Evaluation of selected risk factors for cardiovascular diseases and diabetes as a background for the prevention program in occupational healthcare.

OBJECTIVES: Cardiovascular and metabolic disorders constitute major health problems in the working populations in Europe. The aim of this project was to evaluate the health condition of workers employed in a Polish research and medical institution, and then to establish the necessary preventive actions by creating a modern model of occupational healthcare integrated with civilization disease (CivD) prevention. MATERIAL AND METHODS: Overall, 100 workers voluntarily participated in a health program for CivD prevention during mandatory prophylactic examinations. Data from these examinations was collected in a system of electronic documentation to enable the analysis of the workers' health condition and risk factors of CivDs. RESULTS: Women accounted for 72% of the employees who voluntarily participated in the prevention program, and 80% of the subjects had university education. As regards the health condition, 27% of the patients had elevated systolic, and 23% diastolic, blood pressure, and 21% had an abnormal fasting glucose level. Stressful job was an important factor correlated with an excessive body mass index, diastolic blood pressure, as well as total and low-density lipoprotein cholesterol levels. Smoking, sedentary work and a lack of physical activity were significant factors for abdominal obesity. Generally, 94% of the program participants required some further interventions in lifestyle, diagnostics or treatment. CONCLUSIONS: Civilization disease prevention should focus on increasing physical activity both in leisure time and at the workplace as far as practicable. There is a need for implementing projects leading to occupational stress reduction and smoking cessation. Men as well as workers with vocational and elementary education need to be recruited for prevention programs dedicated to employees. Int J Occup Med Environ Health. 2021;34(3):403-13.

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program.

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established. OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment. MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) >140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients' suitability for RDN. RESULTS: A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), ß-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), ß-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). CONCLUSIONS: Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients.

Relative value of serum pregnancy-associated plasma protein A (PAPP-A) and GRACE score for a 1-year prognostication: A complement to calculation in patients with suspected acute coronary syndrome.

BACKGROUND: The Global Registry of Acute Coronary Events (GRACE) study produced a scale for risk stratification in acute coronary syndromes (ACSs). Pregnancy-associated plasma protein A (PAPP-A) serum concentration was implicated as a marker of unstable atherosclerotic plaques. OBJECTIVES: We hypothesized that the measurement of the concentration of PAPP-A on admission may improve the stratification of cardiovascular risk in suspected ACS patients. MATERIAL AND METHODS: We studied 70 patients with chest pain suggesting ACS diagnosis on admission. Serum cardiac biomarkers and PAPP-A were measured on top of the standard biochemical panel, and the GRACE risk score was calculated. A 12-month follow-up was completed to major adverse cardiac events (MACE): death, myocardial infarction (MI), need for percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG), unplanned cardiovascular hospitalization. RESULTS: In hospital/6-month GRACE, low risk was found in 35 patients (50%)/37 patients (53%), intermediate risk in 23 patients (33%)/21 patients (30%) and high risk in 12 patients (17%)/12 patients (17%). Mean PAPP-A was 39.64 mlU/L (standard deviation - SD 24.2), and median PAPP-A values for in hospital/6-month GRACE were 21.49 mlU/L (quartile 1st; 3rd - 13.41; 32.65) and 22.61 mlU/L (14.03; 34.1) for low risk patients, 51.76 mlU/L (35.18; 59.99) and 51.76 mlU/L (28.9; 62.1) for intermediate risk patients, and 68.82 mlU/L (58.54; 83.76) for high risk patients. The PAAP-A concentration with specific cut-off points had 66.7% positive predictive value (PPV) and 95.5% negative predictive value (NPV) for death, 33.3% PPV and 80.6% NPV for MI, 71.4% PPV and 57.1% NPV for any event. Intermediate and high in hospital/6-months GRACE had 14.3%/15.2% PPV and 100%/100% NPV for death, 34.3%/33.3% PPV and 94.3%/91.9% NPV for MI, 74.3%/72.7% PPV and 65.7%/62.2% NPV for any event. CONCLUSIONS: The PAPP-A serum concentration represents a promising prognostic biomarker with significantly improved PPV. The GRACE score is superior to stratification based on PAPP-A with regard to combined cut-off point for 1-year mortality.

Aorto-Atrial Fistulas: A Contemporary Review.

Aorto-atrial fistulas (AAFs) are a relatively rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria. AAFs are most often the result of an underlying condition concerning the cardiac structures. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. Secondary causes incite local deterioration of cardiac wall integrity leading to formation of fistulous connections, whereas iatrogenic causes are more traumatic in nature. Signs and symptoms include those of volume overload and heart failure, with patients often presenting with fever, regurgitative murmurs, cardiac chamber dilation, and pedal edema. The diagnosis of AAFs requires a high degree of clinical suspicion necessitating imaging techniques such as echocardiography, computer tomography, and more invasive procedures. Management is dependent on underlying conditions and include the use of antibiotics, percutaneous closure, and in many cases, open heart surgery. It is important for physicians to be aware of this pathological condition to aid in timely management and favorable outcomes. This review attempts to summarize the various causes and clinical presentations of AAFs over the past decades.

Pulmonary arterial hypertension: a current review of pharmacological management.

Pulmonary hypertension (PHTN) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance, which eventually leads to right ventricular failure and death. At present there is no cure for pulmonary arterial hypertension (PAH); however over the past decade targeted pharmaceutical options have become available for the treatment of PAH. Prior to evaluation for therapeutic options a definitive diagnosis of pulmonary arterial hypertension must be made via comprehensive physical exam and definitive diagnostic testing. Screening test of choice remains echocardiography and gold standard for definitive diagnosis is right heart catheterization. Once the establishment of a diagnosis of PAH is made therapeutic options may be a possibility based on a diagnostic algorithm and disease severity of the PAH patient. There are different classes of medications available with different mechanisms of actions which net a vasodilatory effect and improve exercise tolerance, quality of life as well and survival.

Pulmonary rehabilitation and exercise in pulmonary arterial hypertension: An underutilized intervention.

Pulmonary arterial hypertension (PAH) is a rare and devastating disease characterized by progressive increases in pulmonary arterial pressure and pulmonary vascular resistance which eventually leads to right ventricular failure and death. Early thought process was that exercise and increased physical activity may be detrimental to PAH patients however many small cohort trials have proven otherwise. In addition to the many pharmaceutical options, exercise and pulmonary rehabilitation have also been shown to increase exercise capacity as well as various aspects of psychosomatic health. As pulmonary and exercise rehabilitation become more widely used as an adjuvant therapy patient outcomes improve and physicians should consider this in the therapeutic algorithm along with pharmacotherapy.

[Barriers to professional activity among people with cardiovascular diseases]. / Bariery w aktywizacji zawodowej osób z chorobami ukladu krazenia.

Cardiovascular diseases (CVD) are a very important issue for the health care system. They are usually chronic diseases widespread in the society that require costly treatment and cause long-term sick absenteeism and partial or total incapacity for work. CVD are one of the most common cause of disability in Poland, therefore they constitute a medical, social and economic problem. Low occupational activity of people with CVD at working age requires special effort to develop and implement methods of their professional activation. A key role in this process should be played by physicians of occupational health services (OHS). In the case of disabled workers with cardiovascular disease, the decision about avoiding professional activity is often medically unjustified. It arises from a lack of sufficient knowledge ofjurisprudence and the fear of both the physician and the employee ofpatient's health deteriorations. Therefore, educational actions addressed to OHS physicians and to the patients are needed to enable the patients with CVD to remain at or to return to work.