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Yu H, Ahn J, Rha SW, Choi BG, Choi SY, Byun JK, Cha JA, Hyun SJ, Park S, Choi CU. Impact of cigarette smoking on long-term clinical outcomes in patients with coronary chronic total occlusion lesions. PLoS One 2024; 19:e0308835. [PMID: 39269973 PMCID: PMC11398673 DOI: 10.1371/journal.pone.0308835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/22/2024] [Indexed: 09/15/2024] Open
Abstract
Cigarette smoking is a significant risk factor for coronary artery disease. However, there is insufficient evidence regarding the long-term clinical effects of smoking in Asian populations with chronic total occlusion (CTO). This study aimed to assess the effects of smoking on 5-year (median follow-up period, 4.2 ± 1.5 [interquartile range, 4.06-5.0] years) clinical outcomes in patients with CTO lesions who underwent percutaneous coronary intervention (PCI) or medical treatment (MT). We enrolled 681 consecutive patients with CTO who underwent diagnostic coronary angiography and subsequent PCI or MT. The patients were categorized into smokers (n = 304) and nonsmokers (n = 377). The primary endpoint was major adverse cardiovascular events (MACE), including a composite of all-cause death, myocardial infarction, and revascularization over a 5-year period. Propensity score matching (PSM) analysis was performed to adjust for potential baseline confounders. After PSM analysis, two propensity-matched groups (200 pairs, n = 400) were generated, and the baseline characteristics of both groups were balanced. The smokers exhibited a higher cardiovascular risk of MACE (29.5% vs. 18.5%, p = 0.010) and non-TVR (17.5 vs. 10.5%, p = 0.044) than the nonsmokers. In a landmark analysis using Kaplan-Meier curves at 1 year, the smokers had a significantly higher rate of MACE in the early period (up to 1 year) (18.8% and 9.2%, respectively; p = 0.008) compared with the nonsmokers. The Cox hazard regression analysis with propensity score adjustment revealed that smoking was independently associated with an increased risk of MACE. These findings indicate that smoking is a strong cardiovascular risk factor in patients with CTO, regardless of the treatment strategy (PCI or MT). In addition, in the subgroup analysis, the risk of MACE was most prominently elevated in the group of smokers who underwent PCI.
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Affiliation(s)
- HyeYon Yu
- School of Nursing, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Jihun Ahn
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Byoung Geol Choi
- Department of Biomedical Laboratory Science, Honam University, Gwanju, Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Ah Cha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Soo Jin Hyun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Wu AD, Lindson N, Hartmann-Boyce J, Wahedi A, Hajizadeh A, Theodoulou A, Thomas ET, Lee C, Aveyard P. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2022; 8:CD014936. [PMID: 35938889 PMCID: PMC9358996 DOI: 10.1002/14651858.cd014936.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking is a leading cause of cardiovascular disease (CVD), particularly coronary heart disease (CHD). However, quitting smoking may prevent secondary CVD events in people already diagnosed with CHD. OBJECTIVES: To examine the impact of smoking cessation on death from CVD and major adverse cardiovascular events (MACE), in people with incident CHD. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the trials registries clinicaltrials.gov and the International Clinical Trials Registry Platform. We ran all searches from database inception to 15 April 2021. SELECTION CRITERIA: We included cohort studies, and both cluster- and individually randomised controlled trials of at least six months' duration. We treated all included studies as cohort studies and analysed them by smoking status at follow-up. Eligible studies had to recruit adults (> 18 years) with diagnosed CHD and who smoked tobacco at diagnosis, and assess whether they quit or continued smoking during the study. Studies had to measure at least one of our included outcomes with at least six months' follow-up. Our primary outcomes were death from CVD and MACE. Secondary outcomes included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, new-onset angina and change in quality of life. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods for screening and data extraction. We assessed the risk of bias for the primary outcomes using the ROBINS-I tool. We compared the incidence of death from CVD and of MACE (primary outcomes) between participants who quit smoking versus those who continued to smoke for each included study that reported these outcomes. We also assessed differences in all-cause mortality, incidence of non-fatal myocardial infarction, incidence of non-fatal stroke and new onset angina. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI). For our outcome, change in quality of life, we calculated the pooled standardised mean difference (SMD) and 95% CI for the difference in change in quality of life from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using the I²statistic. We assessed the certainty of evidence for our primary outcomes using the eight GRADE considerations relevant to non-randomised studies. MAIN RESULTS We included 68 studies, consisting of 80,702 participants. For both primary outcomes, smoking cessation was associated with a decreased risk compared with continuous smoking: CVD death (HR 0.61, 95% CI 0.49 to 0.75; I² = 62%; 18 studies, 17,982 participants; moderate-certainty evidence) and MACE (HR 0.57, 95% CI 0.45 to 0.71; I² = 84%; 15 studies, 20,290 participants; low-certainty evidence). These findings were robust to our planned sensitivity analyses. Through subgroup analysis, for example comparing