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Anghel L, Tudurachi BS, Tudurachi A, Benchea LC, Clement A, Zanfirescu RL, Sascău RA, Stătescu C. Evaluating Long-Term Outcomes in STEMI Patients with New Left Bundle Branch Block: The Impact of Modifiable Risk Factors. J Pers Med 2024; 14:771. [PMID: 39064025 PMCID: PMC11277879 DOI: 10.3390/jpm14070771] [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: 07/01/2024] [Revised: 07/13/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Coronary artery disease, a leading global cause of death, highlights the essential need for early detection and management of modifiable cardiovascular risk factors to prevent further coronary events. Methods: This study, conducted at a major tertiary academic PCI-capable hospital in Romania from 1 January 2011 to 31 December 2013, prospectively analyzed 387 myocardial infarction with ST-segment elevation (STEMI) patients to assess the long-term management of modifiable risk factors. This study particularly focused on patients with new-onset left bundle branch block (LBBB) and compared them with a matched control group without LBBB. Results: During median follow-up periods of 9.6 years for LBBB patients and 9.2 years for those without LBBB, it was found that smoking, obesity, and dyslipidemia were prevalent in 73.80%, 71.42%, and 71.42% of the LBBB group, respectively, at baseline. Significant reductions in smoking were observed in both groups, with the LBBB group's smoking rates decreasing significantly to 61.90% (p = 0.034). Patients with LBBB more frequently achieved low-density lipoprotein cholesterol (LDLc) target levels during the follow-up period (from 71.42% to 59.52%; p = 0.026) compared to the control group (from 66.67% to 71.42%; p = 0.046). Prescription rates for dual antiplatelet therapy (DAPT), angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs), beta-blockers, and statins were initially high but then decreased by the follow-up. Statin use was reduced from 97.62% to 69.04% (p = 0.036) in the LBBB group and from 100% to 61.90% (p = 0.028) in the non-LBBB group. This study also highlighted moderate correlations between obesity (r = 0.627, p = 0.040) and subsequent coronary reperfusion in the LBBB group, while dyslipidemia and smoking showed very strong positive correlations across both groups (dyslipidemia: r = 0.903, p = 0.019 for LBBB; r = 0.503, p = 0.048 for non-LBBB; smoking: r = 0.888, p = 0.035 for LBBB; r = 0.517, p = 0.010 for non-LBBB). Conclusions: These findings underscore the crucial need for targeted management of modifiable risk factors, particularly focusing on dyslipidemia and smoking cessation, to improve subsequent coronary reperfusion outcomes post-STEMI, especially in patients with complicating factors like LBBB.
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Affiliation(s)
- Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Bogdan-Sorin Tudurachi
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Andreea Tudurachi
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Laura-Cătălina Benchea
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Alexandra Clement
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Răzvan-Liviu Zanfirescu
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
- Physiology Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania
| | - Radu Andy Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (B.-S.T.); (L.-C.B.); (A.C.); (R.A.S.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I. M. Georgescu”, 700503 Iași, Romania; (A.T.); (R.-L.Z.)
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Luo Z, Tang K, Huang G, Wang X, Zhou S, Dai D, Yang H, Jiang W. Homocysteine concentration in coronary artery disease and severity of coronary lesions. J Cell Mol Med 2024; 28:e18474. [PMID: 38896027 PMCID: PMC11187881 DOI: 10.1111/jcmm.18474] [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: 03/13/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Our previous study reckons that the impact of the rs1801133 variant of 5,10-methylenetetrahydrofolate reductase (MTHFR) on coronary artery disease (CAD) is possibly mediated by cardiometabolic disorder. This study is performed to verify this hypothesis. Four hundred and thirty CAD patients and 216 CAD-free individuals were enrolled in this case-control study. The rs1801133 variant was genotyped by PCR-RFLP. Severity of coronary lesions was evaluated by number of stenotic coronary vessels and extent of coronary stenosis. The rs1801133 T allele significantly increased homocysteine levels in patients with CAD and CAD-free individuals. Individuals with the T allele of rs1801133 had an increased risk of developing CAD. In contrast, individuals with the TT genotype of rs1801133 were at high risk of multiple vessel lesions. The carriers of CT genotype had higher levels of systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP), and lower levels of apolipoprotein A1 (APOA1) than those with CC genotype in male patients with CAD. The receiver operating characteristic (ROC) curve and precision-recall (PR) curve indicated that hyperhomocysteinemia was sensitive to predict the severity of CAD. Multivariate logistic regression revealed that homocysteine, rs1801133, age, smoking, weight, body mass index (BMI), lipoprotein(a) [Lp(a)], and hs-CRP were independent risk factors for CAD. The increased risk of CAD and severity of coronary lesions associated with rs1801133 in the Chinese Han population were attributed, at least partly, to high homocysteine levels. Hyperhomocysteinemia had a high predictive value for severe CAD or multiple vessel lesions.
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Affiliation(s)
- Zhi Luo
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Kai Tang
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Gang Huang
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Xiao Wang
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Shiheng Zhou
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Daying Dai
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Hanxuan Yang
- Department of CardiologySuining Central HospitalSuiningSichuanChina
| | - Wencai Jiang
- Department of CardiologySuining Central HospitalSuiningSichuanChina
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Espinosa EVP, Matute EM, Sosa Guzmán DM, Khasawneh FT. The Polypill: A New Alternative in the Prevention and Treatment of Cardiovascular Disease. J Clin Med 2024; 13:3179. [PMID: 38892892 PMCID: PMC11172978 DOI: 10.3390/jcm13113179] [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: 03/18/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 06/21/2024] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of death and disability worldwide. Although age-standardized CVD mortality rates decreased globally by 14.5% between 2006 and 2016, the burden of CVD remains disproportionately higher in low- and middle-income countries compared to high-income countries. Even though proven, effective approaches based on multiple-drug intake aimed at the prevention and treatment of CVD are currently available, poor adherence, early discontinuation of treatment, and suboptimal daily execution of the prescribed therapeutic regimes give rise to shortfalls in drug exposure, leading to high variability in the responses to the prescribed medications. Wald and Law, in their landmark paper published in BMJ 2003, hypothesized that the use of a fixed-dose combination of statins, β-blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin (classic Polypill composition) may increase adherence and decrease CVD by up to 80% when prescribed as primary prevention or in substitution of traditional protocols. Since then, many clinical trials have tested this hypothesis, with comparable results. This review aims to describe the available clinical trials performed to assess the impact of fixed-dose combinations on adherence, cost-effectiveness, and the risk factors critical to the onset of CVD.
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Affiliation(s)
- Enma V. Páez Espinosa
- Department of Clinical Laboratory, School of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador;
- Center for Research on Health in Latin America (CISeAL), Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
| | - Eugenia Mato Matute
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), C/Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Delia M. Sosa Guzmán
- Department of Clinical Laboratory, School of Medicine, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador;
| | - Fadi T. Khasawneh
- Department of Pharmaceutical Sciences, Rangel School of Pharmacy, Texas A&M University, College Station, TX 77843, USA;
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Kaldal A, Tonstad S, Jortveit J. Sex differences in secondary preventive follow-up after coronary heart events. BMC Cardiovasc Disord 2023; 23:459. [PMID: 37710178 PMCID: PMC10502978 DOI: 10.1186/s12872-023-03483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND AIMS Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event. METHODS This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007-2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations. RESULTS In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62-1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69-1.31; p = 0.78). CONCLUSIONS The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT00679237).
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital, Kristiansand S, Norway.
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
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Yang H, Zuo H, Wu X, Jia S, Song X. Association between control of cardiovascular risk factors and acute myocardial infarction among re-hospitalized young patients with prior coronary heart disease. Chin Med J (Engl) 2023; 136:1364-1366. [PMID: 37160735 PMCID: PMC10309500 DOI: 10.1097/cm9.0000000000002173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 05/11/2023] Open
Affiliation(s)
- Hongxia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Huijuan Zuo
- Department of Community Health Research, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shujie Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Kaldal A, Tonstad S, Jortveit J. Association of Troponin T measurements with long-term outcomes in patients with coronary artery disease participating in a secondary prevention trial. BMC Cardiovasc Disord 2023; 23:210. [PMID: 37118703 PMCID: PMC10142253 DOI: 10.1186/s12872-023-03249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND AND AIMS Identification of high-risk patients in secondary cardiovascular prevention may be challenging, although risk stratification tools are available. Cardiac troponins might have predictive value in identification of high-risk patients. The aim of this study was to investigate the association between cardiac Troponin T (cTnT) levels following a coronary event and long-term outcomes. METHODS This study was carried out as a subanalysis from a randomized controlled trial conducted at Sørlandet Hospital, Norway, where patients hospitalized with myocardial infarction (MI) or scheduled percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) were included between 2007 and 2017. Participants were followed-up for up to 10 years after the index event through out-patient consultations. cTnT was assessed at each consultation as well as information regarding new cardiovascular events or death. RESULTS A total of 1278 patients (18-80 years) with complete measurements of cTnT were included. cTnT was elevated (≥ 14 ng/L) one year after the primary event in 241 (19%) of participants. Median follow-up was 5.7 [SD 2.7] years. Cox regression analyses showed reduced survival (adjusted HR 0.37, 95% CI 0.19-0.72; p = 0.003) and composite endpoint-free survival (adjusted HR 0.73, 95% CI 0.55-0.98; p = 0.04) in participants with elevated cTnT versus participants with low cTnT after adjustment for risk factors at inclusion and randomization assignment. CONCLUSIONS Assessment of cTnT after coronary heart events may help identify patients at high risk of poor outcomes and might contribute to more focused secondary preventive treatment. TRIAL REGISTRATION The study is registered in ClinicalTrials.gov (NCT00679237).
