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High-sensitivity #troponin in the evaluation of patients with suspected acute #coronary syndrome: a stepped-wedge, cluster-randomised controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31923-8/fulltext
High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome.
Between June 10, 2013, and March 3, 2016, we enrolled 48 282 consecutive patients (61 [SD 17] years, 47% women) of whom 10 360 (21%) patients had cTnI concentrations greater than those of the 99th centile of the normal range of values, who were identified by the contemporary assay or the high-sensitivity assay. The high-sensitivity assay reclassified 1771 (17%) of 10 360 patients with myocardial injury or infarction who were not identified by the contemporary assay. In those reclassified, subsequent myocardial infarction or cardiovascular death within 1 year occurred in 105 (15%) of 720 patients in the validation phase and 131 (12%) of 1051 patients in the implementation phase (adjusted odds ratio for implementation vs validation phase 1·10, 95% CI 0·75 to 1·61; p=0·620).
Interpretation
Use of a high-sensitivity assay prompted reclassification of 1771 (17%) of 10 360 patients with myocardial injury or infarction, but was not associated with a lower subsequent incidence of myocardial infarction or cardiovascular death at 1 year. Our findings question whether the diagnostic threshold for myocardial infarction should be based on the 99th centile derived from a normal reference population
High-sensitivity #troponin in the evaluation of patients with suspected acute #coronary syndrome: a stepped-wedge, cluster-randomised controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31923-8/fulltext
High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome.
Between June 10, 2013, and March 3, 2016, we enrolled 48 282 consecutive patients (61 [SD 17] years, 47% women) of whom 10 360 (21%) patients had cTnI concentrations greater than those of the 99th centile of the normal range of values, who were identified by the contemporary assay or the high-sensitivity assay. The high-sensitivity assay reclassified 1771 (17%) of 10 360 patients with myocardial injury or infarction who were not identified by the contemporary assay. In those reclassified, subsequent myocardial infarction or cardiovascular death within 1 year occurred in 105 (15%) of 720 patients in the validation phase and 131 (12%) of 1051 patients in the implementation phase (adjusted odds ratio for implementation vs validation phase 1·10, 95% CI 0·75 to 1·61; p=0·620).
Interpretation
Use of a high-sensitivity assay prompted reclassification of 1771 (17%) of 10 360 patients with myocardial injury or infarction, but was not associated with a lower subsequent incidence of myocardial infarction or cardiovascular death at 1 year. Our findings question whether the diagnostic threshold for myocardial infarction should be based on the 99th centile derived from a normal reference population
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Clinical significance of hepatic #steatosis according to #coronary plaque morphology: assessment using controlled attenuation parameter
https://link.springer.com/article/10.1007%2Fs00535-018-1516-5
The measurement of the controlled attenuation parameter (CAP) has shown to allow early and noninvasive detection of NAFLD at subclinical stage
A greater number of subjects with CAP-defined NAFLD was found in group with coronary plaques (61.3% vs. 73.5%, p = 0.005 without vs. with any type of plaque). From multivariate regression model, CAP ≥ 222 dB/m was an independent and significant parameter associated with the presence of coronary plaques, after adjusting possible confounders (OR 1.624, 95% 1.047–2.518, p = 0.030). Interestingly, CAP ≥ 222 dB/m was significantly associated with non-calcified plaque (adjusted OR 3.528, 95% CI 1.463–8.511, p = 0.005), whereas it was not significant in calcified plaques (p = 0.171).
Conclusion
CAP-defined NAFLD is independently associated with coronary plaques, especially non-calcified plaques. The association between NAFLD and non-calcified plaques suggests that particular attention should be given to the subjects with NAFLD for primary prevention.
