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1.
Medicine (Baltimore) ; 98(41): e17536, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593130

RESUMO

Recently, the monocyte count to high-density lipoprotein cholesterol ratio (MHR) was found to be associated with the SYNTAX score in patients with both stable coronary artery disease (CAD) and acute coronary syndrome (ACS). The MHR was significantly higher in male patients. However, the sex-specific association of MHR with SYNTAX score in stable CAD was not well explored. Thus, the present study aimed to investigate the association of MHR and presence and severity of CAD evaluated by coronary angiography and the SYNTAX score in males and females.In total, 873 patients who received selective coronary angiography between March 2017 and July 2018 were included in the present study. Patients were divided into 3 groups according to MHR tertiles. The MHR was calculated by dividing the monocyte count by the high-density lipoprotein cholesterol level. CAD was defined as at least 50% diameter stenosis of a major coronary artery, including the right coronary, left main coronary, left anterior descending, and left circumflex arteries. The SYNTAX score was calculated by 2 experienced interventional cardiologists. SYNTAX score ≥23 was defined as a high SYNTAX score.Males showed a significantly higher MHR (12.2 [8.9-15.5] vs 9.3 [6.2-12.1], P < .001), accompanied by a higher prevalence of CAD (68.1% vs 53.4%, P < .001). Male sex remained an independent predictor of elevated MHR after correction for confounding factors (adjusted odds ratio [OR] 3.102, P = .001). The association between MHR and SYNTAX score was confirmed only in male stable patients with CAD (r = 0.113, P = .036). Multivariate logistic regression analysis showed that MHR was an independent predictor of SYNTAX score ≥23 only in male patients with CAD. The receiver-operating characteristic curve showed a predictive value of MHR for high SYNTAX score only in males.A higher MHR in males and a positive correlation of MHR with SYNTAX score were observed only in male stable patients with CAD. Such an easily obtained index may help interventional cardiologists detect high-risk patients before coronary catheterization, but its application may be restricted to males.


Assuntos
HDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Contagem de Leucócitos/métodos , Monócitos/citologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/metabolismo , Idoso , Angina Estável/sangue , Angina Estável/epidemiologia , Angina Estável/metabolismo , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/metabolismo , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Índice de Gravidade de Doença , Fatores Sexuais
2.
Medicine (Baltimore) ; 98(42): e17629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626147

RESUMO

The potential relationship between coronary artery calcium (CAC) and colorectal adenoma has been widely indicated. This study aimed to investigate the relationship between the risk of colorectal adenoma and CAC progression in asymptomatic Korean adults who underwent serial assessments by colonoscopy and CAC scan.A total of 754 asymptomatic participants, who had undergone serial CAC scans and colonoscopies for screening, were enrolled. Changes in CAC were assessed according to the absolute change between baseline and follow-up results. CAC progression was defined using Multi-Ethnic Study of Atherosclerosis method. Risk for adenoma at follow-up colonoscopy was determined using hazard ratio (HR) by Cox regression. The area under the receiver operating characteristic (ROC) curve was measured.The mean follow-up duration was 3.4 ± 2.5 years. CAC progression was found in 215 participants (28.5%). Participants with adenoma at index colonoscopy showed a higher rate of CAC progression than those without (38.8% vs 23.6%, P < .01). In participants with adenoma at index colonoscopy, CAC progression significantly increased the cumulative risk for adenoma at follow-up colonoscopy (HR = 1.48, 95% confidence interval [CI] 1.06-2.06, log-rank P = .021). In multivariate analysis, male sex (HR = 2.57, 95% CI 1.22-5.42, P = .013), ≥3 adenomas at index colonoscopy (HR = 2.60, 95% CI 1.16-5.85, P = .021), and CAC progression (HR = 2.74, 95% CI 1.48-5.08, P = .001) increased the risk of adenoma at follow-up colonoscopy. In participants without adenoma at index colonoscopy, neither baseline CAC presence nor CAC progression increased the risk of adenoma at follow-up colonoscopy. The interaction between CAC progression and adenoma at index colonoscopy was significant in multivariable model (P = .005). In the ROC analysis, AUC of CAC progression for adenoma at follow-up colonoscopy was 0.625 (95% CI 0.567-0.684, P < .001) in participants with adenoma at index colonoscopy.Participants with CAC progression, who are at high risk of coronary atherosclerosis, may need to be considered for follow-up evaluation of colorectal adenoma, especially those with adenoma at index colonoscopy.


