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Pereira Santos S, Guedes S, Pesqueira R, Stuart J, Carvalho AM, Correia P, Lourenço Ribeiro I, Teixeira ÂM. Cardiovascular risk assessment using SCORE2 in a population with hypertension - The reality at a primary health care unit. Rev Port Cardiol 2024:S0870-2551(24)00223-3. [PMID: 39004141 DOI: 10.1016/j.repc.2024.03.007] [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: 08/22/2023] [Revised: 02/11/2024] [Accepted: 03/08/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal, thus it is important to identify individuals at risk. Patients with hypertension have an increased risk of adverse cardiovascular (CV) events. The role of LDL cholesterol (LDL-C) in atherosclerotic CVD is well-established. SCORE2, a new CV risk calculation tool, is used to predict the 10-year risk of fatal or non-fatal CVD. The aim of this study was to understand the impact of SCORE2 on CV risk assessment in a population with hypertension from a moderate risk country, compared to the previously used SCORE. METHODS This observational cross-sectional study analyzed a population census of 3146 patients diagnosed with hypertension without complications (K86). After applying inclusion and exclusion criteria, 654 patients were included. Data from medical records were collected to calculate and compare SCORE and SCORE2 categories and LDL-C targets. RESULTS Patients were classified into SCORE categories: 188 (28.75%) low, 448 (68.5%) moderate, 17 (2.6%) high and 1 (0.15%) very high risk. Using SCORE2, individuals in the SCORE low risk category were reclassified, requiring new targets: 149 individuals (80%) as low to moderate and 39 (20%) as high risk. These differences became more evident when considering SCORE moderate and high-risk categories, where 358 patients (77%) received a higher CV risk categorization, and therefore a lower LDL-C target. There was a significant increase in individuals failing to meet the target when using SCORE2, compared to SCORE (p<0.001). CONCLUSION These findings support the importance of CV risk assessment using SCORE2 algorithm in patients with hypertension.
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Affiliation(s)
| | - Sara Guedes
- Unidade de Saúde Familiar Nova Via, Portugal
| | | | - João Stuart
- Unidade de Saúde Familiar Nova Via, Portugal
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Meccanici F, Thijssen CGE, Gökalp AL, Bom AW, Geuzebroek GSC, ter Woorst JF, van Kimmenade RRJ, Post MC, Takkenberg JJM, Roos-Hesselink JW. Long-Term Health-Related Quality of Life following Acute Type A Aortic Dissection with a Focus on Male-Female Differences: A Cross Sectional Study. J Clin Med 2024; 13:2265. [PMID: 38673538 PMCID: PMC11050969 DOI: 10.3390/jcm13082265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, of which the long-term impact on health-related quality of life (HRQoL) and male-female-specific insights remain inadequately clarified. Methods: Consecutive adult ATAAD patients who underwent surgery were retrospectively included between 2007 and 2017 in four referral centers in the Netherlands, and baseline data were collected. The 36-Item Short-Form (SF-36) Health Survey was sent to all survivors between 2019 and 2021 and compared to validated SF-36 scores of the Dutch general population stratified by age group and sex. Results: In total, 324/555 surviving patients returned the SF-36 questionnaire (response rate 58%), of which 40.0% were female; the median follow-up was 6.5 years (range: 1.7-13.9, IQR: 4.0-9.4) after surgery for ATAAD. In comparison to the general population, ATAAD patients scored significantly lower on 6/8 SF-36 subdomains and higher on bodily pain. Differences in HRQoL domains compared to the sex-matched data were largely comparable between sexes, apart from bodily pain. In the age-matched subgroups impaired HRQoL was most pronounced in younger patients aged 41-60 (5/8 impaired domains). Female ATAAD patients scored significantly worse on 5/8 SF-36 subdomains and the physical component summary (PCS) scores than male patients. Age at ATAAD, female sex, hypertension, COPD, and prior thoracic aortic aneurysm were associated with worse PCS scores. Conclusions: Long-term HRQoL was impaired in both male and female ATAAD patients when compared to the general population. Further studies on the nature of this impairment and on interventions to improve HRQoL after ATAAD are clearly warranted, with special attention to females and younger patients.
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Affiliation(s)
| | - Carlijn G. E. Thijssen
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Arjen L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Annemijn W. Bom
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Guillaume S. C. Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Joost F. ter Woorst
- Department of Cardiothoracic Surgery, Catharina Ziekenhuis Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - Roland R. J. van Kimmenade
- Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marco C. Post
- Department of Cardiology, St. Antonius Ziekenhuis, 3435 CM Nieuwegein, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Li Z, Guo K, Yang Y, Shuai Y, Fan R, Li Y, DU J, Niu J, Yang K. Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study. Eur J Phys Rehabil Med 2024; 60:361-372. [PMID: 38345568 PMCID: PMC11112512 DOI: 10.23736/s1973-9087.23.08165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.
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Affiliation(s)
- Zijun Li
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ke Guo
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongqi Yang
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yuxi Shuai
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Rui Fan
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
| | - Jiawei DU
- Second Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Junqiang Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
- First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China -
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
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Meijer P, Numans H, Lakerveld J. Associations between the neighbourhood food environment and cardiovascular disease: a systematic review. Eur J Prev Cardiol 2023; 30:1840-1850. [PMID: 37499177 DOI: 10.1093/eurjpc/zwad252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
AIMS To systematically review the current evidence on the association between the neighbourhood food environment and cardiovascular disease (CVD) in adults. METHODS AND RESULTS We searched the literature databases CINAHL, MEDLINE, and EMBASE for studies published between 1 January 2000 and 1 May 2022. Studies focusing on the indoor home, workplace, or school food environment were excluded. Two independent reviewers screened all records. Included studies were assessed for risk of bias using the shortened QUIPS tool, and relevant data were extracted. We summarized the findings using a narrative synthesis approach. We included 15 studies after screening 5915 original records. Most studies were published in the last 4 years and were predominantly conducted in North American or European countries. These studies focused on fast-food restaurant density in the residential neighbourhood. A higher fast-food restaurant density was most consistently associated with a higher prevalence and incidence of CVD and CVD mortality, but effect sizes were small. Evidence of an association between fast-food restaurant density and myocardial infarction, or stroke was inconsistent. The other aspects of the food environment were density of food service restaurants, unhealthy food outlets, and food access score. However, there was scant evidence for these aspects. CONCLUSION We found evidence for associations between the neighbourhood food environment and CVD, suggesting that a higher fast-food restaurant density is associated with CVD and CVD mortality. Effect sizes were small but important, given the fact that a large population is exposed. Research is needed to assess the effects of other aspects of the food environment. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022317407.
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Affiliation(s)
- Paul Meijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Str6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081HV Amsterdam, The Netherlands
| | - Hidser Numans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081HV Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 1, 3584CL Utrecht, The Netherlands
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Okon IA, Okorocha AE, Beshel JA, Abali HC, Owu DU. Pulmonary functions and anthropometric parameters of young male and female adults participating in moderate aerobic exercise. Curr Res Physiol 2023; 6:100112. [PMID: 38107791 PMCID: PMC10724201 DOI: 10.1016/j.crphys.2023.100112] [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: 07/25/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 12/19/2023] Open
Abstract
Respiratory disorders may be one of the adverse effects of sedentary lifestyle. This study investigated respiratory functions (FEV1, FVC and PEFR) and anthropometric parameters (body weight and body mass index) of healthy young males and females participating in moderate aerobic exercise. Forty young healthy untrained non-athletes, twenty males and twenty females (age, 25 ± 5.6 years; body weight, 65 ± 4.0 kg; body height, 176.9 ± 2.5 cm) volunteered to participate in this study. The exercise regimen was of moderate intensity lasting for 20 min daily on a treadmill consistently at the speed of 13 km/h for 14 days. The weight and height of participants were measured using medical scale and wall-mounted stadiometer respectively. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were assessed using digital spirometer. The results showed a significant (p < 0.05) decrease in body weight and body mass index of female participants after 14 days of exercise regimen. The FEV1, FVC and PEFR were significantly increased (p < 0.05) in both male and female subjects after exercise. The Pearson correlation showed a significant (p < 0.05) positive correlation between BMI with FEVI/FVC% in female participants. There was an increase in calories burnt from day 4 of the study in both male and female participants. It is concluded that moderate aerobic exercise improved respiratory functions (FEV1, FVC and PEFR) in both male and female subjects with greater improvement in females while reducing body weight and body mass index in females.
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Affiliation(s)
- Idara A. Okon
- Department of Physiology, Faculty of Basic Medical Sciences, PAMO University of Medical Sciences, Port Harcourt, Rivers State, Nigeria
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Albert E. Okorocha
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Justin A. Beshel
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Happiness C. Abali
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Daniel U. Owu
- Department of Physiology, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria
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Gupta A, Barthel AB, Mahajan S, Dreyer RP, Yaggi H, Bueno H, Lichtman JH, Krumholz HM. Sex-Specific Associations of Obstructive Sleep Apnea Risk With Patient Characteristics and Functional Outcomes After Acute Myocardial Infarction: Evidence From the VIRGO Study. J Am Heart Assoc 2023; 12:e027225. [PMID: 37702090 PMCID: PMC10547292 DOI: 10.1161/jaha.122.027225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/01/2023] [Indexed: 09/14/2023]
Abstract
Background Though associations between obstructive sleep apnea (OSA) and cardiovascular outcomes are well described, limited data exist regarding the impact of OSA on sex-specific outcomes after acute myocardial infarction (AMI). Methods and Results The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study enrolled 3572 adults aged 18 to 55 years with AMI from the United States and Spain during 2008 to 2012. We included patients for whom the Berlin Questionnaire for OSA was scored at the time of AMI admission (3141; 2105 women, 1036 men). We examined the sex-specific association between baseline OSA risk with functional outcomes including health status and depressive symptoms at 1 and 12 months after AMI. Among both groups, 49% of patients were at high risk for OSA (1040 women; 509 men), but only 4.7% (148) of patients had a diagnosed history of OSA. Though patients with a high OSA risk reported worse physical and mental health status and depression than low-risk patients in both sexes, the difference in these functional outcomes was wider in women than men. Moreover, women with a high OSA risk had worse health status, depression, and quality of life than high-risk men, both at baseline and at 1 and 12 months after AMI. Conclusions Young women with a high OSA risk have poorer health status and more depressive symptoms than men at the time of AMI, which may place them at higher risk of poorer health outcomes over the year following the AMI. Further, the majority of patients at high risk of OSA are undiagnosed at the time of presentation of AMI.
