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Gurgoglione FL, Rizzello D, Giacalone R, Ferretti M, Vezzani A, Pfleiderer B, Pelà G, De Panfilis C, Cattabiani MA, Benatti G, Tadonio I, Grassi F, Magnani G, Noni M, Cancellara M, Nicolini F, Ardissino D, Vignali L, Niccoli G, Solinas E. Precipitating factors in patients with spontaneous coronary artery dissection: Clinical, laboratoristic and prognostic implications. Int J Cardiol 2023; 385:1-7. [PMID: 37211051 DOI: 10.1016/j.ijcard.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) often presents with acute coronary syndrome and underlying pathophysiology involves the interplay between predisposing factors and precipitating stressors, such as emotional and physical triggers. In our study we sought to compare clinical, angiographic and prognostic features in a cohort of patients with SCAD according to the presence and type of precipitating stressors. METHODS Consecutive patients with angiographic evidence of SCAD were divided into three groups: patients with emotional stressors, patients with physical stressors and those without any stressor. Clinical, laboratoristic and angiographic features were collected for each patient. The incidence of major adverse cardiovascular events, recurrent SCAD and recurrent angina was assessed at follow-up. RESULTS Among the total population (64 subjects), 41 [64.0%] patients presented with precipitating stressors, including emotional triggers (31 [48.4%] subjects) and physical efforts (10 [15.6%] subjects). As compared with the other groups, patients with emotional triggers were more frequently female (p = 0.009), had a lower prevalence of hypertension (p = 0.039] and dyslipidemia (p = 0.039), were more likely to suffer from chronic stress (p = 0.022) and presented with higher levels of C-reactive protein (p = 0.037) and circulating eosinophils cells (p = 0.012). At a median follow-up of 21 [7; 44] months, patients with emotional stressors experienced higher prevalence of recurrent angina (p = 0.025), as compared to the other groups. CONCLUSIONS Our study shows that emotional stressors leading to SCAD may identify a SCAD subtype with specific features and a trend towards a worse clinical outcome.
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Affiliation(s)
| | - Davide Rizzello
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | | | - Marco Ferretti
- Division of Cardiology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, Parma University Hospital, Parma, Italy
| | | | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Italy
| | | | | | - Giorgio Benatti
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Giulia Magnani
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Manjola Noni
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Francesco Nicolini
- Division of Cardio surgery, University of Parma, Parma University Hospital, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy.
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
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Krittanawong C, Liu Y, Mahtta D, Narasimhan B, Wang Z, Jneid H, Tamis-Holland JE, Mahboob A, Baber U, Mehran R, Wilson Tang WH, Ballantyne CM, Virani SS. Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort. Int J Cardiol Heart Vasc 2020; 30:100634. [PMID: 32995474 PMCID: PMC7516292 DOI: 10.1016/j.ijcha.2020.100634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
Young patients with myocardial infarction (MI) have both traditional risk factors and non-traditional risk factors. HTN, smoking, obesity, HLD and a family history of CAD were risks of MI in the young. HIV, SLE, and OSA were all associated with an elevated risk of MI, independent of traditional atherosclerotic risk factors. Close attention should be paid to emerging risk factors such as SLE, HIV and OSA.