Assuntos
Adenoma/complicações , Cálcio/metabolismo , Neoplasias Colorretais/complicações , Doença da Artéria Coronariana/etiologia , Vasos Coronários/diagnóstico por imagem , Medição de Risco/métodos , Calcificação Vascular/etiologia , Adenoma/diagnóstico , Doenças Assintomáticas , Colonoscopia , Neoplasias Colorretais/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/metabolismo , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Calcificação Vascular/diagnóstico , Calcificação Vascular/epidemiologia
3.
Medicine (Baltimore) ; 98(32): e16825, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393416

RESUMO

Observational studies have reported that childhood obesity is positively associated with risks of type 2 diabetes (T2D) and coronary artery disease (CAD) in adults; however, whether this association is causal is still unclear. In the present study, we conducted the 2-sample Mendelian randomization (MR) studies to investigate whether childhood obesity is causally associated with T2D and CAD in adults.Seven single-nucleotide polymorphisms (SNPs) that significantly associated with childhood obesity were used as instrumental variables. The 2-sample MR analyses were performed with the summary-level data of large-sample genome-wide association studies to evaluate the causal effects of childhood obesity on adult T2D and CAD and the levels of cardiometabolic traits.The 2-sample MR analyses suggested that each 1-unit increase in the log-odds of having childhood obesity was causally associated with an increased risk of adult T2D (odds ratio [OR] = 1.16, 95% confidential interval [CI] = 1.06-1.28; P = 1.0 × 10) and CAD (OR = 1.07, 95% CI = 1.02-1.12; P = 4.0 × 10) based on the inverse-variance weighted method. The MR analyses also suggested that childhood obesity was positively associated with the levels of adult body mass index, waist circumference, hip circumference, waist and hip ratio, log-transformed fasting glucose, log-transformed homeostatic model assessment (HOMA) of insulin resistance (%), and triglycerides. The childhood obesity was negatively associated with the adult high-density lipoprotein cholesterol level; however, there was no evidence of a causal association between childhood obesity and the levels of fasting glucose, 2-hour glucose, HbA1c (%), log-transformed HOMA of ß-cell function (%), low-density lipoprotein cholesterol, or total cholesterol in adults.In conclusion, a genetic predisposition to childhood obesity was associated with an increased risk of adult T2D and CAD, providing causal relations between childhood obesity and the risks of T2D and CAD in adults; however, the results need to be validated with larger-scale intervention studies.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/genética , Glicemia , Índice de Massa Corporal , Pesos e Medidas Corporais , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Resistência à Insulina , Lipídeos/sangue , Masculino , Polimorfismo de Nucleotídeo Único , Fatores de Risco
4.
Postgrad Med ; 131(7): 415-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31424301

RESUMO

Alzheimer's disease (AD) is the most common form of dementia manifesting as alterations in cognitive abilities, behavior, and deterioration in memory which is progressive, leading to gradual worsening of symptoms. Major pathological features of AD are accumulations of neuronal amyloid plaques and neurofibrillary tangles, with early lesions appearing primarily in the hippocampus, the area of the brain involved in memory and learning. Cardiovascular-related risk factors are believed to play a crucial role in disease development and the acceleration of cognitive deterioration by worsening cerebral perfusion, promoting disturbances in amyloid clearance. Current evidence supports hypertension, hypotension, heart failure, stroke and coronary artery diseases as potential factors playing a role in cognitive decline in patients with Alzheimer's dementia. Although dementia due to cardiovascular deficits is more strongly linked to the development of vascular dementia, a stepwise decline in cognition, recent researches have also discovered its deleterious influence on AD development.


Assuntos
Doença de Alzheimer/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Doenças Cardiovasculares/epidemiologia , Circulação Cerebrovascular , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Progressão da Doença , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipotensão/epidemiologia , Hipotensão/fisiopatologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
5.
J Dermatol ; 46(10): 867-873, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389066

