Management of Dyslipidemia in Women and Men with Coronary Heart Disease: Results from POLASPIRE Study

Cardiovascular diseases (CVDs) are the leading cause of death in Poland. Starting from 1992, a gradual decrease in mortality due to CVDs has been observed, which is less noticeable in women. Following this notion, we assessed sex differences in the implementation of ESC recommendations regarding lipid control and the use of statins as part of secondary CVDs prevention in 1236 patients with acute coronary syndrome or elective coronary revascularization within the last 6-24 months. During hospitalization women had more frequently abnormal TC levels than men (p = 0.035), with overall higher TC levels (p = 0.009) and lower HDL-C levels (p = 0.035). In the oldest group, they also had more frequently elevated LDL-C levels (p = 0.033). Similar relationships were found during the follow-up visit. In addition, women less often achieved the secondary lipid therapeutic goal for non-HDL-C (p = 0.009). At discharge from hospital women were less frequently prescribed statins (p = 0.001), which included high-intensity statins (p = 0.002). At the follow-up visit the use of high-intensity statins was still less frequent in women (p = 0.02). We conclude that women generally have less optimal lipid profiles than men and are less likely to receive high-intensity statins. There is a need for more organized care focused on the management of risk factors.

Undiagnosed Diabetes and Prediabetes in Patients with Chronic Coronary Syndromes-An Alarming Public Health Issue

Dysglycemia is a public health challenge for the coming decades, especially in patients with chronic coronary syndromes (CCS). We want to assess the prevalence of undiagnosed diabetes mellitus (DM) and prediabetes, as well as identify factors associated with the development of dysglycaemia in patients with CCS. In total, 1233 study participants (mean age 69 ± 9 years), who, between 6 and 18 months earlier were hospitalized for acute coronary syndrome or elective revascularization, were examined (71.4% men). The diagnosis of DM, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) have been made according to World Health Organization (WHO) criteria. Based on the oral glucose tolerance test (OGTT) results, DM has been newly diagnosed in 28 (5.1%, mean age 69.9 ± 8.4 years) patients, 75% were male (n = 21). Prediabetes has been observed in 395 (72.3%) cases. IFG was found in 234 (42.9%) subjects, 161 (29.5%) individuals had IGT. According to multinomial logistic regression, body mass index (BMI) and high-density lipoprotein cholesterol (HDL-C) should be considered when assessing risk of development of dysglycaemia after discharge from the hospital. Among people with previously diagnosed DM, a significantly higher percentage were willing to change their lifestyles after the index event compared to other patients. Patients with chronic coronary syndromes suffer a very high frequency of dysglycaemia. Most patients with chronic coronary syndromes, especially those with high BMI or low HDL-C, should be considered for screening for dysglycemia using OGTT within the first year after hospitalization. A higher percentage of patients who were aware of their diabetic status changed their lifestyles, which added the benefit of timely diagnosis and treatment of diabetes.

Smoking cessation in patients with established coronary artery disease: data from the POLASPIRE survey

BACKGROUND

Smoking cessation in patients with coronary artery disease (CAD) is related to decreased risk of cardiovascular events.

AIMS

To evaluate factors related to persistent smoking in patients with established coronary artery disease.

METHODS

Patients aged 80 years or younger and hospitalized for acute coronary syndrome or a myocardial revascularization procedure were interviewed 6 to 18 months after the recruiting event. Medical history, smoking behavior, and exposure to environmental smoke were assessed during the interview. Self--reported smoking status was validated by carbon monoxide in exhaled air measurement. Persistent smoking was defined as smoking at the time of interview among those who smoked during the month prior to the recruiting event.

RESULTS

We analyzed the data of 1034 patients, including 764 (73.9%) who reported smoking at any time in the past and 296 (28.6%) who smoked within 1 month before the recruiting hospitalization. At the time of the interview, the overall smoking rate was 17.2%, whereas 54.7% of patients were persistent smokers. Secondhand smoke exposure and duration of smoking were associated with lower likelihood whereas older age, high socioeconomic status, cardiac rehabilitation following a cardiovascular event, and consultation with a cardiologist were associated with higher likelihood of smoking cessation.

