Comparison of the performance of the AUB-HAS2 Cardiovascular Risk Index in emergency vs elective surgeries.

BACKGROUND: The AUB-HAS2 Cardiovascular Risk Index is a newly derived tool for preoperative cardiovascular evaluation. It is based on six data elements: history of heart disease, symptoms of angina or dyspnea, age ≥ 75 years, hemoglobin < 12 g/dl, vascular surgery, and emergency surgery. This study compares the performance of this new index among emergency and elective surgeries. METHODS AND RESULTS: The study population consisted of 1,167,414 non-cardiac surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database (153,715 were emergency and 1,013,699 were elective). Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or >3 depending on the number of data elements s/he has. The outcome measure (death, myocardial infarction, or stroke at 30 days after surgery) was higher in emergency than elective surgeries (7.0 % vs 1.4 %, p < 0.0001). The AUB-HAS2 index was able to stratify risk in both types of surgeries with a gradual increase in risk as the score increased (p < 0.0001). The discriminatory power of the AUB-HAS2 index, measured by the area under the receiver operator characteristic curves, was good and similar in the two types of surgeries (0.804 for emergency vs 0.791 for elective surgeries). CONCLUSION: The AUB-HAS2 index is a versatile tool that can effectively and equally stratify risk in both emergency and elective surgeries with a good discriminatory power.

Effect of age and gender on pre-operative cardiovascular risk assessment.

BACKGROUND: The AUB-HAS2 Cardiovascular Risk Index is a recently published tool for pre-operative cardiovascular evaluation. It is based on six data elements: history of heart disease, symptoms of angina or dyspnea, age ≥ 75 years, hemoglobin < 12 mg/dl, vascular surgery, and emergency surgery. The objective of this study is to study the effect of age and gender on the performance of the AUB-HAS2 Index in pre-operative cardiovascular risk assessment. METHODS: The study population consisted of 1,167,414 non-cardiac surgeries registered in the ACS NSQIP database. The population was stratified by age (≥ 40 and < 40 years old) and by gender (men and women). Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or > 3 based on the number of data elements s/he has. The outcome measure was all-cause mortality, myocardial infarction (MI), or stroke at 30 days after surgery. RESULTS: The overall 30-day event rate was higher in patients ≥ 40 years compared to those < 40 years (2.5% vs 0.3%, P < 0.0001) and in men compared to women (2.7% vs 1.8%, P < 0.0001). In both age and gender subgroups, there was a gradual and significant increase in the outcome measure (death, MI, or stroke) as the AUB-HAS2 score increased: from ≤ 0.5% in those with a score of 0 to more than 15% in those with a score > 3 (P < 0.0001). The AUB-HAS2 Index was able to stratify risk in all subgroups into low, intermediate, and high (P < 0.0001). Receiver operating characteristic curves showed the AUB-HAS2 Index has very good discriminatory power in both age (area under the curve (AUC) of 0.81 and 0.78) and gender (AUCs of 0.79 and 0.84) subgroups. CONCLUSION: This study extends the validation of the newly derived AUB-HAS2 Cardiovascular Risk Index to different age and gender subgroups with very good discriminative power.

Effect of lurasidone versus olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia: a randomized controlled trial.