RESUMO

Hidradenitis suppurativa (HS) has been reported to be associated with metabolic syndrome and coronary artery disease (CAD). Nevertheless, a nationwide study of this relationship in the Asian population has not been conducted. The aim of the present study was to clarify the cardiovascular disease risk factors, and the occurrence of CAD and cerebral infarction among patients with HS by using a nationwide database in Taiwan. We obtained data from the National Health Insurance Research Database of Taiwan. After adjusting for confounding factors, we used Cox proportional hazards analysis to reveal the risk of incident hypertension (HTN), diabetes mellitus (DM), dyslipidemia, CAD and cerebral infarction in HS patients. We identified 478 patients with newly diagnosed HS and 1912 patients in the control cohort during the 10-year follow-up period. Compared with the controls, HS patients had a higher risk of dyslipidemia (adjusted hazard ratio [aHR], 3.858; 95% confidence interval [CI], 2.785-5.346; P < 0.001), HTN (aHR, 1.910; 95% CI, 1.463-2.493; P < 0.001), DM (aHR, 1.709; 95% CI, 1.127-2.591; P = 0.012). Regarding comorbidities, our results also revealed a higher risk of CAD in HS patients (aHR, 2.722; 95% CI, 1.628-4.553; P < 0.001), but not cerebral infarction (aHR, 0.514; 95% CI, 0.119-2.231; P = 0.375). Our results indicate that there is a higher risk of dyslipidemia, HTN, DM and CAD in HS patients.


Assuntos
Infarto Cerebral/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Hidradenite Supurativa/epidemiologia , Hipertensão/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
6.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(7): 839-843, 2019 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-31357808

RESUMO

Objective: To assess the casual effect of childhood obesity on adulthood coronary artery disease (CAD) using Mendelian randomization (MR) method. Methods: Data on BMI of children aged 2-10 years in 2015 were downloaded from Early Growth Genetics Consortium and Genetic Investigation of Anthropometric Traits Consortium. Twenty-seven genetic variants related to children's BMI were selected as instrumental variables (IVs), and the associations between IVs and CAD were extracted from a Meta-analysis of the genome-wide association study of CAD cases published in UK Biobank 2015. We used MR-Egger regression to test whether there was the pleiotropy of the selected SNPs. In the present MR methods, we conducted MR analyses by using mode-based estimate method as primary method for summary-level of associations to estimate the causal association between childhood obesity and CAD. Results: The intercept term estimated for CAD from MR-Egger method suggested that the selected SNPs don't exert pleiotropy with a 95%CI including the null (-0.008-0.018). In addition, we found evidence that support the effect of childhood obesity on CAD risk: a 1 s increase in children BMI (kg/m(2)), and the risk of suffering from CAD in adulthood increased by an average of 37% (OR=1.37, 95%CI: 1.09-1.72). Conclusion: This study provides a causal association between childhood obesity and CAD risk.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Obesidade Pediátrica/epidemiologia , Criança , Pré-Escolar , Doença da Artéria Coronariana/genética , Estudo de Associação Genômica Ampla , Humanos , Análise da Randomização Mendeliana , Metanálise como Assunto , Obesidade Pediátrica/genética , Polimorfismo de Nucleotídeo Único
7.
Medicine (Baltimore) ; 98(28): e15959, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305390

RESUMO

The prognostic significance of systemic atherothrombosis in heart failure (HF) with preserved ejection fraction (HFpEF) remains unclear. This study aimed to investigate the relation between the presence of polyvascular disease (PVD) and cardiovascular outcomes in HFpEF patients.A total of 510 consecutive HFpEF patients were prospectively observed for up to 1500 days or until occurrence of cardiovascular events. PVD was defined as ≥2 coexistence of coronary artery disease, peripheral arterial disease, and cerebrovascular disease.Overall, 124 cardiovascular events were observed during follow-up (median: 1430 days). Kaplan-Meier curve showed HFpEF with PVD (n = 84) experienced more cardiovascular events than did those without PVD patients (44.0% vs 20.4%, log-rank: P < .001). Multivariable Cox proportional hazards analysis with significant factors from univariate analysis showed the presence of PVD (hazard ratio [HR]: 2.875, 95% [CI]: 1.894-4.365, P < .001), previous HF hospitalization (HR: 1.578, 95% CI: 1.031-2.414, P = .036), hemoglobin (HR: 0.889, 95% CI: 0.805-0.983, P = .021), serum sodium (HR: 0.946, 95% CI 0.896-1.000, P = .048), ln-BNP (per 1.0, HR: 1.255, 95% CI: 1.055-1.494, P = .010), and E/e' (HR: 1.047, 95% CI: 1.020-1.075, P < .001) significantly predicted future cardiovascular events. Multivariable Cox hazard analysis with 4 established factors (age, BNP, diabetes mellitus, and previous HF hospitalization) from the I-PRESERVE (Irbesartan in HFpEF) study showed PVD was independently associated with cardiovascular events in HFpEF patients (HR: 2.562, 95% CI: 1.715-3.827, P < .001).The presence of PVD is significantly associated with cardiovascular events in HFpEF, suggesting the importance of screening PVD in HFpEF.