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital, Box 416 Lundsiden, 4604, Arendal, Norway.
| | - Serena Tonstad
- Department of Endocrinology, Obesity and Preventive Medicine, Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital, Arendal, Norway
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Albar HM, Alahmdi RA, Almedimigh AA, Shaik RA, Ahmad MS, Almutairi AB, Alghuyaythat WKZ, Alaoufi SY, Aloyari WO, Alanazi RMS. Prevalence of coronary artery disease and its risk factors in Majmaah City, Kingdom of Saudi Arabia. Front Cardiovasc Med 2022; 9:943611. [PMID: 36158800 PMCID: PMC9492946 DOI: 10.3389/fcvm.2022.943611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study was carried out with an aim to outline the prevalence of coronary artery diseases, its risk of one region of the Saudi Arabia. Methods A retrospective observational study conducted across five secondary medical centers located in the city of Majmaah. Hospital medical records and ministry of health records were screened over a 6-month period for data on patients admitted for Coronary artery disease (CAD). Data collected included sociodemographic characteristics, medical profile, and laboratory findings. Results A total of 327 participants were included in this study with a median age of 64 and the majority being male participants (59.8%). The majority were married, held a primary school degree and earned a salary for living. A large number (82.9%) were hypertensive and diabetic (66.7%) and one-fourth had a previous MI (25.1%). A large number (73.7%) had heart failure with a mean ejection fraction of 44% (SD = 13). The causes of heart failure were mainly ischemic (56.3%) and hypertensive (28.1%). Readmission rates at 30 and 90 days then at 6 and 12 months were 22, 53.8, 68.8, and 75.8%, respectively. The mortality rates at the same time intervals were 5.5, 8.9, 14.1, and 22.9%, respectively. Predictors of readmission are age, CCI, and NYHA class. Conclusion Coronary artery disease is the leading cause of heart failure. End stage CAD can have similar results in terms of readmission and mortality as heart failure. Future research should target patients in different stages of the condition and monitor their comorbidities which may impact the study findings.
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Affiliation(s)
- Haitham M. Albar
- Department of Surgery, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Riyadh Ahmed Alahmdi
- Department of Family Medicine, King Abdullah Bin Andulaziz University Hospital, Princess Nora Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Riyaz Ahmed Shaik
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Mohammad Shakil Ahmad
- Department of Family and Community Medicine, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
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Jortveit J, Pripp AH, Langørgen J, Halvorsen S. Time trends in incidence, treatment, and outcome in acute myocardial infarction in Norway 2013–19. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac052. [PMID: 36071696 PMCID: PMC9442850 DOI: 10.1093/ehjopen/oeac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/26/2022] [Indexed: 11/18/2022]
Abstract
Aims Acute myocardial infarction (AMI) is a common cause of morbidity and mortality. The aim of the present study was to assess time trends in the incidence, treatment, and outcome of AMI in a nationwide registry–based cohort of patients. Methods and results All patients with a first AMI registered in the Norwegian Myocardial Infarction Registry between 2013 and 2019 were included in this cohort study. The number of patients admitted to Norwegian hospitals with a first AMI decreased from 8933 in 2013 to 8383 in 2019. The proportion of patients with ST-elevation myocardial infarction (STEMI) was stable at 30% throughout the period, and the percentage of STEMI undergoing coronary angiography was stable at 87%. The proportion of patients with non-STEMI undergoing coronary angiography increased by 2.4% per year (95% confidence interval 1.6–3.3) from 58% in 2013 to 68% in 2019. More patients were discharged with secondary preventive medication at the end of study period. Age-adjusted 1-year mortality was reduced from 16.4% in 2013 to 15.1% in 2018. The changes over time were primarily seen in the oldest patient groups. Conclusion In the period 2013–19 in Norway, we found a reduction in hospitalizations due to a first AMI. Both the percentage of patients undergoing coronary angiography as well as the percentage discharged with recommended secondary preventive therapy increased during the period, and the age-adjusted 1-year mortality after AMI decreased. A national AMI register provides important information about trends in incidence, treatment, and outcome, and may improve adherence to guideline recommendations.
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Affiliation(s)
- Jarle Jortveit
- Sørlandet Hospital , Arendal, Box 416, Lundsiden, 4604 Kristiansand , Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital , Oslo , Norway
| | | | - Sigrun Halvorsen
- Oslo University Hospital Ullevaal and University of Oslo , Oslo , Norway
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Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson CS, van Riel P, Kitas GD, Graham I, Dahlqvist SR, Karpouzas G, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon CA, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg A, Mu R, Mirrakhimov EM, Gheta D, Myasoedova S, Krougly L, Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horák P, Medková H, Semb AG. An international audit of the management of dyslipidaemia and hypertension in patients with rheumatoid arthritis: results from 19 countries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 8:539-548. [PMID: 34232315 DOI: 10.1093/ehjcvp/pvab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 01/05/2023]
Abstract
AIMS To assess differences in estimated cardiovascular disease (CVD) risk among rheumatoid arthritis (RA) patients from different world regions and to evaluate the management and goal attainment of lipids and blood pressure (BP). METHODS AND RESULTS The survey of CVD risk factors in patients with RA was conducted in 14 503 patients from 19 countries during 2014-19. The treatment goal for BP was <140/90 mmHg. CVD risk prediction and lipid goals were according to the 2016 European guidelines. Overall, 21% had a very high estimated risk of CVD, ranging from 5% in Mexico, 15% in Asia, 19% in Northern Europe, to 31% in Central and Eastern Europe and 30% in North America. Of the 52% with indication for lipid-lowering treatment (LLT), 44% were using LLT. The lipid goal attainment was 45% and 18% in the high and very high risk groups, respectively. Use of statins in monotherapy was 24%, while 1% used statins in combination with other LLT. Sixty-two per cent had hypertension and approximately half of these patients were at BP goal. The majority of the patients used antihypertensive treatment in monotherapy (24%), while 10% and 5% as a two- or three-drug combination. CONCLUSION We revealed considerable geographical differences in estimated CVD risk and preventive treatment. Low goal attainment for LLT was observed, and only half the patients obtained BP goal. Despite a high focus on the increased CVD risk in RA patients over the last decade, there is still substantial potential for improvement in CVD preventive measures.
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Affiliation(s)
- Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Joe Sexton
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - George D Kitas
- Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
| | | | | | - George Karpouzas
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Petros P Sfikakis
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Joint Rheumatology Program, First Department of Propaedeutic Internal Medicine, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyro Lazarini
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bindee Kuriya
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Simona Stoenoiu
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Durez
- Rheumatology Department, Cliniques Universitaires Saint Luc, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | | | | | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | | | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | | | - Diane Gheta
- Tallagh University Hospital, Dublin, Ireland
| | | | - Lev Krougly
- Center of Cardiology of Russian Ministry of Healthcare, Moscow, Russia
| | - Tatiana Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Alena Tuchyňová
- National Institute of Rheumatic Diseases, 92101 Piešťany, Slovensko, Slovakia
| | - Michal Tomcik
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Jiri Lastuvka
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, First Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic
- First Medical Faculty, Charles University, Prague, Czech Republic
| | - Pavel Horák
- Iii Interna klinika fn Olomouc, Olomouc, Czech Republic
| | - Helena Medková
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway
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10
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Effectiveness and Tolerability of Trimetazidine 80 Mg Once Daily in Patients with Stable Angina Uncontrolled with Bisoprolol-Based Therapy: The Modus Vivendi Observational Study. Cardiol Ther 2021; 11:93-111. [PMID: 34958427 PMCID: PMC8933606 DOI: 10.1007/s40119-021-00249-z] [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: 10/26/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Modus Vivendi was conducted in routine clinical practice to evaluate the effect of adding trimetazidine 80 mg once daily (TMZ 80 OD) to treat patients with persistent symptoms despite treatment with background antianginal therapies including maximally tolerated bisoprolol. Methods This multicenter, prospective, observational, open-label, uncontrolled study recruited adult outpatients with a confirmed diagnosis of stable angina to whom physicians had decided to prescribe TMZ 80 OD. All patients were symptomatic despite treatment, including maximally tolerated doses of bisoprolol. Data on number of angina attacks, use of short-acting nitrates, and quality of life (QoL) were collected at baseline (V1) and at 1-month (V2) and 3-month (V2) follow-up visits. Two sub-analyses assessed efficacy in patients who remained on a stable bisoprolol dose throughout the study, and in patients in whom background antianginal therapy was known. Results A total of 1939 patients were recruited (57.2% women). The mean age was 65.6 ± 8.8 years; 73.8% had class II and 26.2% class III angina. At V1, the mean number of angina attacks per week was 6.2 ± 6.5 despite antianginal therapy including maximally tolerated bisoprolol dosage. Following the addition of TMZ 80 OD, this decreased to 3.4 ± 4.2 attacks per week at V2, and 1.6 ± 2.6 at V3 (P < 0.05 at V2 and V3), with concomitant reductions in short-acting nitrate use (P < 0.05). Significant improvements in QoL were observed throughout the study. Subgroup analyses showed that the addition of TMZ 80 OD to guideline-recommended antianginal therapy was associated with significant reductions in the mean number of weekly angina attacks and consumption of short-acting nitrates and improvements in QoL whether patients were treated with maximally tolerated bisoprolol and TMZ 80 OD alone, or maximally tolerated bisoprolol and TMZ 80 OD on top of other antianginal therapies. Treatment was well tolerated. Conclusion The study findings support the addition of TMZ 80 OD to bisoprolol with or without other antianginal therapies for patients with persistent angina. Trial Registration This study was retrospectively registered under the number ISRCTN29992579.
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11
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Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial. BMC Cardiovasc Disord 2021; 21:600. [PMID: 34915839 PMCID: PMC8679993 DOI: 10.1186/s12872-021-02426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background and aims Despite established guidelines on secondary prevention of cardiovascular disease, practical implementation of treatment targets is deficient even in high-income countries. This study compared long-term hospital-based treatment with follow-up at primary health care regarding new cardiovascular events and achievement of treatment targets. Methods This randomized controlled trial at Sørlandet Hospital, Norway 2007–2021 included patients hospitalized due to myocardial infarction (n = 760) or after scheduled percutaneous coronary intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103). Patients were randomized to hospital-based secondary preventive care with consultations 2 weeks, 3 months, 6 months and 1 year after the index event and annually for up to 5 years, or follow-up at primary health care. Final data was collected after 10 years and hazard ratios were calculated using Cox regression analyses. Results Composite endpoint-free survival due to a lower rate of PCI improved in patients with hospital-based follow-up (n = 788) compared to patients followed-up at primary health care (n = 752) (HR 0.80, 95% CI 0.66–0.96; p = 0.02) but all-cause mortality was not reduced (HR 0.96, 95% CI 0.59–1.56; p = 0.86). At 1 year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001) and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p < 0.001) were lower in the hospital-based group, and the differences remained significant during the first 5 years. Other secondary preventive measures (smoking cessation, physical activity, body weight, glucose control, drug adherence) did not differ. Conclusions Long-term hospital-based secondary preventive follow-up improved composite endpoint-free survival, but not mortality. Substantial risk factors remained unaddressed. The beneficial effects on blood pressure and LDL-cholesterol disappeared after annual consultations ceased. Trial registration: The study is registered in ClinicalTrials.gov (NCT00679237) May 16, 2008. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02426-3.
