Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study.

BACKGROUND: Most patients are recommended secondary prevention pharmacotherapies following an acute coronary syndromes (ACS). AIM: To identify predictors of adherence at 6 months and strategies to improve adherence to these therapies. METHODS: Patients in the CONCORDANCE registry who were discharged on evidence-based medications were stratified into those receiving ≥75% ('adherent') or <75% ('non-adherent') of indicated medications at 6 months. Baseline characteristics, hospital and post-discharge care were compared between groups. Multivariable logistic analysis identified independent predictors of adherence. The relative contribution of each clinical or treatment factor to 'adherence' was determined using an adequacy measure method. RESULTS: Follow-up data were available for 6595 patients, 4492 (68.1%) of whom were 'adherent'. Clinical factors predictive of adherence included previous stroke, percutaneous coronary intervention (PCI) and hypertension (odds ratios (OR) 1.36-1.56); factors predictive of non-adherence included discharge diagnosis of non-ST-segment elevation myocardial infarction (vs unstable angina) (OR 0.51) and atrial fibrillation (OR 0.59). Discharge on ≥75% of indicated medications was a strong predictor of adherence at 6 months (OR 10.23, 95% confidence interval 7.89-13.27); in-hospital management factors predicting non-adherence were medical management alone (OR 0.34) and coronary artery bypass graft (OR 0.50) (both vs PCI). Post-discharge predictors of adherence included cardiac rehabilitation (OR 1.36) and general practitioner attendance (OR 1.40). CONCLUSION: Failure to discharge patients on indicated therapies is the most important modifiable predictor of adherence failure 6 months after an ACS. Implementing protocols to automate prescription of indicated discharge therapies, has the potential to reduce non-adherence dramatically in the 6 months following discharge.

Troponinemia in Patients With Diabetic Ketoacidosis Without Acute Coronary Syndrome.

Ischemic myocardial injury in a diabetes mellitus (DM) patient can be a trigger or a complication of diabetic ketoacidosis (DKA). This case series examines the phenomenon of elevated troponin levels in patients with DKA in the absence of obstructive coronary artery disease. Two out of three cases showed ST-segment elevation on electrocardiogram (EKG). Despite the absence of obstructive coronary artery disease on coronary angiography, all cases exhibited troponinemia (>79 ng/dl). These elevated troponin levels and EKG changes may pose diagnostic challenges for clinicians. Alternatively, troponinemia could be due to myocardial injury caused by acidotic stress and free fatty acid utilization along with increased myocardial oxygen demand and not obstructive coronary artery pathology in every case. However, a better understanding of the complex interplay between DKA and myocardial injury needs further research.

The Knowledge Assessment of Cardiovascular Disease Risk Factors: A Cross-Sectional Study.

INTRODUCTION: Cardiovascular diseases (CVDs) are the primary cause of mortality worldwide. Numerous factors can indicate the likelihood of developing CVDs. Gaining a comprehensive understanding of these risk factors is the initial step towards implementing successful preventive measures to defy the prevalence of CVDs across all demographics. The aim of this study is to evaluate the Moroccan population's level of knowledge regarding cardiovascular risk factors (CVRF). METHODS: This questionnaire-based cross-sectional study was conducted among 744 participants. Their knowledge of CVD risk factors was assessed by the Heart Disease Facts Questionnaire (HDFQ). Socio-demographic characteristics were collected and statistical analyses were performed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). RESULTS: Among 744 participants, 475 (63%) were male and 409 (55%) were young adults. The mean HDFQ score was 64.36%. Overall, 47.4% of the respondents were aware of CVD risk factors, 27% had moderate knowledge and 25.6% had poor knowledge. The most commonly identified factors were smoking (86.8%), obesity (85.6%), and aging (80.5%). Age was the only factor that showed a significant association with the awareness of CVD risk factors. CONCLUSION: The level of knowledge of CVRF is moderate among the Moroccan population. Effective health education about CVRF and adequate prevention measures is certainly essential to minimize the burden of CVD.