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Affiliation(s)
- Aakriti Gupta
- Division of Cardiology, Department of MedicineCedars‐Sinai Medical CenterLos AngelesCAUSA
- Clinical Trials CenterCardiovascular Research FoundationNew YorkNYUSA
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
| | - Andrea B. Barthel
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
| | - Shiwani Mahajan
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | | | - Henry Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal MedicineYale UniversityNew HavenCTUSA
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
- Cardiology DepartmentHospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12)MadridSpain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV)MadridSpain
- Facultad de MedicinaUniversidad Complutense de MadridMadridSpain
| | - Judith H. Lichtman
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenCTUSA
| | - Harlan M. Krumholz
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCTUSA
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Martín-Rioboó E, Brotons-Cuixart C, Ruiz García A, Villafañe Sanz F, Frías Vargas M, Moyá Amengual A, Divisón Garrote JA, Seoane Vicente MC, Banegas JR, Pallarés Carratalá V. [Luces y sombras de la Guía Europea esc-2021 de Prevención de la Enfermedad Cardiovascular en la Práctica Clínica.]. Rev Esp Salud Publica 2023; 97:e202308064. [PMID: 37921403 PMCID: PMC10541257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/01/2023] [Indexed: 11/04/2023] Open
Abstract
General practitioners see in their consultation a a significant number of patients at high vascular risk (VR). The European Guidelines for Cardiovascular Disease Prevention (2021) recommend a new risk classification and intervention strategies on on vascular risk factors (RF), with the aim of providing a shared decision-making recommendations between professionals and patients. In this document we present a critical analysis of these guidelines, offering possible solutions that can be implemented in Primary Care. It should be noted that there are positive aspects (lights) such as that the SCORE2 (from forty to sixty-nine years) and SCORE2-OP models (from seventy to eighty-nine years) are based on more current cohorts and measure cardiovascular risk in a more accurately manner. In addition, it is proposed to differentiate different risk thresholds according to age-groups. For sake of practicality, cardiovascular risk can be estimated using different websites with the new computer models. However, among the negative aspects (shadows), it seems to be add complexity implementing nine subgroups of subjects according to their age or level of risk, with a defined thresholds that could cause a substantial increase in the potential number of subjects susceptible to treatment without a clear evidence that supports it. In addition, two-step RF interventions could delay achievement of therapeutic goals, especially in very high-risk patients, diabetics, or patients with cardiovascular disease. Given these limitations, in this document we propose practical recommendations in order to simplify and facilitate the implementation of the guideline in primary care.
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Affiliation(s)
- Enrique Martín-Rioboó
- Médico de Familia; Unidad de Gestión Clínica Poniente; Distrito Universitario Córdoba-Guadalquivir; Departamento de Medicina; Universidad de Córdoba. / IMIBIC; Hospital Reina Sofía. Córdoba. España
| | - Carlos Brotons-Cuixart
- Médico de familia; Instituto de Investigaciones Biomédicas Sant Pau; Equipo de Atención Primaria Sardenya. Barcelona. España
| | - Antonio Ruiz García
- Médico de familia; Universidad Europea de Madrid. / Director del Centro de Salud Universitario Pinto; Unidad de Lípidos y Prevención Cardiovascular. Pinto (Madrid). España
| | - Fátima Villafañe Sanz
- Médico especialista en Medicina familiar y comunitaria.Centro de Salud Pisuerga. Arroyo de la Encomienda (Valladolid). España
| | - Manuel Frías Vargas
- Médico de Familia; Centro de Salud San Andrés. / Departamento de Medicina; Facultad de Medicina; Universidad Complutense de Madrid. Madrid. España
| | - Ana Moyá Amengual
- Médico del trabajo; Centro de Salud Sta. Catalina. Palma de Mallorca. España
| | - Juan Antonio Divisón Garrote
- Médico de Atención Primaria; Centro de Salud de Casas Ibáñez. Albacete. España
- Facultad de Medicina; Universidad Católica de Murcia (UCAM). Murcia. España
| | | | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, y Microbiología; Universidad Autónoma de Madrid. / CIBERESP. Madrid. España
| | - Vicente Pallarés Carratalá
- Médico de familia; Unidad de Vigilancia de la Salud; Unión de Mutuas. / Departamento de Medicina; Facultad de Ciencias de la Salud; Universitat Jaume I. Castellón. España
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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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Sarvilina IV, Danilov AB, Tkacheva ON, Gromova OA, Solovieva EY, Dudinskaya EN, Rozanov AV, Kartashova EA. [Influence of chronic pain in osteoarthritis on the risk of cardiovascular diseases and modern methods of drug prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-30. [PMID: 37315238 DOI: 10.17116/jnevro202312305120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.
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Affiliation(s)
- I V Sarvilina
- Medical Center «Novomedicina» LLC, Rostov-on-Don, Russia
| | - Al B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O N Tkacheva
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Gromova
- Federal Research Center «Computer Science and Control», Moscow, Russia
| | - E Yu Solovieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E N Dudinskaya
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Rozanov
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
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Halabi Z, Osman M, Hoteit R. Primary care physicians' awareness and perceptions on adherence to primary cardiovascular disease prevention guidelines in Lebanon: A cross-sectional study. Chronic Illn 2022; 18:719-728. [PMID: 33375844 DOI: 10.1177/1742395320983879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the awareness and have an insight on practice patterns of primary care physicians (PCPs) with respect to several professional primary cardiovascular diseases (CVDs) preventive guidelines. METHODS This is a cross-sectional study, questionnaire-based using a non-probability convenience sampling. Data collection occurred at the annual conferences of the Lebanese Societies of General Practice, Family Medicine, and Internal Medicine in Lebanon. 104 PCPs were recruited. MAIN OUTCOME MEASURES Awareness and practices of CVDs preventive guidelines. RESULTS The response rate was 37%. Awareness of the various CVD preventive guidelines was high among PCPs (>81%). Around 69% of PCPs reported that they always calculate the total cardiovascular risk assessment score. Gaps in managing patients according to guidelines' recommendations were higher in statin initiation compared to antihypertensive initiation. There is over prescription of statin in low risk patients and underutilization in high risk patients. Around 20% of PCPs would initiate aspirin for a low risk patient. Around 17% of physicians do not perform abdominal aortic aneurysm screening. DISCUSSION Although PCPs demonstrated high level of awareness regarding CVD preventive guidelines, gaps remain present in managing patients according to guidelines' recommendations. Less adherence to guidelines will increase mortality and affect patient care.
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Affiliation(s)
- Zeina Halabi
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Osman
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
| | - Reem Hoteit
- Department of Family Medicine, American University of Beirut, Beirut, Lebanon
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Krieg S, Kostev K, Luedde M, Krieg A, Luedde T, Roderburg C, Loosen SH. The association between the body height and cardiovascular diseases: a retrospective analysis of 657,310 outpatients in Germany. Eur J Med Res 2022; 27:240. [DOI: 10.1186/s40001-022-00881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) represents the leading cause of death worldwide. The identification of individuals at increased risk of CVD is essential to reduce its morbidity and mortality globally. Based on existing data on a potential association between the individual body height and the risk for CVD, we investigated this association in a large cohort of outpatients in Germany.
Methods
A total of 657,310 adult outpatients with available body height data from the Disease Analyzer (IQVIA) database were included in Germany between 2019 and 2021. The prevalence of common CVD diagnoses (hypertension, coronary heart disease, atrial fibrillation and flutter, heart failure, ischemic stroke, and venous thromboembolism) was evaluated as a function of the patients’ body height stratified by age and sex.
Results
In both sexes, the prevalence of hypertension, coronary heart disease, heart failure, and ischemic stroke was higher among patients of smaller body height. In contrast, the prevalence of atrial fibrillation and venous thromboembolism was higher in taller patients. In age- and BMI-adjusted logistic regression analyses, an increased body height was negatively associated with coronary heart disease (OR = 0.91 in women and OR = 0.87 in men per 10-cm increase in height) and strongly positively associated with atrial fibrillation (OR = 1.25 in women and men) and venous thromboembolism (OR = 1.23 in women and OR = 1.24 in men).
Conclusion
We present the first data from a large cohort of outpatients in Germany providing strong evidence for an association between the body height and common CVD. These data should stimulate a discussion as to how far the body height should be implemented as a parameter in stratification tools to assess CVD risk in order to further reduce cardiovascular morbidity and mortality in the future.
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12
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Electrocardiogram Risk Score and Prevalence of Subclinical Atherosclerosis: A Cross-Sectional Study. J Pers Med 2022; 12:jpm12030463. [PMID: 35330462 PMCID: PMC8948965 DOI: 10.3390/jpm12030463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
Integrated abnormal electrocardiogram (ECG) parameters predict the risk of cardiovascular disease (CVD); however, its relationship with subclinical CVD is unknown. We aimed to evaluate the association between the integrated ECG risk score and the prevalence of coronary artery calcium (CAC). A cross-sectional study comprised 134,802 participants with no known CVD who underwent ECG and CAC computed tomography. The ECG risk score was the sum of five ECG abnormalities: heart rate of >80 beats, QRS of >110 ms, left ventricular hypertrophy, T-wave inversion, and prolonged QTc. A multinomial regression model was used to estimate the prevalence ratios (PRs) and their 95% confidence intervals (CIs) for prevalent CAC. The prevalence of CAC progressively increased as the ECG risk score increased. After adjustment for conventional CVD risk factors and other confounders, the multivariable-adjusted PRs (95% CI) for a CAC of 1−100 in the 1, 2, and ≥3 ECG risk score groups were 1.06 (1.02−1.10), 1.12 (1.03−1.22), and 1.19 (1.00−1.42), respectively, while the corresponding PRs for a CAC of >100 were 1.03 (0.95−1.12), 1.44 (1.25−1.66), and 1.75 (1.33−2.29), respectively. Integrative ECG scoring may help identify individuals requiring lipid-lowering medications, even in young and asymptomatic populations.