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12
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Shi B, Liu X, Dong Q, Yang Y, Cai Z, Wang H, Yin D, Wang H, Dou K, Song W. The Effect of a WeChat-Based Tertiary A-Level Hospital Intervention on Medication Adherence and Risk Factor Control in Patients With Stable Coronary Artery Disease: Multicenter Prospective Study. JMIR Mhealth Uhealth 2021; 9:e32548. [PMID: 34569467 PMCID: PMC8581769 DOI: 10.2196/32548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In China, ischemic heart disease is the main cause of mortality. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of a tertiary A-level hospital, WeChat-based telemedicine intervention in comparison with conventional community hospital follow-up on medication adherence and risk factor control in individuals with stable coronary artery disease. METHODS In this multicenter prospective study, 1424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At 1-, 3-, 6-, and 12-month follow-up, participants received healthy lifestyle recommendations and medication advice. Subsequently, the control group attended an offline outpatient clinic at 4 separate community hospitals. The intervention group had follow-up visits through WeChat-based telemedicine management. The main end point was medication adherence, which was defined as participant compliance in taking all 4 cardioprotective medications that would improve the patient's outcome (therapies included antiplatelet therapy, β-blockers, statins, and angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers). Multivariable generalized estimating equations were used to compare the primary and secondary outcomes between the 2 groups and to calculate the relative risk (RR) at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and propensity scores were calculated using a multivariable logistic regression model. RESULTS At 1 year, 88% (565/642) of patients in the intervention group and 91.8% (518/564) of patients in the control group had successful follow-up data. We matched 257 pairs of patients between the intervention and control groups. There was no obvious advantage in medication adherence with the 4 cardioprotective drugs in the intervention group (172/565, 30.4%, vs 142/518, 27.4%; RR 0.99, 95% CI 0.97-1.02; P=.65). The intervention measures improved smoking cessation (44/565, 7.8%, vs 118/518, 22.8%; RR 0.48, 95% CI 0.44-0.53; P<.001) and alcohol restriction (33/565, 5.8%, vs 91/518, 17.6%; RR 0.47, 95% CI 0.42-0.54; P<.001). CONCLUSIONS The tertiary A-level hospital, WeChat-based intervention did not improve adherence to the 4 cardioprotective medications compared with the traditional method. Tertiary A-level hospital, WeChat-based interventions have a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505.
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Affiliation(s)
- Boqun Shi
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuting Dong
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Yang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongxing Cai
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyu Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Aboyans V, Abola MTB. The EUCLIDian perspective of global peripheral artery disease (PAD). Vasc Med 2021; 27:30-32. [PMID: 34665983 DOI: 10.1177/1358863x211051425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Victor Aboyans
- Inserm Unit 1094 and IRD, Limoges University, Limoges, France.,Department of Cardiology, Dupuytren-2 University Hospital, Limoges, Nouvelle-Aquitaine, France
| | - Maria Teresa B Abola
- Department of Clinical Research, Philippine Heart Center and University of the Philippines College of Medicine, Quezon City, Metro Manila, Philippines
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14
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Castaño-Amores C, Díaz-Villamarín X, Pérez-Gutiérrez AM, Antúnez-Rodríguez A, Pozo-Agundo A, Moreno-Escobar E, Sánchez-Ramos JG, Martínez-González LJ, Dávila-Fajardo CL. Pharmacogenetic polymorphisms affecting bisoprolol response. Biomed Pharmacother 2021; 142:112069. [PMID: 34470728 DOI: 10.1016/j.biopha.2021.112069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/30/2022] Open
Abstract
β-blockers are commonly prescribed to treat multiple cardiovascular (CV) diseases, but, frequently, adverse drug reactions and intolerance limit their use in clinical practice. Interindividual variability in response to β-blockers may be explained by genetic differences. In fact, pharmacogenetic interactions for some of these drugs have been widely studied, such as metoprolol. But studies that explore genetic variants affecting bisoprolol response are inconclusive, limited or confusing because of mixed results with other β-Blockers, different genetic polymorphisms observed, endpoint studied etc. Because of this, we performed a systematic review in order to find relevant genetic variants affecting bisoprolol response. We have found genetic polymorphism in several genes, but most of the studies focused in ADRB variants. The ADRB1 Arg389Gly (rs1801253) was the most studied genetic polymorphism and it seems to influence the response to bisoprolol, although studies are inconclusive. Even, we performed a meta-analysis about its influence on systolic/diastolic blood pressure in patients treated with bisoprolol, but this did not show statistically significant results. In conclusion, many genetic polymorphisms have been assessed about their influence on patients´ response to bisoprolol and the ADRB1 Arg389Gly (rs1801253) seems the most relevant genetic polymorphism in this regard but results have not been confirmed with a meta-analysis. Our results support the need of further studies about the impact of genetic variants on bisoprolol response, considering different genetic polymorphisms and conducting single and multiple SNPs analysis, including other clinical parameters related to bisoprolol response in a multivariate study.
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Affiliation(s)
- Celia Castaño-Amores
- Pharmacy Unit; Hospital Universitario clínico San Cecilio - Instituto de investigación biosanitaria (ibs.Granada), Granada, Spain
| | - Xando Díaz-Villamarín
- Pharmacy Unit; Hospital Universitario clínico San Cecilio - Instituto de investigación biosanitaria (ibs.Granada), Granada, Spain; Genomics Unit; Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENyO), Granada, Spain.
| | - Ana María Pérez-Gutiérrez
- Department of Biochemistry and Molecular Biology II; School of Pharmacy, University of Granada, Granada, Spain
| | - Alba Antúnez-Rodríguez
- Genomics Unit; Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENyO), Granada, Spain
| | - Ana Pozo-Agundo
- Genomics Unit; Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENyO), Granada, Spain
| | - Eduardo Moreno-Escobar
- Cardiology Unit; Hospital Universitario clínico San Cecilio - Instituto de investigación biosanitaria (ibs.Granada), Granada, Spain
| | - Jesús Gabriel Sánchez-Ramos
- Cardiology Unit; Hospital Universitario clínico San Cecilio - Instituto de investigación biosanitaria (ibs.Granada), Granada, Spain
| | - Luis Javier Martínez-González
- Genomics Unit; Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENyO), Granada, Spain
| | - Cristina Lucía Dávila-Fajardo
- Pharmacy Unit; Hospital Universitario Virgen de las Nieves - Instituto de investigación biosanitaria (ibs.Granada), Granada, Spain
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15
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De Bacquer D, Astin F, Kotseva K, Pogosova N, De Smedt D, De Backer G, Rydén L, Wood D, Jennings C. Poor adherence to lifestyle recommendations in patients with coronary heart disease: results from the EUROASPIRE surveys. Eur J Prev Cardiol 2021; 29:383-395. [PMID: 34293121 DOI: 10.1093/eurjpc/zwab115] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Despite the high use of cardioprotective medications, the risk factor control in patients with coronary heart disease (CHD) is still inadequate. Guidelines identify healthy lifestyles as equally important in secondary prevention as pharmacotherapy. Here, we describe reasons for poor lifestyle adherence from the patient's perspective. METHODS AND RESULTS In the EUROASPIRE IV and V surveys, 16 259 CHD patients were examined and interviewed during a study visit ≥6 months after hospital discharge. Data gathering was fully standardized. The Brief Illness Perception questionnaire was completed by a subsample of 2379 patients. Half of those who were smoking prior to hospital admission, were still smoking; 37% of current smokers had not attempted to quit and 51% was not considering to do so. The prevalence of obesity was 38%. Half of obese patients tried to lose weight in the past month and 61% considered weight loss in the following month. In relation to physical activity, 40% was on target with half of patients trying to do more everyday activities. Less than half had the intention to engage in planned exercise. Only 29% of all patients was at goal for all three lifestyle factors. The number of adverse lifestyles was strongly related to the way patients perceive their illness as threatening. Lifestyle modifications were more successful in those having participated in a cardiac rehabilitation and prevention programme. Patients indicated lack of self-confidence as the main barrier to change their unhealthy behaviour. CONCLUSION Modern secondary prevention programmes should target behavioural change in all patients with adverse lifestyles.
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Affiliation(s)
- Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Nana Pogosova
- National Medical Research Centre of Cardiology, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Guy De Backer
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10-6K3, entrance 42, B-9000 Ghent, Belgium
| | - Lars Rydén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
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16
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Curneen JM, Judge C, Traynor B, Buckley A, Saiva L, Murphy L, Murray D, Fleming S, Kearney P, Murphy RT, Aleong G, Kiernan TJ, O'Neill J, Moore D, Nicaodhabhui B, Birrane J, Hall P, Crowley J, Gibson I, Jennings CS, Wood D, Kotseva K, McEvoy JW. Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study). Open Heart 2021; 8:openhrt-2021-001659. [PMID: 34172561 PMCID: PMC8237732 DOI: 10.1136/openhrt-2021-001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 01/29/2023] Open
Abstract
Background Studying variability in the care provided to secondary prevention coronary heart disease (CHD) outpatients can identify interventions to improve their outcomes. Methods We studied outpatients who had an index CHD event in the preceding 6–24 months. Eligible CHD events included acute coronary syndrome (ACS) and coronary revascularisation for stable chronic coronary syndrome (CCS). Site training was provided by a core team and data were collected using standardised methods. Results Between 2017 and 2019, we enrolled 721 outpatients at nine Irish study sites; 81% were men and mean age was 63.9 (SD ±8.9) years. The study examination occurred a median of 1.16 years after the index CHD event, which was ACS in 399 participants (55%) and stable-CCS in 322. On examination, 42.5% had blood pressure (BP) >140/90 mm Hg, 63.7% had low-density lipoprotein cholesterol (LDL-C) >1.8 mmol/L and 44.1% of known diabetics had an HbA1c >7%. There was marked variability in risk factor control, both by study site and, in particular, by index presentation type. For example, 82% of outpatients with prior-ACS had attended cardiac rehabilitation versus 59% outpatients with prior-CCS (p<0.001) and there were also large differences in control of traditional risk factors like LDL-C (p=0.002) and systolic BP (p<0.001) among outpatients with prior-ACS versus prior-CCS as the index presentation. Conclusions Despite international secondary prevention guidelines broadly recommending the same risk factor targets for all adults with CHD, we found marked differences in outpatient risk factor control and management on the basis of hospital location and index CHD presentation type (acute vs chronic). These findings highlight the need to reduce hospital-level and patient-level variability in preventive care to improve outcomes; a lesson that should inform CHD prevention programmes in Ireland and around the world.