adjusted versus non-adjusted estimates, we found no evidence of differences in the effect size. While there was substantial heterogeneity, this was primarily in magnitude rather than the direction of the effect estimates. Overall, we judged 11 (16%) studies to be at moderate risk of bias and 18 (26%) at serious risk, primarily due to possible confounding. There was also some evidence of funnel plot asymmetry for MACE outcomes. For these reasons, we rated our certainty in the estimates for CVD death as moderate and MACE as low. For our secondary outcomes, smoking cessation was associated with a decreased risk in all-cause mortality (HR 0.60, 95% CI 0.55 to 0.66; I² = 58%; 48 studies, 59,354 participants), non-fatal myocardial infarction (HR 0.64, 95% CI 0.58 to 0.72; I² = 2%; 24 studies, 23,264 participants) and non-fatal stroke (HR 0.70, 95% CI 0.53 to 0.90; I² = 0%; 9 studies, 11,352 participants). As only one study reported new onset of angina, we did not conduct meta-analysis, but this study reported a lower risk in people who stopped smoking. Quitting smoking was not associated with a worsening of quality of life and suggested improvement in quality of life, with the lower bound of the CI also consistent with no difference (SMD 0.12, 95% CI 0.01 to 0.24; I² = 48%; 8 studies, 3182 participants). AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that smoking cessation is associated with a reduction of approximately one-third in the risk of recurrent cardiovascular disease in people who stop smoking at diagnosis. This association may be causal, based on the link between smoking cessation and restoration of endothelial and platelet function, where dysfunction of both can result in increased likelihood of CVD events. Our results provide evidence that there is a decreased risk of secondary CVD events in those who quit smoking compared with those who continue, and that there is a suggested improvement in quality of life as a result of quitting smoking. Additional studies that account for confounding, such as use of secondary CVD prevention medication, would strengthen the evidence in this area.
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Affiliation(s)
- Angela Difeng Wu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth T Thomas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sellke FW. Secondary prevention after coronary artery bypass grafting: Anticoagulation and antiplatelet therapy is only one factor. J Card Surg 2021; 36:1100-1102. [PMID: 33506999 DOI: 10.1111/jocs.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel/ticagrelor/prasugrel does not lead to improved graft patency rates or clinical outcomes after coronary artery bypass grafting (CABG) over aspirin monotherapy, at least for on pump CABG. The protective effects of DAPT tended to be observed to be greater extent in patients undergoing off pump CABG. In general, the addition of the potent thienopyridines increased the risk of major bleeding, although the incidence of major bleeding is relatively low after either on pump or off pump surgical revascularization. There is a lack of evidence that anticoagulation post-CABG provides any protection against graft failure, but it may decrease the incidence of major adverse cardiovascular events. However, antiplatelet and anti thrombotic therapy after CABG is only one component of secondary prevention that needs to be taken into consideration when optimizing the long-term outcomes of patients after CABG.
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Affiliation(s)
- Frank W Sellke
- Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Lifespan Cardiovascular Institute, Rhode Island Hospital, Providence, Rhode Island, USA
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Kim SH, Hwang SY, Shin JH, Lim YH. Self-care and related factors associated with left ventricular systolic function in patients under follow-up after myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:5-13. [PMID: 33570590 DOI: 10.1177/1474515120923201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent advances in treatment have led to long-term survival after myocardial infarction (MI), but subsequent complications such as heart failure have also increased, and, therefore, the relationship between prognosis and self-care needs to be investigated. AIMS This study aimed to confirm the relationship of potential variables affecting self-care of patients after MI and to determine whether self-care predicts left ventricular systolic function. METHODS Using a descriptive study design, a hypothetical model was constructed based on previous studies, and 191 post-MI patients were recruited from three university hospital outpatient clinics in Korea. The modified model was verified by constructing a structural equation model using AMOS version 24.0. The exogenous variables were illness perception, social support, and depression symptoms. The endogenous variables were self-efficacy, self-care compliance, and changes in left ventricular ejection fraction (LVEF). RESULTS The average patient age and disease duration were 66.3 (±11.5) years and 62.1 (±56.6) months, respectively. Self-care compliance was directly influenced by self-efficacy and indirectly affected by social support. Self-care compliance had a direct effect on LVEF changes, which was indirectly associated with illness perception, social support, and self-efficacy. CONCLUSION This study confirmed the direct effect of self-care compliance on changes in LVEF in patients under follow-up after MI. It is necessary to periodically monitor the degree of self-care in outpatients who are undergoing follow-up after MI to prevent a decrease in cardiac function. Counseling and education may be effective forms of social support to improve disease awareness and self-efficacy among patients with low self-care compliance.