Assuntos
Transtornos Cerebrovasculares/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Insuficiência Cardíaca/diagnóstico , Doença Arterial Periférica/diagnóstico , Idoso , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Biomarcadores/sangue , Transtornos Cerebrovasculares/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Doença Arterial Periférica/epidemiologia , Prevalência , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento , Função Ventricular Esquerda
8.
Isr Med Assoc J ; 21(6): 381-385, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280505

RESUMO

BACKGROUND: Malignancy is a known risk factor for venous thromboembolism; however, the association with arterial thromboembolic events remains unclear. OBJECTIVES: To examine the association between non-ST-elevation myocardial infarction (NSTEMI) and non-significant coronary artery disease (CAD) and the presence of new or occult malignancy. METHODS: An observational cohort, single-center study was performed 2010-2015. Adult patients with NSTEMI, who underwent coronary angiography and had no significant coronary lesion, were included. Using propensity score matching, we created a 2:1 matched control group of adults with NSTEMI, and significant coronary artery disease. Risk factors for new or occult malignancy were assessed using multivariate backward stepwise logistic regression analysis. The primary outcome was new or occult malignancy, defined as any malignancy diagnosed in the 3 months prior and 6 months following the myocardial infarction (MI). RESULTS: During the study period, 174 patients who presented with MI with non-obstructive coronary arteries were identified. The matched control group included 348 patients. There was no significant difference in the group demographics, past medical history, or clinical presentation. The incidence of new or occult malignancy in the study group was significantly higher (7/174, 4% vs. 3/348, 0.9%, P = 0.019). NSTEMI with non-significant CAD was an independent risk factor for occult malignancy (odds ratio [OR] 4.6, 95% confidence interval [95%CI] 1.1-18.7). Other risk factors included active smoking (OR 11.2, 95%CI 2.5-49.1) and age (OR 1.1, 95%CI 1.03-1.17). CONCLUSIONS: NSTEMI with non-significant CAD may be a presenting or early marker of malignancy and warrants further investigation.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Neoplasias/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Estudos de Coortes , Comorbidade , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
9.
Medicine (Baltimore) ; 98(25): e16058, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232943

RESUMO

The study aimed to study the related factors of hypertension using multivariate logistic regression analysis and tabu search-based Bayesian Networks (BNs). A cluster random sampling method was adopted to obtain samples of the general population aged 15 years or above. Multivariate logistic regression analysis indicated that gender, age, cultural level, body mass index (BMI), central obesity, drinking, diabetes mellitus, Myocardial infarction, Coronary heart disease, Stroke are associated with hypertension. While BNs found connections between those related factors and hypertension were established by complex network structure, age, smoking, occupation, cultural level, BMI, central obesity, drinking, diabetes mellitus, myocardial infarction, coronary heart disease, nephropathy, stroke were direct connection with hypertension, gender was indirectly linked to hypertension through drinking. The results showed that BNs can not only find out the correlative factors of hypertension but also analyze how these factors affect hypertension and their interrelationships, which is consistent with practical theory better than logistic regression and has a better application prospects.


Assuntos
Hipertensão/classificação , Hipertensão/etiologia , Adolescente , Adulto , Idoso , Teorema de Bayes , Índice de Massa Corporal , China , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Razão de Chances , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
10.
Heart Lung Circ ; 28(7): 1009-1017, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31178022

