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Peters EJ, Frydland MS, Hassager C, Bos LD, van Vught LA, Cremer OL, Møller JE, van den Born BJH, Vlaar AP, Henriques JP. Biomarker patterns in patients with cardiogenic shock versus septic shock. IJC HEART & VASCULATURE 2024; 52:101424. [PMID: 38784047 PMCID: PMC11112335 DOI: 10.1016/j.ijcha.2024.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Background In cardiogenic shock (CS), contractile failure is often accompanied by a systemic inflammatory response syndrome. In contrast, many patients with septic shock (SS) develop cardiac dysfunction. A similar hemodynamic support strategy is often deployed in both syndromes but it is unclear whether this is justified based on profiles of biomarkers expressing neurohormonal activation and cardiovascular stress. Methods In this prospective, multicenter cohort, 111 patients with acute myocardial infarction related CS were identified, and matched to patients with SS. Clinical parameters were collected and blood samples were obtained on day 1-3 of Intensive Care admission. Results In this shock cohort comprising 222 patients, with a mean age of 61 (±13.5) years and of whom 161 (37 %) were male, we found that despite obvious clinical disparities on admission, mortality at 30-days did not differ (CS: 40.5 % vs. SS 43.1 %, p = 0.56). Overall, plasma concentrations of all biomarkers were higher in SS patients, with the largest difference on the first day. However, only in CS patients the biomarker concentrations were associated with mortality. Conclusion In this prospective, multicenter cohort SS and CS patients showed similarities in baseline conditions and had similar mortality. However, several biomarkers only showed prognostic value in CS.
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Affiliation(s)
- Elma J. Peters
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin S. Frydland
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lieuwe D.J. Bos
- Intensive Care, Department of Respiratory Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke A. van Vught
- Department of Intensive Care Medicine & Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacob E. Møller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bert-Jan H. van den Born
- Department of Internal/vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care Medicine & Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Jose P.S. Henriques
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - on behalf of the MARS consortium
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Intensive Care, Department of Respiratory Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Intensive Care Medicine & Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Internal/vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Ding H, Wang Y, Zhang Y, Zhou L, Wang D, Lv L, Wan Q, Tong M, Deng C, Xu H, Zu B, Zhang J, Qiu Z, Sheng H. A new risk factor for coronary artery disease can be detected by an ApoA1 mAb-based assay. Clin Chim Acta 2024; 552:117700. [PMID: 38072299 DOI: 10.1016/j.cca.2023.117700] [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: 06/06/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND This study aimed to find coronary artery disease (CAD) related apolipoprotein A1 (ApoA1) monoclonal antibody (mAb) and to evaluate the diagnostic value of the assay based on it. METHODS Patients with CAD diagnosed by coronary angiography (disease group, n = 180) and healthy subjects (control group, n = 199) were recruited. The correlation between methods and CAD were evaluated by Spearman's rank correlation coefficients. Receiver operating characteristic (ROC) curve analysis was used to evaluate the auxiliary diagnostic value of methods for CAD. Odds ratios (ORs) of the test results in CAD were estimated using logistic regression analysis. RESULTS Measurements from an ApoA1 mAb were found significantly positively correlated with CAD (r = 0.243, P < 0.01), unlike the measurements from the ApoA1 pAb were negatively correlated with CAD (r = -0.341, P < 0.001). The areas under the ROC curve of the ApoA1 mAb and pAb measurements were 0.704 and 0.563, respectively, in patients with normal HDL-C levels. ApoA1 values from the mAb assay had a significant positive impact on CAD risk. CONCLUSION An ApoA1 mAb-based assay can distinguish a high-density lipoprotein (HDL) subclass positively related to CAD, which can be used to improve and reappraise CAD risk assessment.