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Affiliation(s)
- Sun Hwa Kim
- Stroke Unit, Hanyng University Seoul Hospital, South Korea
| | | | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Guri Hospital, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Seoul Hospital, South Korea
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Wang DY, Wu TT, Zheng YY, Ma YT, Xie X. Nomogram developed with selenoprotein S (SelS) genetic variation and clinical characteristics predicting risk of coronary artery disease in a Chinese population. Cardiovasc Diagn Ther 2020; 10:770-777. [PMID: 32968632 DOI: 10.21037/cdt-20-296] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Selenoprotein S (SelS) is a novel selenoprotein encoded by the SelS gene on chromosome 15q26.3. SelS is associated with the development of diabetes, dyslipidemia and macrovascular complications. However, the relationship between genetic polymorphisms of SelS and coronary artery disease (CAD) remains unclear. METHODS In the present study, we genotyped four single nucleotide polymorphisms (rs117613208, rs117512970, rs986500879, rs542989868) of SelS gene using direct sequencing method in a case-control study (576 CAD cases and 452 control subjects). Furthermore, we developed a predictive model using SelS genetic variation and clinical variables to predict risk of CAD. RESULTS We found that rs117613208 T allele was more frequent in the CAD cases than that in the controls. Logistic regression analysis suggested after adjustment of other confounders, the difference remained significant between the two groups [odds ratio (OR) =2.107, 95% confidence interval (CI): 1.239-3.583, P<0.006]. Using SelS rs117613208 T allele, age, smoking, diabetes, hypertension, apolipoprotein A1 (apoA1), and lipoprotein A [Lp(a)] (GASDLY score), we developed a diagnostic model of CAD (AUC: 0.806, 95% CI: 0.776-0.836, P<0.001, sensitivity: 74.7%, specificity:75.5%). CONCLUSIONS The present study suggested that genetic polymorphism of SelS was independent associated with CAD and GASDLY score may be a novel diagnostic model for CAD in a Chinese population.
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Affiliation(s)
- Ding-Yu Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Wang Y, Tse LA, Li G, Yin L, Chen T, Zhao Y, Xu B, Xian Y, Li W. The Role of Diabetes Mellitus as an Effect Modifier of the Association Between Smoking Cessation and Its Clinical Prognoses: An Observational Cohort Study. Angiology 2020; 72:78-85. [PMID: 32812445 DOI: 10.1177/0003319720949784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The smoker's paradox refers to an increased risk of adverse clinical outcomes after smoking cessation in patients with coronary artery disease. The mechanisms involved are controversial. The present study evaluated the effect of delay in smoking cessation on clinical outcomes among patients after percutaneous coronary intervention (PCI) stratified by diabetes mellitus (DM). Patients included in this study came from an established Fu Wai hospital PCI cohort. Smoking behavior was recorded; clinical end points included all-cause mortality and repeat revascularization. The analyses were based on 8489 smokers who underwent PCI. Patients with and without DM were examined separately. Multivariable model analysis suggested that smoking cessation was associated with significant lower all-cause mortality both for non-DM and DM patients. The smoking paradox was observed for revascularization. However, the increased risk of repeat revascularization correlated with quitting time among non-DM patients only, especially if they stopped smoking late (>90 days) after their index procedure (adjusted hazard ratio, 3.40; 95% CI: 2.45-4.72). In conclusion, smoking cessation is associated with a lower mortality rate for PCI patients. However, the relative benefit on repeated revascularization was only observed among non-DM patients if they quit smoking early.