RESUMO

BACKGROUND: Although lipoprotein(a) (Lp(a)) has been regarded as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), its predictive role in outcomes in stable coronary artery disease (CAD) has been undetermined. The aim of the present study was to investigate the relations of Lp(a) to the coronary severity and events in Chinese patients with angiography-proven stable CAD. METHODS: A total of 3,278 patients with stable CAD were consecutively enrolled and the coronary severity was evaluated by the Gensini Score (GS) system. Patients were divided into two groups according to the median of GS: high GS group (n=1,585) and low GS group (n=1,693). The associations of continuous Lp(a), Lp(a) ≥300mg/L, and tertiles of Lp(a) with GS and events were respectively evaluated. RESULTS: Patients in the high GS group had significantly higher concentrations of Lp(a). In addition, the multivariate Cox regression analysis indicated that elevated Lp(a) (odds ratio: 1.164, 95% confidence interval: 1.005-1.349), Lp(a) ≥300mg/L (odds ratio: 1.200, 95% confidence interval: 1.028-1.401), and the highest tertile of Lp(a) (odds ratio: 1.205, 95% confidence interval: 1.010-1.438) were statistically associated with GS after adjusted for potential confounders. However, although 215 (6.56%) events were established during a median of follow-up over 10,170 patient-years, no relationship between Lp(a) and events was found. CONCLUSIONS: In this Chinese cohort study on stable CAD with moderate sample size and follow-up duration, data showed that Lp(a) was significantly associated with the coronary severity while not with cardiovascular events, similar to several studies, suggesting that further study is needed regarding the role of Lp(a) in ASCVD.


Assuntos
Doença da Artéria Coronariana/sangue , Lipoproteína(a)/sangue , Índice de Gravidade de Doença , Idoso , China/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
11.
J Ayub Med Coll Abbottabad ; 31(2): 189-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094114

RESUMO

BACKGROUND: Hypertension is a leading cause of morbidity among developing and developed countries. Hypertensive Retinopathy is a micro vascular complication of long standing hypertension while CAD is a macro vascular complication. The main objective of the study was to determine the association between worsening grade of hypertensive retinopathy with angiographic severity of coronary artery disease (CAD) measured by Syntax Score. METHODS: This was a cross sectional study which was conducted after approval from IRB. All patients with history of hypertension, who underwent coronary angiography, were included in the study. After a detailed history and physical exam, all included patients were subjected to fundoscopy. Patients were categorized into 4 groups according to Keith et al classification of hypertensive retinopathy: No HR, Mild HR, Moderate HR and Severe HR. Patients were also categorized into three groups on the basis of angiographic severity of CAD by syntax score (SS): Mild CAD (SS<22), Moderate CAD (SS: 22-32) and Severe CAD (SS>32). Data was analysed in SPSS Version 20.0. Categorical and continuous variables were described as frequencies/percentages and Mean±SD respectively. RESULTS: A total of 370 patients were included in the study out of which 205 were males with a mean age of 55.3±10.07 years. Mean duration of hypertension was 8.1±2.7 years with a mean SBP of 130.1±37.2 mmHg and mean DBP of 90.3±17.3 mmHg. Patients with no HR, mild HR, moderate HR and severe HR had a mean SS of 11.7±4.5, 17.1±3.9, 26.3±5.1 and 37.9±5.1 respectively. Significant association was found between HR and severity of CAD with a chi square value of 285.53 (p<0.001). PORs for worsening grade of HR with severity of CAD increased from 0.341 (p<0.001) for mild HR to 2.33 (p<0.001) times for severe HR. CONCLUSIONS: A higher grade of hypertensive retinopathy is significantly associated to a higher angiographic severity of CAD by syntax score.


Assuntos
Doença da Artéria Coronariana , Retinopatia Hipertensiva , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Feminino , Humanos , Retinopatia Hipertensiva/complicações , Retinopatia Hipertensiva/epidemiologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
12.
Pan Afr Med J ; 32: 8, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31069001

RESUMO

The treatment of coronary artery diseases has made significant progress. Medication adherence among patients with coronary artery disease, in particular among elderly patients, is a major challenge to disease control and prevention of its complications. Medication adherence could be influenced by the demographic and socio-economic vulnerable situation in the African countries. We conducted a cross-sectional study of elderly patients treated for stable coronary artery disease on an ambulatory basis from March to October 2016. Medication adherence was evaluated by a questionnaire: Morisky Medication Adherence Scale. The informations about predictive factors of medication adherence were obtained from a multidimensional adherence model. The study involved 115 elderly patients (age > 65 years). Medication adherence accounted for 72.2%, according to Morisky Medication Adherence Scale. Physical inactivity was found in 59% of patients, hypertension and diabetes in 42.6% and 41.7% of patients respectively. Poor compliance predictive factors were: the absence of a mutual health (p = 0.02), the severity of symptoms (p = 0.001), patients who had acute coronary syndrome (p = 0.006), the level of social support (p = 0.011) and depression (p = 0.006). Medication adherence is a health problem in Morocco, particularly among elderly subjects. Health care providers should be aware of factors associated with a higher probability of stopping treatment, in particular of variable factors, in order to implement personalized strategies to improve adherence to treatment.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Doença da Artéria Coronariana/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Marrocos , Comportamento Sedentário , Índice de Gravidade de Doença , Inquéritos e Questionários
13.
BMC Public Health ; 19(1): 448, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035958