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Affiliation(s)
- Hui Ding
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Yin Wang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Yan Zhang
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai 201318, China
| | - Lida Zhou
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Dong Wang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Liangjie Lv
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai 201318, China
| | - Qianli Wan
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Minghong Tong
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Chenxia Deng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Huihong Xu
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Bailing Zu
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Jie Zhang
- Shanghai R&D Center, DiaSys Diagnostic Systems (Shanghai) Co., Ltd., Shanghai 201318, China.
| | - Zhaohui Qiu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
| | - Huiming Sheng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, Bowen S, Regan E, Lander M, van Berlo S, Freene N. Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e48229. [PMID: 37788043 PMCID: PMC10582808 DOI: 10.2196/48229] [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: 04/28/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. OBJECTIVE We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. METHODS A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI -22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. CONCLUSIONS The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-040479.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Sarah Bowen
- National Capital Private Hospital, Garran, ACT, Australia
| | | | | | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Walukiewicz M, Rogowicz D, Wołowiec Ł, Chudzińska M, Sinkiewicz A, Grześk G. Implementation of recommendations on the check of risk factors for cardiovascular diseases in patients undergoing coronary re-interventions. Ir J Med Sci 2023; 192:2117-2128. [PMID: 36702989 PMCID: PMC10522510 DOI: 10.1007/s11845-023-03285-x] [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: 09/23/2022] [Accepted: 01/14/2023] [Indexed: 01/28/2023]
Abstract
METHOD The study involved 905 patients after coronary interventions, qualified for invasive diagnosis due to symptomatic coronary disease. AIM The aim of this study was to check the implementation of recommendations on the control of risk factors for cardiovascular diseases in patients undergoing re-interventions. RESULTS Compared to elderly persons, younger people more often increased their physical activity (62 vs. 65 years, p = 0.009), stopped smoking (61 vs. 65 years, p < 0.001) and reduced alcohol consumption (62 vs. 65 years, p = 0.001). People with secondary and higher education increased their physical activity more often than those with primary education (51%, 31% vs. 23%, p = 0.006). Men more often than women decided to limit their alcohol consumption (48% vs. 37%, p = 0.007). Patients with a history of acute coronary syndrome were more likely to quit smoking and reduce their alcohol consumption than those without such a history (47% vs. 37%, p = 0.003 and 42% vs. 34%, p = 0.020, respectively). Only 2% of the subjects achieved the recommended LDL cholesterol values. Forty-eight percent were qualified for reinvasive procedures on the coronary arteries. Less than half of the patients undertook health-promoting behaviors that required modification of existing habits. CONCLUSION Age, gender, and education level influence pro-health behaviors. The majority of patients do not achieve the levels of LDL cholesterol and triglycerides consistent with the ESC guidelines in the secondary prevention of coronary disease. Inadequate check of risk factors may result in faster disease progression and coronary re-interventions.
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Affiliation(s)
- Marcin Walukiewicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, Bydgoszcz, 85-168 Poland
| | - Daniel Rogowicz
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, Bydgoszcz, 85-168 Poland
| | - Łukasz Wołowiec
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, Bydgoszcz, 85-168 Poland
| | - Małgorzata Chudzińska
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa Street, Bydgoszcz, 85-626 Poland
| | - Anna Sinkiewicz
- Department of Otolaryngology, Audiology and Phoniatrics, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, Bydgoszcz, 85-168 Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, Bydgoszcz, 85-168 Poland
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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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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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SIAFARIKAS CHRISTOS, LIATIS STAVROS, KAPELIOS CHRISTOS, SKOULOUDI MARINA, BONOU MARIA, BARBETSEAS JOHN. Inadequate management of cardiovascular risk factors prior to admission for an acute coronary event. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E598-E603. [PMID: 36891008 PMCID: PMC9986978 DOI: 10.15167/2421-4248/jpmh2022.63.4.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/12/2022] [Indexed: 03/10/2023]
Abstract
Objectives Optimal regulation of modifiable risk factors has been proposed as the standard of care both for primary and secondary prevention of cardiovascular disease (CVD). The aim of this study was to assess primary and secondary cardiovascular risk management received before admission for an acute coronary event. Methods Data were analyzed for 185 consecutive hospitalized patients with a diagnosis of acute coronary syndrome (ACS) in the Cardiology department of a University hospital during an annual period (1/7/2019 until 30/6/2020). The study population was divided into two groups, the primary and secondary prevention subgroups, according to previous medical history of cardiovascular disease (CVD). Results The mean age of the participants was 65.5 ±12.2 years and most patients were male (81.6%). Previous CVD was present in 51 patients (27.9%). Fifty-seven patients (30.8%) had a history of diabetes mellitus (DM) and 97 (52.4%) had a history of dyslipidemia. Hypertension was present in 101 (54.6%) patients. In the secondary prevention group, the LDL-C was on target in only 33.3% of the patients, while 20% patients did not use statins. The use of antiplatelet/anticoagulant agents was 94.5%. Among patients with diabetes, only 20% had been using a GLP-1 receptor agonist or/and an SGLT-2 inhibitor, while the HbA1c was on target in 47.8%. Twenty-five percent of the patients were active smokers. In the primary prevention group, the use of statins was overall low (25.8%) but more frequent in patients with diabetes and those without diabetes at very high-risk for CVD (47.1% and 32.1% respectively). The LDL-C was on target in less than 23.1% of the patients. The use of antiplatelet/anticoagulant agents was low (20.1%), but higher in those with diabetes (52.9%). In the diabetic group, HbA1c was on target in 61.8%. Active smoking was practiced by 46.3% of the patients. Conclusions Our data show that in a substantial proportion of patients presenting with ACS, previous CVD prevention, both primary and secondary, fails to meet the current recommendations provided by scientific societies.