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Affiliation(s)
- Yang Wang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, 196536Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, the 26451Chinese University of Hong Kong, Hong Kong, China
| | - Guangwei Li
- Fu Wai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, 196536Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Chen
- Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropic Medicine, Liverpool, UK
| | - Yanyan Zhao
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, 196536Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, 34736Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xian
- 3065Duke Clinical Research Institute, Durham, NC, USA
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, 196536Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Goettler D, Wagner M, Faller H, Kotseva K, Wood D, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Factors associated with smoking cessation in patients with coronary heart disease: a cohort analysis of the German subset of EuroAspire IV survey. BMC Cardiovasc Disord 2020; 20:152. [PMID: 32228474 PMCID: PMC7106891 DOI: 10.1186/s12872-020-01429-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background Tobacco smoking is one of the most important risk factors of coronary heart disease (CHD). Hence, smoking cessation is considered pivotal in the prevention of CHD. The current study aimed to evaluate smoking cessation patterns and determine factors associated with smoking cessation in patients with established CHD. Methods The fourth European Survey of Cardiovascular Disease Prevention and Diabetes investigated quality of CHD care in 24 countries across Europe in 2012/13. In the German subset, smoking cessation patterns and clinical characteristics were repetitively assessed a) during index event due to CHD by medical record abstraction, b) as part of a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit), and c) by telephone-based follow-up interview two years after the baseline visit. Logistic regression analysis was performed to search for factors determining smoking status at the time of the telephone interview. Results Out of 469 participants available for follow-up, 104 (22.2%) had been classified as current smokers at the index event. Of those, 65 patients (62.5%) had quit smoking at the time of the telephone interview, i.e., after a median observation period of 3.5 years (quartiles 3.0, 4.1). Depressed mood at baseline visit and higher education level were less prevalent amongst quitters vs non-quitters (17.2% vs 35.9%, p = 0.03 and 15.4% vs 33.3%, p = 0.03), cardiac rehabilitation programs were more frequently attended by quitters (83.1% vs 48.7%, p < 0.001), and there was a trend for a higher prevalence of diabetes at baseline visit in quitters (37.5% vs 20.5%, p = 0.07). In the final multivariable model, cardiac rehabilitation was associated with smoking cessation (OR 5.19; 95%CI 1.87 to 14.46; p = 0.002). Discussion Attending a cardiac rehabilitation program after a cardiovascular event was associated with smoking cessation supporting its use as a platform for smoking cessation counseling and relapse prevention.
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Affiliation(s)
- D Goettler
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - M Wagner
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - H Faller
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - K Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - D Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
| | - R Leyh
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - G Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Department of Internal Medicine I, University and University Hospital of Würzburg, Würzburg, Germany
| | - W Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - P U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany.,Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital of Würzburg, Würzburg, Germany
| | - S Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Haus A15, D-97078, Würzburg, Germany. .,Department of Internal Medicine I, University and University Hospital of Würzburg, Würzburg, Germany.
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8
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Ashraf T, Afaque SM, Aziz R, Khan MN, Achakzai AS, Lateef A, Karim M, Saghir T, Hassan Rizvi SN, Rasool SI. Clinical, Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention. Glob Heart 2019; 14:335-341. [PMID: 31451242 DOI: 10.1016/j.gheart.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients. OBJECTIVES This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan. METHODS We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (Catheterization-Percutaneous Coronary Intervention) Registry from our site. RESULTS A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 ± 10.59 versus 55.98 ± 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p = 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p = 0.502. CONCLUSIONS Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.
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Affiliation(s)
- Tariq Ashraf
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
| | - Syed Muhammad Afaque
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Rashid Aziz
- Department of Cardiac Surgery at National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Nauman Khan
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Abdul Samad Achakzai
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Alizay Lateef
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Musa Karim
- Department of Research, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Syed Ishtiaq Rasool
- Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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9
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Wang YT, Maitusong B, Ma YT, Fu ZY, Yang YN, Ma X, Li XM, Liu F, Chen BD. Acyl-CoA: cholesterol acyltransferases-2 gene polymorphism is associated with increased susceptibility to coronary artery disease in Uygur population in Xinjiang, China. Biosci Rep 2019; 39:BSR20182129. [PMID: 30696703 PMCID: PMC6390127 DOI: 10.1042/bsr20182129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/06/2019] [Accepted: 01/25/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acyl-CoA: cholesterol acyltransferases (ACAT) is the only enzyme that catalyzes the synthesis of cholesterol esters (CE) from free cholesterol and long-chain fatty acyl-CoA and plays a critical role in cellular cholesterol homeostasis. In the present study, our primary objective was to explore whether the single-nucleotide polymorphisms (SNPs) in ACAT-2 gene were associated with coronary artery disease (CAD) in Uygur subjects, in Xinjiang, China. METHODS We designed a case-control study including 516 CAD patients and 318 age- and sex-matched control subjects. Using the improved multiplex ligation detection reaction (iMLDR) method, we genotyped two SNPs (rs28765985 and rs7308390) of ACAT-2 gene in all subjects. RESULTS We found that the genotypes, the dominant model (CC + CT vs TT) and over-dominant model (CT vs CC + TT) of rs28765985 were significantly different between CAD patients and the controls (P=0.027, P=0.012 and P=0.035, respectively). The rs28765985 C allele was associated with a significantly elevated CAD risk [CC/CT vs TT: odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.02-2.16, P=0.04] after adjustment for confounders. The TC and LDL-C levels were significantly higher in rs28765985 CC/CT genotypes than that in TT genotypes (P<0.05). CONCLUSIONS Rs28765985 of ACAT-2 gene are associated with CAD in Uygur subjects. Subjects with CC/CT genotype or C allele of rs28765985 were associated with an increased risk of CAD.