Clinical significance of hepatic #steatosis according to #coronary plaque morphology: assessment using controlled attenuation parameter
https://link.springer.com/article/10.1007%2Fs00535-018-1516-5
The measurement of the controlled attenuation parameter (CAP) has shown to allow early and noninvasive detection of NAFLD at subclinical stage
A greater number of subjects with CAP-defined NAFLD was found in group with coronary plaques (61.3% vs. 73.5%, p = 0.005 without vs. with any type of plaque). From multivariate regression model, CAP ≥ 222 dB/m was an independent and significant parameter associated with the presence of coronary plaques, after adjusting possible confounders (OR 1.624, 95% 1.047–2.518, p = 0.030). Interestingly, CAP ≥ 222 dB/m was significantly associated with non-calcified plaque (adjusted OR 3.528, 95% CI 1.463–8.511, p = 0.005), whereas it was not significant in calcified plaques (p = 0.171).
Conclusion
CAP-defined NAFLD is independently associated with coronary plaques, especially non-calcified plaques. The association between NAFLD and non-calcified plaques suggests that particular attention should be given to the subjects with NAFLD for primary prevention.
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#Alirocumab and Cardiovascular Outcomes after Acute #Coronary Syndrome
https://www.nejm.org/doi/full/10.1056/NEJMoa1801174
We sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy
The median duration of follow-up was 2.8 years. A composite primary end-point event occurred in 903 patients (9.5%) in the alirocumab group and in 1052 patients (11.1%) in the placebo group (hazard ratio, 0.85; 95% confidence interval [CI], 0.78 to 0.93; P<0.001). A total of 334 patients (3.5%) in the alirocumab group and 392 patients (4.1%) in the placebo group died (hazard ratio, 0.85; 95% CI, 0.73 to 0.98). The absolute benefit of alirocumab with respect to the composite primary end point was greater among patients who had a baseline LDL cholesterol level of 100 mg or more per deciliter than among patients who had a lower baseline level. The incidence of adverse events was similar in the two groups, with the exception of local injection-site reactions (3.8% in the alirocumab group vs. 2.1% in the placebo group).
CONCLUSIONS
Among patients who had a previous acute coronary syndrome and who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab than among those who received placebo.
#Alirocumab and Cardiovascular Outcomes after Acute #Coronary Syndrome
https://www.nejm.org/doi/full/10.1056/NEJMoa1801174
We sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy
The median duration of follow-up was 2.8 years. A composite primary end-point event occurred in 903 patients (9.5%) in the alirocumab group and in 1052 patients (11.1%) in the placebo group (hazard ratio, 0.85; 95% confidence interval [CI], 0.78 to 0.93; P<0.001). A total of 334 patients (3.5%) in the alirocumab group and 392 patients (4.1%) in the placebo group died (hazard ratio, 0.85; 95% CI, 0.73 to 0.98). The absolute benefit of alirocumab with respect to the composite primary end point was greater among patients who had a baseline LDL cholesterol level of 100 mg or more per deciliter than among patients who had a lower baseline level. The incidence of adverse events was similar in the two groups, with the exception of local injection-site reactions (3.8% in the alirocumab group vs. 2.1% in the placebo group).
CONCLUSIONS
Among patients who had a previous acute coronary syndrome and who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab than among those who received placebo.
The New England Journal of Medicine
Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome | NEJM
Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic
cardiovascular events. We sought to determine whether alirocumab, a human monoclonal
antibody to proprotein ...
cardiovascular events. We sought to determine whether alirocumab, a human monoclonal
antibody to proprotein ...
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Association of Nonfasting vs Fasting #Lipid Levels With Risk of Major #Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2733560
Recent guidelines have recommended nonfasting for routine testing of lipid levels based on comparisons of nonfasting and fasting populations
Among the 8270 participants (82.1% male; mean SD age, 63.4 8.5 years), nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels compared to fasting samples. Associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels
Results were consistent by randomized treatment arm (atorvastatin calcium, 10 mg/d, or placebo) and similar for ASCVD events. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories was high (94.8%).
Conclusions and Relevance Measurement of nonfasting and fasting lipid levels yields similar results in the same individuals for association with incident coronary and ASCVD events. These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.
