suggested that treatment with ARB has little or no effect on cardiovascular mortality, all-cause mortality, heart failure hospitalisation, or quality of life. ARB was associated with an increased risk of hyperkalaemia (0.9% of participants in the intervention group versus 0.5% in the control group; RR 1.88; 95% CI 1.07 to 3.33; 7148 participants; 2 studies; high-quality evidence).We identified a single ongoing placebo-controlled study investigating the effect of angiotensin receptor neprilysin inhibitors (ARNI) in people with heart failure with preserved ejection fraction. AUTHORS' CONCLUSIONS There is evidence that MRA treatment reduces heart failure hospitalisation in heart failure with preserverd ejection fraction, however the effects on mortality related outcomes and quality of life remain unclear. The available evidence for beta-blockers, ACEI, ARB and ARNI is limited and it remains uncertain whether these treatments have a role in the treatment of HFpEF in the absence of an alternative indication for their use. This comprehensive review highlights a persistent gap in the evidence that is currently being addressed through several large ongoing clinical trials.
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Affiliation(s)
- Nicole Martin
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Karthick Manoharan
- John Radcliffe HospitalEmergency Department3 Sherwood AvenueLondonMiddlesexUKUb6 0pg
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of EducationLondonUK
| | - Ceri Davies
- Barts Heart Centre, St Bartholomew's HospitalDepartment of CardiologyWest SmithfieldLondonUKEC1A 7BE
| | - R Thomas Lumbers
- University College LondonInstitute of Health InformaticsLondonUK
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Cohen DJ, Schulman S, Masarsky CS, Todres-Masarsky M. The Kaleidoscope Model of Integrative Healthcare as a collaborative paradigm for cardiology and chiropractic: a call to action. Integr Med Res 2018; 7:1-8. [PMID: 29629286 PMCID: PMC5884005 DOI: 10.1016/j.imr.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022] Open
Abstract
This review article proposes a model of integrative care for cardiovascular patients in institutional settings. We review relevant historic and contemporary examples of medical-chiropractic cooperation and a brief review of the literature illustrating the clinical benefits of chiropractic care for patients with cardiovascular disease. The groundwork proposes a distinct research and clinical practice model incorporating the doctor of chiropractic (D.C.) as a synergistic partner with the medical cardiologist coined the Kaleidoscope Model of Integrative Care (KM). While a traditional kaleidoscope does not alter the nature of light itself, the observer does see the 'raw data' of colors and shapes, wavelengths, etc. contained within the "potential" of the light itself; left unrecognized, even subtle re-orientations of the instrument changes the perspective. Similarly, the KM is intended as a conduit for slight reorientations to traditional medical-chiropractic-patient hierarchies, thus creating new treatment options and generating robust changes in inter-professional perception of the patient's condition(s) and treatment options. It is hoped that this model will not only serve future patients within hospitals, but that institutions will serve as incubators for better collaboration and research among the majority of free-standing medical and chiropractic practices ultimately benefitting the patient with cardiovascular disease.
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Affiliation(s)
| | - Steven Schulman
- Coronary Care Unit, Johns Hopkins, Baltimore, MD, United States
| | - Charles S. Masarsky
- Biology Department, Northern Virginia Community College, Springfield, VA, United States
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Mega TA, Dabe NE. Khat ( Catha Edulis) as a Risk Factor for Cardiovascular Disorders: Systematic Review and Meta-Analysis. Open Cardiovasc Med J 2017; 11:146-155. [PMID: 29387278 PMCID: PMC5748832 DOI: 10.2174/1874192401711010146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/11/2017] [Accepted: 11/28/2017] [Indexed: 11/22/2022] Open
Abstract
Background About 20 million people worldwide are believed to be using khat. Although some studies reported that khat chewing might result in cardiovascular disorders, conclusive evidence is limited. Method The objective of this review was to synthesize the best available evidence for the effect of khat on the cardiovascular system. Databases searched were PubMed, Cochrane database of systematic reviews, CINAHL, poplin, LILACS, MedNar and Scopus. All papers included in the review were subjected to rigorous appraisal using the Joanna Briggs Institute (JBI) standardized critical appraisal tool. Review Manager Software (Revman 5.3) was used for meta-analysis and effect size and the 95% confidence interval (CI) was calculated. Result Data was extracted from 10 articles. Our meta-analysis included 9,207 subjects, (2123 chewers and 7084 non-chewers, respectively) to elucidate the effect of khat on heart rate, diastolic and systolic blood pressure. The mean diastolic and systolic blood pressure of khat chewers was higher than the non-chewers with a mean difference of 5.1 mmHg, 95%CI [2.7,7.5] and 7.9 mmHg, 95%CI [2.65, 13.18], respectively. Similarly, the heart rate of the chewers remained consistently higher, making the mean difference of 6.9 beats/min, 95%CI [0.5, 13.3]. In addition, khat was found to have either a causative or worsening effect on stroke, myocardial infarction and heart failure. Conclusion We showed that khat chewing could significantly affect the cardiovascular system through its effect on heart rate and blood pressure. Therefore, health promotion should be aimed to encourage quitting khat chewing.
