Association between hormone therapy and short-term cardiovascular events in women with spontaneous coronary artery dissection.

INTRODUCTION AND OBJECTIVES: Changes in sex hormone levels are a known triggering factor for spontaneous coronary artery dissection (SCAD) in women. However, it is unknown whether exposure to exogenous hormone therapy (HT) at the time of SCAD presentation modifies the clinical course of this condition. We investigated the association between HT in female patients presenting with SCAD and short-term clinical outcomes. METHODS: We enrolled consecutive patients presenting with SCAD from the DISCO-IT/SPA (dissezioni spontanee coronariche Italian-Spanish) registry. Women on HT (estrogens, progestagens, or gonadotropins) at the time of presentation were identified, and their clinical characteristics and short-term outcomes were compared with those not receiving active HT. The outcome measure was nonfatal myocardial infarction and/or unplanned percutaneous coronary intervention during the first 28 days after the index catheterization. RESULTS: Of 224 women presenting with SCAD (mean age 52.0±10.0 years), 39 (17.4%) were currently using HT while 185 (82.6%) were not. No significant differences were noted in the baseline demographics, clinical presentation, angiographic features, or initial treatment received between the 2 groups. All patients on systemic HT (n=36, 92%) discontinued it at the time of diagnosis. The composite outcome occurred in 7 (17.9%) patients with prior HT compared with 14 (7.6%) without (P=.039). After multivariable adjustment, HT remained associated with the composite outcome recorded in the first 28 days of follow-up (HR, 3.53; 95%CI, 1.30-9.61; P=.013). CONCLUSIONS: In women with SCAD, exposure to HT at the time of clinical presentation was associated with short-term recurrent cardiovascular events such as nonfatal myocardial infarction and/or unplanned percutaneous revascularization.

Profile of Cardiovascular Disease Patients Who are Diagnosed with COPD in a Smoking-Cessation Unit.

INTRODUCTION: Cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD) have similar prevalence rates and risk factors, and both frequently occur in the same patient. The primary objective of the study was to evaluate the rate of COPD patients among subjects with some form of CVD referring to a smoking cessation unit. The secondary objective was to analyze the demographic and clinical profile of these subjects and to identify independent factors potentially associated with COPD. METHODS: Observational, prospective study involving 132 patients with smoking habits, and some form of CVD, referring to the smoking cessation unit at the Pulmonology Department of the University Hospital of Cáceres, Spain, between October 2015 and March 2017. RESULTS: A total of 58 patients (43.9%) were diagnosed with COPD. Main CVDs were: ischemic heart disease (76.5%), chronic heart failure (24.8%), peripheral arterial disease (18.5%), and atrial fibrillation (7.6%). Independent factors were: pack-years (> 30 versus < 30; odds ratio, OR 5.3; 95% CI 1.3-21.4); forced expiratory volume in the first second (OR 0.9; 95% CI 0.9-1.0); chronic heart failure (yes versus no; OR 4.7; 95% CI 1.3-16.4); and modified Medical Research Council (mMRC) dyspnea (2-3 versus 0; OR 18.7; 95% CI 1.9-182.0). CONCLUSIONS: Four of ten patients with some form of CVD also experience COPD. Dyspnea, airflow limitation, smoking habits, and chronic heart failure were significant factors associated with COPD in patients with CVD. Smoking cessation units are useful to improve the diagnosis of COPD in these patients. Further prospective studies with a greater cohort of patients are required to corroborate the present results and to enhance the knowledge of the clinical profile of these patients.