Association of Nonfasting vs Fasting #Lipid Levels With Risk of Major #Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2733560
Recent guidelines have recommended nonfasting for routine testing of lipid levels based on comparisons of nonfasting and fasting populations
Among the 8270 participants (82.1% male; mean SD age, 63.4 8.5 years), nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels compared to fasting samples. Associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels
Results were consistent by randomized treatment arm (atorvastatin calcium, 10 mg/d, or placebo) and similar for ASCVD events. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories was high (94.8%).
Conclusions and Relevance Measurement of nonfasting and fasting lipid levels yields similar results in the same individuals for association with incident coronary and ASCVD events. These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.
Jamanetwork
Association of Nonfasting vs Fasting Lipid Levels With Risk of Major Coronary Events in the ASCOT-LLA
This secondary analysis of a randomized clinical trial compares the association of nonfasting vs fasting lipid levels with coronary and vascular outcomes and assesses differences in calculated risk among participants undergoing both measurements.
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Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial #Fibrillation Undergoing Percutaneous #Coronary Intervention
https://jamanetwork.com/journals/jamacardiology/article-abstract/2735647
The antithrombotic treatment of patients with atrial fibrillation (AF) and coronary artery disease, in particular with acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI), poses a significant treatment dilemma in clinical practice.
Compared with a regimen of vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT; P2Y12 inhibitor plus aspirin), the odds ratios (ORs) for TIMI major bleeding were 0.58 (95% CI, 0.31-1.08) for VKA plus P2Y12 inhibitor, 0.49 (95% CI, 0.30-0.82) for non-VKA oral anticoagulant (NOAC) plus P2Y12 inhibitor, and 0.70 (95% CI, 0.38-1.23) for NOAC plus DAPT. Compared with VKA plus DAPT, the ORs for MACE were 0.96 (95% CI, 0.60-1.46) for VKA plus P2Y12 inhibitor, 1.02 (95% CI, 0.71-1.47) for NOAC plus P2Y12 inhibitor, and 0.94 (95% CI, 0.60-1.45) for NOAC plus DAPT.
Conclusions and Relevance A regimen of NOACs plus P2Y12 inhibitor was associated with less bleeding compared with VKAs plus DAPT. Strategies omitting aspirin caused less bleeding, including intracranial bleeding, without significant difference in MACE, compared with strategies including aspirin. Our results support the use of NOAC plus P2Y12 inhibitor as the preferred regimen post–percutaneous coronary intervention for these high-risk patients with AF. A regimen of VKA plus DAPT should generally be avoided.
Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial #Fibrillation Undergoing Percutaneous #Coronary Intervention
https://jamanetwork.com/journals/jamacardiology/article-abstract/2735647
The antithrombotic treatment of patients with atrial fibrillation (AF) and coronary artery disease, in particular with acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI), poses a significant treatment dilemma in clinical practice.
Compared with a regimen of vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT; P2Y12 inhibitor plus aspirin), the odds ratios (ORs) for TIMI major bleeding were 0.58 (95% CI, 0.31-1.08) for VKA plus P2Y12 inhibitor, 0.49 (95% CI, 0.30-0.82) for non-VKA oral anticoagulant (NOAC) plus P2Y12 inhibitor, and 0.70 (95% CI, 0.38-1.23) for NOAC plus DAPT. Compared with VKA plus DAPT, the ORs for MACE were 0.96 (95% CI, 0.60-1.46) for VKA plus P2Y12 inhibitor, 1.02 (95% CI, 0.71-1.47) for NOAC plus P2Y12 inhibitor, and 0.94 (95% CI, 0.60-1.45) for NOAC plus DAPT.
Conclusions and Relevance A regimen of NOACs plus P2Y12 inhibitor was associated with less bleeding compared with VKAs plus DAPT. Strategies omitting aspirin caused less bleeding, including intracranial bleeding, without significant difference in MACE, compared with strategies including aspirin. Our results support the use of NOAC plus P2Y12 inhibitor as the preferred regimen post–percutaneous coronary intervention for these high-risk patients with AF. A regimen of VKA plus DAPT should generally be avoided.