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Affiliation(s)
- Teshale Ayele Mega
- School of Pharmacy, Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Nikodimos Eshetu Dabe
- Department of Biomedical Science, College of Health Science, Mizan Tepi University, Mizan Teferi, Ethiopia
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19
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Seo SM, Chung WB, Choi IJ, Koh YS, Ihm SH, Kim PJ, Chung WS, Seung KB. Visit-to-visit variability of systolic blood pressure predicts all-cause mortality in patients received percutaneous coronary intervention with drug-eluting stents. Heart Vessels 2017; 33:489-497. [PMID: 29151154 DOI: 10.1007/s00380-017-1085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/10/2017] [Indexed: 11/29/2022]
Abstract
Blood pressure (BP) and its variability are associated with atherosclerotic disease and cardiovascular events. The prognostic implications of outpatient clinic visit-to-visit blood pressure variability (BPV) are unknown in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 1,463 patients undergoing PCI with DES were consecutively enrolled from January 2009 to December 2013. We analyzed the 1,234 patients, who measured clinic BP more than three times during the first year after PCI. The BPV is determined by standard deviation of systolic and diastolic BP, and coefficient of variation. Median follow-up duration was 905 days (interquartile range 529-1,310 days). All patients were divided into two groups according to the coefficient of variation of systolic BP (CVSBP); high CVSBP group (> 8.78, n = 617) and low CVSBP group (≤ 8.78, n = 617). High CVSBP group had significantly higher all-cause mortality (7.9% versus 3.1%, p < 0.001) and composite of all-cause mortality, myocardial infarction, and stroke (13.1% versus 6.2%, p < 0.001). In multivariate logistic regression analysis for prediction of all-cause mortality, and composite of all-cause mortality, myocardial infarction, and stroke after PCI with DES, hazard ratios of high CVSBP group were 2.441 (95% of confidence interval 1.042-5.718, p = 0.040), and 1.980 (95% of confidence interval 1.125-3.485, p = 0.018). The higher visit-to-visit BPV is associated higher mortality in patients undergoing PCI with DES. The clinic measured visit-to-visit BPV may serve as a predictor of all-cause mortality after PCI with DES.
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Affiliation(s)
- Suk Min Seo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo-Baek Chung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Ik Jun Choi
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yoon-Seok Koh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Hyun Ihm
- Cardiovascular Center and Cardiology Division, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Pum-Jun Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Wook Sung Chung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ki-Bae Seung
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study. Int J Cardiol 2017; 240:37-42. [DOI: 10.1016/j.ijcard.2017.03.146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 11/23/2022]
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21
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Reinstadler SJ, Stiermaier T, Eitel C, Saad M, Metzler B, de Waha S, Fuernau G, Desch S, Thiele H, Eitel I. Antecedent hypertension and myocardial injury in patients with reperfused ST-elevation myocardial infarction. J Cardiovasc Magn Reson 2016; 18:80. [PMID: 27832796 PMCID: PMC5105316 DOI: 10.1186/s12968-016-0299-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antecedent hypertension is associated with poor outcome in patients with ST-elevation myocardial infarction (STEMI). Whether differences in myocardial salvage, infarct size and microvascular injury contribute to the adverse outcome is unknown. We investigated the association between antecedent hypertension and cardiovascular magnetic resonance (CMR) parameters of myocardial salvage and damage in a multicenter CMR substudy of the AIDA-STEMI trial (Abciximab Intracoronary versus intravenously Drug Application in ST-elevation myocardial infarction). METHODS We analyzed 792 consecutive STEMI patients reperfused within 12 h after symptom onset. Patients underwent CMR imaging for assessment of myocardial salvage, infarct size and microvascular obstruction within 10 days after infarction. Major adverse cardiac events (MACE) were recorded at 12-month follow-up. RESULTS Antecedent hypertension was present in 540 patients (68 %) and was associated with a significantly increased baseline risk profile (advanced age, higher body mass index, higher incidence of diabetes, hypercholesterolemia, previous angioplasty and multivessel disease, p < 0.001 for all). MACE were more frequent in patients with hypertension as compared to patients without hypertension (45 [8 %] vs. 8 [3 %], p < 0.01). Antecedent hypertension remained an independent predictor of MACE after multivariate adjustment (hazard ratio 3.42 [confidence interval 1.45-8.08], p < 0.01). There was, however, no significant difference in the area at risk, infarct size, myocardial salvage index, extent of microvascular obstruction, and left ventricular ejection fraction between the groups (all p > 0.05). CONCLUSION Despite a higher rate of MACE in contemporary reperfused STEMI patients with antecedent hypertension, there was no difference in reperfusion efficacy, infarct size and reperfusion injury as visualized by CMR. TRIAL REGISTRATION NCT00712101 .