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13
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DeFilippis AP, Trainor PJ, Thanassoulis G, Brumback LC, Post WS, Tsai MY, Tsimikas S. Atherothrombotic factors and atherosclerotic cardiovascular events: the multi-ethnic study of atherosclerosis. Eur Heart J 2022; 43:971-981. [PMID: 34508626 PMCID: PMC8899529 DOI: 10.1093/eurheartj/ehab600] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/09/2021] [Accepted: 08/18/2021] [Indexed: 01/02/2023] Open
Abstract
AIMS Traditional atherosclerotic cardiovascular disease (ASCVD) risk factors fail to address the full spectrum of the complex interplay of atherosclerotic and atherothrombotic factors integral to ASCVD events. This study sought to examine the association between atherothrombotic biomarkers and ASCVD events. METHODS AND RESULTS The association between atherothrombotic biomarkers and 877 ASCVD events with and without adjustment for traditional risk factors was evaluated via Cox proportional hazards models and factor analysis in 5789 Multi-Ethnic Study of Atherosclerosis participants over a median follow-up of 14.7 years. Factor analysis accounted for multidimensional relationship and shared variance among study biomarkers, which identified two new variables: a thrombotic factor (Factor 1), principally defined by shared variance in fibrinogen, plasmin-antiplasmin complex, factor VIII, D-dimer, and lipoprotein(a), and a fibrinolytic factor (Factor 2), principally defined by shared variance of plasminogen and oxidized phospholipids on plasminogen. In a model including both factors, the thrombotic factor was associated with the higher risk of ASCVD events [hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.45, 1.70], while the fibrinolytic factor was associated with the lower risk of ASCVD events (HR 0.76, 95% CI 0.70, 0.82), with estimated ASCVD free survival highest for low atherothrombotic Factor 1 and high atherothrombotic Factor 2. CONCLUSION Two atherothrombotic factors, one representative of thrombotic propensity and the other representative of fibrinolytic propensity, were significantly and complementarily associated with incident ASCVD events, remained significantly associated with incident ASCVD after controlling for traditional risk factors, and have promise for identifying patients at high ASCVD event risk specifically due to their atherothrombotic profile.
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Affiliation(s)
- Andrew P DeFilippis
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE 5th Floor, North Tower, Nashville, TN 37232, USA
| | - Patrick J Trainor
- Department of Chemistry and Biochemistry, New Mexico State University, 1175 N Horseshoe Dr., Las Cruces, NM 88003, USA
| | - George Thanassoulis
- Department of Medicine, Division of Experimental Medicine, McGill University Health Center, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada
| | - Lyndia C Brumback
- Department of Biostatistics, University of Washington, 1959 NE Pacific Street Seattle, WA 98105, USA
| | - Wendy S Post
- Department of Medicine, Division of Cardiology, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware ST SE, Minneapolis, Minnesota 55455, USA
| | - Sotirios Tsimikas
- Division of Cardiology, Department of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
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14
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Metelskaya VA, Zhatkina MV, Gavrilova NE, Yarovaya EB, Bogdanova NL, Kutsenko VA, Rudenko BA, Drapkina OM. Associations of circulating biomarkers with the presence and severity of coronary, carotid and femoral arterial atherosclerosis. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2021-3098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To identify and characterize the associations of the presence and severity of atherosclerosis of various localization with the blood level of biochemical parameters, as well as to assess the potential of their use as markers of metabolic disorders with increased atherogenic potential.Material and methods. The study included 216 patients (men, 53%) aged 24-87 years (mean age, 61,5±10,73 years). All patients underwent coronary angiography, carotid (CA) and femoral arterial (FA) duplex ultrasound to assess the presence and severity of atherosclerosis. In blood serum/plasma, biochemical parameters were analyzed using standard methods.Results. Based on the analysis of circulating biomarker profile, diagnostic complexes have been established that allow assessing atherosclerosis of different localization. According to the data obtained, the determinants of coronary and CA atherosclerosis are endothelial dysfunction (concentration of nitric oxide metabolites <36,0 μmol/L) and an increased level of creatinine (≥73,0 μmol/L). The specific markers associated with severe atherosclerosis of coronary and FAs (but not CA) were low high-density lipoprotein cholesterol (≤1,0/1,2 μmol/L for male/ female, respectively) and an increased C-reactive protein level (≥1,0 mg/l). Severe peripheral atherosclerosis (CA and FA involvement) was associated with hyperglycemia (glucose ≥6,1 μmol/L), while severe FA atherosclerosis — with hyperinsulinemia (insulin ≥14,0 μU/ml).Conclusion. The analysis of associations of circulating biochemical parameters with atherosclerosis localization and severity revealed a number of metabolic markers associated with the increased atherogenic potential. It is possible to distinguish both universal parameters that are associated with atherosclerosis, regardless of its localization and/or severity, and specific biomarkers that characterize either the localization or the severity of atherosclerosis, or both.
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Affiliation(s)
| | - M. V. Zhatkina
- National Medical Research Center for Therapy and Preventive Medicine; O.M. Filatov City Clinical Hospital № 15
| | | | | | - N. L. Bogdanova
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - B. A. Rudenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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15
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Zhang S, Zuo H, Meng X, Hu D. Support Life Club: A New Model Based on Social Media Group Chats and Social Activities That Can Improve Adherence and Clinical Outcomes in Patients Receiving Cardiac Rehabilitation. Patient Prefer Adherence 2022; 16:1907-1917. [PMID: 35945984 PMCID: PMC9357385 DOI: 10.2147/ppa.s368615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To describe a new model, the Support Life Club (SLC), for participants of Phase II cardiac rehabilitation (CR) programs and to evaluate this model for adherence, completion rates, and clinical outcomes. METHODS This retrospective study involved 391 consecutive patients who participated in an outpatient CR program between September 2016 and May 2020. The intervention group (SLC) was comprised of 198 patients who participated in education, WeChat-based group activity as well as outdoor activities, while the control group (non-intervention) was comprised of 193 cases. All patients attended a 12-week supervised outpatient CR program (three sessions per week, each lasting 40min). The intervention and control groups were compared for completion rates, Cardiopulmonary Exercise Test (CPET) results, Six-minute Walk Test (6MWT) distances, and Patient Health Questionnaire-9 (PHQ-9) scores. RESULTS Patients in the intervention group attended at least 75% of the exercise training sessions more often than those in the control group (72.5% vs 40.41%, adjusted odds ratio (OR): 27.385; 95% CI: 10.2 to 73.6; P = 0.0000). Analysis of variance (2 × 2 ANOVA) revealed a significant group-by-time interaction in PHQ9 and 6MWT test results (p = 0.000). CONCLUSION The addition of SLC to a cardiac rehabilitation program resulted in better outcomes for PHQ9 and 6MWT tests and may be a useful strategy to improve exercise adherence.
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Affiliation(s)
- Sisi Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Houjuan Zuo
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiaoping Meng
- Affiliated Hospital of Changchun Traditional Chinese Medicine, Changchun, People’s Republic of China
- Correspondence: Xiaoping Meng, Affiliated Hospital of Changchun Traditional Chinese Medicine, Gongnong Avenue No. 1478, Chaoyang District, Changchun, 130000, People’s Republic of China, Tel +86-13180889540, Email
| | - Dayi Hu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- People’s Hospital of Peking University, Beijing, People’s Republic of China
- Dayi Hu, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Qiaokou District, Wuhan, 430000, People’s Republic of China, Tel +86-13901389171, Email
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16
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Zhang J, Xu Y, Ding W, Zhao M, Liu J, Ye J, Wang Z, Ye D, Wang M, Wan J. Increased expression of IL-20 is associated with ischemic cardiomyopathy and acute myocardial infarction. Biomark Med 2021; 15:1641-1650. [PMID: 34704818 DOI: 10.2217/bmm-2020-0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The expression and clinical significance of IL-20 in coronary artery diseases needs to be analyzed. Methods: IL-20 and its receptors were analyzed in coronary artery tissues. In a separate study, plasma IL-20 was also evaluated. Results: IL-20 and its receptors were significantly higher in coronary artery stenosis tissues from ischemic cardiomyopathy patients than that from controls. T lymphocytes and macrophages were the main source of IL-20 and expressed its receptors abundantly. Plasma IL-20 was significantly higher in acute myocardial infarction patients than that in controls. Conclusion: IL-20 was closely associated with the presence of acute myocardial infarction. IL-20 may participate in the progression of coronary artery stenosis and plaque vulnerability via regulating T lymphocytes and macrophages.
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Affiliation(s)
- Jishou Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Yao Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Wen Ding
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Mengmeng Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Jianfang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Jing Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Zhen Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Di Ye
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Menglong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
| | - Jun Wan
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, 430060, China
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17
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Coca-Martinez M, Carli F, Gill HL. Multimodal Prehabilitation to Improve Quality of Life and Functional Capacity in Peripheral Arterial Disease: A Case Series. Arch Rehabil Res Clin Transl 2021; 3:100139. [PMID: 34589689 PMCID: PMC8463456 DOI: 10.1016/j.arrct.2021.100139] [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] [Indexed: 12/02/2022] Open
Abstract
Objectives To assess feasibility and effect of multimodal prehabilitation in patients with severe life-limiting intermittent claudication and complex infrainguinal disease. Design Case series of patients who underwent a 12-week prehabilitation program. Setting Outpatient clinic of a public tertiary hospital Participants Patients with a diagnosis of severe life-limiting intermittent claudication (Fontaine stage IIb and III) with complex infrainguinal disease or previous failed bypass attempts (N=5) who were referred to the prehabilitation clinic by a vascular surgeon. Interventions Patients underwent a baseline assessment that included quality of life questionnaires and functional capacity tests. After baseline assessment, they received a 12-week prehabilitation program that consisted of (1) a supervised exercise session 1 time per week; (2) home-based exercise prescription; (3) nutritional counseling; (4) smoking cessation; and (5) psychosocial intervention. Adherence to all components was recorded as well as the occurrence of any adverse event. After completion of the 12-week program, patients were reassessed. Main Outcome Measure Feasibility of prehabilitation measured by adherence to the different components of the program and occurrence of adverse events. Results All 5 patients completed the program. No serious adverse events occurred during the length of prehabiliation. Median adherence to each prehabilitation component was 91.7% (interquartile range [IQR], 33.5%) for supervised training, 91.7% (IQR, 40%) for home-based exercise, and 75% (IQR, 50%) for nutrition. Three of the 5 patients underwent psychosocial intervention and all who were active smokers enrolled in the smoking cessation program. Functional capacity measured with the 6-minute walk distance improved by 70 m (IQR, 99 m), and disease-specific quality of life measured with the Vascular Quality of Life Questionnaire improved by 25%. Conclusion Multimodal prehabilitation appears to be a feasible tool that could be used to increase functional capacity and quality of life for patients with complex infrainguinal disease and expected poor revascularization outcome or previous failed bypass attempts.