Jamanetwork
Safety and Efficacy of Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing PCI
This network meta-analysis of randomized controlled trials examines the safety and efficacy of different antithrombotic regimens.
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Development and validation of a ceramide- and #phospholipid-based cardiovascular risk estimation score for #coronary artery disease patients
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz387/5519585
Distinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospholipids have also been linked with CVD risk, we investigated whether the combination of ceramides with phosphatidylcholines (PCs) would be synergistic in the prediction of CVD events in patients with atherosclerotic coronary heart disease in three independent cohort studies
This score was highly significant in predicting CVD mortality multiadjusted hazard ratios (HRs; 95% confidence interval) per standard deviation were 1.44 (1.28–1.63) in WECAC, 1.47 (1.34–1.61) in the LIPID trial, and 1.69 (1.31–2.17) in KAROLA. In addition, a combination of the risk score with high-sensitivity troponin T increased the HRs to 1.63 (1.44–1.85) and 2.04 (1.57–2.64) in WECAC and KAROLA cohorts, respectively. The C-statistics in WECAC for the risk score combined with sex and age was 0.76 for CVD death. The ceramide-phospholipid risk score showed comparable and synergistic predictive performance with previously published CVD risk models for secondary prevention.
Conclusion
A simple ceramide- and phospholipid-based risk score can efficiently predict residual CVD event risk in patients with coronary artery disease.
Development and validation of a ceramide- and #phospholipid-based cardiovascular risk estimation score for #coronary artery disease patients
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz387/5519585
Distinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospholipids have also been linked with CVD risk, we investigated whether the combination of ceramides with phosphatidylcholines (PCs) would be synergistic in the prediction of CVD events in patients with atherosclerotic coronary heart disease in three independent cohort studies
This score was highly significant in predicting CVD mortality multiadjusted hazard ratios (HRs; 95% confidence interval) per standard deviation were 1.44 (1.28–1.63) in WECAC, 1.47 (1.34–1.61) in the LIPID trial, and 1.69 (1.31–2.17) in KAROLA. In addition, a combination of the risk score with high-sensitivity troponin T increased the HRs to 1.63 (1.44–1.85) and 2.04 (1.57–2.64) in WECAC and KAROLA cohorts, respectively. The C-statistics in WECAC for the risk score combined with sex and age was 0.76 for CVD death. The ceramide-phospholipid risk score showed comparable and synergistic predictive performance with previously published CVD risk models for secondary prevention.
Conclusion
A simple ceramide- and phospholipid-based risk score can efficiently predict residual CVD event risk in patients with coronary artery disease.
OUP Academic
Development and validation of a ceramide- and phospholipid-based cardiovascular risk estimation score for coronary artery disease…
AbstractAims. Distinct ceramide lipids have been shown to predict the risk for cardiovascular disease (CVD) events, especially cardiovascular death. As phospho
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A Nationwide Flash-Mob Study for Suspected Acute #Coronary Syndrome
http://www.annfammed.org/content/17/4/296.abstract
Our primary objective was to evaluate the Marburg Heart Score (MHS), a clinical decision rule, or to develop an adapted clinical decision rule for family physicians (FPs) to safely rule out acute coronary syndrome (ACS) in patients referred to secondary care for suspected ACS..
..A final diagnosis was obtained for 243 patients (94.2%), of whom 45 (18.5%) received a diagnosis of ACS. Sex, sex-adjusted age, and ischemic changes on electrocardiography were significantly associated with ACS. The sensitivity of the MHS (cut-off ≤2) was 75.0%, specificity was 44.0%, positive predictive value was 24.3%, and negative predictive value was 88.0%. For the FP assessment (cut-off ≤5), these test characteristics were 86.7%, 41.4%, 25.2%, and 93.2%, respectively.
CONCLUSIONS For patients referred to emergency care, ACS could not be safely ruled out using the MHS or FP clinical assessment. The flash-mob study design may be a feasible alternative research method to investigate relatively simple, clinically relevant research questions in family medicine on a large scale and over a relatively short time frame.
