Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial

OBJECTIVE

This study aimed to assess whether an obesity paradox (lower event rates with higher body mass index [BMI]) exists in participants with advanced chronic kidney disease (CKD) and chronic coronary disease in the International Study of Comparative Health Effectiveness of Medical and Invasive Approaches (ISCHEMIA)-CKD, and whether BMI modified the effect of initial treatment strategy.

METHODS

Baseline BMI was analyzed as both a continuous and categorical variable (< 25, ≥ 25 to < 30, ≥ 30 kg/m2). Associations between BMI and the primary outcome of all-cause death or myocardial infarction (D/MI), and all-cause death, cardiovascular death, and MI individually were estimated. Associations with health status were also evaluated using the Seattle Angina Questionnaire-7, the Rose Dyspnea Scale, and the EuroQol-5D Visual Analog Scale.

RESULTS

Body mass index ≥ 30 kg/m2 vs < 25 kg/m2 demonstrated increased risk for MI (hazard ratio [HR] [95% confidence interval] = 1.81 [1.12-2.92]) and for D/MI (HR 1.45 [1.06-1.96]) with a HR for MI of 1.22 (1.05-1.40) per 5 kg/m2 increase in BMI in unadjusted analysis. In multivariate analyses, a BMI ≥ 30 kg/m2 was marginally associated with D/MI (HR 1.43 [1.00-2.04]) and greater dyspnea throughout follow-up (P < .05 at all time points). Heterogeneity of treatment effect between baseline BMI was not evident for any outcome.

CONCLUSIONS

In the ISCHEMIA-CKD trial, an obesity paradox was not detected. Higher BMI was associated with worse dyspnea, and a trend toward increased D/MI and MI risk. Larger studies to validate these findings are warranted.

Generation of two clonal iPSC lines, ICGi019-A and ICGi019-B, by reprogramming peripheral blood mononuclear cells of a patient suffering from hypertrophic cardiomyopathy and carrying a heterozygous p.M659I mutation in MYH7

Hypertrophic cardiomyopathy (HCM) is one of the most frequent cardiovascular diseases but no methods to prevent its progression have been developed. Cardiomyocytes derived from patient-specific induced pluripotent stem cells can become a platform to study pathogenesis of the disease and to search for more effective therapy methods. We generated two iPSC lines from peripheral blood mononuclear cells of an HCM patient with heterozygous p.M659I mutation in MYH7 using episomal vectors. The iPSC lines expressed pluripotency markers, demonstrated ability to spontaneously differentiate into derivatives of three germ layers, and retained the mutation.

Management of Coronary Disease in Patients with Advanced Kidney Disease

BACKGROUND

Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease.

METHODS

We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.

RESULTS

At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03).

CONCLUSIONS

Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).

[Effect of polyethylene terephthalate (Dacron®) on functional potential of human bone-marrow/progenitor stem cells]

Vascular grafts made of polytetrafluoroethylene and polyethylene terephthalate have widely been used in cardiovascular surgery. The causes of delayed colonization of such grafts by endotheliocytes and mesenchymal stem cells have not been adequately investigated. The authors examined the effect of polyethylene terephthalate on the functional activity of human bone marrow mesenchymal stem cells and endothelial progenitor cells in vitro. Proliferation (MTT assay, real-time cellular impedance), migration (Boyden chamber, real-time cellular impedance), and nitric oxide production (spectrophotometciacally) by progenitor endothelial cells and mesenchymal stem cells were assessed with and without the presence of polyethylene terephthalate. The functional activity of the cells was shown to depend on the presence of polyethylene terephthalate in a well with cells. Thus, polyethylene terephthalate turned out to exhibit a toxic effect on progenitor endothelial and mesenchymal stem cells. Treatment of grafts with gelatine or fibronectin improved colonization of grafts with cells.

[Hybrid procedures for aortic arch disease]

Different surgical approaches for aortic arch disease were reviewed in the article. We have also compared various vascular prostheses for aortic replacement.

[The Problem of Adherence to Therapy in Cardiology]

This review article presents results of studies on adherence to drug therapy of patients after discharge from hospital. It contains analysis of the reasons for poor adherence, assessment of the impact of quality of adherence on the immediate and long-term results of surgical and medical treatment, structured methods of improvement of adherence to therapy; as well as economic aspects of the problem.

[Endovascular treatment of major vascular aneurysms: successful experience]

Major vascular aneurysm is a severe pathology with poor prognosis. Due to wide variations of vascular anatomy, an endovascular intervention may require intraoperative adjustment of procedural strategy. The paper presents results of successive stent-graft implantations in different anatomical situations.