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Affiliation(s)
- Sebastian J. Reinstadler
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Mohammed Saad
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Suzanne de Waha
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Georg Fuernau
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Steffen Desch
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Holger Thiele
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Abdul-Rahim AH, Docherty KF, Skali H, Køber L, Dickstein K, Maggioni AP, Mareev V, Zannad F, Velazquez EJ, Califf RM, Pfeffer MA, Solomon SD, Lees KR, McMurray JJ. Effect of single and dual renin-angiotensin blockade on stroke in patients with and without diabetes in VALIANT. Eur Stroke J 2016; 1:93-100. [PMID: 31008270 DOI: 10.1177/2396987316646025] [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: 12/30/2015] [Accepted: 03/27/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Concern has been raised about a possible increase in risk of stroke in patients with diabetes treated with the combination of the renin-inhibitor aliskiren and an angiotensin converting enzyme inhibitor or angiotensin receptor blocker. We compared the rate of stroke in patients with and without diabetes treated with single or dual renin-angiotensin system blockade after acute myocardial infarction. Patients and methods We performed a post hoc analysis of the Valsartan in Acute Myocardial Infarction trial in which 14,703 patients with heart failure, left ventricular systolic dysfunction or both, were randomised to captopril (C), valsartan (V) or both (C + V) after 0.5-10 days after acute myocardial infarction and followed for a median of 2.1 years. We used Cox proportional-hazard regression to estimate the hazard ratios [HR (95% CI)] of stroke in each treatment group. Results Among patients with diabetes, 60/1303 (4.6%) receiving captopril, 60/1337 (4.5%) valsartan and 41/1340 (3.1%) valsartan plus captopril suffered a stroke: V + C versus V or C HR 0.68 (0.47-0.96), p = 0.03. The corresponding numbers in patients without diabetes were 106/3606 (2.9%), 97/3572 (2.7%) and 99/3545 (2.8%): V + C versus V or C HR 0.99 (0.78-1.26), p = 0.92 (interaction p = 0.08). Conclusion The risk of stroke after myocardial infarction in patients with diabetes was lower in patients treated with both an angiotensin converting enzyme inhibitor and angiotensin receptor blocker than in patients receiving either monotherapy.
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Affiliation(s)
- Azmil H Abdul-Rahim
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Viacheslav Mareev
- University Clinic M.V.Lomonosov Moscow State University, Moscow, Russia
| | - Faiez Zannad
- Clinical Investigation Center 1493, INSERM, Nancy, France
| | - Eric J Velazquez
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert M Califf
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Translational Medicine Institute, Durham, NC, USA
| | | | | | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - John Jv McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with coronary artery disease. J Hypertens 2016; 34:1011-8. [DOI: 10.1097/hjh.0000000000000874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shaya GE, Al-Mallah MH, Hung RK, Nasir K, Blumenthal RS, Ehrman JK, Keteyian SJ, Brawner CA, Qureshi WT, Blaha MJ. High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project. Mayo Clin Proc 2016; 91:129-39. [PMID: 26848000 DOI: 10.1016/j.mayocp.2015.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/01/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI). PATIENTS AND METHODS This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI. RESULTS The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001). CONCLUSION Higher baseline EC was independently associated with a lower risk of early death after a first MI.