A Nationwide Flash-Mob Study for Suspected Acute #Coronary Syndrome
http://www.annfammed.org/content/17/4/296.abstract
Our primary objective was to evaluate the Marburg Heart Score (MHS), a clinical decision rule, or to develop an adapted clinical decision rule for family physicians (FPs) to safely rule out acute coronary syndrome (ACS) in patients referred to secondary care for suspected ACS..
..A final diagnosis was obtained for 243 patients (94.2%), of whom 45 (18.5%) received a diagnosis of ACS. Sex, sex-adjusted age, and ischemic changes on electrocardiography were significantly associated with ACS. The sensitivity of the MHS (cut-off ≤2) was 75.0%, specificity was 44.0%, positive predictive value was 24.3%, and negative predictive value was 88.0%. For the FP assessment (cut-off ≤5), these test characteristics were 86.7%, 41.4%, 25.2%, and 93.2%, respectively.
CONCLUSIONS For patients referred to emergency care, ACS could not be safely ruled out using the MHS or FP clinical assessment. The flash-mob study design may be a feasible alternative research method to investigate relatively simple, clinically relevant research questions in family medicine on a large scale and over a relatively short time frame.
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Five-Year Outcomes after #PCI or #CABG for Left Main #Coronary Disease
https://www.nejm.org/doi/full/10.1056/NEJMoa1909406
..In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, −1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, −1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, −1.9 percentage points; 95% CI, −3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, −0.8 percentage points; 95% CI, −2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0).
CONCLUSIONS
In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years.
Five-Year Outcomes after #PCI or #CABG for Left Main #Coronary Disease
https://www.nejm.org/doi/full/10.1056/NEJMoa1909406
..In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, −1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, −1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, −1.9 percentage points; 95% CI, −3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, −0.8 percentage points; 95% CI, −2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0).
CONCLUSIONS
In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years.
New England Journal of Medicine
Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease | NEJM
Original Article from The New England Journal of Medicine — Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease
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Long-Term Evolution of Premature #Coronary Artery Disease
They were age 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia. At baseline presentation, 91.2% underwent coronary revascularization, predominantly for acute MI (78.8%). Over a follow-up of 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n = 131 of 264), mostly related to new coronary lesions (17.3% vs. 7.8%; p = 0.01; hazard ratio [HR]:1.45; 95% confidence interval [CI]: 1.09 to 1.93 for new vs. initial culprit lesion). All-cause death (n = 55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted hazard ratio [adjHR]: 1.95; 95% CI: 1.13 to 3.35; p = 0.02), inflammatory disease (adjHR: 1.58; 95% CI: 1.05 to 2.36; p = 0.03), and persistent smoking (adjHR: 2.32; 95% CI: 1.63 to 3.28; p < 0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis.
Conclusions Premature CAD is an aggressive disease despite the currently recommended prevention measures, with high rates of recurrent events and mortality. Ethnicity and concomitant inflammatory disease are associated with poor prognoses, along with insufficient control of risk factors.
http://www.onlinejacc.org/content/74/15/1868
Long-Term Evolution of Premature #Coronary Artery Disease
They were age 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia. At baseline presentation, 91.2% underwent coronary revascularization, predominantly for acute MI (78.8%). Over a follow-up of 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n = 131 of 264), mostly related to new coronary lesions (17.3% vs. 7.8%; p = 0.01; hazard ratio [HR]:1.45; 95% confidence interval [CI]: 1.09 to 1.93 for new vs. initial culprit lesion). All-cause death (n = 55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted hazard ratio [adjHR]: 1.95; 95% CI: 1.13 to 3.35; p = 0.02), inflammatory disease (adjHR: 1.58; 95% CI: 1.05 to 2.36; p = 0.03), and persistent smoking (adjHR: 2.32; 95% CI: 1.63 to 3.28; p < 0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis.