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Affiliation(s)
- James Mg Curneen
- Clinical Pharmacology and Therapeutics, Galway University Hospital, Galway, Ireland
| | - Conor Judge
- Medicine, Galway University Hospital, Galway, Ireland.,HRB Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Bryan Traynor
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Anthony Buckley
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - Lavanya Saiva
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Laura Murphy
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Donal Murray
- Cardiology, Sligo University Hospital, Sligo, Ireland
| | - Sean Fleming
- Cardiology, Midland Regional Hospital Portlaoise, Portlaoise, Ireland
| | | | | | - Godfrey Aleong
- Cardiology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Thomas J Kiernan
- Cardiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - James O'Neill
- Cardiology, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - David Moore
- Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - Bridog Nicaodhabhui
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John Birrane
- Medicine, Galway University Hospital, Galway, Ireland.,National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Patricia Hall
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - James Crowley
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Irene Gibson
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Catriona S Jennings
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
| | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland
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17
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Doxorubicin and subsequent risk of cardiovascular diseases among survivors of diffuse large B-cell lymphoma in Hong Kong. Blood Adv 2021; 4:5107-5117. [PMID: 33085755 DOI: 10.1182/bloodadvances.2020002737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/09/2020] [Indexed: 02/01/2023] Open
Abstract
Evidence regarding the dose-related impact of doxorubicin on subsequent cardiovascular diseases (CVDs) in Asian patients with diffuse large B-cell lymphoma (DLBCL) without preexisting CVDs is lacking. From a territory-wide electronic database in Hong Kong, we identified adults who were diagnosed with DLBCL and treated with chemotherapy between 2000 and 2018. We evaluated the patients for incident CVDs (including ischemic heart disease, heart failure, and cardiomyopathy). We evaluated the cause-specific cumulative incidence (csCI) of CVD with levels of doxorubicin exposure by using flexible parametric competing risk analysis and adjusting for demographics, comorbidities, therapeutic exposure, cardiovascular risk factors, and lifestyle factors. Controls were age- and sex-matched to DLBCL patients. We analyzed 2600 patients and 13 000 controls. The adjusted cause-specific hazard ratio (HR) for CVD in patients treated with >500 mg doxorubicin compared with non-doxorubicin regimens was 2.65 (95% confidence interval [CI], 1.23-5.74; P = .013). The 5-, 10-, and 15-year csCIs were 8.2%, 11.3%, and 12.8% in patients vs 3.1%, 4.4%, and 5.2% in controls, respectively. Hypertension (HR, 6.20; 95% CI, 0.79-48.44; P = .082) and use of aspirin/angiotensin-converting enzyme inhibitor/beta-blocker at baseline (HR, 2.13-4.63; P < .001 to .002) might confer a higher risk of subsequent CVDs. In this Hong Kong population-based study, doxorubicin exposure (absolute dose >500 mg), together with hypertension or baseline use of medication for cardiovascular risk factors, was found to be associated with an increase in csCIs of CVDs. Tailoring therapeutic strategies to underlying CVD risk factors and risk-adapted monitoring and follow-up of susceptible DLBCL patients are advisable.
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18
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Hopstock LA, Morseth B, Cook S, Eggen AE, Grimsgaard S, Lundblad MW, Løchen ML, Mathiesen E, Nilsen A, Njølstad I. Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015-16. Eur J Prev Cardiol 2021; 29:362-370. [PMID: 33778888 DOI: 10.1093/eurjpc/zwab050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 12/29/2022]
Abstract
AIMS To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway. METHODS AND RESULTS In the population-based Tromsø Study 2015-16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (<140/90 mmHg, <130/80 mmHg if diabetes), LDL cholesterol (<1.8 mmol/L), HbA1c (<7.0% if diabetes), overweight (body mass index (BMI) <25 kg/m2, waist circumference women <80 cm, men <94 cm), smoking (non-smoking), physical activity (self-reported >sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat <10E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers. CONCLUSION Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care and treatment after MI and stroke is needed.
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Affiliation(s)
- Laila A Hopstock
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway.,Pandemic Unit, Tromsø Municipality, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sarah Cook
- Faculty of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Elise Eggen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Marie W Lundblad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
| | - Ellisiv Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Amalie Nilsen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway.,Department of Medicine, Nordland Hospital, Bodø, Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens vei, 9037 Tromsø, Norway
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19
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Pedersen E, Garcia BH, Halvorsen KH, Eggen AE, Schirmer H, Waaseth M. Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7. BMC Cardiovasc Disord 2021; 21:44. [PMID: 33478404 PMCID: PMC7819182 DOI: 10.1186/s12872-021-01866-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement. METHOD We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015-2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol. RESULTS The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6-54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7-2.7). CONCLUSION Treatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.
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Affiliation(s)
- Elisabeth Pedersen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway.
| | | | - Kjell H Halvorsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine Campus Ahus, University of Oslo, Oslo, Norway
| | - Marit Waaseth
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
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20
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Silva PGMDBE, Berwanger O, Precoma DB, Cavalcante MA, Vilela-Martin JF, Figueiredo EL, Lopes RD, Bodanese LC, Guimarães JI, Andrade JPD, Paola AAVD, Malachias MVB, Mattos LAPE, Bacal F, Dutra OP. Evaluation of 1-Year Follow-up of Patients Included in the Registry of Clinical Practice in Patients at High Cardiovascular Risk (REACT). Arq Bras Cardiol 2021; 116:108-116. [PMID: 33331461 PMCID: PMC8159499 DOI: 10.36660/abc.20190885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/17/2020] [Accepted: 05/14/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In clinical practice, there is evidence of failure to prescribe evidence-based therapies for patients at high cardiovascular risk. However, in Brazil, data on 1-year outcomes of these patients remain insufficient. OBJECTIVES To describe the use of evidence-based therapies and the occurrence of major cardiovascular outcomes and their major predictors in a 12-month follow-up of a Brazilian multicenter registry of patients at high cardiovascular risk. METHODS This prospective observational study documented the outpatient clinical practice of managing patients over 45 years of age and of high cardiovascular risk in both primary and secondary prevention. Patients were followed-up for 1 year, and the prescription of evidence-based therapies and the occurrence of major cardiovascular events (myocardial infarction, stroke, cardiac arrest, and cardiovascular death) were assessed. P-values < 0.05 were considered statistically significant. RESULTS From July 2010 to August 2014, a total of 5076 individuals were enrolled in 48 centers, 91% of the 4975 eligible patients were followed-up in cardiology centers, and 68.6% were in secondary prevention. At 1 year, the concomitant use of antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors reduced from 28.3% to 24.2% (p < 0.001). Major cardiovascular event rate was 5.46%, and the identified predictors were age, patients in secondary prevention, and diabetic nephropathy. CONCLUSIONS In this large national registry of patients at high cardiovascular risk, risk predictors similar to those of international registries were identified, but medical prescription adherence to evidence-based therapies was inferior and significantly worsened at 1 year. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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Affiliation(s)
| | | | - Dalton Bertolim Precoma
- Pontificia Universidade Católica do Paraná - Escola de Medicina, Curitiba, PR - Brasil
- Sociedade Hospitalar Angelina Caron - Cardiologia, Campina Grande do Sul, PR - Brasil
| | - Margaret Assad Cavalcante
- Universidade do Oeste Paulista (Unoeste), Presidente Prudente, SP - Brasil
- Hospital Regional de Presidente Prudente, Presidente Prudente, SP - Brasil
| | - José Fernando Vilela-Martin
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Marcus Vinicius Bolivar Malachias
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Instituto de Hipertensão Arterial - Diretoria Clínica, Belo Horizonte, MG - Brasil
| | | | - Fernando Bacal
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração, São Paulo, SP - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
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21
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Claessen BE, Guedeney P, Gibson CM, Angiolillo DJ, Cao D, Lepor N, Mehran R. Lipid Management in Patients Presenting With Acute Coronary Syndromes: A Review. J Am Heart Assoc 2020; 9:e018897. [PMID: 33289416 PMCID: PMC7955383 DOI: 10.1161/jaha.120.018897] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Despite many improvements in its prevention and management, acute coronary syndrome (ACS) remains a major cause of morbidity and mortality in the developed world. Lipid management is an important part of secondary prevention after ACS, but many patients currently remain undertreated and do not attain guideline‐recommended levels of low‐density lipoprotein cholesterol reduction. This review details the current state of evidence on lipid management in patients presenting with ACS, provides directions for identification of patients who may benefit from early escalation of lipid‐lowering therapy, and discusses novel lipid‐lowering medication that is currently under investigation in clinical trials. Moreover, a treatment algorithm aimed at attaining guideline‐recommended low‐density lipoprotein cholesterol levels is proposed. Despite important advances in the initial treatment and secondary prevention of ACS, ≈20% of ACS survivors experience a subsequent ischemic cardiovascular event within 24 months, and 5‐year mortality ranges from 19% to 22%. Knowledge of the current state of evidence‐based lipid management after ACS is of paramount importance to improve outcomes after ACS.