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Affiliation(s)
- CHRISTOS SIAFARIKAS
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527, Athens, Greece
- Correspondence: Siafarikas Christos, First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Agiou Thoma 17, 11527, Athens. Tel.: +306944604258 - E-mail:
| | - STAVROS LIATIS
- First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527, Athens, Greece
| | - CHRISTOS KAPELIOS
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - MARINA SKOULOUDI
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - MARIA BONOU
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
| | - JOHN BARBETSEAS
- Department of Cardiology, Laiko General Hospital, 11527 Athens, Greece
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Engebretsen I, Munkhaugen J, Bugge C, Halvorsen S, Ødegaard KM, Støvring H, Kristiansen IS. Gaps and discontinuation of statin treatment in Norway: potential for optimizing management of lipid lowering drugs. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac070. [PMID: 36440353 PMCID: PMC9683394 DOI: 10.1093/ehjopen/oeac070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/03/2022] [Indexed: 05/31/2023]
Abstract
Aims In clinical practice, many patients do not reach the recommended treatment targets for LDL-cholesterol levels. We aimed to examine treatment patterns and adherence for patients on lipid lowering drugs in Norway to inform future strategies to improve therapies. Methods and results We obtained information on all dispensed statins, ezetimibe, and proprotein convertase subtilisin/-kexin 9 (PCSK9) inhibitors 2010-2019 from the Norwegian Prescription Database. Treatment gaps were assessed assuming patients take one tablet per day and were defined to occur if a patient did not refill a prescription when the previous one should have been depleted. Treatment was defined as discontinued when the preceding prescription would have been used and no new subsequent prescription was filled. The mean proportion of days covered (PDC) was calculated by aggregating the total number of tablets dispensed during each calendar year and dividing by 365. Patients 80 years were excluded. A considerable proportion of statin users in Norway had long treatment gaps or discontinuation in treatment. The 19.6% of the patients had treatment gaps of 180 days or more, and 10.8% had gaps or greater than 365 days. Similar results were found for patients on antidiabetics and hypertensives. PDC ranged from 84.9% for simvastatin to 72.2% for ezetimibe (2019). The most common lipid lowering drugs in 2019 were atorvastatin, simvastatin, and ezetimibe. Conclusion There is a great potential for improving drug adherence and optimizing lipid lowering therapy by switching to more effective statins in greater doses, and more often add ezetimibe and PCSK9 inhibitors to treatment.