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Affiliation(s)
- Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL
| | - Mouaz H Al-Mallah
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia; Henry Ford Hospital, Detroit, MI
| | - Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | | | | | - Waqas T Qureshi
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Ma W, Liang Y, Zhu J, Yang Y, Tan H, Yu L, Gao X, Feng G, Li J. Impact of Admission Systolic Blood Pressure and Antecedent Hypertension on Short-Term Outcomes After ST-Segment Elevation Myocardial Infarction: Strobe-Compliant Article. Medicine (Baltimore) 2015; 94:e1446. [PMID: 26313807 PMCID: PMC4602932 DOI: 10.1097/md.0000000000001446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Data were derived from a multicenter survey of 7303 consecutive patients with STEMI. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 7 and 30-day all-cause mortality. The prevalence of hypertension was 40.7%, and the best cutoff of admission SBP for predicting 30-day mortality was 108 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often female, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (≤108 mmHg) and hypertension group had significantly higher 7 and 30-day mortality than those in other groups (all P < 0.001). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 7-day mortality (hazard ratios [HR] 1.86, 95% confidence interval [CI] 1.41-2.46; P < 0.001) and 30-day mortality (HR 1.88, 95% CI 1.46-2.43; P < 0.001). In patients with SBP > 108 mmHg, a history of hypertension could increase the risk of 30-day mortality by 27% (HR 1.00 vs 1.27, P = 0.012), while in patients with SBP ≤ 108 mmHg, this increased risk reached to 37% (HR 1.51 vs 1.88, P < 0.001). In conclusion, low admission SBP was the relatively dominant contributor for predicting 7 and 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality.
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Affiliation(s)
- Wenfang Ma
- From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O'Connor CM, O'Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of hypertension in patients with coronary artery disease. ACTA ACUST UNITED AC 2015; 9:453-98. [PMID: 25840695 DOI: 10.1016/j.jash.2015.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe G, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. Hypertension 2015; 65:1372-407. [PMID: 25828847 DOI: 10.1161/hyp.0000000000000018] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O'Connor CM, O'Gara PT, Ogedegbe G, Oparil S, White WB. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation 2015; 131:e435-70. [PMID: 25829340 PMCID: PMC8365343 DOI: 10.1161/cir.0000000000000207] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Gondo K, Miura SI, Suematsu Y, Shiga Y, Kuwano T, Sugihara M, Ike A, Iwata A, Motozato K, Kusumoto T, Nishikawa H, Saku K. Association Between Visit-to-Visit Variability in Blood Pressure and Cardiovascular Events in Hypertensive Patients After Successful Percutaneous Coronary Intervention. J Clin Med Res 2015; 7:545-50. [PMID: 26015820 PMCID: PMC4432897 DOI: 10.14740/jocmr2173w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 01/28/2023] Open
Abstract
Background Visit-to-visit variability (VVV) in blood pressure (BP) in addition to high BP has been shown to be a strong predictor of coronary events and stroke. Therefore, we investigated the associations between VVV in BP or BP levels and cardiovascular events after successful percutaneous coronary intervention (PCI). Methods We enrolled 176 hypertensive patients who had undergone successful PCI and who had four clinic visits to measure BP until follow-up coronary angiography (CAG) at 6 - 9 months after PCI. The patients were divided into those with acute coronary syndrome (ACS group; n = 50) and those with stable angina pectoris (SAP group; n = 126). We determined VVV in BP expressed as the standard deviation (SD) of average BP, average, and the maximum and minimum BP during the follow-up period. Major adverse cardiovascular events (MACEs) (myocardial infarction (MI), target lesion revascularization (TLR) and all-cause death) were also analyzed. Results There were no significant differences in VVV in BP, average BP or maximum or minimum BP between the patients with and without MACE in all patients, the ACS and SAP groups. Interestingly, in the ACS group, VVV in SBP and maximum SBP in patients with MI were significantly higher than those in patients without MI. The cut-off levels for VVV in BP and maximum SBP that gave the greatest sensitivity and specificity for MI in the ACS group were 15.1 and 138 mm Hg, respectively. Conclusion Higher VVV in SBP and maximum SBP in patients with ACS after successful PCI were associated with the onset of MI.
