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Kumar N, Paray NKB, Ramphul K, Verma R, Dhaliwal JS, Schroeder C, Liu L, Bawna F, Sakthivel H, Ahmed R. Unmasking the cannabis paradox: in-hospital outcomes of cannabis users admitted with acute myocardial infarction over a 20-year period in the United States. Arch Med Sci Atheroscler Dis 2024; 9:e137-e146. [PMID: 39086618 PMCID: PMC11289235 DOI: 10.5114/amsad/189731] [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: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Cannabis is increasingly becoming a socially acceptable substance, with multiple countries having legalised its consumption. Epidemiological studies have demonstrated an association between cannabis use and an increased risk of developing coronary artery disease. However, there is a lack of studies about the influence of cannabis consumption on the outcomes following acute myocardial infarction (AMI). Material and methods We retrospectively analysed hospitalised patients with a primary diagnosis of AMI from the 2001 to 2020 National Inpatient Sample (NIS). Pearson's χ2 tests were applied to categorical variables, and t-tests for continuous variables. We conducted a 1:1 propensity score matching (PSM). Multivariate regression models were deployed on the PSM sample to estimate the differences in several events and all-cause mortality. Results A total of 9,930,007 AMI patients were studied, of whom 117,641 (1.2%) reported cannabis use. Cannabis users had lower odds of atrial fibrillation (aOR = 0.902, p < 0.01), ventricular fibrillation (aOR = 0.919, p < 0.01), cardiogenic shock (aOR = 0.730, p < 0.01), acute ischaemic stroke (aOR = 0.825, p < 0.01), cardiac arrest (aOR = 0.936, p = 0.010), undergoing PCI (aOR = 0.826, p < 0.01), using IABP (aOR = 0.835, p < 0.01), and all-cause mortality (aOR = 0.640, p < 0.01), but with higher odds of supraventricular tachycardia (aOR = 1.104, p < 0.01), ventricular tachycardia (aOR = 1.054, p < 0.01), CABG use (aOR = 1.040, p = 0.010), and acute kidney injury (aOR = 1.103, p < 0.01). Conclusions Among patients aged 18-80 years admitted to hospital with AMI between 2001 and 2020 in the United States, cannabis use was associated with lower risks of cardiogenic shock, acute ischaemic stroke, cardiac arrest, PCI use, and in-hospital mortality.
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Affiliation(s)
- Nomesh Kumar
- Department of Internal Medicine, Detroit Medical Center-Wayne State University of Sinai Grace, Michigan, US
| | | | | | - Renuka Verma
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, US
| | | | - Camryn Schroeder
- Medical Student at Kirk Kerkorian School of Medicine at UNLV, Las Vegas, US
| | - Lily Liu
- Medical Student at Kirk Kerkorian School of Medicine at UNLV, Las Vegas, US
| | - Fnu Bawna
- Independent researcher, Farmington Hills, Michigan, US
| | | | - Raheel Ahmed
- Royal Brompton Hospital, part of Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
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Fadah K, Hechanova A, Mukherjee D. Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly. Int J Angiol 2022; 31:244-250. [PMID: 36588871 PMCID: PMC9803549 DOI: 10.1055/s-0042-1751234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Elderly patients over the age of ≥ 75 years are especially susceptible to coronary artery disease (CAD) as age is an important nonmodifiable risk factors for atherosclerosis and a predictor of poorer outcomes. In fact, CAD is a major cause of mortality and morbidity in this population. Due to concerns of functional frailty, comorbidities, and patient preference of conservative to no treatment have played a role in reducing the interest in pursuing prospective studies in this high-risk group. In this review, we provide an overview of the epidemiology, pathophysiology, and management of CAD in older adults.