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Affiliation(s)
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004 Drammen, Norway
- Department of Behavioral Medicine, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a, 0317 Oslo, Norway
- Oslo Economics, Klingenberggata 7A, 0161 Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Kristina Malene Ødegaard
- Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 20, 0372 Oslo, Norway
- Novartis Norway AS, Nydalen Allé 37, 0484 Oslo, Norway
| | - Henrik Støvring
- Department of Public Health, University of Aarhus, Bartholins Allé 2, DK-8000 Aarhus, Denmark
- Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, DK-5000 Odense, Denmark
- Oslo Economics, Klingenberggata 7A, 0161 Oslo, Norway
| | - Ivar Sønbø Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a, 0317 Oslo, Norway
- Oslo Economics, Klingenberggata 7A, 0161 Oslo, Norway
- Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, DK-5000 Odense, Denmark
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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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10
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Martinez-Sanchez FD, Medina-Urrutia AX, Jorge-Galarza E, Martínez-Alvarado MDR, Reyes-Barrera J, Osorio-Alonso H, Arellano-Buendía AS, Del Carmen González-Salazar M, Posadas-Sánchez R, Vargas-Alarcón G, Posadas-Romero C, Juárez-Rojas JG. Effect of metabolic control on recurrent major adverse cardiovascular events and cardiovascular mortality in patients with premature coronary artery disease: Results of the Genetics of Atherosclerotic Disease study. Nutr Metab Cardiovasc Dis 2022; 32:2227-2237. [PMID: 35843799 DOI: 10.1016/j.numecd.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Coronary artery disease (CAD) is the leading cause of death around the world, and its rate of presentation is increasing at young ages. Despite the evidence that secondary prevention in CAD reduces the risk of recurrent major adverse cardiovascular events (MACE), no studies have analyzed the composite control of blood pressure, lipids, and glucose control in premature CAD. METHODS AND RESULTS This was a real-world prospective cohort study of patients with premature CAD. The composite control in blood pressure <140/80 mmHg, LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and Hemoglobin A1c <8% was considered as metabolic control. The primary endpoint was the occurrence of non-fatal and fatal MACE. The data included 1042 patients with premature CAD. The mean age of the patients was 54.1 ± 8.1 years, 18.5% were women, and had a median follow-up of 59.1 ± 11.8 months. Of them, 7% had non-fatal MACE, and 4% had a fatal MACE. Overall, 21.3% achieved metabolic control, and 3.0% did not achieve any target. Cox regression analysis showed that percutaneous coronary intervention (Hazzard ratio = 1.883 [95% CI, 1.131-3.136]), C-reactive protein (1.046 [1.020-1.073]), blood pressure >140/90 mmHg (2.686 [1.506-4.791]), fibrates (2.032 [1.160-3.562]), calcium channel blockers (2.082 [1.158-3.744]) had greater risk to present a recurrent non-fatal MACE; whereas familial history of premature CAD (2.419 [1.240-4.721]), heart failure (2.139 [1.032-4.433]), LDL-C >70 mg/dL (4.594 [1.401-15.069]), and diuretics (3.328 [1.677-6.605]) were associated with cardiovascular mortality. CONCLUSIONS The composite goal achievement in lipids, blood pressure and glucose, reduced the risk for recurrent MACE in 80%.
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Affiliation(s)
- F D Martinez-Sanchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - A X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - E Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | | | - J Reyes-Barrera
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - H Osorio-Alonso
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - A S Arellano-Buendía
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | | | - R Posadas-Sánchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - G Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - C Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - J G Juárez-Rojas
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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11
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Gonzalez-Jaramillo N, Wilhelm M, Arango-Rivas AM, Gonzalez-Jaramillo V, Mesa-Vieira C, Minder B, Franco OH, Bano A. Systematic Review of Physical Activity Trajectories and Mortality in Patients With Coronary Artery Disease. J Am Coll Cardiol 2022; 79:1690-1700. [PMID: 35483757 DOI: 10.1016/j.jacc.2022.02.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. OBJECTIVES The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. METHODS Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression. RESULTS A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results. CONCLUSIONS This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.
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Affiliation(s)
- Nathalia Gonzalez-Jaramillo
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Valentina Gonzalez-Jaramillo
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Cristina Mesa-Vieira
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Oscar H Franco
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Arjola Bano
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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12
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Falcone É, Colson S, Deharo JC, Lucas G. [Role of the advanced practice nurse in the management of patients with coronary artery disease]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:60-64. [PMID: 35914886 DOI: 10.1016/j.soin.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardiovascular disease is the leading cause of death in the world and the second leading cause of death in France. Patients with coronary artery disease have a high risk of recurrence. Nevertheless, by acting on health determinants and secondary prevention, it is possible to reduce the risks. With the development of advanced nursing practice, a new professional with specific skills can take charge of and accompany people with this pathology. This player works in an interdisciplinary manner to provide holistic and optimal patient care.