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Affiliation(s)
- Kouki Gondo
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan ; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Amane Ike
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kota Motozato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan ; Division of Cardiology, Izumi General Medical Center, Kagoshima, Japan
| | - Takaaki Kusumoto
- Division of Cardiology, Izumi General Medical Center, Kagoshima, Japan
| | - Hiroaki Nishikawa
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan ; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, Cannon CP, de Lemos JA, Elliott WJ, Findeiss L, Gersh BJ, Gore JM, Levy D, Long JB, O’Connor CM, O’Gara PT, Ogedegbe O, Oparil S, White WB. Treatment of Hypertension in Patients With Coronary Artery Disease. J Am Coll Cardiol 2015; 65:1998-2038. [PMID: 25840655 DOI: 10.1016/j.jacc.2015.02.038] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Chapter 6. Hypertension associated with organ damage. Hypertens Res 2014. [DOI: 10.1038/hr.2014.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zofenopril and ramipril and acetylsalicylic acid in postmyocardial infarction patients with left ventricular systolic dysfunction: a retrospective analysis in hypertensive patients of the SMILE-4 study. J Hypertens 2014; 31:1256-64. [PMID: 23552127 DOI: 10.1097/hjh.0b013e3283605cd8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antecedent hypertension represents a risk factor for adverse outcomes in survivors of acute myocardial infarction (AMI). Prognosis of such patients might be greatly improved by drugs enhancing blood pressure control. In the present retrospective analysis of the randomized, double-blind, parallel-group, SMILE-4 study we compared the efficacy of zofenopril 60 mg and acetylsalicylic acid (ASA) 100 mg versus ramipril 10 mg and ASA in patients with AMI complicated by left ventricular dysfunction, classified according to a history of hypertension. METHODS The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. Hypertension was defined according to medical history and current blood pressure values at entry and could be determined in 682 of 716 patients of the intention-to-treat analysis. RESULTS One hundred and fifty-seven patients (23%) were normotensives and 525 (77%) hypertensives. In the normotensive population the primary end-point occurred in 19 of 76 zofenopril-treated patients (25%) and in 23 of 81 ramipril-treated patients (28%) [odds ratio (95% confidence interval): 0.84 (0.41-1.71), P = 0.631]. In the hypertensive population, major cardiovascular outcomes were reported in 84 of 273 zofenopril-treated patients (31%) and in 99 of 252 ramipril-treated patients (39%), with a 31% significantly (P = 0.041) lower risk with zofenopril [0.69 (0.48-0.99)]. The superiority of zofenopril versus ramipril was particularly evident in patients with isolated systolic hypertension [n = 131, 0.48 (0.23-0.99), P = 0.045]. CONCLUSION This retrospective analysis of the SMILE-4 study confirmed the good efficacy of zofenopril and ASA in the prevention of long-term cardiovascular outcomes also in the subgroup of patients with hypertension.
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Affiliation(s)
- Amil M. Shah
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis St Boston MA 02445 USA
| | - Scott D. Solomon
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis St Boston MA 02445 USA
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Dorobantu M, Tautu OF, Fruntelata A, Calmac L, Tatu-Chitoiu G, Bataila V, Dimulescu D, Craiu E, Nanea T, Istvan A, Babes K, Macarie C, Militaru C, Cenko E, Manfrini O. Hypertension and acute coronary syndromes in Romania: data from the ISACS-TC registry. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/sut006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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35
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Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Prognostic impact of diabetes mellitus and hypertension for mid-term outcome of patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Cardiol 2012; 60:257-63. [DOI: 10.1016/j.jjcc.2012.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/19/2012] [Accepted: 06/06/2012] [Indexed: 12/20/2022]
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Abstract
Arterial hypertension is the most important risk factor for coronary artery disease (CAD). There is a high coincidence of both diseases, whereby both impair coronary microcirculatory function synergistically, which can be measured functionally by decreased coronary flow reserve. This dysfunction leads to permanent damage to the left ventricular myocardium. Lifestyle changes play a central role in the primary and secondary prevention of CAD. Additionally, there are well-established options for antihypertensive drug therapy, which should be combined with aspirin and statins. Pharmacological treatment should follow distinctive blood pressure goals in relation to the severity of CAD. Particular attention is paid in this context to the relation between diastolic blood pressure values and cardiovascular endpoints, which displays a j-shaped curve with the lowest risk at levels between 70 and 90 mmHg.
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Pedrinelli R, Ballo P, Fiorentini C, Denti S, Galderisi M, Ganau A, Germanò G, Innelli P, Paini A, Perlini S, Salvetti M, Zacà V. Hypertension and acute myocardial infarction: an overview. J Cardiovasc Med (Hagerstown) 2012; 13:194-202. [PMID: 22317927 DOI: 10.2459/jcm.0b013e3283511ee2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.