OBJECTIVE: Patients with schizophrenia are at higher risk of cardiovascular morbidity and mortality than healthy individuals. This study was conducted to compare the effect of lurasidone and olanzapine on cardiometabolic parameters in unmedicated patients with schizophrenia. METHODS: The present study was a randomized open-label, parallel design, active-controlled clinical trial. After recruitment and randomization of 101 patients, a baseline assessment was done by PANSS, SOFAS, lipid profile, fasting blood glucose, HbA1c, serum insulin and serum hs-CRP. HOMA-IR, atherogenic index, coronary risk index and cardiovascular risk indices were calculated as derived parameters. Patients received either lurasidone 80 mg or olanzapine 10 mg as monotherapy and followed up after 6 weeks. RESULTS: There was a significant increase in fasting blood glucose (p < 0.001), HbA1c (p < 0.001) and serum insulin (p < 0.001) after 6 weeks of therapy in both the treatment groups but the difference between the groups was not significant (FBS, p = 0.209; HbA1c, p = 0.209; serum insulin, p = 0.720). Olanzapine showed worsening of lipid profile (p < 0.001) while the same improved with lurasidone (p < 0.001) and the difference between the groups was found to be significant (p < 0.001). Serum HDL level decreased in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) but the difference between the groups was not significant (p = 0.333). There was an increase in hs-CRP levels in both the treatment groups (olanzapine, p < 0.001; lurasidone, p < 0.001) with no significant difference between them (p = 0.467). Atherogenic index, coronary risk index and cardiovascular risk index increased significantly in the olanzapine group as compared with the lurasidone group (p < 0.001). CONCLUSION: Lurasidone showed a favourable effect on lipid profile and cardiovascular risk indices over olanzapine. However, long-term studies are needed to establish and generalize the findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03304457.

AUB-HAS2 Cardiovascular Risk Index: Performance in Surgical Subpopulations and Comparison to the Revised Cardiac Risk Index.

Background The American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index is a newly derived index for preoperative cardiovascular evaluation. It is based on 6 data elements: history of heart disease; symptoms of angina or dyspnea; age ≥75 years; hemoglobin <12 mg/dL; vascular surgery; and emergency surgery. In this study we analyze the performance of this new index and compare it with that of the Revised Cardiac Risk Index in a broad spectrum of surgical subpopulations. Methods and Results The study population consisted of 1 167 278 noncardiac surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database. Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or >3, depending on the number of data elements present. The performance of the AUB-HAS2 index was studied in 9 surgical specialty groups and in 8 commonly performed site-specific surgeries. Receiver operating characteristic curves were constructed for the AUB-HAS2 and Revised Cardiac Risk Index measures, and the areas under the curve were compared. The outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. The AUB-HAS2 score was able to stratify risk in all surgical subgroups (P<0.001). In the majority of surgeries, patients with an AUB-HAS2 score of 0 had an event rate of <0.5%. The performance of the AUB-HAS2 index was superior to that of the Revised Cardiac Risk Index in all surgical subgroups (P<0.001). Conclusions This study extends the validation of the AUB-HAS2 index to a broad spectrum of surgical subpopulations and demonstrates its superior discriminatory power compared with the commonly utilized Revised Cardiac Risk Index.

A New Index for Pre-Operative Cardiovascular Evaluation.

BACKGROUND: Currently used indices for pre-operative cardiovascular evaluation are either powerful, but complex, or simple, but with weak discriminatory power. OBJECTIVES: This study sought to prospectively derive and validate a simple powerful index that can stratify the cardiovascular risk of patients undergoing noncardiac surgery. METHODS: The derivation cohort consisted of 3,284 prospectively enrolled adult patients undergoing noncardiac surgery at the American University of Beirut Medical Center. The validation cohort consisted of 1,167,414 patients registered in the American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. RESULTS: The primary outcome occurred in 38 patients (1.2%) in the derivation cohort. Multivariate logistic regression analysis in the derivation cohort identified 6 data elements to be included in the prediction model: age ≥75 years, history of heart disease, symptoms of angina or dyspnea, hemoglobin <12 mg/dl, vascular surgery, and emergency surgery. Each patient was assigned a Cardiovascular Risk Index (CVRI) of 0, 1, 2, 3, and >3 based on the number of data elements present. The incidence of the primary outcome increased steadily across the CVRI groups in both the derivation (0%, 0.5%, 2.0%, 5.6%, and 15.7%, respectively; p < 0.0001) and validation (0.3%, 1.6%, 5.6%, 11.0%, and 17.5%, respectively; p < 0.0001) cohorts. The discriminatory power of the new CVRI was further confirmed by constructing a receiver-operating characteristic curve that had an area under the curve of 0.90 in the derivation cohort and 0.82 in the validation dataset. CONCLUSIONS: This study reports a new index for pre-operative cardiovascular evaluation which has a strong discriminatory power that can effectively stratify patients into low- (CVRI 0 to 1), intermediate- (CVRI 2 to 3), and high-risk (CVRI >3) groups. This has important implications for the efficient triage and management of patients scheduled for noncardiac surgery.