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Affiliation(s)
- Élodie Falcone
- Faculté des sciences médicales et paramédicales, Aix-Marseille Université, 27 boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
| | - Sébastien Colson
- Faculté des sciences médicales et paramédicales, Aix-Marseille Université, 27 boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - Jean-Claude Deharo
- Faculté des sciences médicales et paramédicales, Aix-Marseille Université, 27 boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - Guillaume Lucas
- Faculté des sciences médicales et paramédicales, Aix-Marseille Université, 27 boulevard Jean-Moulin, 13385 Marseille cedex 5, France
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13
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Pedersen OB, Pasalic L, Nissen PH, Grove EL, Kristensen SD, Hvas AM. Flow Cytometric Assessment of Changes in Platelet Reactivity after Acute Coronary Syndrome: A Systematic Review. Semin Thromb Hemost 2022; 48:542-551. [PMID: 35226948 DOI: 10.1055/s-0042-1742742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Increased platelet activity is an important predictor for recurrent cardiovascular events in patients with acute coronary syndromes (ACS). Flow cytometry is an advanced method for evaluation of platelet activity. We aimed to summarize the current literature on dynamic changes in platelet activity analyzed by flow cytometry in patients with ACS. Employing the guidelines of Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed and Embase on October 26, 2021, and identified studies measuring platelet activity with flow cytometry in ACS patients in the acute phase (baseline) and at follow-up in a more stable phase. In the 12 included studies, fibrinogen receptor, α-granule secretion, platelet reactivity index, monocyte-platelet aggregates, neutrophil-platelet aggregates, and reticulated platelets were measured. The fibrinogen receptor and α-granule secretion were either unchanged or lower during follow-up measurements than in the acute phase. Platelet reactivity index showed inconsistent results. Values of monocyte-platelet aggregates and neutrophil-platelet aggregates were lower at follow-up than at baseline (p-values <0.05). Reticulated platelets were either unchanged (p-value >0.64) or lower at 1 to 2 months follow-up (p-value 0.04), and also lower at 5 months to 1-year follow-up (p-value >0.005) compared with baseline. Overall, flow cytometric analyses of platelet function in ACS patients showed that platelet activity was lower at follow-up than at baseline. However, in some patients, platelet activity remained unchanged from baseline to follow-up, possibly indicating a sustained high platelet activity that may increase the risk of recurrent cardiovascular events.
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Affiliation(s)
- Oliver Buchhave Pedersen
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Leonardo Pasalic
- Institute of Clinical Pathology and Medical Research, Departments of Clinical and Laboratory Hematology, Westmead University Hospital, Sydney, Australia
| | - Peter H Nissen
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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14
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Kaldal A, Tonstad S, Jortveit J. 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] [MESH Headings] [Grants] [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.
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Affiliation(s)
- Anete Kaldal
- Department of Research, Sørlandet Hospital HF, Lundsiden, Box 416, 4604, 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, Sørlandet Hospital Arendal, Arendal, Norway
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15
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Coronary Artery Disease in Patients Older than 35 and Eligible for Cardiovascular Secondary Prevention: An Italian Retrospective Observational Analysis of Healthcare Administrative Databases. J Clin Med 2021; 10:jcm10204708. [PMID: 34682831 PMCID: PMC8540912 DOI: 10.3390/jcm10204708] [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: 09/16/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: This study describes patients with coronary artery disease (CAD) who are eligible for secondary prevention and assesses their healthcare consumption and costs from the perspective of the Italian National Health Service (INHS). Methods: From the Fondazione Ricerca e Salute’s database, which collects Italian healthcare administrative data, all patients aged ≥ 35, with ≥1 primary in-hospital CAD diagnosis and/or procedure on the coronary arteries, or with the specific disease exemption code, and who are suitable for long-term secondary prevention treatments, were identified in 2018 and analyzed. Demographics, comorbidities, one-year supplied drugs, hospitalizations, and costs were analyzed. Results: From >3 million inhabitants aged ≥ 35, 46,063 (1.3%) were identified (72.1% males, mean age 70 ± 12; approximately 50% with ≥3 comorbidities). During a one-year follow-up, 96.4% were treated with ≥1 drug for secondary prevention (mainly antiplatelets and lipid lowering agents), 69.4% with ≥1 concomitant cardiovascular drug, and 95.8% with ≥1 concomitant non-cardiovascular therapy. Within one year, 30.6% of patients were hospitalized at least once, mostly due to non-cardiovascular events. Calculated by mean, the INHS paid EUR 6078 per patient. Conclusions: This analysis confirms the relevant burden of CAD for patients with many comorbidities and who are frequently hospitalized, and the burden on the INHS. A multidisciplinary healthcare approach is encouraged to improve patients’ outcomes and reduce costs for the INHS.