CONCLUSIONS

Over half of all smokers hospitalized for CAD are still smoking 6 to 18 months after discharge. Older age, secondhand smoking, low socioeconomic status, lack of consultation with a cardiologist, and cardiac rehabilitation following hospitalization were related to persistent smoking. Our findings may help develop strategies aimed at assisting smoking cessation in patients with CAD.

Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey

BACKGROUND

The highest priority in preventive cardiology is given to patients with established coronary artery disease (CAD). The aim of the study was to assess the current implementation of the guidelines for secondary prevention in everyday clinical practice by evaluating control of the main risk factors and the cardioprotective medication prescription rates in patients following hospitalization for CAD.

METHODS

Fourteen departments of cardiology participated in the study. Patients (aged ≤ 80 years) hospitalized due an acute coronary syndrome or for a myocardial revascularization procedure were recruited and interviewed 6-18 months after the hospitalization.

RESULTS

Overall, 947 patients were examined 6-18 months after hospitalization. The proportion of patients with high blood pressure (≥ 140/90 mmHg) was 42%, with high low-density lipoprotein cholesterol (LDL-C ≥ 1.8 mmol/L) 62%, and with high fasting glucose (≥ 7.0 mmol/L) 22%, 17% of participants were smokers and 42% were obese. The proportion of patients taking an antiplatelet agent 6-18 months after hospitalization was 93%, beta-blocker 89%, angiotensin converting enzyme inhibitor or sartan 86%, and a lipid-lowering drug 90%. Only 2.3% patients had controlled all the five main risk factors well (non-smoking, blood pressure < 140/90 mmHg, LDL-C < 1.8 mmol/L and glucose < 7.0 mmol/L, body mass index < 25 kg/m2), while 17.9% had 1 out of 5, 40.9% had 2 out of 5, and 29% had 3 out of 5 risk factors uncontrolled.

CONCLUSIONS

The documented multicenter survey provides evidence that there is considerable potential for further reductions of cardiovascular risk in CAD patients in Poland. A revision of the state funded cardiac prevention programs seems rational.

[Amiodarone administered orally or intravenously - the same or different drug?]

Amiodarone is used to manage virtually all forms of supraventricular and ventricular tachycardia and has therefore become one of the most frequently used antiarrhythmic drugs in clinical practice. Amiodarone has a variable oral bioavailability. After absorption, the drug undergoes extensive enterohepatic circulation. A large first pass effect results in desethylamiodarone, which is active and has similar electrophysiologic effects as the parent compound. Peak amiodarone serum levels, after oral dosing, are achieved within 3-7 hours. Acute amiodarone therapy results in a use-dependent inhibition of inward sodium and inward calcium currents, as well as a non-competitive alpha- and beta-blockade effect. Acute amiodarone therapy has no consistent effects on the repolarization phase of action potentials. The major effect of chronic amiodarone therapy is an inhibition of outward potassium currents resulting in a prolongation of action potential duration, not only in atrial and ventricular muscles but also in the sinoatrial node and atrioventricular nodes. A basic understanding of the pharmacokinetics is important for the clinician to understand the antiarrhythmic properties of both the oral and intravenous preparation.

[Role of inflammation in etiology of atrial fibrillation--is lone arrhythmia really alone]

We present the case study of recurrent AF episodes initially considered as a lone arrhythmia. Due to elevated C-reactive protein and fibrinogen serum levels with absence of other potential risk factors of arrhythmia and diseases underlying the genesis of inflammatory response we consider the plays a prominent role in etiology in perpetuation and maintenance of AF. Additional use of atorvastatin to a conventional therapy leads to significant reduction of C-reactive protein and fibrinogen and improves effect of long-term sinus rhythm maintenance.