Conclusions Premature CAD is an aggressive disease despite the currently recommended prevention measures, with high rates of recurrent events and mortality. Ethnicity and concomitant inflammatory disease are associated with poor prognoses, along with insufficient control of risk factors.
http://www.onlinejacc.org/content/74/15/1868
JACC: Journal of the American College of Cardiology
Long-Term Evolution of Premature Coronary Artery Disease
Background The long-term evolution of premature coronary artery disease (CAD) is unknown.
Objectives The objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes.
…
Objectives The objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes.
…
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#Glycated hemoglobin predicts #coronary artery disease in non-diabetic adults
..All patients underwent coronary computed tomography angiography (CCTA) for evaluation of chest pain. The extent of coronary artery stenosis (CAS) was quantified as percentage for each patient based on plaques detected in CCTA.
..Mean blood pressure of the patients was (91.2 ± 11.9 mmHg), BMI (28.3 ± 5.8 kg/m2), serum cholesterol level (174 ± 33.1 mg/dl), and HbA1c levels (mean 5.7 ± 0.45, median 5.7 and range 4.7–6.4%). Eighteen patients showed no CAS (47.4%), 12 showed minimal stenosis (31.6%), 3 showed mild stenosis (7.9%), 3 showed moderate stenosis (7.9%) and 2 showed severe stenosis (5.3%). A moderate correlation was detected between HbA1c and CAS percentages (r = 0.47, p < 0.05) as well as between HbA1c and the number of affected coronary vessels (r = 0.53, p < 0.001).
Conclusion
Glycated hemoglobin can be used as a predictive biomarker for CAD in non-diabetic low-risk patients.
https://bit.ly/2sghj8e
#Glycated hemoglobin predicts #coronary artery disease in non-diabetic adults
..All patients underwent coronary computed tomography angiography (CCTA) for evaluation of chest pain. The extent of coronary artery stenosis (CAS) was quantified as percentage for each patient based on plaques detected in CCTA.
..Mean blood pressure of the patients was (91.2 ± 11.9 mmHg), BMI (28.3 ± 5.8 kg/m2), serum cholesterol level (174 ± 33.1 mg/dl), and HbA1c levels (mean 5.7 ± 0.45, median 5.7 and range 4.7–6.4%). Eighteen patients showed no CAS (47.4%), 12 showed minimal stenosis (31.6%), 3 showed mild stenosis (7.9%), 3 showed moderate stenosis (7.9%) and 2 showed severe stenosis (5.3%). A moderate correlation was detected between HbA1c and CAS percentages (r = 0.47, p < 0.05) as well as between HbA1c and the number of affected coronary vessels (r = 0.53, p < 0.001).
Conclusion
Glycated hemoglobin can be used as a predictive biomarker for CAD in non-diabetic low-risk patients.
https://bit.ly/2sghj8e
BMC Cardiovascular Disorders
Glycated hemoglobin predicts coronary artery disease in non-diabetic adults
Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Due to increased CAD risk factors in Saudi Arabia, research on more feasible and predictive biomarkers is needed. We aimed to evaluate glycated hemoglobin (HbA1c) as a predictor…
#Coronary Artery Calcium for Personalized Allocation of #Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The Multi-Ethnic Study of Atherosclerosis (MESA)
https://2medical.news/2020/04/15/coronary-artery-calcium-for-personalized-allocation-of-aspirin-in-primary-prevention-of-cardiovascular-disease-in-2019-the-multi-ethnic-study-of-atherosclerosis-mesa/
..The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention using 2019 aspirin meta-analysis data on CVD relative risk reduction (RRR) and bleeding risk ..Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to ACC/AHA guidelines and using >20% estimated ASCVD risk to define “higher risk”. Benefit/harm calculations were restricted …
https://2medical.news/2020/04/15/coronary-artery-calcium-for-personalized-allocation-of-aspirin-in-primary-prevention-of-cardiovascular-disease-in-2019-the-multi-ethnic-study-of-atherosclerosis-mesa/
..The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention using 2019 aspirin meta-analysis data on CVD relative risk reduction (RRR) and bleeding risk ..Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to ACC/AHA guidelines and using >20% estimated ASCVD risk to define “higher risk”. Benefit/harm calculations were restricted …