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Affiliation(s)
- Kahtan Fadah
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Aimee Hechanova
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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Diagnosing Arterial Stiffness in Pregnancy and Its Implications in the Cardio-Renal-Metabolic Chain. Diagnostics (Basel) 2022; 12:diagnostics12092221. [PMID: 36140621 PMCID: PMC9497660 DOI: 10.3390/diagnostics12092221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
Cardio-renal and metabolic modifications during gestation are crucial determinants of foetal and maternal health in the short and long term. The cardio-renal metabolic syndrome is a vicious circle that starts in the presence of risk factors such as obesity, hypertension, diabetes, kidney disease and ageing, all predisposing to a status dominated by increased arterial stiffness and alteration of the vascular wall, which eventually damages the target organs, such as the heart and kidneys. The literature is scarce regarding cardio-renal metabolic syndrome in pregnancy cohorts. The present paper exposes the current state of the art and emphasises the most important findings of this entity, particularly in pregnant women. The early assessment of arterial function can lead to proper and individualised measures for women predisposed to hypertension, pre-eclampsia, eclampsia, and diabetes mellitus. This review focuses on available information regarding the assessment of arterial function during gestation, possible cut-off values, the possible predictive role for future events and modalities to reverse or control its dysfunction, a fact of crucial importance with excellent outcomes at meagre costs.
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Association between abnormal myocardial scintigraphy findings and long-term outcomes for elderly patients 85 years or older: a retrospective cohort study. BMC Cardiovasc Disord 2019; 19:246. [PMID: 31694562 PMCID: PMC6833266 DOI: 10.1186/s12872-019-1240-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Normal findings of cardiac scintigraphy predict good outcomes. However, a paucity of the data exists for elderly patients 85 years or older. In the present study, we aimed to demonstrate the association between the abnormal findings of cardiac scintigraphy and the risk of all cause death in patients 85 years or older. Methods We enrolled 143 consecutive patients 85 years or older with known or suspected coronary artery disease who underwent stress scintigraphy under adenosine or an exercise test and a 99mTechnetium (Tc)-labeled tracer or thallium 201 (201Tl), dual tracer rest scintigraphy using 201Tl and 123I-β-methyl iodophenyl pentadecanoic acid (123I-BMIPP), or 123I-BMIPP single tracer scintigraphy. Ischemia was defined by an induced perfusion abnormality according to a provocation test with recovery at rest or decreased uptake of 123I-BMIPP despite normal perfusion at rest. Infarction was defined by perfusion abnormalities assessed by images at rest on 201Tl or 99mTc-labeled tracer. We defined these findings as abnormal when at least one of these aforementioned characteristics was observed. Results Patients in the abnormal findings group (N = 62) were more likely to have undergone prior coronary angiography and to have decreased ejection fraction than those in the normal findings group (N = 81). The median follow-up duration was 797 days (interquartile range, 635–1045 days), with follow-up rates of 90% at 1 year and 73% at 2 years. The 2-year mortality rate were significantly higher in the abnormal findings group than in the normal findings group (26.8% vs. 10.9%; p = 0.01). The risk of abnormal findings relative to normal findings remained significant for the mortality (adjusted hazard ratio, 5.99; 95% CI, 1.37–42.8; P = 0.015). Conclusion Abnormal myocardial scintigraphy findings were associated with the increased risk for mortality, even for patients 85 years or older.