Myocardial Infarction With Non-obstructive Coronary Arteries: A Clinical Conundrum.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined by the presence of positive cardiac biomarkers with clinical evidence of infarction, the absence of significant coronary stenosis (≥50%) on angiography, and the lack of alternative diagnosis for the index presentation. MINOCA poses a diagnostic and therapeutic challenge due to the various pathophysiologic mechanisms underlying its presentation. Coronary artery plaque disruption is recognized as a crucial mechanism contributing to MINOCA. Plaque rupture and thrombus formation with subsequent myocardial ischemia may occur without significant luminal narrowing. A high index of suspicion is needed to make an early diagnosis. Here, a 68-year-old African American male patient presented with substernal chest pain, nonspecific ST segment changes on electrocardiogram, and elevation in cardiac biomarkers only one day after undergoing diagnostic cardiac catheterization that revealed non-obstructed coronary arteries. This case provides an example of MINOCA occurring secondary to suspected coronary artery plaque disruption in the setting of recent cardiac catheterization.

Cardiac Damage After SARS-CoV2 Infection.

COVID-19 is a viral disease that can manifest acutely in the respiratory tract and other organs. In this study, we aimed to investigate potential long-term damage to the heart from COVID-19. For this study, we divided 97 consecutive unselected COVID-19 patients aged 18-80 years at a cardiology practice in Cologne, Germany, into two groups based on the severity of their infection. We performed a resting ECG and a resting transthoracic echocardiography three and six months after SARS-CoV2 infection. The key discriminator determining disease severity was bed confinement or hospital admission. Group 1 included patients with less severe COVID-19, whereas group 2 contained more severe cases. Heart rate as the primary ECG endpoint was lower by a statistically significant amount for the entire study population (p=0.024), subdivided by gender (pwomen <0.001, pmen <0.001) and in group 1 p =0.003 compared to three months. QTc time and repolarization disturbances as primary ECG endpoints and the echocardiographic primary endpoints, left ventricular ejection fraction, and left ventricular end-diastolic diameter (LVEDD), showed no relevant difference between the subgroups at three and six months or between the measurements taken at each point. In contrast, LVEDD normalized to body surface area was statistically significantly lower at six months in women in group 1 compared to group 2 (p=0.048) and in the overall study population at six months compared with the data after three months (p=0.034). E/E' was statistically lower at six months than at three months in the whole population (p=0.004) and in women (p=0.031). All measured echocardiographic and electrocardiographic mean values were within the normal range in all groups and follow-up controls. Overall, the prospective study conducted showed no significant evidence of long-term cardiac damage from COVID-19 disease, as evidenced by electrocardiographic and echocardiographic examinations at three and six months after infection.

Unlocking the Potential of Immunotherapy in Cardiovascular Disease: A Comprehensive Review of Applications and Future Directions.

Immunotherapy has emerged as a pioneering therapeutic approach that harnesses the immune system's abilities to combat diseases, particularly in the field of oncology where it has led to significant advancements. However, despite its significant impact in the field of oncology, the potential of immunotherapy in the context of cardiovascular disease (CVD) has not been thoroughly investigated. The purpose of this narrative review is to address the existing knowledge and potential uses of immunotherapy in the field of cardiovascular disease (CVD), with the intention of filling the existing gap in understanding. Furthermore, the review thoroughly examines the future prospects of this swiftly advancing field, providing insights into the aspects that necessitate further investigation and addressing the forthcoming challenges. The review is organized into four distinct sections to enhance comprehension. The first section introduces immunotherapy, presenting the fundamental concepts and principles. The second section explores the immunomodulatory mechanisms in cardiovascular disease (CVD), with a specific focus on the intricate interplay between the immune system and the development of cardiovascular pathogenesis. The utilization of immunotherapy in specific cardiovascular conditions will be examined, investigating the application of immunotherapy in the context of different cardiovascular diseases. The future prospects and challenges in immunotherapy for cardiovascular diseases will be discussed, highlighting the potential areas for future research and addressing the barriers that must be overcome to effectively implement immunotherapeutic interventions in the management of cardiovascular diseases.

Asymptomatic Hyperuricemia as an Independent Risk Factor for Myocardial Infarction in Adult Population: A Four-Year Follow-Up Study.