RESUMO

BACKGROUND: Cardiovascular diseases (CADs) are the first leading cause of death across the world. World Health Organization has estimated that morality rate caused by heart diseases will mount to 23 million cases by 2030. Hence, the use of data mining algorithms could be useful in predicting coronary artery diseases. Therefore, the present study aimed to compare the positive predictive value (PPV) of CAD using artificial neural network (ANN) and SVM algorithms and their distinction in terms of predicting CAD in the selected hospitals. METHODS: The present study was conducted by using data mining techniques. The research sample was the medical records of the patients with coronary artery disease who were hospitalized in three hospitals affiliated to AJA University of Medical Sciences between March 2016 and March 2017 (n = 1324). The dataset and the predicting variables used in this study was the same for both data mining techniques. Totally, 25 variables affecting CAD were selected and related data were extracted. After normalizing and cleaning the data, they were entered into SPSS (V23.0) and Excel 2013. Then, R 3.3.2 was used for statistical computing. RESULTS: The SVM model had lower MAPE (112.03), higher Hosmer-Lemeshow test's result (16.71), and higher sensitivity (92.23). Moreover, variables affecting CAD (74.42) yielded better goodness of fit in SVM model and provided more accurate result than the ANN model. On the other hand, since the area under the receiver operating characteristic (ROC) curve in the SVM algorithm was more than this area in ANN model, it could be concluded that SVM model had higher accuracy than the ANN model. CONCLUSION: According to the results, the SVM algorithm presented higher accuracy and better performance than the ANN model and was characterized with higher power and sensitivity. Overall, it provided a better classification for the prediction of CAD. The use of other data mining algorithms are suggested to improve the positive predictive value of the disease prediction.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Mineração de Dados/métodos , Redes Neurais (Computação) , Máquina de Vetores de Suporte , Fatores Etários , Algoritmos , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
14.
Int Heart J ; 60(3): 708-714, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105140

RESUMO

Multivessel disease (MVD) is an independent risk factor for poor prognosis in acute myocardial infarction patients. Although several global risk scoring systems (RSS) are in use in clinical practice, there is no dedicated RSS for MVD in ST-segment elevation myocardial infarction (STEMI). The primary objective of this study is to develop a novel RSS to estimate the prognosis of patients with MVD in STEMI.We used the Korean Acute Myocardial Infarction Registry (KAMIR) to identify 2,030 STEMI patients with MVD who underwent appropriate percutaneous coronary intervention (PCI). Their data were analyzed to develop a new RSS. The prognostic power of this RSS was validated with 2,556 STEMI patients with MVD in the Korean Working Group on Myocardial Infarction Registry (KORMI).Six prognostic factors related to all-cause death in STEMI patients with MVD were age, serum creatinine, Killip Class, lower body weight, decrease in left ventricular ejection fraction, and history of cerebrovascular disease. The RSS for all-cause death was constructed using these risk factors and their statistical weight. The RSS had appropriate performance (c-index: 0.72) in the KORMI validation cohort.We developed a novel RSS that estimates all-cause death in the year following discharge for patients with MVD in STEMI appropriately treated by PCI. This novel RSS was transformed into a simple linear risk score to yield a simplified estimate prognosis of MVD among STEMI patients.


Assuntos
Doença da Artéria Coronariana/mortalidade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Doença Aguda , Idoso , Índice de Massa Corporal , Causas de Morte , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Prognóstico , República da Coreia/epidemiologia , Fatores de Risco , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia
15.
Vasc Health Risk Manag ; 15: 109-113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118652