Influencia del consumo de pulpa de aguacate,Persea americana, sobre el metabolismo lipídico en ratones normolipémicos e hiperlipémicos inducidos por dieta / Influence of avocado (persea americana) pulp consumption on lipid metabolism in normolipidemic and diet induced hyperlipidemic mice

La dislipidemia es un factor de riesgo para el desarrollo de enfermedades cardiovasculares, una de las principales causas de muertes a nivel mundial. En este trabajo se estudió el efecto del aguacate (Persea americana) sobre el metabolismo lipídico de ratones normo e hiperlipémicos inducidos con dieta hiperlipídica. Ratones machos, fueron distribuidos en 4 grupos DE (dieta estándar), DEa (dieta estándar y aguacate); DH (dieta hiperlipídica) y DHa (dieta hiperlipídica y aguacate) y observados por 28 días. Luego de este periodo se determinaron los niveles de Colesterol Total, Triglicéridos y col-HDL y se calcularon los valores de col-LDL, VLDL e índices de riesgo aterogénico y de riesgo coronario. El grupo DH mostró niveles de CT, TG, col-LDLy VLDL significativamente superiores (p<0,001) a los valores alcanzados en el grupo DE. En los grupos DHa y DEa se redujeron significativamente (p<0,001) las concentraciones de CT, TG, col-LDL y VLDL, en comparación al grupo DH. Los grupos DEa y DHa difieren significativamente (p<0,005) en el nivel de CT, éste último presenta valores más bajos, los otros parámetros cuantificados no mostraron diferencias significativas. No hubo diferencias significativas para los valores del col-HDL en ningún grupo de estudio. La inducción a la hiperlipemia con un modelo de dieta hiperlipídica, generó incrementos importantes en el CT, TG, col-LDL y VLDL, además de aumentar el riesgo aterogénico. El consumo de la pulpa de aguacate redujo los niveles de CT, TG, col-LDL, VLDL y el índice de riesgo aterogénico en el grupo de ratones hiperlipémicos(AU)

Influence of avocado (Persea americana) pulp consumption on lipid metabolism in normolipidemic and diet induced hyperlipidemic mice . Dyslipidemia is a risk factor for developing cardiovascular disease, a major cause of deaths worldwide. The aim of this work is to study the effect of avocado (Persea americana), on lipid metabolism on normolipidemic and hyperlipidemic mice induced with high fat diet. Four groups of animals receiving standard diet (DE), standard and avocado diet (DEa), high fat diet (DH) and high fat and avocado diet (DHA) were used. All animals were observed for a period of 28 days. Blood sample was obtained at the end of experimentation period by cardiac puncture on anesthetized animals, and the levels of Cholesterol, triglycerides and col-HDL were de- termined and c-LDL, VLDL and atherogenic and coronary risk factors were calculated. DH group showed levels of TC, TG, c-LDL and VLDL significantly higher (p<0,001) than the values achieved in DHa group. DHa and DEa plasmatic values of TC, TG, c-LDL and VLDL were significantly reduced (p <0.001) compared to DH group. DEa and DHA groups differed significantly (p <0.005) in the level of CT, the latter has lower values, the other quantified parameters showed no significant differences. There were no significant differences for c-HDL values in any group. Hyperlipidemia induction with a model of high fat diet produced significantly increasing values of TC, TG, c-LDL and VLDL, besides of increasing the atherogenic risk. The benefit of avocado pulp consists in reduction of TC, TG, c-LDL, VLDL and the index of atherogenic risk(AU)