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Anand A, Bhati P, Mujaddadi A, Verma S, Naqvi I, Hussain M. Influence of physical activity on cardiac autonomic control in patients with dyslipidaemia. COMPARATIVE EXERCISE PHYSIOLOGY 2019. [DOI: 10.3920/cep190024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study was to compare the cardiac autonomic control of dyslipidaemia patients engaged in different levels of physical activity and to determine the predictive ability of physical activity for cardiac autonomic dysfunction in these patients. This study also aimed to compare the cardiac autonomic control of dyslipidaemia patients and healthy adults. 52 patients (age: 49.1±4.53 years) with dyslipidaemia were recruited along with 16 healthy adults. Physical activity levels were assessed by International Physical Activity Questionnaire, and subjects were divided into three categories – low, moderate, and high physical activity. Heart rate variability (HRV) analysis was performed for obtaining time and frequency domain parameters. Presence of cardiac autonomic dysfunction was defined as standard deviation of N-N intervals <44 ms. HRV parameters were compared between 3 groups of dyslipidaemia patients and healthy controls. Predictive ability of physical activity for cardiac autonomic dysfunction in dyslipidaemia was evaluated after adjusting clinical covariates. There was a significant difference between low-frequency power (cardiac sympathetic control), and ratio of low- and high-frequency (HF) power (sympatho-vagal balance) in low versus moderate physical activity group and low versus high physical activity group (P<0.001). Significant differences were also observed for HFnu power (cardiac vagal activity) and total power between the dyslipidaemia groups. Physical activity was found to be a significant (P=0.03), independent predictor of cardiac autonomic dysfunction in dyslipidaemia patients. Findings of the present study suggest that cardiac autonomic profile of dyslipidaemia patients with different physical activity levels varied significantly. Dyslipidaemia patients engaged in moderate and high physical activity demonstrated significantly less sympathetic activity and better sympatho-vagal balance than those engaged in low levels of physical activity; also, vagal cardiac control was significantly greater in high physical activity group. Lower levels of physical activity determined the presence of cardiac autonomic dysfunction in these patients at an optimal cut-off value of ≤1,558 Metabolic Equivalent of Tasks- min/week.
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Affiliation(s)
- A. Anand
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - P. Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - A. Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - S. Verma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - I.H. Naqvi
- M.A. Ansari Medical Centre, Jamia Millia Islamia (A Central University), New Delhi-110025, India
| | - M.E. Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi-110025, India
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Mesoporous Pravastatin Solid Dispersion Granules Incorporable Into Orally Disintegrating Tablets. J Pharm Sci 2018. [DOI: 10.1016/j.xphs.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Katsiki N, Kolovou G, Perez-Martinez P, Mikhailidis DP. Dyslipidaemia in the elderly: to treat or not to treat? Expert Rev Clin Pharmacol 2018; 11:259-278. [PMID: 29303009 DOI: 10.1080/17512433.2018.1425138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The elderly population (i.e. aged ≥ 65 years) is increasing worldwide. Ageing is associated with a higher incidence and prevalence of cardiovascular disease (CVD). Areas covered: The prevalence of CVD risk factors including type 2 diabetes mellitus, hypertension and dyslipidaemia also increases with advancing age, contributing to the higher absolute CVD risk observed in the elderly. The present narrative review comments on the associations of dyslipidaemia with CVD as well as the effects of lifestyle measures and lipid-lowering drugs on lipids and CVD risk with a special focus on the elderly population. Individual treatment goals and therapeutic options according to current guidelines are also reviewed. Finally, we discuss special characteristics of the elderly that may influence the efficacy and safety of drug therapy and should be considered before selection of hypolipidaemic pharmacotherapy. Expert commentary: There may be a greater CVD benefit in older patients following drug therapy compared with younger ones. Treatment goals and therapeutic options should be individualized according to current guidelines. Specific characteristics that may influence the efficacy and safety of drug therapy in the elderly should be considered in relation to dyslipidaemia treatment.