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Affiliation(s)
- Bimmer E Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,Noordwest Ziekenhuisgroep Alkmaar the Netherlands
| | - Paul Guedeney
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY.,ACTION Study Group Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche Scientifique_1166 Cardiology Institute Pitié Salpêtrière Hospital ParisSorbonne University Paris France
| | | | | | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
| | - Norman Lepor
- Cedars-Sinai Heart InstituteGeffen School of Medicine-University of Califonia - Los Angeles Los Angeles CA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY
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22
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Sverre E, Peersen K, Perk J, Husebye E, Gullestad L, Dammen T, Otterstad JE, Munkhaugen J. Challenges in coronary heart disease prevention - experiences from a long-term follow-up study in Norway. SCAND CARDIOVASC J 2020; 55:73-81. [PMID: 33274648 DOI: 10.1080/14017431.2020.1852308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective. To determine longitudinal changes in lifestyle behaviour and lipid management in a chronic coronary heart disease (CHD) population. Design. A multi-centre cohort study consecutively included 1127 patients at baseline in 2014-2015, on average 16 months after a CHD event. Data were collected from hospital records, a questionnaire and clinical examination. Seven hundred and seven of 1021 eligible patients participated in a questionnaire-based follow-up in 2019. Data were analysed with univariate statistics. Results. After a mean follow-up of 4.7 years (SD 0.4) from baseline, the percentage of current smokers (15% versus 16%), obesity (23% versus 25%) and clinically significant symptoms of anxiety (21% versus 17%) and depression (13% versus 14%) remained unchanged, whereas the proportion with low physical activity increased from 53% to 58% (p < .001). The proportions with reduced physical activity level were similar in patients over and under 70 years of age. Most patients were still taking statins (94% versus 92%) and more patients used high-intensity statin (49% versus 54%, p < .001) and ezetimibe (5% versus 15%, p < .001) at follow-up. 73% reported ≥1 primary-care consultation(s) for CHD during the last year while 27% reported no such follow-up. There were more smokers among participants not attending primary-care consultations compared to those attending (19% versus 14%, p = .026). No differences were found for other risk factors. Conclusions. We found persistent suboptimal risk factor control in coronary outpatients during long-term follow-up. Closer follow-up and intensified risk management including lifestyle and psychological health are needed to improved secondary prevention and outcome of CHD. Trial registration: Registered at ClinicalTrials.gov: NCT02309255.Registered at 5 December 2014, registered retrospectively.
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Affiliation(s)
- E Sverre
- Department of Medicine, Drammen Hospital, Drammen, Norway.,Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - K Peersen
- Department of Medicine, Vestfold Hospital, Tønsberg, Norway
| | - J Perk
- Department of Cardiology, Public Health Department Linnaeus University, Kalmar, Sweden
| | - E Husebye
- Department of Medicine, Drammen Hospital, Drammen, Norway
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Cardiac Research Center and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - T Dammen
- Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J E Otterstad
- Department of Medicine, Vestfold Hospital, Tønsberg, Norway
| | - J Munkhaugen
- Department of Medicine, Drammen Hospital, Drammen, Norway.,Department of Behavioral Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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23
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Glezer M. Trimetazidine and Bisoprolol to Treat Angina in Symptomatic Patients: Post Hoc Analysis From the CHOICE-2 Study. Cardiol Ther 2020; 10:161-173. [PMID: 33247333 PMCID: PMC8126526 DOI: 10.1007/s40119-020-00202-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction Angina is the cardinal symptom of chronic coronary syndrome (CCS), which is the leading cause of death worldwide. As such, the control of angina is important. The current guidelines recommend beta blockers (BB) or calcium channel blockers to reduce angina, yet many patients with stable angina remain symptomatic. It has been suggested that combining trimetazidine (TMZ), an anti-ischemic agent, with a BB is beneficial for symptomatic patients. Bisoprolol, a BB, is often used to treat patients with CCS, yet no data are currently available regarding the efficacy of bisoprolol combined with TMZ in patients who remain symptomatic despite receiving bisoprolol. Methods The aim of this post-hoc analysis of the CHOICE-2 study was to evaluate the efficacy and safety of TMZ 35 mg twice daily in combination with different bisoprolol doses in symptomatic patients with stable angina patients receiving hemodynamic therapy in a real-world clinical setting. Results This analysis involved 221 patients (mean [± standard deviation] age 64.8 ± 8.9 years) with stable angina. The mean number of weekly angina episodes gradually fell from 6.2 ± 5.3 at inclusion (M0) to 1.5 ± 1.9 at 6 months after treatment initiation (M6) with combined TMZ–bisoprolol therapy (P < 0.001). The number of patients assessed to be angina-free increased almost sixfold from 5.4% (12/221) at M0 to 33.9% (74/221) at M6. Exercise capacity improved, as measured by walking distance, from 308 ± 207 m at M0 to 497 ± 253 m at M6 (P < 0.05). The number of patients with Canadian Cardiovascular Society class 1 angina increased by tenfold during the study, whereas those with class 3 angina decreased by threefold. Conclusion The TMZ–bisoprolol combination is a rapidly effective treatment for reducing the frequency of angina attacks and the use of short-acting nitrates in patients with stable angina in a real-world clinical setting. The benefits of this combination therapy was observed as early as 2 weeks after treatment initiation and the treatment was well tolerated. Trial Registration ISRCTN identifier: ISRCTN65209863
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Affiliation(s)
- Maria Glezer
- Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University, Moscow, Russia.
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24
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Shalnova SA, Yarovaya EV, Makarova YK, Kutsenko VA, Kapustina AV, Balanova YA, Imaeva AE, Muromtseva GA. Are Russian Men with Intermittent Claudication and/or Angina Pectoris Have the Same Cardiovascular and All-Cause Mortality Risks? The Data of the Prospective Population-Based Study. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-10-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To investigate the distribution of the intermittent claudication(IC) and/or angina pectoris (AP) and to evaluate the risk of cardiovascular and allcause mortality in Russian male population with pain syndrome of varying severity during more than 30-year observation period.Material and methods. The data were obtained from representative samples observed in Moscow and Saint-Petersburg (former Leningrad) from 1975 to 1986 with 75% response. Men (n=10953) aged 35-71 years (mean age 48.8±6.6 years) were examined by the same protocol which includes standard questionnaire, blood biochemistry, blood pressure (BP) and heart rate measurements, anthropometry and electrocardiography (ECG) in 12 leads. The original Rose questionnaire to determine the IC and AP was used. There were defined five risk groups with different pain features. The first group – no pain; the second group – mixed pain in legs and/or in chest including the pain connected with the effort, but without typical IC and AP features; the third group – only IC without AP; the fourth group – only AP without IC; finally, the fifth group – both IC and AP. The median follow-up period was 21.9 years with interquartile range of 13.4-33.5 years. During the follow-up 7893 all-cause deaths including 4220 cardiovascular deaths were found. The Kaplan-Meier method was applied to find out the associations between risk groups and survival. Mortality risk, including cardiovascular mortality, was evaluated by the Cox proportional hazard model.Results. There were 38.7% men with any pain. The prevalence of IC without AP was 0.7% and the prevalence of AP without IC was 5.8%. Only 0.3% of the population had both IC and AP. The prevalence of both parameters increased with age. As expected, men with no pain live longer than others. Median of the survival time in this group, which means the point when half of the population dies, was 24.9 years. Only in this group the value when 75% of population dies was not reached. Compared to no pain group, loss of the life expectancy of only IC group was 10.9 years, only AP group – 9.2 years, IC and AP group – 17.9 years. Both IC and AP had statistically significant contribution to mortality adjusted for high blood pressure, smoking, presence of ECG disturbances, history of myocardial infarction. Survival curves of isolated IC and AP groups did not have statistically significant difference which means that both diseases have the same contribution to mortality. Similar results were obtained for cardiovascular mortality.Conclusion. The prevalence of IC without AP was 0.7% and the prevalence of AP without IC was 5.8%. IC and AP are independent factors of all-cause and cardiovascular mortality among the Russian male population aged 35-71 years. However, no statistically significant difference was found between groups only with IC and only with AP for cardiovascular and all-cause deaths. The presence of both conditions in combination reduces the median survival time by 17.9 years compared to the group with no pain.
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Affiliation(s)
- S. A. Shalnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. V. Yarovaya
- National Medical Research Center for Therapy and Preventive Medicine;
Lomonosov Moscow State University
| | - Yu. K. Makarova
- National Medical Research Center for Therapy and Preventive Medicine;
Lomonosov Moscow State University
| | - V. A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine;
Lomonosov Moscow State University
| | - A. V. Kapustina
- National Medical Research Center for Therapy and Preventive Medicine
| | - Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. E. Imaeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. A. Muromtseva
- National Medical Research Center for Therapy and Preventive Medicine
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25
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Coca A, Kreutz R, Manolis AJ, Mancia G. A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension. J Hypertens 2020; 38:1890-1898. [PMID: 32890261 DOI: 10.1097/hjh.0000000000002464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
: Pharmacological treatment recommended by guidelines for very high-risk patients with established cardiovascular disease (CVD) includes lipid-lowering drugs, antihypertensive agents and antiplatelet therapy. Depending on the associated comorbidities, this baseline regimen has to be complemented with other drugs. Therefore, the number of pills to be taken is usually high and adherence to these multiple pill therapeutic regimens and long-term persistence on treatment is low, being the main factor for insufficient control of cardiovascular risk factors. The CNIC (Centro Nacional de Investigaciones Cardiovasculares, Ministerio de Ciencia e Innovación, España) polypill is the only polypill containing low-dose aspirin approved by the EMA and marketed in Europe, and has demonstrated to improve adherence. For this reason, guidelines recommend its use for secondary prevention of CVD, and also for primary prevention of cardiovascular events in patients with multiple cardiovascular risk factors and advanced atherosclerotic process at high risk of thrombosis and low risk of bleeding. This article pretends to simplify the steps that clinicians may follow to switch from any baseline regimen to the polypill with the use of several algorithms and tables showing the equivalent effective daily doses of different angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins to facilitate switching, as well as the steps to be followed depending of the initial levels of BP and LDL-cholesterol values to achieve BP and lipid control with the association to the polypill of other BP-lowering or lipid-lowering drugs whenever needed.