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Affiliation(s)
- Miquel Coca-Martinez
- Division of Vascular Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | - Heather L Gill
- Division of Vascular Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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18
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Mrázová J, Bӧtӧšová S, Kopčeková J, Lenártová P, Gažarová M, Habánová M, Jančichová K. Monitoring of risk factors of cardiovascular diseases in adult men. POTRAVINARSTVO 2021. [DOI: 10.5219/1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The study aims to evaluate the monitoring of risk factors of cardiovascular diseases in the young population, which significantly contribute to the origin and development of cardiovascular diseases, such as peripheral artery diseases, atherosclerosis, stroke, and others. We focused on a group of young adult men (n = 110) in the age range of 30 to 50 years, which we selected from the database of 800 patients hospitalized in the Cardio Center in Nitra during 2010 – 2020. When evaluating the influence of meat products consumption frequency on biochemical parameters and BMI, we recorded a statistically significant effect at the level of p <0.05 in the evaluation of meat products such as salami, brawn, and sausages. When consuming sausages, BMI values also increased with increasing frequency of consumption. The effect on BMI was also observed when eating salami, between consuming 1 – 2 times a week and not at all. We recorded a statistically significant effect (p <0.05) in frequent consumption of brawn (1 – 2 weeks) on the level of HDL cholesterol. The most frequent fish consumption was 1 – 2 times a month for freshwater (51.8%) and marine fish (56.3%). Daily consumption of fruit was reported in 64.6% of men, while daily consumption of vegetables was recorded in only 44.6% of men. In the lifestyle assessment, we focused on probands' time spent on physical activity. Only 35.5% of men stated that they spend more than an hour a day on physical activity. 40% of men from the surveyed respondents were active smokers. Another risk factor for cardiovascular diseases is stress, which significantly affected up to 42.7% of respondents. Nutrition and lifestyle play an important role in the prevention of cardiovascular diseases, which significantly affect blood lipid parameters, vascular endothelial elasticity, and factors determining the etiopathogenesis of cardiovascular diseases.
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19
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Sieben A, A.W. van Onzenoort H, J.H.M. van Laarhoven K, Bredie SJ, van Dulmen S. Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis. J Cardiovasc Nurs 2021; 36:489-497. [PMID: 32501862 PMCID: PMC8366598 DOI: 10.1097/jcn.0000000000000702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately. OBJECTIVE The first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined. METHODS In this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013. RESULTS Cardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present. CONCLUSION This study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.
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20
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Zhang X, Xu D, Sun G, Jiang Z, Tian J, Shan Q. Effects of high-intensity interval training in patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Nurs Open 2021; 8:1424-1435. [PMID: 33528117 PMCID: PMC8046134 DOI: 10.1002/nop2.759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To evaluate whether high-intensity interval training (HIIT) was superior to low-intensity training or usual care among patients after percutaneous coronary intervention. The hypothesis was that HIIT would help patients after percutaneous coronary intervention (PCI) improve cardiopulmonary function, lipid profiles and in-stent restenosis. DESIGN A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA)2009 Checklist. METHODS Randomized controlled trials (RCTs) focusing on HIIT programme in patients after PCI were searched in Cochrane Library, Web of Science Core Collection, EMbase, PubMed, China National Knowledge Infrastructure (CNKI) and SinoMed from the inception to 24 March 2020. Standard Mean difference (SMD) and 95% confidence intervals (CI) were performed to summarize the effect sizes. RESULTS Six RCTs (247 patients) met the criteria. HIIT programme had a statistically significant effect on raising left ventricular ejection function (LVEF) (SMD = 0.38, 95%CI [0.03, 0.73], I2 = 3%), VO2peak (SMD = 0.94, 95%CI [0.61, 1.28], I2 = 0%), as well as improving the serum level of high-density lipoprotein (SMD = 0.55, 95%CI [0.06, 1.03], I2 = 0%) and late luminal loss (SMD = -0.65, 95%CI [-1.07, -0.23], I2 = 0%). But HIIT had no prominent effect on improving heart rate (SMD = -0.04, 95%CI [-0.29, 0.21], I2 = 0%). Summarily, HIIT programme appears to be favourable for CAD patients after PCI by improving cardiopulmonary function, such as LVEF and VO2peak , as well as reducing late luminal loss in per stented arteries. Nevertheless, HIIT has no advantage for adjusting heart rate. More researches with rigorous methods are warranted to explore the controversy about lipid profiles.
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Affiliation(s)
- Xinyue Zhang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Dongmei Xu
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Guozhen Sun
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhixin Jiang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jinping Tian
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qijun Shan
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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21
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Khismatullina ZR, Koreshkova KM. The role of endothelial damage and dyslipidemia in the development of cardiovascular pathology in psoriatic arthritis. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
An increased risk of cardiovascular events has now been identified in patients with psoriatic arthritis. The chronic immune-mediated inflammation underlying psoriatic arthritis (PA) leads to the development of dyslipidemia, atherosclerosis and its complications, in particular, a high risk of cardiovascular complications. For PA, dyslipidemias are most characteristic, manifested by an increased level of low and very low density lipoproteins, triglycerides and total cholesterol, which correlates with the activity of the disease. The literature review studied the pathogenesis of dyslipidemias and vascular wall lesions in psoriatic arthritis, analyzed the literature on cardiovascular complications and mortality among patients with PA, studied the issues of total cardiovascular risk, presented the results of numerous clinical studies that allow PA to be considered a disease associated with increased the risk of cardiovascular complications. Considering the role of proinflammatory cytokines in the pathogenesis of psoriatic arthritis, early detection of endothelial lesions represents the most promising direction in the prevention of cardiovascular diseases, which are the main cause of mortality in this group of patients.
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22
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Pozuelo-Carrascosa DP, Cavero-Redondo I, Lee I, Álvarez-Bueno C, Reina-Gutierrez S, Martínez-Vizcaíno V. Resting Heart Rate as a Predictor of Cancer Mortality: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:1354. [PMID: 33806038 PMCID: PMC8037294 DOI: 10.3390/jcm10071354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
This work was aimed to synthetize the evidence available about the relationship between resting heart rate (RHR) and the risk of cancer mortality. A computerized search in the Medline, EMBASE, Web of Science, and Cochrane Library databases from their inception to 24 September 2020 was performed. We performed three meta-analyses: (1) cancer mortality comparing the "less than 60 bpm" and "more than 60 bpm" categories; (2) cancer mortality comparing "less than 60 bpm", "60 to 80 bpm", and "more than 80 bpm" categories; and (3) analysis for 10-12 and 20 bpm increase in RHR and risk of cancer mortality. Twenty-two studies were included in the qualitative review, and twelve of them met the inclusion criteria for the meta-analysis. Our results showed a positive association between RHR and the risk of cancer mortality. This association was shown in a meta-analysis comparing studies reporting mean RHR values below and above 60 bpm, when comparing three RHR categories using less than 60 bpm as the reference category and, finally, in dose response analyses estimating the effect of an increase of 10-12 bpm in RHR, both in men and in women. In conclusion, a low RHR is a potential marker of low risk of cancer mortality.
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Affiliation(s)
- Diana P. Pozuelo-Carrascosa
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Iván Cavero-Redondo
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Echaurren Street 140, 2nd Floor, 72819 Santiago, Chile
| | - I.M. Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Celia Álvarez-Bueno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Universidad Politécnica y Artística del Paraguay, Asunción 001518, Paraguay
| | - Sara Reina-Gutierrez
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, 1670 Talca, Chile
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Mols RE, Hald M, Vistisen HS, Lomborg K, Maeng M. Nurse-led Motivational Telephone Follow-up After Same-day Percutaneous Coronary Intervention Reduces Readmission and Contacts to General Practice. J Cardiovasc Nurs 2020; 34:222-230. [PMID: 30789491 DOI: 10.1097/jcn.0000000000000566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Same-day discharge of patients undergoing percutaneous coronary intervention (PCI) may challenge preparation of patients for discharge. OBJECTIVE The objective of this study was to investigate whether nurse-led telephone follow-up influenced patients' self-management post-PCI. METHODS We performed a randomized study with an allocation rate of 1:1. A standardized nurse-led motivational telephone consultation was conducted between 2 and 5 days after PCI to support adherence to medical therapy, follow-up activities, emotional well-being, and healthy lifestyle. The control group received usual care and discharge procedures. Primary outcome was adherence to use of P2Y12 inhibitor (clopidogrel or ticagrelor) therapy at 30 days of follow-up. RESULTS We consecutively included 294 elective patients (83%) undergoing PCI and with planned same-day discharge. Adherence to P2Y12 inhibitors was not influenced by the intervention (intervention vs control, 95% vs 93%, respectively; P = .627). However, the proportion of patients readmitted (8% vs 16%, P = .048), as well as self-initiated contacts to general practitioners (29% vs 42%, P = .020), was lower in the intervention group compared with the control group. Patients in the intervention group were more likely to know how to manage symptoms of angina pectoris (90% vs 80%, P = .015), and a higher proportion of patients in the intervention group commenced healthy physical activities (53% vs 41%, P = .043). CONCLUSION Nurse-led motivational telephone follow-up did not influence adherence to antiplatelet medical therapy after PCI. However, the intervention positively influenced self-management of angina pectoris and reduced hospital readmissions and self-initiated contacts to general practitioners and hospitals.