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16
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Aboyans V, Boukhris M. Secondary prevention after an acute cardiovascular event: far from targets and large room for improvement. Eur J Prev Cardiol 2021; 29:360-361. [PMID: 34058007 DOI: 10.1093/eurjpc/zwab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094 & IRD, Limoges University, 2, ave Gerard Mrcland, 87025, Limoges, France
| | - Marouane Boukhris
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
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17
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Shaya GE, Leucker TM, Jones SR, Martin SS, Toth PP. Coronary heart disease risk: Low-density lipoprotein and beyond. Trends Cardiovasc Med 2021; 32:181-194. [PMID: 33872757 DOI: 10.1016/j.tcm.2021.04.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
Coronary heart disease (CHD) is the leading cause of morbidity and mortality world-wide and has been characterized as a chronic immunoinflammatory, fibroproliferative disease fueled by lipids. Great advances have been made in elucidating the complex mechanistic interactions among risk factors associated with CHD, yielding abundant success towards preventive measures and the development of pharmaceuticals to prevent and treat CHD via attenuation of lipoprotein-mediated risk. However, significant residual risk remains. Several potentially modifiable CHD risk factors ostensibly contributing to this residual risk have since come to the fore, including systemic inflammation, diabetes mellitus, high-density lipoprotein, plasma triglycerides (TG) and remnant lipoproteins (RLP), lipoprotein(a) (Lp[a]), and vascular endothelial dysfunction (ED). Herein, we summarize the body of evidence implicating each of these risk factors in residual CHD risk.
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Affiliation(s)
- Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Thorsten M Leucker
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Community Hospital General Medical Center, Sterling, IL, USA.
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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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Blöndal M, Ainla T, Eha J, Lõiveke P, Marandi T, Saar A, Veldre G, Edfors R, Lewinter C, Jernberg T, Jortveit J, Halvorsen S, Becker D, Csanádi Z, Ferenci T, Andréka P, Jánosi A. Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway and Sweden according to national ongoing registries. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:307-314. [PMID: 33710273 DOI: 10.1093/ehjqcco/qcaa098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/19/2020] [Indexed: 12/17/2022]
Abstract
AIM Describe the characteristics, management and outcomes of hospitalized ST-segment elevation myocardial infarction (STEMI) patients according to national ongoing myocardial infarction registries in Estonia, Hungary, Norway and Sweden. METHODS AND RESULTS Country-level aggregated data was used to study baseline characteristics, use of in-hospital procedures, medications at discharge, in-hospital complications, 30-day and 1-year mortality for all patients admitted with STEMI during 2014-2017 using data from EMIR (Estonia; n = 4584), HUMIR (Hungary; n = 23685), NORMI (Norway; n = 12414, data for 2013-2016) and SWEDEHEART (Sweden; n = 23342). Estonia and Hungary had a higher proportion of women, patients with hypertension, diabetes and peripheral artery disease compared to Norway and Sweden. Rates of reperfusion varied from 75.7% in Estonia to 84.0% in Sweden. Rates of recommendation of discharge medications were generally high and similar. However, Estonia demonstrated the lowest rates of dual antiplatelet therapy (78.1%) and statins (86.5%). Norway had the lowest rates of beta-blockers (80.5%) and angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (61.5%). The 30-day mortality rates ranged between 9.9-13.4% remaining lowest in Sweden. 1-year mortality rates ranged from 14.8% in Sweden and 16.0% in Norway to 20.6% in Hungary and 21.1% in Estonia. Age-adjusted lethality rates were highest for Hungary and lowest for Sweden. CONCLUSION This inter-country comparison of data from four national ongoing European registries provide new insights into the risk factors, management and outcomes of patients with STEMI. There are several possible reasons for the findings, including coverage of the registries and variability of baseline-characteristics' definitions that need to be further explored.