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Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
- Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | - Giuseppe Mancia
- Policlinico di Monza, Monza
- University of Milano-Bicocca, Milan, Italy
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26
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Ferrannini G, Norhammar A, Gyberg V, Mellbin L, Rydén L. Is Coronary Artery Disease Inevitable in Type 2 Diabetes? From a Glucocentric to a Holistic View on Patient Management. Diabetes Care 2020; 43:2001-2009. [PMID: 32661109 DOI: 10.2337/dci20-0002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 02/03/2023]
Affiliation(s)
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Viveca Gyberg
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
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27
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Jorge-Galarza E, Martínez-Sánchez FD, Javier-Montiel CI, Medina-Urrutia AX, Posadas-Romero C, González-Salazar MC, Osorio-Alonso H, Arellano-Buendía AS, Juárez-Rojas JG. Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study. J Clin Hypertens (Greenwich) 2020; 22:1253-1262. [PMID: 32644257 DOI: 10.1111/jch.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 01/19/2023]
Abstract
High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90 mm Hg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80 mm Hg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10 years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.
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Affiliation(s)
- Esteban Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Cesar I Javier-Montiel
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Aida X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - María C González-Salazar
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Horacio Osorio-Alonso
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Abraham S Arellano-Buendía
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan G Juárez-Rojas
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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28
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Jortveit J, Halvorsen S, Kaldal A, Pripp AH, Govatsmark RES, Langørgen J. Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease. BMC Cardiovasc Disord 2019; 19:71. [PMID: 30922234 PMCID: PMC6437860 DOI: 10.1186/s12872-019-1062-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 03/22/2019] [Indexed: 01/14/2023] Open
Abstract
Background Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. Methods Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry. Results In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5–1.7). Conclusions Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.
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Affiliation(s)
- Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital, Box 783, Stoa, 4809, Arendal, Norway.
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Anete Kaldal
- Department of Cardiology, Sørlandet Hospital, Box 783, Stoa, 4809, Arendal, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Jørund Langørgen
- Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway
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Kotseva K, De Backer G, De Bacquer D, Rydén L, Hoes A, Grobbee D, Maggioni A, Marques-Vidal P, Jennings C, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Deckers J, De Smedt D, De Sutter J, Dilic M, Dolzhenko M, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Heuschmann P, Hasan-Ali H, Jankowski P, Lalic N, Lehto S, Lovic D, Mancas S, Mellbin L, Milicic D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Z, Stöerk S, Tokgözoğlu L, Tsioufis C, Vulic D, Wood D. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019; 26:824-835. [DOI: 10.1177/2047487318825350] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.
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Affiliation(s)
- Kornelia Kotseva
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Guy De Backer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Dirk De Bacquer
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Lars Rydén
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arno Hoes
- European Society of Cardiology, Sophia Antipolis, France
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Diederick Grobbee
- European Society of Cardiology, Sophia Antipolis, France
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Aldo Maggioni
- European Society of Cardiology, Sophia Antipolis, France
- ANMCO Research Centre, Florence, Italy
| | - Pedro Marques-Vidal
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Switzerland
| | - Catriona Jennings
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
| | - Ana Abreu
- Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carlos Aguiar
- European Society of Cardiology, Sophia Antipolis, France
- Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jolita Badariene
- Clinic of Cardiac and Vascular diseases, Medical Faculty, Vilnius University, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Jan Bruthans
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Almudena Castro Conde
- Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Renata Cifkova
- European Society of Cardiology, Sophia Antipolis, France
- Centre for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic
| | - Jim Crowley
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Galway University Hospital and Croí, the West of Ireland Cardiac and Stroke Foundation, Croí Heart and Stroke Centre, Galway, Ireland
| | - Kairat Davletov
- School of Public Health, Public Health Research Centre, Kazakh National Medical University, Almaty, Kazakhstan
| | - Jaap Deckers
- European Society of Cardiology, Sophia Antipolis, France
- Erasmus MC, Rotterdam, The Netherlands
| | - Delphine De Smedt
- European Society of Cardiology, Sophia Antipolis, France
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Johan De Sutter
- European Society of Cardiology, Sophia Antipolis, France
- Department of Internal Medicine and Paediatrics, Ghent University, Belgium
- AZ Maria Middelares Ghent, Belgium
| | - Mirza Dilic
- European Society of Cardiology, Sophia Antipolis, France
- Medical Faculty, University of Sarajevo, Bosnia and Herzegovina
| | - Marina Dolzhenko
- Supyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Vilnis Dzerve
- European Society of Cardiology, Sophia Antipolis, France
- Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia
| | - Andrejs Erglis
- European Society of Cardiology, Sophia Antipolis, France
- Pauls Stradins Clinical University Hospita, University of Latvia, Riga, Latvia
| | - Zlatko Fras
- European Society of Cardiology, Sophia Antipolis, France
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
| | - Dan Gaita
- European Society of Cardiology, Sophia Antipolis, France
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Nina Gotcheva
- National Heart Hospital, Dept Cardiology, Sofia, Bulgaria
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Centre, University Hospital Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
| | - Hosam Hasan-Ali
- Assiut University Heart Hospital, Cardiovascular Medicine Department, Egypt
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Nebojsa Lalic
- Department for Metabolic Disorder, Intensive Treatment and Cell Therapy in Diabetes, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Seppo Lehto
- European Society of Cardiology, Sophia Antipolis, France
- Varkaus Hospital, Finland
| | - Dragan Lovic
- European Society of Cardiology, Sophia Antipolis, France
- Clinic for Internal Disease Intermedic, Cardiology Department, Hypertension Centre, Nis, Serbia
| | - Silvia Mancas
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania
| | - Linda Mellbin
- European Society of Cardiology, Sophia Antipolis, France
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Davor Milicic
- European Society of Cardiology, Sophia Antipolis, France
- University of Zagreb School of Medicine & University Hospital Centre Zagreb, Croatia
| | - Erkin Mirrakhimov
- European Society of Cardiology, Sophia Antipolis, France
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- National Centre of Cardiology and Internal Medicine named after academician Mirrakhimov MM, Bishkek, Kyrgyzstan
| | - Rafael Oganov
- National Research Centre for Preventive Medicine, Directorate, Moscow, Russia
| | - Nana Pogosova
- Federal State Budget Organization, National Medical Research Centre of Cardiology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Zeljko Reiner
- European Society of Cardiology, Sophia Antipolis, France
- University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Stefan Stöerk
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Lâle Tokgözoğlu
- European Society of Cardiology, Sophia Antipolis, France
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Costas Tsioufis
- European Society of Cardiology, Sophia Antipolis, France
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dusko Vulic
- Centre for Medical Research, School of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - David Wood
- European Society of Cardiology, Sophia Antipolis, France
- National Heart and Lung Institute, Imperial College London, UK
- National University of Ireland, Galway, Ireland *Listed in Supplemental Appendix
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Ferrières J, Lautsch D, Ambegaonkar BM, De Ferrari GM, Vyas A, Baxter CA, Bash LD, Velkovski-Rouyer M, Horack M, Almahmeed W, Chiang FT, Poh KK, Elisaf M, Brudi P, Gitt AK. Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study. Int J Cardiol 2018; 270:21-27. [DOI: 10.1016/j.ijcard.2018.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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Incidence of cardiovascular events in patients with stabilized coronary heart disease: the EUROASPIRE IV follow-up study. Eur J Epidemiol 2018; 34:247-258. [PMID: 30353266 DOI: 10.1007/s10654-018-0454-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022]
Abstract
The EUROASPIRE surveys (EUROpean Action on Secondary Prevention through Intervention to Reduce Events) demonstrated that most European coronary patients fail to achieve lifestyle, risk factor and therapeutic targets. Here we report on the 2-year incidence of hard cardiovascular (CV) endpoints in the EUROASPIRE IV cohort. EUROASPIRE IV (2012-2013) was a large cross-sectional study undertaken at 78 centres from selected geographical areas in 24 European countries. Patients were interviewed and examined at least 6 months following hospitalization for a coronary event or procedure. Fatal and non-fatal CV events occurring at least 1 year after this baseline screening were registered. The primary outcome in our analyses was the incidence of CV death or non-fatal myocardial infarction, stroke or heart failure. Cox regression models, stratified for country, were fitted to relate baseline characteristics to outcome. Our analyses included 7471 predominantly male patients. Overall, 222 deaths were registered of whom 58% were cardiovascular. The incidence of the primary outcome was 42 per 1000 person-years. Comorbidities were strongly and significantly associated with the primary outcome (multivariately adjusted hazard ratio HR, 95% confidence interval): severe chronic kidney disease (HR 2.36, 1.44-3.85), uncontrolled diabetes (HR 1.89, 1.50-2.38), resting heart rate ≥ 75 bpm (HR 1.74, 1.30-2.32), history of stroke (HR 1.70, 1.27-2.29), peripheral artery disease (HR 1.48, 1.09-2.01), history of heart failure (HR 1.47, 1.08-2.01) and history of acute myocardial infarction (HR 1.27, 1.05-1.53). Low education and feelings of depression were significantly associated with increased risk. Lifestyle factors such as persistent smoking, insufficient physical activity and central obesity were not significantly related to adverse outcome. Blood pressure and LDL-C levels appeared to be unrelated to cardiovascular events irrespective of treatment. In patients with stabilized CHD, comorbid conditions that may reflect the ubiquitous nature of atherosclerosis, dominate lifestyle-related and other modifiable risk factors in terms of prognosis, at least over a 2-year follow-up period.