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Affiliation(s)
- Rikke Elmose Mols
- Rikke Elmose Mols, PhD, RN Healthcare Researcher, Department of Cardiology, Aarhus University Hospital, Denmark. Marianne Hald, RNProject Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Heidi Soenderby Vistisen, MCn, RNDevelopment Nurse, Department of Cardiology, Aarhus University Hospital, Denmark. Kirsten Lomborg, PhD, RNProfessor, Department of Clinical Medicine, Aarhus University; and the Research Program in Patient Involvement, Aarhus University Hospital, Denmark. Michael Maeng, PhD, MD Associated Professor and Invasive Cardiologist, Department of Cardiology, Aarhus University Hospital, Denmark
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24
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Keith RJ, Fetterman JL, Orimoloye OA, Dardari Z, Lorkiewicz PK, Hamburg NM, DeFilippis AP, Blaha MJ, Bhatnagar A. Characterization of Volatile Organic Compound Metabolites in Cigarette Smokers, Electronic Nicotine Device Users, Dual Users, and Nonusers of Tobacco. Nicotine Tob Res 2020; 22:264-272. [PMID: 30759242 DOI: 10.1093/ntr/ntz021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/08/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Limited research exists about the possible cardiovascular effects of electronic nicotine delivery systems (ENDS). We therefore sought to compare exposure to known or potentially cardiotoxic volatile organic compounds (VOCs) in ENDS users, smokers, and dual users. METHODS A total of 371 individuals from the Cardiovascular Injury due to Tobacco Use study, a cross-sectional study of healthy participants aged 21-45 years, were categorized as nonusers of tobacco (n = 87), sole ENDS users (n = 17), cigarette smokers (n = 237), and dual users (n = 30) based on 30-day self-reported tobacco product use patterns. Participants provided urine samples for VOC and nicotine metabolite measurement. We assessed associations between tobacco product use and VOC metabolite measures using multivariable-adjusted linear regression models. RESULTS Mean (SD) age of the population was 32 (±6.8) years, 55% men. Mean urinary cotinine level in nonusers of tobacco was 2.6 ng/mg creatinine, whereas cotinine levels were similar across all tobacco product use categories (851.6-910.9 ng/mg creatinine). In multivariable-adjusted models, sole ENDS users had higher levels of metabolites of acrolein, acrylamide, acrylonitrile, and xylene compared with nonusers of tobacco, but lower levels of most VOC metabolites compared with cigarette smokers or dual users. In direct comparison of cigarettes smokers and dual users, we found lower levels of metabolites of styrene and xylene in dual users. CONCLUSION Although sole ENDS use may be associated with lower VOC exposure compared to cigarette smoking, further study is required to determine the potential health effects of the higher levels of certain reactive aldehydes, including acrolein, in ENDS users compared with nonusers of tobacco. IMPLICATIONS ENDS use in conjunction with other tobacco products may not significantly reduce exposure to VOC, but sole use does generally reduce some VOC exposure and warrants more in-depth studies.
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Affiliation(s)
- Rachel J Keith
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Jessica L Fetterman
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Olusola A Orimoloye
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Zeina Dardari
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Pawel K Lorkiewicz
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Naomi M Hamburg
- American Heart Association Tobacco, Regulation and Addiction Center, Vascular Biology Section, Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Andrew P DeFilippis
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
| | - Michael J Blaha
- American Heart Association Tobacco, Regulation and Addiction Center, Ciccarone Center for the Prevention of Heart Disease, John Hopkins Hospital, Baltimore, MD
| | - Aruni Bhatnagar
- American Heart Association Tobacco, Regulation and Addiction Center, University of Louisville School of Medicine, Louisville, KY
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Jancsó Z, Rurik I, Kolozsvári L, Mester L, Nánási A, Oláh C, Ungvári T, TCs KV, Kalabay L, Torzsa P. Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement. BMC FAMILY PRACTICE 2020; 21:83. [PMID: 32384878 PMCID: PMC7210674 DOI: 10.1186/s12875-020-01150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
Abstract
Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.
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Affiliation(s)
- Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Lajos Mester
- Institute of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Csaba Oláh
- Central and University Teaching Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Katalin Vraukó TCs
- Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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Susca MG, Hodas R, Benedek T, Benedek I, Chitu M, Opincariu D, Chiotoroiu A, Rezus C. Impact of cardiac rehabilitation programs on left ventricular remodeling after acute myocardial infarction: Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19759. [PMID: 32311978 PMCID: PMC7220465 DOI: 10.1097/md.0000000000019759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION While the role of early mobilization in the immediate postinfarction period has been well demonstrated, little is known in present about the link between early mobilization and reduction of systemic inflammation. At the same time, the impact of early mobilization on regression of left ventricular remodeling has not been elucidated so far. MATERIAL AND METHODS Here we present the study protocol of the REHAB trial, a clinical descriptive, prospective study, conducted in a single-center, with the purpose to analyze the impact of early mobilization in reducing left ventricular remodeling, the complication rates and mortality in patients who had suffered a recent acute myocardial infarction (AMI). At the same time, the study aims to demonstrate the contribution of early mobilization to reduction of systemic inflammation, thus reducing the inflammation-mediated ventricular remodeling. 100 patients with AMI in the last 12 hours, and successful revascularization of the culprit artery within the first 12 hours after the onset of symptoms in ST-segment elevation acute myocardial infarction or within first 48 hours in non ST-segment elevation AMI will be enrolled in the study. Based on the moment of mobilization after AMI patients will be distributed in 2 groups: group 1 - patients with early mobilization (<2 days after the onset of symptoms) and; group 2 - subjects with delayed mobilization after AMI (>2 days after the onset of symptoms). Study outcomes will consist in the impact of early mobilization after AMI on the ventricular remodeling in the post-infarction period, as assessed by cardiac magnetic resonance imaging, the rate of in-hospital mortality, the rate of repeated revascularization or MACE and the effect of early mobilization on systemic inflammation in the immediate postinfarction phase. CONCLUSION In conclusion, REHAB will be the first trial that will elucidate the impact of early mobilization in the first period after AMI, as a first step of a complex cardiac rehabilitation program, to reduce systemic inflammation and prevent deleterious ventricular remodeling in patients who suffered a recent AMI.
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Affiliation(s)
| | | | - Theodora Benedek
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Imre Benedek
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Monica Chitu
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Diana Opincariu
- Clinic of Cardiology, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
- Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Targu Mures
| | - Andreea Chiotoroiu
- University of Medicine, Pharmacy, Sciences and Technology of Targu Mures
| | - Ciprian Rezus
- University of Medicine and Pharmacy ‘Gr.T.Popa’, Iasi, Romania
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Groenwold RHH. Informative missingness in electronic health record systems: the curse of knowing. Diagn Progn Res 2020; 4:8. [PMID: 32699824 PMCID: PMC7371469 DOI: 10.1186/s41512-020-00077-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Electronic health records provide a potentially valuable data source of information for developing clinical prediction models. However, missing data are common in routinely collected health data and often missingness is informative. Informative missingness can be incorporated in a clinical prediction model, for example by including a separate category of a predictor variable that has missing values. The predictive performance of such a model depends on the transportability of the missing data mechanism, which may be compromised once the model is deployed in practice and the predictive value of certain variables becomes known. Using synthetic data, this phenomenon is explained and illustrated.
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Affiliation(s)
- Rolf H. H. Groenwold
- grid.10419.3d0000000089452978Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
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Anker MS, von Haehling S, Papp Z, Anker SD. ESC Heart Failure receives its first impact factor. Eur J Heart Fail 2019; 21:1490-e8. [PMID: 31883221 DOI: 10.1002/ejhf.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, George August University, Göttingen, Germany and German Center for Cardiovascular Medicine (DZHK), partner site Göttingen, Göttingen, Germany
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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Castañeda S, Vicente-Rabaneda EF, García-Castañeda N, Prieto-Peña D, Dessein PH, González-Gay MA. Unmet needs in the management of cardiovascular risk in inflammatory joint diseases. Expert Rev Clin Immunol 2019; 16:23-36. [DOI: 10.1080/1744666x.2019.1699058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
- Department of Medicine, Cátedra UAM-ROCHE, EPID Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | - Diana Prieto-Peña
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Patrick H. Dessein
- Honorary Research Professor, School of Physiology and School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Miguel A. González-Gay
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- School of Medicine, University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Kadesjö E, Roos A, Siddiqui A, Desta L, Lundbäck M, Holzmann MJ. Acute versus chronic myocardial injury and long-term outcomes. Heart 2019; 105:1905-1912. [PMID: 31337668 DOI: 10.1136/heartjnl-2019-315036] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE There is a paucity of data regarding prognosis in patients with acute versus chronic myocardial injury for long-term outcomes. We hypothesised that patients with chronic myocardial injury have a similar long-term prognosis as patients with acute myocardial injury. METHODS In an observational cohort study of 22 589 patients who had high-sensitivity cardiac troponin T (hs-cTnT) measured in the emergency department during 2011-2014, we identified all patients with level >14 ng/L and categorised them as acute myocardial injury, type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI) or chronic myocardial injury through adjudication. We estimated adjusted HRs with 95% CIs for the primary outcome all-cause mortality and secondary outcomes MI, and heart failure in patients with acute myocardial injury, T1MI and T2MI compared with chronic myocardial injury. RESULTS In total, 3853 patients were included. During 3.9 (±2) years of follow-up, 48%, 24%, 44% and 49% of patients with acute myocardial injury, T1MI, T2MI and chronic myocardial injury died, respectively. Patients with acute myocardial injury had higher adjusted risks of death (1.21, 95% CI 1.08 to 1.36) and heart failure (1.24, 95% CI 1.07 to 1.43), but a similar risk for myocardial infarction (MI) compared with the reference group. Patients with T1MI had a lower adjusted risk of death (0.86, 95% CI 0.74 to 1.00) and higher risk of MI (2.09, 95% CI 1.62 to 2.68), but a similar risk of heart failure. Patients with T2MI had a higher adjusted risk of death (1.46, 95% CI 1.18 to 1.80) and heart failure (1.30, 95% CI 1.00 to 1.69) compared with patients with chronic myocardial injury. CONCLUSIONS Absolute long-term risks for death are similar, and adjusted risks are slightly higher, among patients with acute myocardial injury and T2MI, respectively, compared with chronic myocardial injury. The lowest risk of long-term mortality was found in patients with T1MI. Both acute and chronic myocardial injury are associated with very high risks of adverse outcomes.