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Affiliation(s)
- Roberto Pedrinelli
- Dipartimento Cardio Toracico e Vascolare, Universita' Di Pisa, 56100 Pisa, Italy.
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Ayhan E, Uyarel H, Cicek G, Ergelen M, Işık T, Eren M. Clinical outcomes of primary angioplasty in ST elevation myocardial infarction patients with antecedent hypertension during hospital stay and follow-up. Clin Exp Hypertens 2012; 34:357-62. [PMID: 22468933 DOI: 10.3109/10641963.2011.649934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hypertension is a known risk factor for coronary artery disease. However, the number of studies focusing on the events following ST elevation myocardial infarction (STEMI) in patients with an antecedent hypertension is limited. Our aim is to evaluate the clinical outcomes of primary angioplasty in STEMI patients with antecedent hypertension during hospital stay and follow-up. A total of 373 patients (177 of whom had antecedent hypertension) who were treated by primary angioplasty because of STEMI were included in this study. All parameters were compared between the groups with and without hypertension. Hypertensive patients who received primary angioplasty were older (59.9 ± 12.6 vs. 52 ± 12.3, P < .001) and had higher rates of in-hospital mortality and major adverse cardiac events than patients without hypertension. Among STEMI patients, only history of hypertension for more than 10 years was a predictor of in-hospital mortality (odds ratio: 4.374, 95% CI 1.017-18.822, P = .04). Patients with an antecedent hypertension have higher initial risk profiles and show more negative outcomes during a 6-month follow-up period.
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Affiliation(s)
- Erkan Ayhan
- Department of Cardiology, Balıkesir University School of Medicine, Balikesir, Turkey.
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39
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Krause MW, Fonseca VA, Shah SV. Combination inhibition of the renin–angiotensin system: is more better? Kidney Int 2011; 80:245-55. [DOI: 10.1038/ki.2011.142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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40
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Picariello C, Lazzeri C, Attanà P, Chiostri M, Gensini GF, Valente S. The impact of hypertension on patients with acute coronary syndromes. Int J Hypertens 2011; 2011:563657. [PMID: 21747979 PMCID: PMC3124673 DOI: 10.4061/2011/563657] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 01/12/2023] Open
Abstract
Arterial chronic hypertension (HTN) is a well-known cardiovascular risk factor for development of atherosclerosis. In order to explain the relation between HTN and acute coronary syndromes the following factors should be considered: (1) risk factors are shared by the diseases, such as genetic risk, insulin resistance, sympathetic hyperactivity, and vasoactive substances (i.e., angiotensin II); (2) hypertension is associated with the development of atherosclerosis (which in turn contributes to progression of myocardial infarction). From all the registries and the data available up to now, hypertensive patients with ACS are more likely to be older, female, of nonwhite ethnicity, and having a higher prevalence of comorbidities. Data on the prognostic role of a preexisting hypertensive state in ACS patients are so far contrasting. The aim of the present paper is to focus on hypertensive patients with ACS, in order to better elucidate whether these patients are at higher risk and deserve a tailored approach for management and followup.
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Affiliation(s)
- Claudio Picariello
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Chiara Lazzeri
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Paola Attanà
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Marco Chiostri
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Gian Franco Gensini
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
| | - Serafina Valente
- Intensive Cardiac Care Unit, Careggi Hospital, Viale Morgagni 85, 50184 Florence, Italy
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Ali WM, Zubaid M, El-Menyar A, Al Mahmeed W, Al-Lawati J, Singh R, Ridha M, Al-Hamdan R, Alhabib K, Al Suwaidi J. The prevalence and outcome of hypertension in patients with acute coronary syndrome in six Middle-Eastern countries. Blood Press 2010; 20:20-6. [PMID: 20843191 DOI: 10.3109/08037051.2010.518673] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The aim was to report the prevalence and significance of hypertension (HTN) in patients with acute coronary syndrome (ACS). METHODS AND MAJOR FINDINGS Over a 6-month period in 2007, 8171 consecutive patients (49.4% hypertensive and 50.6% non-hypertensive) presenting with ACS were enrolled in a prospective, multicenter study from six Middle Eastern adjacent countries. Patients with HTN were older (59.2 vs 53.1 years, p<0.001), and more likely to be female (34% vs 14.4%, p<0.001) when compared with patients without HTN. Patients with HTN were also more likely to have diabetes mellitus, hyperlipidemia, cerebrovascular disease, prior history of coronary artery disease, peripheral artery disease but less likely to be cigarette smokers. At admission, HTN patients had higher Killip class, heart rate and GRACE risk scoring. In-hospital mortality was higher in hypertensive patients with ST-elevation myocardial infarction (STEMI) but not in patients with non-STEMI or unstable angina. The incidence of heart failure complications was significantly higher among patients with HTN in overall ACS type (OR = 1.2, 95% CI 1.001-1.338, p= 0.04). MAIN CONCLUSION In this large cohort of patients with ACS, HTN was an independent predictor of heart failure and was associated with an increased rate of in-hospital mortality in STEMI only.