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Kotseva K. Attainment of low-density lipoprotein cholesterol target in patients with coronary heart disease: Still a long way to go. Eur J Prev Cardiol 2018; 25:1947-1949. [PMID: 30335509 DOI: 10.1177/2047487318806984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Kornelia Kotseva
- 1 National Heart and Lung Institute, Imperial College London, UK.,2 Department of Public Health, Ghent University, Belgium
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Tsukanova K, Fitilev S, Vozzhaev A, Shkrebneva I, Klyuev D. Analysis of changes in pharmacotherapy of stable angina over the five-year period at specialized out-patient level of medical care (pharmacoepidemiological study). RESEARCH RESULTS IN PHARMACOLOGY 2018. [DOI: 10.3897/rrpharmacology.4.27709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Ischemic heart disease (IHD) remains the leading cause of death both in Europe and in Russia. The most common form of IHD is stable angina. There is compelling evidence that strict adherence to clinical guidelines greatly contributes to mortality reduction. However, the gap between modern knowledge and use of guideline-recommended medications remains significant. As shown by Western practice, one of the possible solutions of this problem is regular conduction of pharmacoepidemiological studies.Objective: Investigate the dynamics of drug prescription rates in patients with stable angina over the five-year period on the example of routine clinical practice of outpatient cardiology institution of Moscow for the purpose of further eliminating the prescribing gap for guideline recommended pharmacological strategies.Materials and methods: Our research work was performed as a retrospective pharmacoepidemiological study including two stages with five-year interval using cross-section method.Results and discussion: We found a significant increase in use of antiplatelets (82.7 vs. 56.2%, p<0.05) and statins (45.6 vs. 16.1%, p<0.05). Despite the unchanged use of ACE inhibitors, the prescription rate of angiotensin receptor blockers II increased (14.7 vs. 9.7%, p<0.05). Analysis of anti-ischemic pharmacotherapy revealed an increase in beta-adrenoblockers use (74.3 vs. 63.6%, р<0.05) and a decrease in use of long-acting nitrates (26.3 vs. 31.1%, р<0.05) and calcium channel blockers (35.7 vs. 39.6%, р<0.05). Significant changes were found in prescription rates and dosage regimens of single medications in each pharmacological group. The study results demonstrated an increase in frequency of capturing data on lipid profile and diet recommendations in patient records.Conclusion: Such type of pharmacoepidemiological study carried out for the first time made it possible to investigate the dynamics of specialists’ adherence to guidelines of stable angina pharmacotherapy in routine outpatient clinical practice.
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Changing patterns in the prevalence and management of cardiovascular risk factors in India and their comparison with the rest of the world along with clinical outcomes at 5-year: An analysis of stable coronary artery disease patients from The Prospective Observational Longitudinal Registry of patients with stable coronary artery disease (CLARIFY) registry. Indian Heart J 2018; 70 Suppl 3:S36-S42. [PMID: 30595290 PMCID: PMC6309139 DOI: 10.1016/j.ihj.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 02/01/2023] Open
Abstract
Objective Present paper describes trends in prevalence and control of cardiovascular risk factors and clinical outcomes at 5-years for CLARIFY Indian cohort compared with rest of the world (ROW). Method CLARIFY is an international, prospective-observational, longitudinal cohort study in stable coronary artery disease outpatients. The 5-year data of both cohorts were compared, and evaluated. Results In Indian cohort, the angina prevalence declined significantly. There are few favorable changes in the pattern of receiving guideline-recommended therapy over 5 years, and the Indian cohort exhibited significantly lower adverse clinical outcomes than ROW. Conclusion The 5-year trend of CLARIFY India registry indicate varying trends in prevalence and control of cardiovascular risk factors, the need for approaches to improve control of all modifiable risk factors, and increase in long-term use of essential primary and secondary prevention medications in clinical practice as emphasized in the latest Indian guidelines for management of stable CAD.
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Błażejczyk A, Błażejczyk K, Baranowski J, Kuchcik M. Heat stress mortality and desired adaptation responses of healthcare system in Poland. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:307-318. [PMID: 28864962 DOI: 10.1007/s00484-017-1423-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 05/09/2017] [Accepted: 08/07/2017] [Indexed: 05/06/2023]
Abstract
Heat stress is one of the environmental factors influencing the health of individuals and the wider population. There is a large body of research to document significant increases in mortality and morbidity during heat waves all over the world. This paper presents key results of research dealing with heat-related mortality (HRM) in various cities in Poland which cover about 25% of the country's population. Daily mortality and weather data reports for the years 1991-2000 were used. The intensity of heat stress was assessed by the universal thermal climate index (UTCI). The research considers also the projections of future bioclimate to the end of twenty-first century. Brain storming discussions were applied to find necessary adaptation strategies of healthcare system (HCS) in Poland, to minimise negative effects of heat stress. In general, in days with strong and very strong heat stress, ones must expect increase in mortality (in relation to no thermal stress days) of 12 and 47%, respectively. Because of projected rise in global temperature and heat stress frequency, we must expect significant increase in HRM to the end of twenty-first century of even 165% in comparison to present days. The results of research show necessity of urgent implementation of adaptation strategies to heat in HCS.
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Affiliation(s)
- Anna Błażejczyk
- Bioklimatologia, Laboratory of Bioclimatology and Environmental Ergonomics, Łukowska 17/55, 04-133, Warsaw, Poland.
| | - Krzysztof Błażejczyk
- Institute of Geography and Spatial Organization, Polish Academy of Sciences, Twarda 51/55, 00-818, Warsaw, Poland
| | - Jarosław Baranowski
- Institute of Geography and Spatial Organization, Polish Academy of Sciences, Twarda 51/55, 00-818, Warsaw, Poland
| | - Magdalena Kuchcik
- Institute of Geography and Spatial Organization, Polish Academy of Sciences, Twarda 51/55, 00-818, Warsaw, Poland
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Komajda M, Kerneis M, Tavazzi L, Balanescu S, Cosentino F, Cremonesi A, Ferrari R, Kownator S, Szwed H, Mintale I, Olivari Z, Rittger H, Shlyakhto EV, Slapikas R, Steg PG, Valgimigli M, Van Belle E, Tsioufis K, Majda W, Laroche C, Maggioni AP. The chronic ischaemic cardiovascular disease ESC Pilot Registry: Results of the six-month follow-up. Eur J Prev Cardiol 2018; 25:377-387. [DOI: 10.1177/2047487317751955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim Chronic ischaemic cardiovascular disease (CICD) remains a leading cause of morbidity and mortality worldwide. The CICD Pilot Registry enrolled 2420 patients across 10 European Society of Cardiology countries prospectively to describe characteristics, management strategies and clinical outcomes in this setting. We report here the six-month outcomes. Methods and results From the overall population, 2203 patients were analysed at six months. Fifty-eight patients (2.6%) died after inclusion; 522 patients (23.7%) experienced all-cause hospitalisation or death. The rate of prescription of angiotensin-converting enzyme inhibitors, beta-blockers and aspirin was mildly decreased at six months (all P < 0.02). Patients who experienced all-cause hospitalisation or death were older, more often had a history of non-ST-segment elevation myocardial infarction, of chronic kidney disease, peripheral revascularisation and/or chronic obstructive pulmonary disease than those without events. Independent predictors of all-cause mortality/hospitalisation were age (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07–1.27) per 10 years, and a history of previous peripheral revascularisation (HR 1.45, 95% CI 1.03–2.03), chronic kidney disease (HR 1.31, 95% CI 1.0–1.68) or chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.06–1.91, all P < 0.05). We observed a higher rate of events in eastern, western and northern countries compared to southern countries and in cohort 1. Conclusion In this contemporary European registry of CICD patients, the rate of severe clinical outcomes at six months was high and was influenced by age, heart rate and comorbidities. The medical management of this condition remains suboptimal, emphasising the need for larger registries with long-term follow-up. Ad-hoc programmes aimed at implementing guidelines adherence and follow-up procedures are necessary, in order to improve quality of care and patient outcomes.
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Affiliation(s)
| | | | - Luigi Tavazzi
- GVM Care and Research, Maria Cecilia Hospital, Italy
| | - Serban Balanescu
- Department of Cardiology, Monza Hospital Centru Cardiovascular, Romania
| | | | | | | | | | - Hanna Szwed
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Poland
| | - Iveta Mintale
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Latvia
| | - Zoran Olivari
- Department of Cardiology, Ca’ Foncello Hospital, Italy
| | | | - Evgeny V Shlyakhto
- Cardiac Arrhythmias Department, Almazov Research Institute of Cardiology, Russian Federation
| | - Rimvydas Slapikas
- Department of Cardiology, Hospital of the Lithuanian Health Science University, Lithuania
| | | | - Marco Valgimigli
- Department of Cardiology, Erasmus Medical Centre, The Netherlands
| | | | | | - Wojciech Majda
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Poland
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, France
- ANMCO Research Centre, Firenze, Italy
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Jardim TV, Reiger S, Abrahams-Gessel S, Crowther NJ, Wade A, Gómez-Olivé FX, Salomon J, Tollman S, Gaziano TA. Disparities in Management of Cardiovascular Disease in Rural South Africa: Data From the HAALSI Study (Health and Aging in Africa: Longitudinal Studies of International Network for the Demographic Evaluation of Populations and Their Health Communities). Circ Cardiovasc Qual Outcomes 2017; 10:e004094. [PMID: 29150535 PMCID: PMC5777525 DOI: 10.1161/circoutcomes.117.004094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/18/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Optimal secondary prevention is critical for the reduction of repeated cardiovascular events, and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. METHODS AND RESULTS We recruited adults aged ≥40 years residing in the Agincourt subdistrict of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, human immunodeficiency virus status, and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Of 5059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2%, and myocardial infarction in 3.7%. Percent controlled of the 5 individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; body mass index 33.8%; low-density lipoprotein 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all 5 risk factors controlled and 42.4% had ≥3 risk factors controlled. Male sex (β coefficient=0.44; 95% confidence interval, 0.25-0.63; P<0.001), absence of physical disability (β coefficient=0.40; 95% confidence interval, 0.16-0.65; P=0.001), and socioeconomic status (β coefficient=0.10; 95% confidence interval, 0.01-0.19; P=0.035) were directly associated with the number of risk factors controlled. CONCLUSIONS Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, socioeconomic status, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower socioeconomic status, and those with physical disabilities.
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Affiliation(s)
- Thiago Veiga Jardim
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Sheridan Reiger
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Shafika Abrahams-Gessel
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Nigel J Crowther
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Alisha Wade
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - F Xavier Gómez-Olivé
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Joshua Salomon
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Stephen Tollman
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.)
| | - Thomas A Gaziano
- From the Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, MA (T.V.J., S.R., T.A.G.); Center for Health Decision Science (T.V.J., S.A.-G., T.A.G.), Department of Global Health and Population (J.S.), and Center for Population and Development Studies (F.X.G.-O.), Harvard T.H. Chan School of Public Health, Boston, MA; Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences (N.J.C.) and Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences (A.W., F.X.G.-O., S.T.), University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health Network, Accra, Ghana (F.X.G.-O.).