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Affiliation(s)
- Erik Kadesjö
- Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm
| | - Andreas Roos
- Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm
| | - Anwar Siddiqui
- Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm
| | - Liyew Desta
- Heart and Vascular Theme, Functional Area of Ischemic Heart Disease, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Magnus Lundbäck
- Department of Clinical Sciences, Division of CardiovascularMedicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin J Holzmann
- Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm
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(Patient's level of information on prevention of cardiovascular diseases). COR ET VASA 2019. [DOI: 10.33678/cor.2019.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Selak V, Jackson R, Poppe K, Wu B, Harwood M, Grey C, Pylypchuk R, Mehta S, Choi YH, Kerr A, Wells S. Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention: A Benefit-Harm Analysis. Ann Intern Med 2019; 171:529-539. [PMID: 31525775 DOI: 10.7326/m19-1132] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Whether the benefits of aspirin for the primary prevention of cardiovascular disease (CVD) outweigh its bleeding harms in some patients is unclear. OBJECTIVE To identify persons without CVD for whom aspirin would probably result in a net benefit. DESIGN Individualized benefit-harm analysis based on sex-specific risk scores and estimates of the proportional effect of aspirin on CVD and major bleeding from a 2019 meta-analysis. SETTING New Zealand primary care. PARTICIPANTS 245 028 persons (43.6% women) aged 30 to 79 years without established CVD who had their CVD risk assessed between 2012 and 2016. MEASUREMENTS The net effect of aspirin was calculated for each participant by subtracting the number of CVD events likely to be prevented (CVD risk score × proportional effect of aspirin on CVD risk) from the number of major bleeds likely to be caused (major bleed risk score × proportional effect of aspirin on major bleeding risk) over 5 years. RESULTS 2.5% of women and 12.1% of men were likely to have a net benefit from aspirin treatment for 5 years if 1 CVD event was assumed to be equivalent in severity to 1 major bleed, increasing to 21.4% of women and 40.7% of men if 1 CVD event was assumed to be equivalent to 2 major bleeds. Net benefit subgroups had higher baseline CVD risk, higher levels of most established CVD risk factors, and lower levels of bleeding-specific risk factors than net harm subgroups. LIMITATIONS Risk scores and effect estimates were uncertain. Effects of aspirin on cancer outcomes were not considered. Applicability to non-New Zealand populations was not assessed. CONCLUSION For some persons without CVD, aspirin is likely to result in net benefit. PRIMARY FUNDING SOURCE Health Research Council of New Zealand.
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Affiliation(s)
- Vanessa Selak
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Rod Jackson
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Katrina Poppe
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Billy Wu
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Matire Harwood
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Corina Grey
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Romana Pylypchuk
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Suneela Mehta
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Yeun-Hyang Choi
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
| | - Andrew Kerr
- University of Auckland and Middlemore Hospital, Auckland, New Zealand (A.K.)
| | - Sue Wells
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.)
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Lotfy HM, Erk N, Rostom Y. Developing spectral numerical factor technique for the determination of amlodipine besylate and the latest generation of statins in their new pharmaceutical combination. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2019; 218:320-330. [PMID: 31022682 DOI: 10.1016/j.saa.2019.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/31/2019] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
Spectral numerical factor techniques have been developed for quantification of a new pharmaceutical combination. Five simple, fast and accurate spectrophotometric methods using spectral factor manipulation have been tested and validated so as to determine quantitatively a new fixed-dose combination tablet containing both amlodipine besylate (ADB) and rosuvastatin calcium (ROS). Namely, these methods are induced dual wavelength, absorbance correction, absorbance subtraction, amplitude correction and advanced amplitude subtraction. Their corresponding spectral factors are equality, absorption, absorbance, amplitude and unity factor, respectively. Calibration curves of ADB and ROS were set up for all the previously mentioned methods under the optimum conditions in a concentration range of 3.0-21.0 μg/mL with correlation coefficients ≥0.9990. Selectivity was calculated by analyzing laboratory-prepared synthetic blends of the cited drugs. A comparative study between these methods and the reported ones has been carried out statistically forming a judgment that the difference between both results is totally insignificant. Actually, the suggested spectral factor technique is so effective for use in routine laboratory essay owing to its simplicity, rapidity and precision. Generally, the proposed factor procedures have the ability to run smoothly without any interference from additives that may deteriorate analysis efficiency of a pharmaceutical combination.
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Affiliation(s)
- Hayam M Lotfy
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt; Pharmaceutical Chemistry Department, Faculty of Pharmaceutical Science and Pharmaceutical Industries, Future University, Cairo, Egypt
| | - Nevin Erk
- Analytical Chemistry Department, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Yasmin Rostom
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr El-Aini Street, Cairo, Egypt.
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Mlynarska A, Mlynarski R, Sosnowski M. Usefulness of the Coronary Artery Calcium Score in Predicting Subsequent Coronary Interventions-A Ten-Year Single-Center Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2132. [PMID: 31208148 PMCID: PMC6617306 DOI: 10.3390/ijerph16122132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 01/26/2023]
Abstract
There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients' management over a period of ten years after application of the CACS. Methods: The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)-G1: CACS = 0 AU (52 pts); G2: CACS = 1-399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI-Percutaneous Coronary Intervention; CABG-Coronary Artery Bypass Graft) were also analyzed. Results: The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; p = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714-0.841); in CABG, it was 0.825 (95% CI: 0.760-0.878) and the average for both groups was 0.838 (95% CI: 0.774-0.889). Conclusions: The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.
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Affiliation(s)
- Agnieszka Mlynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
- Department of Electrocardiology, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
| | - Rafal Mlynarski
- Department of Electrocardiology, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
| | - Maciej Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Upper Silesian Medical Centre, 40-635 Katowice, Poland.
- 3rd Division of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland.
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Do self-reported data accurately measure health inequalities in risk factors for cardiovascular disease? Int J Public Health 2019; 64:721-729. [DOI: 10.1007/s00038-019-01232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022] Open
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Sieben A, van Onzenoort HAW, van Dulmen S, van Laarhoven CJHM, Bredie SJH. A nurse-based intervention for improving medication adherence in cardiovascular patients: an evaluation of a randomized controlled trial. Patient Prefer Adherence 2019; 13:837-852. [PMID: 31213778 PMCID: PMC6537037 DOI: 10.2147/ppa.s197481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/21/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Poor medication adherence is a limitation in the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Purpose: To examine the process and effect of a nurse-led, web-based intervention based on behavioral change strategies to improve medication adherence in patients with CVD. Patients and methods: In this single-center, prospective, controlled clinical trial, cardiovascular patients were assigned to usual care, usual care plus a personalized website, or usual care plus a personalized website and personal consultations. Primary outcome was the level of adherence to cardiovascular medication. Data collection occurred between October 2011 and January 2015. Results: In total, 419 patients were randomized. Just 77 patients logged on the website and half of the invited patients attended the group consultation. Due to the limited use of the website, we combined the results of usual care and the usual care plus website group in one group (usual care) and compared these with the results of the group which received the nurse intervention (intervention group). No significant difference in adherence between the usual care group and the intervention group was observed. The adherence level in the usual care group was 93%, compared to 89% in the intervention group (p=0.08). 29% (usual care) and 31% (intervention group) of the patients showed a low adherence according to the Modified Morisky Scale® (p-value=0.94). The mean necessity concern differential was 3.8 with no differences between the two studied groups (mean 3.8 vs mean 3.9, p-value =0.86). Conclusion: Our intervention program did not show an effect. This could indicate that structured usual care provided to all cardiovascular patients already results in high medication adherence or that shortly after a cardiovascular event adherence is high. It could also indicate that the program did not have enough impact because there was not enough compliance with the intervention protocol. Trial registration: ID number NCT01449695, approved May 2011.
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Affiliation(s)
- Angelien Sieben
- Department of Surgery, Division of Vascular Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Hein AW van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - CJHM van Laarhoven
- Department of General Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Sebastian JH Bredie
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Araya-Quintanilla F, Gutiérrez-Espinoza H, Moyano-Gálvez V, Muñoz-Yánez MJ, Pavez L, García K. Effectiveness of black tea versus placebo in subjects with hypercholesterolemia: A PRISMA systematic review and meta-analysis. Diabetes Metab Syndr 2019; 13:2250-2258. [PMID: 31235165 DOI: 10.1016/j.dsx.2019.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/22/2019] [Indexed: 01/27/2023]
Abstract
AIM To determine if the black tea is more effective in serum lipid profile that placebo in subjects with hypercholesterolemia. DESIGN Systematic review with meta-analysis of randomized clinical trials (RCTs). DATA SOURCES The databases Medline, Central, Embase, Lilacs, Cinahl, SPORTDiscus, and Web of Science were searched from inception up to January 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RCTs that compared black tea versus placebo, that included serum lipid profile outcomes in subjects older than 18 years of age with hypercholesterolemia. RESULTS Seven RCTs met the eligibility criteria, and for the quantitative synthesis, six studies were included. Mean difference for total cholesterol was 1.67 mg/dl 95% CI = -5.47 to 8.80 (p = 0.65), mean difference 0.28 mg/dl, 95% CI = -3.89 to 4.45 (p = 0.90) for triglycerides, mean difference 3.21 mg/dl, 95% CI = -11.02 to 4.60 (p = 0.42) for low density lipoprotein-cholesterol, mean difference 0.38 mg/dl, 95% CI = -1.12 to 1.87 (p = 0.62) for high density lipoprotein-cholesterol. CONCLUSION In the short term, no significant differences were found in lipid serum profile comparing black tea consumption with placebo.