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Affiliation(s)
- Waleed M Ali
- Department of Cardiology, Hamad Medical Corporation (HMC), Qatar and Weill Cornell Medical College, Doha, Qatar
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Kang DG, Jeong MH, Ahn Y, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae JK, Rhew JY, Chae IH, Cho MC, Bae JH, Rha SW, Kim CJ, Jang YS, Yoon J, Seung KB, Park SJ. Clinical effects of hypertension on the mortality of patients with acute myocardial infarction. J Korean Med Sci 2009; 24:800-6. [PMID: 19794974 PMCID: PMC2752759 DOI: 10.3346/jkms.2009.24.5.800] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 11/22/2008] [Indexed: 11/20/2022] Open
Abstract
The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
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Affiliation(s)
| | | | | | | | - Seung Ho Hur
- Keimyung University Dongsan Medical Center, Daegu, Korea
| | | | | | - In Whan Seong
- Chungnam National University Hospital, Daejeon, Korea
| | | | | | - In Ho Chae
- Seoul National University Bundang Hospital, Seongam, Korea
| | | | | | | | | | | | | | - Ki Bae Seung
- Catholic University of Seoul St. Mary's Hospital, Seoul, Korea
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Chen G, Hemmelgarn B, Alhaider S, Quan H, Campbell N, Rabi D. Meta-analysis of adverse cardiovascular outcomes associated with antecedent hypertension after myocardial infarction. Am J Cardiol 2009; 104:141-7. [PMID: 19576336 DOI: 10.1016/j.amjcard.2009.02.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate the association of antecedent hypertension with adverse cardiovascular outcomes after myocardial infarction. A search of Medline and EMBASE was supplemented by manual searches of the bibliographies of key retrieved reports. The studies were included if they reported antecedent hypertension as a risk factor for adverse outcomes (death, stroke, congestive heart failure, recurrent myocardial infarction) in survivors of myocardial infarctions. Relative risks (RRs) were pooled using a random-effects model, and the robustness of the pooled RRs was evaluated in sensitivity analyses. Cumulative meta-analysis, by chronologic year of study beginning, was also performed. The search yielded 17 studies (n = 56,748 participants) that reported antecedent hypertension with adverse outcomes for survivors of myocardial infarctions. Randomized clinical trials (n = 8) were pooled separately from cohort studies (n = 9). For randomized clinical trials, the pooled RRs were 1.19 (95% confidence interval [CI] 1.13 to 1.26) for all-cause mortality and 1.29 (95% CI 1.09 to 1.53) for cardiovascular disease mortality. For cohort studies, the pooled RRs were 1.46 (95% CI 1.34 to 1.61) for all-cause mortality and 1.54 (95% CI 1.22 to 1.93) for cardiovascular disease mortality. Antecedent hypertension was also consistently associated with an increased risk for stroke, congestive heart failure, and recurrent myocardial infarction. Pooled estimates were robust in sensitivity analysis. In conclusion, antecedent hypertension was associated with adverse outcomes for survivors of myocardial infarctions, the association of antecedent hypertension with all-cause mortality outcomes decreased over time, and this decreased association reflects improved treatment and management of hypertension in more recent years.