RESUMO

Aims: This study aimed to utilize a validated sleep questionnaire as a screening tool for symptoms and risk of obstructive sleep apnea in patients undergoing coronary catheterization in Jordan. Materials and methods: A cross-sectional design was used to screen adult patients undergoing coronary catheterization for obstructive sleep apnea (OSA). The Berlin sleep questionnaire was used to record nocturnal and daytime symptoms of OSA and to stratify patients into "low-risk" or "high-risk" for OSA. Coronary artery disease was defined as ≥50% intraluminal stenosis in at least one coronary vessel. Results: A total of 398 patients were studied, mean age was 58.7 years (SD=10.70), ranging from 21-92 years, and 68.6% were males. Based on the Berlin sleep questionnaire's definition, 176 patients (44.2%) were at high-risk for obstructive sleep apnea. Snoring was reported by 61%; loud in 42.1%, and frequent in 62%. Daytime sleepiness was reported by 36%, and 18.9% had fallen asleep while driving. Witnessed apnea during sleep was less reported (7.8%). Prevalence of symptoms and risk of OSA were not different between patients with and without coronary artery disease, P>0.05. In addition, logistic regression indicated that there was no significant association between risk of OSA and coronary artery disease, adjusted (odds ratio=0.93, 95% Confidence Interval=0.60-1.44, P=0.752). Conclusions: Symptoms and risk of obstructive sleep apnea were common among adult Jordanians undergoing coronary catheterization. There was no association between risk of obstructive sleep apnea and coronary artery disease. Larger studies are needed to assess the role of screening for obstructive sleep apnea in this patient population.


Assuntos
Cateterismo Cardíaco , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico , Sono , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/epidemiologia , Estenose Coronária/epidemiologia , Estudos Transversais , Feminino , Humanos , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Adulto Jovem
16.
Indian Heart J ; 71(1): 60-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31000184

RESUMO

BACKGROUND: The cytochrome P-450 2J2 (CYP2J2) is known to be one of the major enzymes of epoxygenase pathway of arachidonic acid in extrahepatic tissues, which produces series of regioisomeric cis-epoxyeicosatrienoic acids (EETs) such as 5,6-, 8,9-, 11,12-, and 14,15-EETs. In the present study, we analyzed the impact of a genetic variant in CYP2J2 on coronary artery disease (CAD) in the Telangana region of Indian population. MATERIAL AND METHODS: The case-control study consisted of 100 CAD cases and 110 healthy controls. The deoxyribonucleic acid was extracted using the salting out method. Genotyping and gene expression was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism and real-time-PCR methods. RESULTS: In the present study, the percentage of smokers, alcoholics, hypertensive patients, and diabetics was high. Increase in fasting glucose, urea, creatinine, fasting triglycerides, total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), total cholesterol/high-density lipoprotein (TC/HDL), LDL/HDL, homocysteine, and C-reactive protein levels were significantly higher in patients with CAD than in controls (p < 0.001). CYP2J2 G-50T was associated with CAD (p = 0.04). The mRNA expression of CYP2J2 showed altered gene expression in this study among CAD patients in comparison with control (p = 0.01). CONCLUSIONS: A functionally relevant polymorphism of the CYP2J2 gene was independently associated with an increased risk of CAD.


Assuntos
Doença da Artéria Coronariana/genética , Sistema Enzimático do Citocromo P-450/genética , DNA/genética , Regulação da Expressão Gênica , Predisposição Genética para Doença , Adulto , Doença da Artéria Coronariana/enzimologia , Doença da Artéria Coronariana/epidemiologia , Sistema Enzimático do Citocromo P-450/biossíntese , Feminino , Seguimentos , Testes Genéticos , Genótipo , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Fatores de Risco
17.
South Med J ; 112(4): 210-214, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30943538

RESUMO

With the increase in participation in endurance events in the general population, patient concern may arise as to whether endurance exercise is safe. Acute but not chronic increases in blood urea nitrogen, creatinine, and urine albumin occur in endurance exercise. Iron-deficiency anemia may be observed in female athletes. Upper respiratory illness is increased in elite athletes but decreased in intense recreational athletes. No convincing evidence of developing osteoarthritis exists. Common gastrointestinal symptoms occur and isolated reports of gastrointestinal bleeding exist. Nevi are increased and the minimal erythematous dose is decreased. Exercising in the presence of air pollution has negative pulmonary effects, but overall, benefit exists. Numerous reports pertain to the cardiovascular system. The risk of cardiac arrest increases during exercise, troponin is elevated after exercise, and a predisposition for atrial fibrillation exists. Ventricular myocardial scar formation as assessed by gadolinium enhancement on magnetic resonance imaging is inconsistently observed, and increased coronary plaque of a more stable variety is reported. Left ventricular compliance is chronically increased and no decrease in longevity is found. Although some concerns exist, endurance exercise is safe.