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Affiliation(s)
- Yong-Tao Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Buamina Maitusong
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 17177 Stockholm, Sweden
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Zhen-Yan Fu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Yi-Ning Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Xiao-Mei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
| | - Bang-Dang Chen
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Urumqi 830054, P.R. China
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10
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Neves RD, Avila GK, Oliveira FDB, Sampaio JAFD. Impact of Myocardial Revascularization Method on Smoking Cessation: Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention. Braz J Cardiovasc Surg 2018; 32:383-389. [PMID: 29211218 PMCID: PMC5701112 DOI: 10.21470/1678-9741-2017-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/02/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Smoking is a serious public health issue, being a precursor of heart disease
and a predictor of sudden death due to myocardial ischemia. Major events in
the patient's health can lead to radical changes in habits and the choice
for different myocardial revascularization methods might differently impact
smoking cessation and relapse. Objective To study the rate and perpetuation of smoking cessation after myocardial
revascularization comparing coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI). Methods Smokers submitted to myocardial revascularization were divided into CABG and
PCI groups. The research was conducted through interviews at the Hospital
Santa Lucinda outpatient clinic. Patients with smoking cessation longer than
90 days before hospital admission, combined procedures, hospital readmission
before 360 days after discharge, cases of death at any time, and emergency
procedures were excluded from the study. The start of the smoking cessation
period was determined as just after hospital discharge, with a follow-up of
12 months. Results The proportion of patients reporting smoking relapse was significantly lower
in the CABG than in the PCI group at 30 (11.1% vs. 20.8%;
P=0.039) and at 180 days (23.1% vs.
41.5%; P=0.002), but no differences were observed between
the two groups at 360 days after hospital discharge (51.9%
vs. 54.1%; P=0.719). High levels of
nicotine dependence and passive smoking showed to be important predictors of
smoking relapse in the long-term. Conclusion The occurrence of a major surgical procedure seems to have beneficial
psychological effects, representing an interesting setting for smoking
cessation counseling to have higher chances of success.
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Affiliation(s)
- Ricardo das Neves
- Cardiovascular Surgery Department of Hospital Santa Lucinda, Sorocaba, São Paulo, Brazil
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11
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Halle TR, Benarroch-Gampel J, Teodorescu VJ, Rajani RR. Surgical Intervention for Peripheral Artery Disease Does Not Improve Patient Compliance with Recommended Medical Therapy. Ann Vasc Surg 2018; 46:104-111. [DOI: 10.1016/j.avsg.2017.06.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
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12
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Tchicaya A, Lorentz N, Demarest S. Income-related inequality in smoking cessation among adult patients with cardiovascular disease: a 5-year follow-up of an angiography intervention in Luxembourg. BMC Cardiovasc Disord 2017; 17:107. [PMID: 28476143 PMCID: PMC5420161 DOI: 10.1186/s12872-017-0541-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking contributes to cardiovascular diseases (CVD), a leading cause of death and a large source of healthcare costs in Western countries. We examined the association between income and smoking cessation among smokers who underwent coronary angiography at the National Institute for Cardiac Surgery and Interventional Cardiology in Luxembourg. METHODS Data were derived from a follow-up study conducted in 2013/2014 among 4391 patients (of which 1001 patients were smokers) at the time of coronary angiography in 2008/2009. Four logistic regression models were applied. In three models, the predictor was income and the covariates were sex, age, nationality, marital status, diagnosis, body mass, physical activity, and awareness of tobacco as a cardiovascular (CV) risk factor. In the other model, the predictor was an interaction term composed of income and awareness of tobacco as a CV risk factor; the other variables were covariates. RESULTS Among patients who were current smokers at baseline, 43.2% were current smokers at follow-up and 56.8% had quit smoking. In the multivariate logistic models, quitting smoking was