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Ahmed A, Pitt B. A history of systemic hypertension and incident heart failure hospitalization in patients with acute myocardial infarction and left ventricular systolic dysfunction. Am J Cardiol 2009; 103:1374-80. [PMID: 19427431 PMCID: PMC2924591 DOI: 10.1016/j.amjcard.2009.01.347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 01/19/2023]
Abstract
The associations of a history of hypertension with subsequent outcomes after acute myocardial infarction have not been examined in propensity-matched studies. Of the 6,632 patients with acute myocardial infarctions and left ventricular systolic dysfunction in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), 4,407 had histories of hypertension. Propensity scores for a history of hypertension, estimated for each patient using 64 baseline characteristics, were used to match 1,990 pairs of patients with and without hypertension. Matched Cox regression models were used to estimate associations between hypertension and outcomes during a mean of 16 months of follow-up. Heart failure (HF) hospitalization occurred in 11.9% and 8.8% of patients, respectively, with and without hypertension (hazard ratio [HR] for hypertension vs no hypertension 1.36, 95% confidence interval [CI] 1.10 to 1.68, p = 0.004). The association between a history of hypertension and HF hospitalization was significant only in patients without previous HF (n = 3,495, HR 1.48, 95% CI 1.18 to 1.84, p = 0.001), but not in those with previous HF (n = 485, HR 1.09, 95% CI 0.73 to 1.62, p = 0.688, p for interaction = 0.179). A history of hypertension was not associated with all-cause mortality (HR 1.02, 95% CI 0.86 to 1.22, p = 0.790) or cardiovascular hospitalization (HR 1.08, 95% CI 0.92 to 1.27, p = 0.339). In conclusion, a history of hypertension was associated with subsequent HF hospitalization after acute myocardial infarction, especially in patients without histories of HF, suggesting that hypertension increased the risk for hospitalization with incident HF but did not affect hospitalization for worsening HF symptoms in those with prevalent HF.
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Affiliation(s)
- Ali Ahmed
- University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Sato Y, Hatakeyama K, Marutsuka K, Asada Y. Incidence of asymptomatic coronary thrombosis and plaque disruption: Comparison of non-cardiac and cardiac deaths among autopsy cases. Thromb Res 2009; 124:19-23. [DOI: 10.1016/j.thromres.2008.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/28/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
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Gaddam KK, Verma A, Thompson M, Amin R, Ventura H. Hypertension and cardiac failure in its various forms. Med Clin North Am 2009; 93:665-80. [PMID: 19427498 DOI: 10.1016/j.mcna.2009.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension clearly increases the risk of systolic or diastolic heart failure. With aging population and advancements in treatment of cardiovascular diseases, the prevalence of heart failure is ever-increasing and is a principal cause of cardiovascular morbidity and mortality. Treating hypertension has been shown to decrease the risk of development of heart failure and hence underscores the early recognition and treatment of hypertension and hypertensive heart disease. Antihypertensive treatment with drugs from all classes except direct vasodilators is effective in reversing LVH and preventing heart failure. Also, all of the major classes of antihypertensive drugs, particularly beta-blockers and RAS antagonists, with the exception of calcium antagonists, have been shown to improve survival in patients who have LV systolic dysfunction. However, phenotyping and identifying the pathophysiology and appropriate treatments for patients who have diastolic dysfunction and heart failure with preserved ejection fraction has been a daunting task. At this time, treatment of these patients is largely empiric, focusing on BP control, and treating or avoiding intravascular volume overload.
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Affiliation(s)
- Krishna K Gaddam
- Department of Medicine, Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Ueshima K, Yasuno S, Oba K, Fujimoto A, Ogihara T, Saruta T, Nakao K. Effects of Cardiac Complications on Cardiovascular Events in Japanese High-Risk Hypertensive Patients Subanalysis of the CASE-J Trial. Circ J 2009; 73:1080-5. [DOI: 10.1253/circj.cj-08-0886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenji Ueshima
- EBM Research Center, Kyoto University Graduate School of Medicine
| | - Shinji Yasuno
- EBM Research Center, Kyoto University Graduate School of Medicine
| | - Koji Oba
- EBM Research Center, Kyoto University Graduate School of Medicine
| | - Akira Fujimoto
- EBM Research Center, Kyoto University Graduate School of Medicine
| | | | | | - Kazuwa Nakao
- EBM Research Center, Kyoto University Graduate School of Medicine
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine
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49
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Vongpatanasin W. Management of hypertension in patients with coronary artery disease. Curr Hypertens Rep 2008; 10:349-54. [DOI: 10.1007/s11906-008-0066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scobie J, Keyhani S, Hebert PL, McLaughlin MA. Response to Gender and Blood Pressure Control. Hypertension 2008. [DOI: 10.1161/hypertensionaha.108.112623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Janice Scobie
- Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Salomeh Keyhani
- Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans’ Administration Medical Center, Bronx, NY, Departments of Health Policy and General Internal Medicine, Mount Sinai School of Medicine, New York, NY
| | - Paul L. Hebert
- Department of Health Policy, Mount Sinai School of Medicine, New York, NY
| | - Mary Ann McLaughlin
- Departments of Health Policy, Medicine, and Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY
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