RESUMO
Aims: Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results: We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02â mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions: The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
Assuntos
Fármacos Cardiovasculares/uso terapêutico , Aprovação de Drogas/legislação & jurisprudência , Medicina Baseada em Evidências/legislação & jurisprudência , Regulamentação Governamental , Disparidades em Assistência à Saúde/legislação & jurisprudência , Insuficiência Cardíaca/tratamento farmacológico , Ivabradina/uso terapêutico , United States Food and Drug Administration/legislação & jurisprudência , Europa (Continente) , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Ivabradina/efeitos adversos , Segurança do Paciente , Formulação de Políticas , Medição de Risco , Fatores de Risco , Estados UnidosAssuntos
Doenças Cardiovasculares/prevenção & controle , Meios de Comunicação , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Disseminação de Informação/métodos , Educação de Pacientes como Assunto , Recusa do Paciente ao Tratamento , Acesso à Informação , Doenças Cardiovasculares/mortalidade , Conflito de Interesses , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Marketing de Serviços de Saúde , Segurança do Paciente , Medição de Risco , Fatores de RiscoAssuntos
Antiarrítmicos/farmacologia , Arritmias Cardíacas , Tomada de Decisão Clínica/métodos , Conduta do Tratamento Medicamentoso/normas , Arritmias Cardíacas/classificação , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/tratamento farmacológico , Consenso , Monitoramento de Medicamentos/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , HumanosAssuntos
Reabilitação Cardíaca/métodos , Doenças Cardiovasculares/prevenção & controle , Adulto , Fatores Etários , Idoso , Anti-Hipertensivos/uso terapêutico , Biomarcadores/metabolismo , Reabilitação Cardíaca/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etnologia , Análise Custo-Benefício , Angiopatias Diabéticas/prevenção & controle , Diagnóstico por Imagem/métodos , Dieta Saudável , Exercício Físico/fisiologia , Medicina Geral/métodos , Promoção da Saúde/métodos , Estilo de Vida Saudável , Humanos , Hiperlipidemias/prevenção & controle , Hipertensão , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas , Linhagem , Padrões de Prática Médica/normas , Medição de Risco , Fatores Sexuais , Abandono do Hábito de Fumar , Fatores SocioeconômicosRESUMO
Patient-reported outcomes (PROs), such as symptoms, health-related quality of life (HRQOL), or patient perceived health status, are reported directly by the patient and are powerful tools to inform patients, clinicians, and policy-makers about morbidity and 'patient suffering', especially in chronic diseases. Patient-reported outcomes provide information on the patient experience and can be the target of therapeutic intervention. Patient-reported outcomes can improve the quality of patient care by creating a holistic approach to clinical decision-making; however, PROs are not routinely used as key outcome measures in major cardiovascular clinical trials. Thus, limited information is available on the impact of cardiovascular therapeutics on PROs to guide patient-level clinical decision-making or policy-level decision-making. Cardiovascular clinical research should shift its focus to include PROs when evaluating the efficacy of therapeutic interventions, and PRO assessments should be scientifically rigorous. The European Society of Cardiology and other professional societies can take action to influence the uptake of PRO data in the research and clinical communities. This process of integrating PRO data into comprehensive efficacy evaluations will ultimately improve the quality of care for patients across the spectrum of cardiovascular disease.
Assuntos
Doenças Cardiovasculares/terapia , Ensaios Clínicos como Assunto/métodos , Avaliação de Resultados da Assistência ao Paciente , Cardiologia , Coleta de Dados , Interpretação Estatística de Dados , Europa (Continente) , Humanos , Disseminação de Informação , Reembolso de Seguro de Saúde , Política Organizacional , Qualidade de Vida , Sociedades Médicas , Terminologia como AssuntoAssuntos
Dislipidemias/terapia , Algoritmos , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Dislipidemias/economia , Objetivos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Lipídeos/sangue , Medição de Risco , EspanhaRESUMO
OBJECTIVES: To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls. METHODS: 113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations. RESULTS: Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers. CONCLUSION: Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.
Assuntos
Artrite Reumatoide/complicações , Doenças Cardiovasculares/etiologia , Adulto , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Autoanticorpos/sangue , Biomarcadores/sangue , Doenças Cardiovasculares/prevenção & controle , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Cíclicos/imunologia , Indução de Remissão , Gestão de Riscos/métodosAssuntos
Angiografia Coronária/economia , Custos de Cuidados de Saúde , Infarto do Miocárdio , Guias de Prática Clínica como Assunto , Biomarcadores/sangue , Redução de Custos , Diagnóstico Precoce , Europa (Continente) , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia , Infarto do Miocárdio/terapia , Revascularização Miocárdica , Inibidores da Agregação Plaquetária/uso terapêutico , Medição de Risco , Fatores de Tempo , Troponina T/sangueRESUMO
OBJECTIVE: To compare different non-invasive methods for determination of human endothelial function in peripheral circulation. DESIGN: Observational, cross-sectional study in 39 healthy subjects (21 females, age 17-56 years). SETTING: Vascular research laboratory at university hospital. METHODS: Laser Doppler (LD) flowmetry was used to compare skin microvascular perfusion changes during postocclusive reactive hyperaemia with those induced by iontophoretic administration of acetylcholine (ACh), an endothelial-dependent vasodilator. LD measurements were compared with ultrasonographic measurements of postocclusive flow-mediated dilatation (FMD) in the brachial artery (n = 21). RESULTS: Local ACh induced a larger and more sustained skin perfusion increase than reactive hyperaemia after 4 min of regional arterial occlusion (P<0.001). A significant correlation was found between the magnitude of ACh-induced vasodilatation and peak reactive hyperaemia, both in absolute (r = 0.62, P<0.001) and relative terms (r = 0.58, P<0.001). A correlation was also found between brachial artery FMD and the magnitude of ACh-induced skin perfusion increase (r = 0.43, P<0.05) but not between FMD and reactive hyperaemia. CONCLUSION: Endothelial function, an early marker of cardiovascular risk, can be non-invasively assessed and graded by LD and FMD-measurements and despite inherent differences, both methods do correlate.