#Coronary artery disease prediction in women and men using chest pain characteristics and risk factors: an observational study in outpatient clinics
https://2medical.news/2020/05/02/coronary-artery-disease-prediction-in-women-and-men-using-chest-pain-characteristics-and-risk-factors-an-observational-study-in-outpatient-clinics/
..Twenty-four women (5%) and 75 men (15%) were diagnosed with coronary artery disease by invasive coronary angiography or CT angiography during regular care follow-up. Elastic net regression was performed to assess which chest pain characteristics and risk factors were of diagnostic value. The overall model selected age, provocation by temperature or stress, relief at rest and functional class as determinants and was accurate in both …
https://2medical.news/2020/05/02/coronary-artery-disease-prediction-in-women-and-men-using-chest-pain-characteristics-and-risk-factors-an-observational-study-in-outpatient-clinics/
..Twenty-four women (5%) and 75 men (15%) were diagnosed with coronary artery disease by invasive coronary angiography or CT angiography during regular care follow-up. Elastic net regression was performed to assess which chest pain characteristics and risk factors were of diagnostic value. The overall model selected age, provocation by temperature or stress, relief at rest and functional class as determinants and was accurate in both …
Age- and Weight-Adapted Dose of #Prasugrel Versus Standard Dose of #Ticagrelor in Patients With Acute #Coronary Syndromes
https://2medical.news/2020/07/24/age-and-weight-adapted-dose-of-prasugrel-versus-standard-dose-of-ticagrelor-in-patients-with-acute-coronary-syndromes/
The efficacy and safety of a reduced dose of prasugrel versus a standard dose of ticagrelor in elderly patients or those with a low body weight presenting with an acute coronary syndrome (ACS) are unknown.. ..The efficacy and safety of a reduced dose of prasugrel versus a standard dose of ticagrelor in elderly patients or those with a low body weight presenting with an acute …
https://2medical.news/2020/07/24/age-and-weight-adapted-dose-of-prasugrel-versus-standard-dose-of-ticagrelor-in-patients-with-acute-coronary-syndromes/
The efficacy and safety of a reduced dose of prasugrel versus a standard dose of ticagrelor in elderly patients or those with a low body weight presenting with an acute coronary syndrome (ACS) are unknown.. ..The efficacy and safety of a reduced dose of prasugrel versus a standard dose of ticagrelor in elderly patients or those with a low body weight presenting with an acute …
Association of Hepatic #Steatosis with Major Adverse Cardiovascular Events, Independent of #Coronary Artery Disease
https://2medical.news/2020/07/27/association-of-hepatic-steatosis-with-major-adverse-cardiovascular-events-independent-of-coronary-artery-disease/
Hepatic steatosis has been associated with increased risk of major adverse cardiovascular events (MACE) but it is not clear whether steatosis is independently associated with risk of MACE. We investigated whether steatosis is associated with risk of MACE independently of the presence and extent of baseline coronary artery disease, assessed by comprehensive contrast-enhanced computed tomography angiography (CTA).. ..Among the 959 subjects who had steatosis (25.5% …
https://2medical.news/2020/07/27/association-of-hepatic-steatosis-with-major-adverse-cardiovascular-events-independent-of-coronary-artery-disease/
Hepatic steatosis has been associated with increased risk of major adverse cardiovascular events (MACE) but it is not clear whether steatosis is independently associated with risk of MACE. We investigated whether steatosis is associated with risk of MACE independently of the presence and extent of baseline coronary artery disease, assessed by comprehensive contrast-enhanced computed tomography angiography (CTA).. ..Among the 959 subjects who had steatosis (25.5% …
Prevalence and Prognostic Significance of #Malnutrition in Patients With Acute #Coronary Syndrome
https://2medical.news/2020/10/11/prevalence-and-prognostic-significance-of-malnutrition-in-patients-with-acute-coronary-syndrome/
Malnutrition is associated with poor prognosis in a wide range of illnesses. However, its prognostic impact in patients with acute coronary syndrome (ACS) is not well known.. ..In this study, the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI) was applied to 5,062 consecutive patients with ACS. The relationships between malnutrition risk and all-cause mortality and major …