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Affiliation(s)
- Niki Katsiki
- a Second Propedeutic Department of Internal Medicine, Medical School , Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
| | - Genovefa Kolovou
- b Cardiology Department and LDL-Apheresis Unit , Onassis Cardiac Surgery Center , Athens , Greece
| | - Pablo Perez-Martinez
- c Lipid and Atherosclerosis Unit , IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III , Spain
| | - Dimitri P Mikhailidis
- d Department of Clinical Biochemistry , Royal Free Hospital Campus, University College London Medical School, University College London (UCL) , London , UK
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Lo LMP, Kang MY, Yi SJ, Chung SI. Dietary supplementation of germinated pigmented rice (Oryza sativa L.) lowers dyslipidemia risk in ovariectomized Sprague-Dawley rats. Food Nutr Res 2016; 60:30092. [PMID: 27032671 PMCID: PMC4816810 DOI: 10.3402/fnr.v60.30092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 01/07/2023] Open
Abstract
Background In the recent years, cases of elderly women suffering from metabolic diseases such as dyslipidemias brought about by hormonal imbalance after menopause are continuously increasing. In this regard, a continuous and escalating demand to develop a more functional and highly nutritional food product as an adjunct supplement that can help alleviate these diseases is still being sought. Objective This study investigated the effects of germinated blackish-purple rice cultivars Keunnunjami, Superjami, and reddish-brown cultivar Superhongmi in the lipid metabolism of ovariectomized Sprague–Dawley rats. Method The animals were randomly divided into nine groups (n=5) and were supplemented with either non-germinated or germinated rice for 9 weeks. Then the plasma, liver, and fat samples were collected for the lipid metabolism effects analyses. Results Animals fed with germinated rice cultivars had improved lipid profile levels relative to the groups supplemented with non-germinated rice cultivars. The germinated rice groups, Keununjami and Superjami in particular, showed a low total cholesterol levels, high levels of high-density lipoproteins-cholesterol, high fecal lipid output, low hepatic lipid values, and low hepatic adipocyte accumulation. There was also an increase in the rate of lipolysis and decrease in lipogenesis based on the lipid-regulating enzyme activity profiles obtained for the groups that fed on germinated rice. Also, results revealed that pigmented rice cultivars had superior effects in improving the lipid metabolism relative to the non-pigmented normal brown rice variety. Conclusion Based on the results, this study suggests that germinated pigmented rice consumption can confer better lipid metabolism than ordinary white rice and constitutes as an effective functional food in alleviating the risk of having dyslipidemias like those suffering from menopausal co-morbidities.
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Affiliation(s)
- Lara Marie Pangan Lo
- Department of Food Science and Nutrition, Brain Korea 21 Plus, Kyungpook National University, Daegu, Republic of Korea
| | - Mi Young Kang
- Department of Food Science and Nutrition, Brain Korea 21 Plus, Kyungpook National University, Daegu, Republic of Korea
| | - Seong Joon Yi
- College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Im Chung
- Department of Food Science and Nutrition, Brain Korea 21 Plus, Kyungpook National University, Daegu, Republic of Korea;
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Wang MJ, Lo YT. Thoughts about Person-Centered Care for the Adult Population with Multimorbidity. Health (London) 2016. [DOI: 10.4236/health.2016.812130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gravina CF, Bertolami M, Rodrigues GH. Dyslipidemia: evidence of efficacy of the pharmacological and non-pharmacological treatment in the elderly. J Geriatr Cardiol 2012; 9:83-90. [PMID: 22916052 PMCID: PMC3418895 DOI: 10.3724/sp.j.1263.2011.12292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 04/23/2012] [Accepted: 04/30/2012] [Indexed: 01/14/2023] Open
Abstract
The clinical decision to control risk factors for cardiovascular disease (CVD) in the elderly takes the followings into consideration: (1) the elderly life expectancy; (2) the elderly biological age and functional capacity; (3) the role of cardiovascular disease in the elderly group; (4) the prevalence of risk factors in the elderly; and (5) The effectiveness of treatment of risk factors in the elderly. A large number of studies showed the efficacy of secondary and primary prevention of dyslipidemia in the elderly. However, the only trial that included patients over 80 years was the Heart Protection Study (HPS). Statins are considered the first line therapy for lowering low-density lipoprotein cholesterol (LDL-C). Because lifestyle changes are very difficult to achieve, doctors in general tend to prescribe many drugs to control cardiovascular risk factors. However, healthy food consumption remains a cornerstone in primary and secondary cardiovascular prevention and should be implemented by everyone.
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Affiliation(s)
- Claudia F Gravina
- Geriatric Cardiology Section, Dante Pazzanese Institute of Cardiology,Avenida Dr Dante Pazzanese 500, Ibirapuera, São Paulo 04012-180, Brazil
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