Assuntos
Treino Aeróbico/estatística & dados numéricos , Exercício/fisiologia , Poluição do Ar , Albuminúria/epidemiologia , Anemia Ferropriva/epidemiologia , Fibrilação Atrial/epidemiologia , Nitrogênio da Ureia Sanguínea , Cicatriz/diagnóstico por imagem , Cicatriz/epidemiologia , Complacência (Medida de Distensibilidade) , Doença da Artéria Coronariana/epidemiologia , Creatinina/sangue , Exposição Ambiental/estatística & dados numéricos , Coração/diagnóstico por imagem , Hemoglobinas/metabolismo , Humanos , Imagem por Ressonância Magnética , Nevo/epidemiologia , Osteoartrite/epidemiologia , Placa Aterosclerótica/epidemiologia , Infecções Respiratórias/epidemiologia , Troponina/sangue
18.
Georgian Med News ; (287): 78-82, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30958293

RESUMO

The elderly patients problem is comorbidity - concurrent presence of different diseases. Coronary artery disease (CAD) and gastroesophageal reflux disease (GERD) are one of the most common diseases worldwide that in a considerable percentage of cases occur together. The aim of our study was to investigate features of endothelial dysfunction in old people with CAD and concomitant GERD. Endothelial dysfunction manifests itself as a decrease in stable nitric oxide metabolite levels and an increase in endothelin-1 levels, disturbance of celiac trunk regional blood flow, causing a decrease in oesophageal tissue resistance, leading to lower oesophageal sphincter dysfunction. Endothelial dysfunction is one of the leading mechanisms of GERD development in people with CAD, while in people with isolated GERD, endothelial dysfunction is secondary, exacerbating the disease presentation.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Endotélio/fisiopatologia , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/fisiopatologia , Idoso , Comorbidade , Humanos
19.
Biomed Res Int ; 2019: 4069097, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31008104

RESUMO

Objectives: To investigate the influence of statins on major adverse cardiovascular events (MACE) in patients with coronary microvascular dysfunction (CMVD). Participants: 23,494 patients who received coronary angiography (CAG) were included. Thrombolysis in Myocardial Infarction, Myocardial Perfusion Grading (TMPG), a useful angiographic method, was used to evaluate CMVD. Results: Using multivariate analysis, NYHA III/IV (HR, 1.44; 95% CI, 1.03-2.01; P=0.031), PCI history (HR, 3.69; 95% CI, 2.57-5.31; P<0.001), TG (HR, 1.15; 95% CI, 1.06-1.26; P=0.001), creatinine (HR, 1.00; 95% CI, 1.00-1.01; P<0.001), cTnT (HR, 0.98; 95% CI, 0.96-0.99; P<0.001), heart rate (HR, 0.98; 95% CI, 0.97-0.99; P=0.001), ß-blocker (HR, 0.68; 95% CI, 0.51-0.91; P=0.008), aspirin (HR, 0.38; 95% CI, 0.24-0.61; P<0.001), and statins (HR, 0.33; 95% CI, 0.19-0.60; P<0.001) significantly correlated with reduced MACE in CMVD patients. In subgroups analysis, statins decreased MACE overall (HR, 0.33; 95% CI, 0.19-0.59; P<0.001) and in CMVD patients with smoking history (HR, 0.64; 95% CI, 0.43-0.93; P=0.014), diabetes (HR,0.27; 95% CI,0.12-0.61; P=0.002), hypertension (HR, 0.10; 95% CI, 0.03-0.36; P=0.001), and hypertension and diabetes (HR, 0.09; 95% CI, 0.014-0.53; P=0.008). Conclusion: Statins could reduce MACE in patients with CMVD.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Idoso , Aspirina/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/patologia , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/patologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipertensão/diagnóstico por imagem , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/patologia , Imagem de Perfusão do Miocárdio , Estudos Retrospectivos , Fumar/efeitos adversos , Resultado do Tratamento
20.
Vasc Health Risk Manag ; 15: 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30936712

RESUMO

Background: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. Patients and methods: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. Results: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. Conclusion: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Técnicas de Apoio para a Decisão , Infarto do Miocárdio/diagnóstico , Fatores Etários , Idoso , Biomarcadores/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/sangue , Estenose Coronária/epidemiologia , Estenose Coronária/terapia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Troponina/sangue , Regulação para Cima
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