https://2medical.news/2020/10/11/prevalence-and-prognostic-significance-of-malnutrition-in-patients-with-acute-coronary-syndrome/
Malnutrition is associated with poor prognosis in a wide range of illnesses. However, its prognostic impact in patients with acute coronary syndrome (ACS) is not well known.. ..In this study, the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI) was applied to 5,062 consecutive patients with ACS. The relationships between malnutrition risk and all-cause mortality and major …
Elevated #Coronary Artery Calcium scores are associated with #tooth loss
https://2medical.news/2020/12/21/elevated-coronary-artery-calcium-scores-are-associated-with-tooth-loss/
This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph–OPG).. ..212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, …
https://2medical.news/2020/12/21/elevated-coronary-artery-calcium-scores-are-associated-with-tooth-loss/
This study explores the association between Coronary Artery Calcium (CAC) scores and dental pathology such as missing teeth, the (peri-apical) health status and restoration grade of the teeth, and the grade of alveolar bone loss seen on a dental panoramic radiograph (Orthopantomograph–OPG).. ..212 patients were included. We found a statistically significant association between the number of missing teeth and the CAC score. When modeling age, …
Association between Pre-Existing #Coronary Artery Disease and 5-Year Mortality in #Stroke Patients with High-Grade Carotid Artery Stenosis
https://2medical.news/2020/12/27/association-between-pre-existing-coronary-artery-disease-and-5-year-mortality-in-stroke-patients-with-high-grade-carotid-artery-stenosis/
The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. Methods: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients …
https://2medical.news/2020/12/27/association-between-pre-existing-coronary-artery-disease-and-5-year-mortality-in-stroke-patients-with-high-grade-carotid-artery-stenosis/
The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. Methods: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients …
#Coronary heart disease in mothers and fathers of adult children with #alcohol use disorders
https://2medical.news/2021/06/04/coronary-heart-disease-in-mothers-and-fathers-of-adult-children-with-alcohol-use-disorders/
https://2medical.news/2021/06/04/coronary-heart-disease-in-mothers-and-fathers-of-adult-children-with-alcohol-use-disorders/
2Medical.News
#Coronary heart disease in mothers and fathers of adult children with #alcohol use disorders
Having a family member with an alcohol use disorder (AUD) may negatively affect a person’s health. Our aim was to study the long-term risk of coronary heart disease (CHD) in parents who have an off…
Long-term night #shift work is associated with the risk of atrial #fibrillation and #coronary heart disease
https://2medical.news/2021/08/18/long-term-night-shift-work-is-associated-with-the-risk-of-atrial-fibrillation-and-coronary-heart-disease/
https://2medical.news/2021/08/18/long-term-night-shift-work-is-associated-with-the-risk-of-atrial-fibrillation-and-coronary-heart-disease/
2Medical.News
Long-term night #shift work is associated with the risk of atrial #fibrillation and #coronary heart disease
The aim of this study was to test whether current and past night shift work was associated with incident atrial fibrillation (AF) and whether this association was modified by genetic vulnerability.…
Estimating dose-response relationships for vitamin #D with #coronary heart disease, #stroke, and all-cause mortality: observational and Mendelian randomisation analyses
https://2medical.news/2021/11/05/estimating-dose-response-relationships-for-vitamin-d-with-coronary-heart-disease-stroke-and-all-cause-mortality-observational-and-mendelian-randomisation-analyses/
https://2medical.news/2021/11/05/estimating-dose-response-relationships-for-vitamin-d-with-coronary-heart-disease-stroke-and-all-cause-mortality-observational-and-mendelian-randomisation-analyses/
2Medical.News
Estimating dose-response relationships for vitamin #D with #coronary heart disease, #stroke, and all-cause mortality: observational…
SummaryBackgroundRandomised trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings. However, generalisability of results to ind…