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Affiliation(s)
- Felipe Araya-Quintanilla
- Faculty of Health Sciences, Universidad Gabriela Mistral. Santiago, Chile; Faculty of Health, Universidad de las Americas. Santiago, Chile.
| | - Héctor Gutiérrez-Espinoza
- Faculty of Health, Universidad de las Americas. Santiago, Chile; Center of Diagnostic and Treatment, Clinical Hospital San Borja Arriaran. Santiago, Chile
| | | | | | - Leonardo Pavez
- Instituto de Ciencias Naturales, Universidad de las Américas. Santiago, Chile; Departamento de Ciencias Químicas y Biológicas, Universidad Bernardo O'Higgins. Santiago, Chile
| | - Katherine García
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile, Santiago, Chile
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Pokimica B, García-Conesa MT, Zec M, Debeljak-Martačić J, Ranković S, Vidović N, Petrović-Oggiano G, Konić-Ristić A, Glibetić M. Chokeberry Juice Containing Polyphenols Does Not Affect Cholesterol or Blood Pressure but Modifies the Composition of Plasma Phospholipids Fatty Acids in Individuals at Cardiovascular Risk. Nutrients 2019; 11:E850. [PMID: 30991718 PMCID: PMC6520894 DOI: 10.3390/nu11040850] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022] Open
Abstract
Chokeberry polyphenols have been suggested to reduce cholesterol and blood pressure and thus protect against cardiovascular diseases (CVD), but the evidence in humans is limited and inconsistent. This randomized double-blinded three-parallel groups trial investigated the changes in various anthropometric and clinical biomarkers, and in plasma phospholipids fatty acids (PPFA) in volunteers at cardiovascular risk after a four-week intervention with 100 mL/day of (1) chokeberry juice with a high-dose of polyphenols (1177.11 mg gallic acid equivalents, GAE); (2) chokeberry juice with a low-dose of polyphenols (294.28 mg GAE) and; (3) a nutritionally matched polyphenol-free placebo drink. Our results indicate that the intake of chokeberry juice containing either the low or the high dose of polyphenols cannot be linked with a reduction in total- and low-density lipoprotein (LDL)cholesterol or in systolic (SBP) and diastolic (DBP) blood pressure in comparison with the consumption of the placebo drink. However, we found evidence of moderate changes in the PPFA, i.e., increased saturated fatty acids (SFA), mostly palmitic acid, and reduced n-6 polyunsaturated fatty acids (PUFA), principally linoleic acid (LA) with the intake of chokeberry against the placebo. These effects may be associated with the polyphenols but we could not differentiate a clear dose-response effect. Further research is still needed to elucidate the contribution of the polyphenolic fraction to the potential cardiovascular effects of the chokeberry and to build up the evidence of its potential benefit via the modulation of PPFA composition.
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Affiliation(s)
- Biljana Pokimica
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - María-Teresa García-Conesa
- Research Group on Quality, Safety and Bioactivity of Plant Foods, Campus de Espinardo, Centro de Edafología y Biología Aplicada del Segura-Consejo Superior de Investigaciones Científicas (CEBAS-CSIC), P.O. Box 164, 30100 Murcia, Spain.
| | - Manja Zec
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Jasmina Debeljak-Martačić
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Slavica Ranković
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Nevena Vidović
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Gordana Petrović-Oggiano
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Aleksandra Konić-Ristić
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
| | - Maria Glibetić
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
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Ofori EK, Owusu-Ababio D, Tagoe EA, Asare-Anane H. Dyslipidaemia is common among patients with type 2 diabetes: a cross-sectional study at Tema Port Clinic. BMC Res Notes 2019; 12:204. [PMID: 30944035 PMCID: PMC6448301 DOI: 10.1186/s13104-019-4245-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate dyslipidemia in Ghanaian subjects with type 2 diabetes. RESULTS Hundred individuals with type 2 diabetes and 61 apparently healthy controls participated. The prevalence of hypercholesterolemia among persons with type 2 diabetes was 53%. Blood pressure, fasting blood glucose (FBG), triglyceride (TG), low-density lipoproteins (LDL) and alanine transaminase (ALT) levels were higher in persons with type 2 diabetes compared with the control group (p < 0.01). Positive correlations were found within persons with type 2 diabetes for triglyceride vs FBG; ALT vs age and aspartate transaminase (AST) vs TG (p < 0.05 respectively). This study demonstrated hyperlipidemia and poor liver health in persons with type 2 diabetes.
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Affiliation(s)
- Emmanuel Kwaku Ofori
- Department of Chemical Pathology, School of Biomedical and Allied Health Sciences (S.B.A.H.S.), University of Ghana, Accra, Ghana.
| | | | - Emmanuel A Tagoe
- Department of Medical Laboratory, S.B.A.H.S, University of Ghana, Accra, Ghana
| | - Henry Asare-Anane
- Department of Chemical Pathology, School of Biomedical and Allied Health Sciences (S.B.A.H.S.), University of Ghana, Accra, Ghana
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Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Hallas J, Diederichsen AC. Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. Br J Surg 2019; 106:862-871. [DOI: 10.1002/bjs.11135] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease.
Methods
Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests.
Results
In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent).
In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication.
Conclusion
Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.
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Affiliation(s)
- J S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - K Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - M H Olsen
- CIMA, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A C Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark
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Selak V, Jackson R, Poppe K, Wu B, Harwood M, Grey C, Pylypchuk R, Mehta S, Kerr A, Wells S. Predicting Bleeding Risk to Guide Aspirin Use for the Primary Prevention of Cardiovascular Disease: A Cohort Study. Ann Intern Med 2019; 170:357-368. [PMID: 30802900 DOI: 10.7326/m18-2808] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many prognostic models for cardiovascular risk can be used to estimate aspirin's absolute benefits, but few bleeding risk models are available to estimate its likely harms. OBJECTIVE To develop prognostic bleeding risk models among persons in whom aspirin might be considered for the primary prevention of cardiovascular disease (CVD). DESIGN Prospective cohort study. SETTING New Zealand primary care. PARTICIPANTS The study cohort comprised 385 191 persons aged 30 to 79 years whose CVD risk was assessed between 2007 and 2016. Those with indications for or contraindications to aspirin and those who were already receiving antiplatelet or anticoagulant therapy were excluded. MEASUREMENTS For each sex, Cox proportional hazards models were developed to predict major bleeding risk; participants were censored at the earliest of the date on which they first met an exclusion criterion, date of death, or study end date (30 June 2017). The main models included the following predictors: demographic characteristics (age, ethnicity, and socioeconomic deprivation), clinical measurements (systolic blood pressure and ratio of total-high-density lipoprotein cholesterol), family history of premature CVD, medical history (smoking, diabetes, bleeding, peptic ulcer disease, cancer, chronic liver disease, chronic pancreatitis, or alcohol-related conditions), and medication use (nonsteroidal anti-inflammatory agents, corticosteroids, and selective serotonin reuptake inhibitors). RESULTS During 1 619 846 person-years of follow-up, 4442 persons had major bleeding events (of which 313 [7%] were fatal). The main models predicted a median 5-year bleeding risk of 1.0% (interquartile range, 0.8% to 1.5%) in women and 1.1% (interquartile range, 0.7% to 1.6%) in men. Plots of predicted-against-observed event rates showed good calibration throughout the risk range. LIMITATION Hemoglobin level, platelet count, and body mass index were excluded from the main models because of high numbers of missing values, and the models were not externally validated in non-New Zealand populations. CONCLUSION Prognostic bleeding risk models were developed that can be used to estimate the absolute bleeding harms of aspirin among persons in whom aspirin is being considered for the primary prevention of CVD. PRIMARY FUNDING SOURCE The Health Research Council of New Zealand.
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Affiliation(s)
- Vanessa Selak
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Rod Jackson
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Katrina Poppe
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Billy Wu
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Matire Harwood
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Corina Grey
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Romana Pylypchuk
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Suneela Mehta
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
| | - Andrew Kerr
- University of Auckland and Middlemore Hospital, Auckland, New Zealand (A.K.)
| | - Sue Wells
- University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., S.W.)
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Kilic S, Turkoglu C. Timing of Coronary Angiography After Successful Fibrinolytic Therapy in ST-Segment Elevated Myocardial Infarction. Cardiol Res 2019; 10:34-39. [PMID: 30834057 PMCID: PMC6396801 DOI: 10.14740/cr817] [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: 12/13/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022] Open
Abstract
Background We aimed to compare outcomes of patients received successful fibrinolytic treatment (FT) for ST-segment elevated myocardial infarction (STEMI) and performed coronary angiography (CAG) within 24 - 72 h or after 72 h. Methods Between March 2013 and November 2014, 76 STEMI patients received successful FT and performed CAG > 24 h were included in the study. Patients were divided into two groups according to the time-interval from FT admission to CAG performing (Group-1, 24 - 72 h (n = 29), Group-2, > 72 h (n = 47)). The primary end point was major adverse cardiac events (MACE) defined as cardiovascular death, non-fatal myocardial infarction, and heart failure. Results The mean age of patients were 56 ± 11.4 years old (27.6% female). CAG was performed within mean 2.17 ± 0.38 days in the Group-1 and 2.9 ± 11.5 days in the Group 2 (P < 0.001). At short-term follow-up (6 months), MACE rate was higher in Group-2 (21.3%) than Group-1(13.8%), but it was not statistically significant (P = 0.661). The rate of MACE was 37.9% in Group-1 and 38.3% in Group-2 (P = 0.974) in the long-term follow-up (median: 57 months). Overall cardiac mortality rate was 7.9%, the re-infarction rate was 19.7% and heart failure was 17.1% in long-term follow-up, and there were no significant difference between groups. Conclusions Present study has shown that performance of CAG after 24 h of successful FT, within 24 - 74 h or > 72 h, did not shown any difference in term of MACE both in short and long-term follow-up.