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Affiliation(s)
- Mai Blöndal
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014, Tartu, Estonia.,Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, 51014, Tartu, Estonia
| | - Tiia Ainla
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014, Tartu, Estonia.,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419, Tallinn, Estonia
| | - Jaan Eha
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014, Tartu, Estonia.,Heart Clinic, Tartu University Hospital, 8 L. Puusepa Street, 51014, Tartu, Estonia
| | - Piret Lõiveke
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014, Tartu, Estonia.,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419, Tallinn, Estonia
| | - Toomas Marandi
- Department of Cardiology, University of Tartu, 8 L. Puusepa Street, 51014, Tartu, Estonia.,Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419, Tallinn, Estonia.,Quality Department, North Estonia Medical Centre, 19 J. Sütiste Street, 13419, Tallinn, Estonia
| | - Aet Saar
- Centre of Cardiology, North Estonia Medical Centre, 19 J. Sütiste Street, 13419, Tallinn, Estonia
| | - Gudrun Veldre
- Estonian Myocardial Infarction Registry, Tartu University Hospital, 8 L. Puusepa Street, 51014, Tartu, Estonia
| | - Robert Edfors
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Bayer AB, Solna, Sweden
| | - Christian Lewinter
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Box 783, Stoa 4809, Arendal, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Ullevål Hospital, PB 4956, Nydalen, 0424, Oslo, Norway.,Department of Cardiology, University of Oslo, OUS HF Rikshospitalet, PB 4950, Nydalen, 0424, Oslo, Norway
| | - Dávid Becker
- Semmelweis University Heart and Vascular Center, 9 Gaál József street, Budapest, Hungary
| | - Zoltán Csanádi
- University of Debrecen, Cardiology and Heart Surgery Clinic, 22 Móricz Zsigmond street, Debrecen, Hungary
| | - Tamas Ferenci
- Obuda University, John von Neumann Faculty of Informatics, Applied Informatics Institute, Physiological Controls Group, Becsi ut 96/B, 1034, Budapest, Hungary
| | - Péter Andréka
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, 29 Haller street, 1096, Budapest, Hungary
| | - András Jánosi
- Gottsegen National Institute of Cardiology, Hungarian Myocardial Infarction Registry, 29 Haller street, 1096, Budapest, Hungary
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20
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The global prevalence of Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus and Herpes simplex virus in patients with coronary artery disease: A systematic review and meta-analysis. Microb Pathog 2020; 152:104572. [PMID: 33166619 DOI: 10.1016/j.micpath.2020.104572] [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: 06/22/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Coronary Artery Disease (CAD) is one of the most important causes of death worldwide. The aim of this study was to determine the prevalence of C. pneumoniae, H. pylori, Cytomegalovirus (CMV) and Herpes simplex virus (HSV) in CAD patients based on published serological and molecular studies. METHODS A systematic literature search was conducted in Medline (via PubMed), Embase, Scopus and Web of Science databases (1996-2019). Both molecular and serological studies were analyzed using STATA software (Version 14). RESULTS 145 studies were included for final analysis. We gathered and investigated the prevalence of C. pneumoniae (25.1% [95% confidence interval (CI) 21.5-28.8%]), H. pylori (12.8% [(95% CI) 4.0-22.0%]), CMV (64.4% [(95% CI) 57.7-73.0%]) and HSV (31.8% [(95% CI) 21.5-42.2%]) in CAD patients from the analysis of molecular studies. Additionally, in serological studies, the prevalence of mentioned pathogens were 72.7% [(95% CI) 67.8-77.6%], 63.3% [(95% CI) 60.0-66.5%], 62.2% [(95% CI) 58.0-66.3%] and 34.3% [(95% CI) 23.6-45.1%] respectively. CONCLUSION Interestingly, there was only a significant increase in the prevalence of C. pneumoniae and H. pylori in serological studies compared to the reported data from molecular studies, while the prevalence of CMV and HSV were the same in both types of studies.