associated with income even after controlling for socio-demographic, diagnostic, and behavioural risk factors. In the full model, the odds of quitting smoking among patients in the two highest income categories remained significant when compared to patients in the lowest income category: odds ratio (OR) = 2.8; 95% confidence interval (CI), 1.3-6.1 and OR = 2.8; 95% CI, 1.2-6.5, respectively. In the full model with an interaction term, quitting smoking was only associated with income when patients knew tobacco was a CV risk factor. The odds of smoking cessation were 5.62 (95% CI: 2.13-14.86) and 3.65 (95% CI: 1.51-8.86) times for patients with annual incomes of 36,000-53,999€ and ≥54,000€, respectively), compared to those for patients with an annual income of <36,000€. CONCLUSIONS This study highlights the influence of income on behaviours regarding CVD risk factors after a major CVD event. Patients in the highest income groups were more likely to quit smoking, although only when they were aware of tobacco as a CV risk factor. Therefore, intervention strategies targeting lower income groups should be implemented in major health facilities.
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Affiliation(s)
- Anastase Tchicaya
- Luxembourg Institute of Socio-Economic Research (LISER), Living Conditions Department/Health Research Team, Esch-sur-Alzette, Luxembourg.
| | - Nathalie Lorentz
- Luxembourg Institute of Socio-Economic Research (LISER), Living Conditions Department/Health Research Team, Esch-sur-Alzette, Luxembourg
| | - Stefaan Demarest
- Scientific Institute of Public Health WIV-ISP, DO Santé publique et surveillance, Brussels, Belgium
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13
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Alhaddad IA, Tabbalat R, Khader Y, Al-Mousa E, Izraiq M, Nammas A, Jarrah M, Saleh A, Hammoudeh A. Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry. Heart Views 2017; 18:3-7. [PMID: 28584584 PMCID: PMC5448249 DOI: 10.4103/1995-705x.206206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. Methods and Results: We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. Conclusions: In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.
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Affiliation(s)
- Imad A Alhaddad
- Department of Cardiovascular, Jordan Hospital, Amman, Jordan
| | - Ramzi Tabbalat
- Department of Cardiology, Khalidi Medical Center, Amman, Jordan
| | - Yousef Khader
- School of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Eyas Al-Mousa
- Department of Cardiology, Istishari Hospital, Amman, Jordan
| | - Mahmoud Izraiq
- Department of Cardiology, Specialty Hospital, Amman, Jordan
| | - Assem Nammas
- Department of Cardiology, Ibn Al-Haytham Hospital, Amman, Jordan
| | - Mohammad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Akram Saleh
- Department of Internal Medicine, Jordan University of Jordan School of Medicine, Amman, Jordan
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14
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Peltzer K. Correlates of tobacco use among tuberculosis patients in South Africa: A brief report. JOURNAL OF PSYCHOLOGY IN AFRICA 2016. [DOI: 10.1080/14330237.2016.1219567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Karl Peltzer
- ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
- Department of Research & Innovation, University of Limpopo, Turfloop, South Africa
- HIV/AIDS/STIs/and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
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15
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The fundamental importance of smoking cessation in those with premature ST-segment elevation acute myocardial infarction. Curr Opin Cardiol 2016; 31:531-6. [DOI: 10.1097/hco.0000000000000320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Rahman MA, Edward KL, Montgomery L, McEvedy S, Wilson A, Worrall-Carter L. Is There any Gender Difference for Smoking Persistence or Relapse Following Diagnosis or Hospitalization for Coronary Heart Disease? Evidence From a Systematic Review and Meta-Analysis. Nicotine Tob Res 2015; 18:1399-407. [DOI: 10.1093/ntr/ntv222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 12/17/2022]
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17
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Navar AM, Peterson ED. Smoke signals: urgent need for more successful interventions. Circ Cardiovasc Interv 2015; 8:CIRCINTERVENTIONS.115.002702. [PMID: 25969548 DOI: 10.1161/circinterventions.115.002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ann M Navar
- From the Duke Clinical Research Institute, Durham, NC; and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Eric D Peterson
- From the Duke Clinical Research Institute, Durham, NC; and Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
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