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Affiliation(s)
- Salih Kilic
- Department of Cardiology, Doctor Ersin Arslan Research and Training Horpital, Gaziantep, Turkey
| | - Cuneyt Turkoglu
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
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Mols RE, Nørgaard BL, Vedsted P, Farkas DK, Bøtker HE, Jensen JM. General practice preventive health care in non-obstructive coronary artery disease determined by coronary computed tomography angiography. Int J Cardiol 2019; 278:14-21. [DOI: 10.1016/j.ijcard.2018.09.094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 08/19/2018] [Accepted: 09/24/2018] [Indexed: 01/24/2023]
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Roos A, Sartipy U, Ljung R, Holzmann MJ. Relation of Chronic Myocardial Injury and Non-ST-Segment Elevation Myocardial Infarction to Mortality. Am J Cardiol 2018; 122:1989-1995. [PMID: 30314814 DOI: 10.1016/j.amjcard.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/19/2018] [Accepted: 09/05/2018] [Indexed: 11/30/2022]
Abstract
The prognosis in patients with chest pain and chronic myocardial injury compared with patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unknown. This study aims to investigate differences in long-term outcomes. Patients with chest pain at Karolinska University Hospital, Sweden from 2011 to 2014, who had stable high-sensitivity cardiac troponin T (hs-cTnT) levels were compared with patients with NSTEMI. We estimated hazard ratios with 95% confidence intervals for the risk of all-cause mortality, myocardial infarction, and heart failure at different hs-cTnT levels using patients with NSTEMI as referent. A total of 20,387 patients were included, of whom 927 had NSTEMI. Among 19,460 patients with stable hs-cTnT levels, 1,528 had chronic myocardial injury defined as stable hs-cTnT levels > 14 ng/L. Mean follow-up was 3.2 years. Patients with hs-cTnT levels of <5 and 5 to 9 ng/L had a lower risk, while patients with chronic myocardial injury with hs-cTnT levels of 30 to 49 and ≥50 ng/L had a higher risk of death (adjusted hazard ratios, 95% confidence intervals: 1.65, 1.30 to 2.10 and 2.13, 1.60 to 2.84, respectively) compared with patients with NSTEMI. Patients with hs-cTnT levels <15 ng/L had a lower risk of heart failure, with no difference in risk at higher hs-cTnT levels. All stable hs-cTnT levels were associated with a lower risk of myocardial infarction (MI). In conclusion, patients with chest pain and stable hs-cTnT levels 10 to 29 ng/L have a similar risk, and those with chronic myocardial injury with hs-cTnT levels of ≥30 ng/L have an increased risk of long-term all-cause mortality compared with patients with NSTEMI.
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Affiliation(s)
- Andreas Roos
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Ulrik Sartipy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
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Aronov DM. History of cardiac rehabilitation in Russia. ACTA ACUST UNITED AC 2018; 58:14-21. [PMID: 30625086 DOI: 10.18087/cardio.2604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/18/2022]
Abstract
The review presents the history of establishing cardiac rehabilitation for patients who have had acute myocardial infarction, acute coronary conditions, cardiac and vascular surgery, and intravascular interventions. Stages and physiological basis of this treatment are described.
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Affiliation(s)
- D M Aronov
- National Research Center for Preventive Medicine.
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Kunz SM, Holzmann D, Soyka MB. Association of epistaxis with atherosclerotic cardiovascular disease. Laryngoscope 2018; 129:783-787. [PMID: 30549051 DOI: 10.1002/lary.27604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the association between epistaxis and atherosclerotic cardiovascular disease. STUDY DESIGN Case-control cohort study. METHODS This study included patients from the tertiary-care ear, nose, and throat department at the University Hospital of Zurich between December 1, 2016 and June 1, 2017. We assessed the cardiovascular risk profiles in a group of 41 patients presenting with epistaxis, and a group of 41 matched controls, focusing on a surrogate parameter for atherosclerosis: the carotid intima-media thickness (CIMT). RESULTS With a mean of 1.06 mm (standard deviation [SD] = 0.17), CIMT values were on average 26% higher in epistaxis patients than in their controls, with a mean of 0.84 mm (SD = 0.14; P < .001). Occurrence of severe epistaxis was also associated with lower ankle-brachial index values at 0.96 (SD = 0.12) versus 1.05 (SD = 0.17) (P < .001) and significantly higher QRISK2 relative risks (an algorithm for predicting cardiovascular risk) than found in the control group (1.81, SD = 0.97 vs. 1.35, SD = 0.28; P = .028). A binary logistic regression model, adjusted for possible confounders, showed an odds ratio of 2.5 for the occurrence of epistaxis per increase in CIMT of 0.1 mm in the study population (95% confidence interval: 1.56-4.11; P < .001). CONCLUSIONS The occurrence of severe epistaxis was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease. Accordingly, patients affected by epistaxis should be regarded as at an elevated cardiovascular risk, which indicates the need for appropriate further medical assessment and preventive measures. LEVEL OF EVIDENCE 3b TRIAL REGISTRATION: Clinical trials NCT03092973 Laryngoscope, 129:783-787, 2019.
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Affiliation(s)
- Seraina M Kunz
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
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Schachner T, Garrido F, Bonaros N, Krapf C, Dumfarth J, Grimm M. Factors limiting physical activity after acute type A aortic dissection. Wien Klin Wochenschr 2018; 131:174-179. [PMID: 30456514 PMCID: PMC6459793 DOI: 10.1007/s00508-018-1412-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
Background Acute type A aortic dissection (AAD) leads to high hospital mortality rates in the first 48 h after the onset of symptoms. Survivors, however, have good long-term perspectives and enhanced survival especially if regaining moderate amounts of physical activity. Methods This study analyzed 131 survivors (from 180 consecutive patients, aged 60 years (rande 30–84 years, 71% male) of acute AAD after a median time of 44 months (range 1–147 months). The hospital mortality was 13.5%. The group of physically active patients was compared with those with a sedentary life style. The qualitative and quantitative data on physical activity were correlated with data from an aortic registry. Results Overall 87% of patients reported 1 or more types of physical activities after hospital discharge. The most common types were walking (51%), biking (29%), hiking (15%) and gymnastics (14%). Patients with a sedentary life style underwent longer hypothermic circulatory arrest times (39 min, range 8–167 min vs. 47 min, range 27–79 min, p = 0.009), had a longer intensive care unit (ICU) stay (Pearsons r = −0.226 [between length of ICU stay and hours of physical activity after hospital discharge], p = 0.033) and suffered more frequently from postoperative paresis (33.3% vs. 3.8%, p < 0.001) compared with physically active patients. Binary logistic regression analysis showed female gender (p = 0.026) and higher body mass index (p = 0.019) to be independently associated with a reduced amount of physical activity. Conclusions This study demonstrate that the majority of survivors of acute aortic dissection type A regain a physically active life including the practice of a variety of sports. Factors predictive of a sedentary life style can be identified. Female patients deserve special attention.
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Affiliation(s)
- Thomas Schachner
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Fabian Garrido
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Nikolaos Bonaros
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christoph Krapf
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Julia Dumfarth
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Grimm
- University Clinic of Cardiac Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria
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Ghaddar F, Salameh P, Saleh N, Farhat F, Chahine R, Lahoud N, Hleyhel M, Zeidan RK. Noncardiac Lebanese hospitalized adult patients' awareness of their coronary artery disease risk factors. Vasc Health Risk Manag 2018; 14:371-382. [PMID: 30510428 PMCID: PMC6231450 DOI: 10.2147/vhrm.s176167] [Citation(s) in RCA: 9] [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] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Noncommunicable diseases are the leading cause of death in Lebanon, with cardiovascular diseases accounting for almost half of the annual deaths. PURPOSE We aimed to determine awareness of noncardiac Lebanese hospitalized patients for their coronary artery disease risk factors, their level of adherence to medications or lifestyle modifications, and assess factors associated with awareness. MATERIALS AND METHODS A cross-sectional study was conducted in 14 hospitals with a total of 382 patients. Levels of awareness were evaluated by the comparison of self-report with measurements and laboratory test results. Healthy behaviors and adherence to treatment were evaluated. Factors associated with better awareness were studied using multivariate regressions, while adherence to treatments and healthy lifestyle were described for the different risk factors and in the Framingham Risk Score categories. RESULTS Our work revealed a moderate-to-high level of awareness (58.7% for overweight/obesity, 75% for hypertension, 85.7% for diabetes, and 86.4% for dyslipidemia) among patients for most cardiovascular risk factors, but a low-to-moderate level of adherence for some interventions such as physical exercise, weight loss, and smoking cessation. CONCLUSION The results emphasize on the importance of educational campaigns on healthy habits and screening to improve early diagnosis, increase patients' awareness of their risk factors, and, therefore, optimize primary prevention.
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Affiliation(s)
- Fatima Ghaddar
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
| | - Pascale Salameh
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon,
| | - Nadine Saleh
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
| | - Firas Farhat
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ramez Chahine
- Faculty of Public Health, La Sagesse University, Beirut, Lebanon
| | - Nathalie Lahoud
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Mira Hleyhel
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Rouba K Zeidan
- Faculty of Public Health II, Lebanese University, Fanar, Lebanon,
- National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon,
- CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon
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Markabayeva A, Bauer S, Pivina L, Bjørklund G, Chirumbolo S, Kerimkulova A, Semenova Y, Belikhina T. Increased prevalence of essential hypertension in areas previously exposed to fallout due to nuclear weapons testing at the Semipalatinsk Test Site, Kazakhstan. ENVIRONMENTAL RESEARCH 2018; 167:129-135. [PMID: 30014894 DOI: 10.1016/j.envres.2018.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 06/08/2023]
Abstract
This study examines the association between environmental radiation exposure and essential hypertension in a series of investigated geographical districts adjacent to the Semipalatinsk nuclear test site in Kazakhstan. The sample consists of 2000 volunteers participants in screening examinations in three administrative districts close to the nuclear test site, which was carried out as part of the Government Programs on Environmental Health Hazard. The cross-sectional study compares prevalence ratios in a population sample with long-term exposure in the low and intermediate dose range. Age-adjusted odds ratios for hypertension were found significantly increased with higher exposure groups. After accounting for main cardiovascular risk factors into the model and stratifying by gender, the prevalence odds ratios for radiation remained significantly increased, with a significant dose-response effect observed for some but not all subgroups. The results support existing evidence of cardiovascular health effects of radiation exposure and of persisting environmental health issues that require attention in both epidemiological surveys and healthcare provision.
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Affiliation(s)
| | | | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610 Mo i Rana, Norway.
| | - Salvatore Chirumbolo
- Department of Neuroscience, Biomedicine and Movement Sciences-University of Verona, Verona, Italy
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Sanz Pérez I, Martínez Valle F, Guillén-del-Castillo A, Roque Pérez A, Cuéllar Calàbria H, Pizzi M, Fernández Codina A, Callejas-Moraga E, Orozco Gálvez O, Fonollosa Pla V, Simeón Aznar C. Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev 2018; 17:900-905. [DOI: 10.1016/j.autrev.2018.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/21/2018] [Indexed: 12/13/2022]
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