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21
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Bårdsgjerde EK, Landstad BJ, Hole T, Nylenna M, Gjeilo KH, Kvangarsnes M. Nurses' perceptions of patient participation in the myocardial infarction pathway. Nurs Open 2020; 7:1606-1615. [PMID: 32802382 PMCID: PMC7424437 DOI: 10.1002/nop2.544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Abstract
Aim To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Design Qualitative design with a hermeneutical approach. Methods Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February-November 2018. Participants were recruited through purposive sampling. Twenty-two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach. Results The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.
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Affiliation(s)
- Elise Kvalsund Bårdsgjerde
- Department of Health Sciences in ÅlesundFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyÅlesundNorway
| | - Bodil J. Landstad
- Department of Health SciencesMid Sweden UniversitySundsvall and ÖstersundSweden
- Levanger HospitalNord‐Trøndelag Hospital TrustNord‐TrøndelagNorway
| | - Torstein Hole
- Clinic of Medicine and RehabilitationMøre og Romsdal Hospital TrustÅlesundNorway
- Department of Circulation and Medical ImagingFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Magne Nylenna
- Institute of Health and SocietyUniversity of OsloOsloNorway
- Norwegian Institute of Public HealthOsloNorway
| | - Kari Hanne Gjeilo
- Department of Cardiothoracic SurgerySt. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of CardiologySt. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Public Health and NursingFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyTrondheimNorway
| | - Marit Kvangarsnes
- Department of Health Sciences in ÅlesundFaculty of Medicine and Health SciencesNTNU – Norwegian University of Science and TechnologyÅlesundNorway
- Møre og Romsdal Hospital TrustÅlesundNorway
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22
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Mayala HA, Mafuru M, Mkangala A, Mayala M, Pallangyo P, Minja D, Janabi M, Zhao-Hui W. Factors influencing left ventricular ejection fraction in patients with coronary microvascular disease and obstructive coronary artery disease. BMC Res Notes 2020; 13:157. [PMID: 32178717 PMCID: PMC7077157 DOI: 10.1186/s13104-020-05008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of our research was to evaluate the relationship involving left ventricular ejection fraction, low density lipoprotein, B-type natriuretic peptide, Troponin I and coronary flow reserve, and to determine the predictors of left ventricular ejection fraction in patients with coronary microvascular disease and obstructive coronary artery disease, and in patients with coronary microvascular disease. Results The mean age was 58.5 ± 12.5 years. In patients with obstructive coronary disease and coronary microvascular disease we found low density lipoprotein-c had significant inverse relationship with left ventricular ejection fraction, left ventricular ejection fraction also had significant negative relationship with B-type natriuretic peptide, and Troponin-I. While a significant direct relationship turned out to be observed linking left ventricular ejection fraction with coronary flow reserve. Left ventricular ejection fraction had significant negative relationship with low density lipoprotein, and B-type natriuretic peptide in patients with obstructive coronary artery disease only. Age, blood pressure, lipid levels, red cell distribution width, glycated hemoglobin, symptoms, New York heart association classification, alcohol drinking, hypertension, diabetes mellitus, troponin levels and B-type natriuretic peptide were the predictors for left ventricular ejection fraction in coronary microvascular disease patients.
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Affiliation(s)
- Henry Anselmo Mayala
- Jakaya Kikwete Cardiac Institute, P. O. Box 65141, West Upanga, Kalenga Street, Ilala District, Dar es Salaam, Tanzania.
| | - Magesa Mafuru
- Tongji Medical College, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, 43000, Hubei, China
| | - Abdalah Mkangala
- Jakaya Kikwete Cardiac Institute, P. O. Box 65141, West Upanga, Kalenga Street, Ilala District, Dar es Salaam, Tanzania
| | - Mark Mayala
- Muhimbili University of Health and Allied Science, Upanga, Ilala District, Dar es Salaam, Tanzania
| | - Pedro Pallangyo
- Jakaya Kikwete Cardiac Institute, P. O. Box 65141, West Upanga, Kalenga Street, Ilala District, Dar es Salaam, Tanzania
| | - Dickson Minja
- Jakaya Kikwete Cardiac Institute, P. O. Box 65141, West Upanga, Kalenga Street, Ilala District, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Jakaya Kikwete Cardiac Institute, P. O. Box 65141, West Upanga, Kalenga Street, Ilala District, Dar es Salaam, Tanzania
| | - Wang Zhao-Hui
- Tongji Medical College, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, 43000, Hubei, China
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