Although most prevalent in elderly, myocardial infarction (MI) also affects younger adults. We sought to investigate baseline characteristics in young patients (<55 years) with MI using the National Inpatient Sample (NIS) database between 2004 and 2015. Multivariable logistic regression models were used to assess factors associated with acute myocardial infarction (AMI) in young patients. After multivariable analyses adjusted for age, sex, race, family history of atherosclerosis, body mass index (BMI), diabetes, hypertension, hyperlipidemia, chronic kidney disease, and current cigarette smoking; novel risk factors such as human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), and obstructive sleep apnea (OSA) were associated with a higher risk of developing an AMI in the young (adjusted OR for HIV 4.06; 95 CI 3.48–4.71, p < 0.001), (adjusted OR for SLE 2.12; 95 CI 1.89–2.39, p 0.04), and (adjusted OR for OSA 1.16; 95 CI 1.12–1.20, p < 0.001), respectively. Rheumatoid arthritis was associated with a lower risk of AMI (adjusted OR 0.83; 95 CI 0.76–0.89, p < 0.001). After multivariable analyses, cigarette smoking (adjusted OR 1.98; 95 CI 1.95–2.02, p < 0.001), obesity (adjusted OR 1.37; 95 CI 1.33–1.41, p = 0.003), hyperlipidemia (adjusted OR 1.07; 95 CI 1.04–1.08, p < 0.001) and a family history of CAD (adjusted OR 1.35; 95 CI 1.3–1.4, p < 0.001) were also associated with a higher risk of developing an AMI in the young. In conclusion, young patients with AMI have both traditional risk factors and non-traditional risk factors. In addition to traditional risk factors, close attention should be paid to emerging risk factors such as SLE, HIV and OSA.
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Affiliation(s)
- Chayakrit Krittanawong
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Yiming Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dhruv Mahtta
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Bharat Narasimhan
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA
| | | | - Alam Mahboob
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Usman Baber
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Roxana Mehran
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - W H Wilson Tang
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Salim S Virani
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Cardiology, Baylor College of Medicine, USA
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Almeida-Pititto B, Silva IT, Goulart AC, Fonseca MIH, Bittencourt MS, Santos RD, Blaha M, Jones S, Toth PP, Kulakarni K, Lotufo PA, Bensenor IM, Ferreira SRG. Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diabetol Metab Syndr 2018; 10:82. [PMID: 30479668 PMCID: PMC6247673 DOI: 10.1186/s13098-018-0388-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS 807 individuals (35-54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (≤ 2 CVRF). RESULTS In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL3-cholesterol and TG/HDL ratio increased significantly, while HDL2-cholesterol and HDL3-cholesterol decreased across NC quartiles. In linear regression models, a direct association [β(95% CI)] of NC with leptin [(0.155 (0.068-0.242); 0.147 (0.075-0.220)], E-selectin [(0.105 (0.032-0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641-3.091); 2.372 (1.391-3.353)] and an inverse association with HDL2-cholesterol [(- 0.519 (- 0.773 to - 0.266); - 0.815 (- 1.115 to 0.515)] adjusted for age were detected for men and women, respectively. CONCLUSION Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.
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Affiliation(s)
- B. Almeida-Pititto
- Department of Preventive Medicine, Federal University of Sao Paulo, Rua Botucatu 740, São Paulo, SP 04023900 Brazil
| | - I. T. Silva
- School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904 Brazil
| | - A. C. Goulart
- Department of Internal Medicine, University of São Paulo, Av. Lineu Prestes 2565, 4th Floor, São Paulo, SP 05508-000 Brazil
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 3rd Floor, São Paulo, 05508-000 Brazil
| | - M. I. H. Fonseca
- School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904 Brazil
| | - M. S. Bittencourt
- Department of Internal Medicine, University of São Paulo, Av. Lineu Prestes 2565, 4th Floor, São Paulo, SP 05508-000 Brazil
| | - R. D. Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo, Medical School Hospital, Av. Dr. Enéas de Carvalho Aguiar 44, São Paulo, 01246-000 Brazil
| | - M. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD USA
| | - S. Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD USA
| | - P. P. Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524 D1, 600 N. Wolfe St, Baltimore, MD USA
- Department of Preventive Cardiology, CGH Medical Center, 100 E. Le Fevre Road, Sterling, IL 61081 USA
| | - K. Kulakarni
- VAP Diagnostics Laboratory, 201 London Pkwy, Birmingham, AL 35211 USA
| | - P. A. Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 3rd Floor, São Paulo, 05508-000 Brazil
| | - I. M. Bensenor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 3rd Floor, São Paulo, 05508-000 Brazil
| | - S. R. G. Ferreira
- School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP 01246-904 Brazil
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Av. Lineu Prestes 2565, 3rd Floor, São Paulo, 05508-000 Brazil
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