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Sorbets E, Greenlaw N, Ferrari R, Ford I, Fox KM, Tardif JC, Tendera M, Steg PG. Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease. Clin Cardiol 2017; 40:797-806. [PMID: 28561986 PMCID: PMC5697615 DOI: 10.1002/clc.22730] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/08/2023] Open
Abstract
Background Despite major advances in prevention and treatment, coronary artery disease (CAD) remains the leading cause of death worldwide. Whereas many sources of data are available on the epidemiology of acute coronary syndromes, fewer datasets reflect the contemporary management and outcomes of stable CAD patients. Hypothesis A worldwide contemporary registry would improve our knowledge about stable CAD. The main objectives are to describe the demographics, clinical profile, contemporary management and outcomes of outpatients with stable CAD; to identify gaps between evidence and treatment; and to investigate long‐term prognostic determinants. Methods CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an ongoing international observational longitudinal registry. Stable CAD patients from 45 countries in Europe, Asia, America, Middle East, Australia and Africa were enrolled between November 2009 and June 2010. The inclusion criteria were previous myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischemia or prior revascularization procedure. The main exclusion criteria were serious non‐cardiovascular disease, conditions interfering with life expectancy or severe other cardiovascular disease (including advanced heart failure). Follow‐up visits were planned annually for up to 5 years, interspersed with 6‐month telephone calls. Results Of the 32,703 patients enrolled, most (77.6%) were male, age (mean ± SD) was 64.2 ± 10.5 years, and 71.0% were receiving treatment for hypertension; mean ± SD resting heart rate was 68.2 ± 10.6 bpm. Patients were enrolled based on a history of myocardial infarction >3 months earlier (57.7%), having at least one stenosis >50% on coronary angiography (61.1%), proven symptomatic myocardial ischemia on non‐invasive testing (23.1%), or history of percutaneous coronary intervention or coronary artery bypass graft (69.8%). Baseline characteristics were similar across the four subgroups identified by the four inclusion criteria. Conclusion CLARIFY will provide a useful resource for understanding the current epidemiology of stable CAD.
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Affiliation(s)
- Emmanuel Sorbets
- FACT (French Alliance for Cardiovascular Clinical Trials, an F-CRIN Network), Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France; INSERM U-1148, Paris, France.,Université Paris 13, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom
| | - Roberto Ferrari
- Centro Cardiologico Universitario e and LTTA Centre, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola (RA), Italy
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, United Kingdom
| | - Kim M Fox
- National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom
| | | | - Michal Tendera
- School of Medicine, Medical University of Silesia, Katowice, Poland
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Clinical Trials, an F-CRIN Network), Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France; INSERM U-1148, Paris, France.,National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, United Kingdom
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Real-world Evidence for the Antianginal Efficacy of Trimetazidine from the Russian Observational CHOICE-2 Study. Adv Ther 2017; 34:915-924. [PMID: 28220388 DOI: 10.1007/s12325-017-0490-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The guidelines recommend a beta-blocker or calcium channel blocker as the first-line medication for angina, supplemented by other agents for additional symptoms. One such agent is trimetazidine (TMZ), which has been shown to reduce the frequency of anginal episodes and improve exercise performance without affecting haemodynamic parameters. However, extensive real-world evidence for its efficacy in combination with first-line therapies has been lacking. METHODS The aim of this large-scale, Russian, multicentre, 6-month, open-label, prospective observational study was to assess the effect of adding TMZ modified release 35 mg bid to background antianginal therapy in the real-world clinical setting. RESULTS The study included 896 patients: 54% women, aged 29-90 years (42.6% >65 years), 63% with class II angina, and receiving beta-blockers alone or in combination (93%). Add-on TMZ reduced angina frequency and short-acting nitrate use within 2 weeks (both p < 0.0001) regardless of background therapy and maintained this effect over 6 months. It increased the proportion of patients with class I angina sixfold while decreasing that of class 3 angina almost fourfold. It also improved walking distance and well-being at 6 months (both p < 0.0001). Treatment was well tolerated. CONCLUSION Add-on TMZ is a safe and rapidly effective treatment for reducing angina attacks and nitrate use in the real-world clinical setting. It also increases exercise capacity and well-being. These effects are observed within 2 weeks and persist for at least 6 months.
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Sverre E, Peersen K, Husebye E, Gjertsen E, Gullestad L, Moum T, Otterstad JE, Dammen T, Munkhaugen J. Unfavourable risk factor control after coronary events in routine clinical practice. BMC Cardiovasc Disord 2017; 17:40. [PMID: 28109259 PMCID: PMC5251244 DOI: 10.1186/s12872-016-0387-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/26/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event. METHODS A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up. RESULTS Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed. CONCLUSIONS The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits. TRIAL REGISTRATION Registered at ClinicalTrials.gov (ID NCT02309255 ).
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Affiliation(s)
- Elise Sverre
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Kari Peersen
- Department of Medicine, Vestfold Hospital, Tonsberg, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Medical Faculty, University of Oslo, Oslo, Norway
| | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | | | - Toril Dammen
- Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, 3004 Drammen, Norway
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Kingue S, Rakotoarimanana S, Rabearivony N, Bompera FL. Prevalence of selected cardiometabolic risk factors among adults in urban and semi-urban hospitals in four sub-Saharan African countries. Cardiovasc J Afr 2016; 28:147-153. [PMID: 27701489 PMCID: PMC5558135 DOI: 10.5830/cvja-2016-072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/10/2016] [Indexed: 11/10/2022] Open
Abstract
Aim: Cardiovascular diseases (CVDs) are a global challenge but the burden in sub-Saharan African (SSA) countries is less well documented than elsewhere. We aimed to describe the key cardiometabolic risk factors in four SSA countries. Methods: A cross-sectional, multi-national, hospital-based study was carried out among adults (> 35 years) across four SSA countries from 12 December 2011 to 7 February 2013. Risk factors were defined using the World Health Organisation and International Diabetes Federation guidelines. Results: Of the 844 adults (57.4% female, mean age 52.6 years), 76.6% were urban residents. The predominant CVD risk factors were hypertension (74.1%), obesity (36.2%) and excessive alcohol consumption (25.6%). Diabetes (17.7 vs 10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia (25.8 vs 18.0%) were more prevalent among the hypertensive subjects (all p < 0.007) than the normotensives. The metabolic syndrome (39.4%) was more common in women and hypertensive subjects. Conclusions: Hospital patients in SSA countries present with excessive rates of cardiometabolic risk factors. Focus on their prevention and control is warranted.
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Affiliation(s)
- Samuel Kingue
- Department of Cardiology, Faculty of Medicine of Yaounde, General Hospital of Yaounde, Yaounde, Cameroon.
| | | | - Nirina Rabearivony
- Department of Cardiology, Joseph Raseta Defelatalala University Hospital, Antananariv, Madagascar
| | - Francois Lepira Bompera
- Division of Nephrology, Department of Internal Medicine, University Clinic, Democratic Republic of Congo
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Silvay G, Zafirova Z. Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home". Semin Cardiothorac Vasc Anesth 2015; 20:120-32. [PMID: 26620138 DOI: 10.1177/1089253215619236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery.
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Affiliation(s)
- George Silvay
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kartalis A, Didagelos M, Georgiadis I, Benetos G, Smyrnioudis N, Marmaras H, Voutas P, Zotika C, Garoufalis S, Andrikopoulos G. Effects of Chios mastic gum on cholesterol and glucose levels of healthy volunteers: A prospective, randomized, placebo-controlled, pilot study (CHIOS-MASTIHA). Eur J Prev Cardiol 2015; 23:722-9. [DOI: 10.1177/2047487315603186] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/09/2015] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | - Georgios Benetos
- Cardiology Department, ‘Skylitseio’ General Hospital of Chios, Greece
| | | | | | - Petros Voutas
- Cardiology Department, ‘Skylitseio’ General Hospital of Chios, Greece
| | - Christina Zotika
- Cardiology Department, ‘Skylitseio’ General Hospital of Chios, Greece
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in combination with Beta-blockers in patients with chronic stable angina after percutaneous coronary intervention. Adv Ther 2015; 32:120-37. [PMID: 25687888 PMCID: PMC4349945 DOI: 10.1007/s12325-015-0182-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 12/28/2022]
Abstract
Introduction The anti-anginal efficacy of ivabradine is well established. We describe a post hoc analysis in the ADDITIONS database to investigate effectiveness and tolerability of ivabradine in combination with beta-blocker in patients with angina who have had a percutaneous coronary intervention (PCI). Methods ADDITIONS was a non-interventional, multicenter prospective study including 2,330 patients with stable angina. In addition to beta-blocker, patients were treated with ivabradine in approved dosages for 4 months. We divided the population according to whether they had previously had a PCI or not, and explored the effect of ivabradine on heart rate, number of weekly angina attacks, frequency of nitrate consumption, as well as quality of life (QoL) and tolerability. Results Data were available for 2,319 patients, of whom 51.4% had previously had a PCI. There was no difference in the effect of ivabradine on mean heart rate between patients with a previous PCI [64.4 ± 7.6 beats per minute (bpm)] than those without (66.8 ± 8.5 bpm) at 4 months (both P < 0.0001). Similarly, the number of angina attacks decreased from 1.9 ± 2.4 to 0.5 ± 1.5 per week in patients with a previous PCI and 1.5 ± 2.0 to 0.3 ± 1.0 per week in patients without a previous PCI (both P < 0.0001). The frequency of nitrate consumption fell from 2.7 ± 3.7 to 1.0 ± 1.9 per week and 1.8 ± 2.8 to 0.6 ± 1.5 per week (both P < 0.0001) in patients with and without a previous PCI, respectively. There was no difference in the improvements in Canadian Cardiovascular Society class of angina, QoL, and physicians’ assessment of effectiveness and tolerability between patients with a previous PCI and those without. Conclusion Ivabradine is an effective and well-tolerated anti-anginal treatment in patients with stable angina after PCI. Ivabradine reduced the frequency of weekly angina attacks and nitrate consumption, led to an improvement in Canadian Cardiovascular Society class and a substantial improvement in the QoL of stable angina patients. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0182-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
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