Introduction A condition in which uric acid levels are elevated but there are no accompanying symptoms is known as asymptomatic hyperuricemia. As a result of the disparity in opinions and findings between the studies, the guidelines regarding whether or not asymptomatic hyperuricemia should be treated are unclear. Material and methods Between the months of January 2017 and June 2022, this research was carried out in the community in collaboration with the internal medicine unit and the public health unit of Liaquat University of Medical and Health Sciences. After obtaining informed consent from each participant, the researchers enrolled 1,500 patients in the study who had uric acid levels that were greater than 7.0 mg/dL. These patients ranged in age from 40 to 70 years old and were of either gender. As a control group, 1,500 patients were recruited who did not have abnormally high levels of uric acid. Patients were monitored for a total of 48 months or until the occurrence of a major cardiovascular event (MACCE) or death from all causes, whichever occurred first. Death, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke were the four categories that made up the primary outcome, also known as MACCEs. Results In the hyperuricemic group, the incidence of myocardial infarction that did not result in death was significantly higher than in the non-hyperuricemic group (1.6% vs. 0.7%; p-value, 0.04). However, the result was not significant for deaths from all causes, deaths from cardiovascular disease, or strokes that did not result in death. Conclusion Asymptomatic hyperuricemia is a potential threat to one's health that can lead to cardiovascular diseases and may go undiagnosed in some cases. It is important to remember that hyperuricemia can lead to delirious complications, so efforts should be made to perform routine monitoring and management of the condition.

A Systematic Review of Lipid Management in Secondary Prevention and Comparison of International Lipid Management Pathways.

Acute coronary syndrome remains a major cause of morbidity and mortality despite significant improvements in its prevention and management. Lipid management and other risk factors such as hypertension, diabetes, obesity, smoking and sedentary lifestyle stratification is the key to minimising this risk. Lipid management is an important part of secondary prevention and patients are historically undertreated after post-acute coronary syndrome. We performed a narrative review on observational studies on lipid management pathways post ACS on PubMed, Google Scholar, Journal Storage and ScienceDirect and excluded case reports, case series and randomized controlled trials. Our review showed that most patients following acute coronary syndrome receive suboptimal treatment for hypercholesterolemia. The role of statin in reducing future cardiac events risk is undisputable, however, statin intolerance remains a major concern. There is substantial variation in the management of lipids in patients following an acute cardiac event and patients were followed up in primary care in some countries and secondary care in others. The mortality risk is significantly high in patients with second or recurrent cardiac events and future cardiac events are associated with higher morbidity and mortality risk. There is significant variation in lipid management pathways in patients who suffer from cardiac events across the globe and lipid therapy optimization remains suboptimal in these patients, putting them at future risk of cardiovascular events. It is therefore imperative to optimally manage dyslipidemia in these patients in order to minimize the risk of subsequent cardiac events. Cardiac rehabilitation programs might be a way forward to incorporate lipid management for patients discharged from the hospital after having acute coronary events for lipid therapy optimization.

Demographics and Prevalence of Risk Factors in Patients With Peripheral Arterial Disease Presenting to a Tertiary Care Center in Northern India.

Introduction Globally around 236.62 million people over 25 had the peripheral arterial occlusive disease (PAOD) in 2015, out of which 72.91 were in lower and middle-income countries. It will be a significant health problem in our country as the Indian population is aging. Our study aims to determine the demographics and prevalence risk factors in patients presenting with PAOD. Methods This prospective observational study was conducted from January 2020 to April 2021 at a tertiary care center in Northern India. A total of 275 patients with PAOD were enrolled in the study. The demographics and the prevalence of the risk factors were studied. Results Males (85.8%) were predominantly affected compared to females (14.2%). About 80.4% were smokers, of which 84.16% predominantly smoked Bidi. Around 39.3% had diabetes mellitus, 43.3% were hypertensive, and dyslipidemia was present in 17.1%. History of coronary artery disease and cerebrovascular accident was present in 22.3% and 12%, respectively. Farming was the occupation for 29.1% and 32.4% had not received formal schooling. The mean annual income was Rupees 1,56,025 (rupees 13,000 per month). Overall, the socioeconomic status was low. Conclusion The demographics and the prevalence of risk factors in patients with PAOD in Northern India differ from those in South India and the Western populations. Most of the patients were elderly males belonging to low socioeconomic status. There is a need for a central registry for vascular diseases in India to monitor the trends of the annual incidence of PAOD and to look for the prevalence of risk factors.

A Systematic Review of Major Cardiovascular Risk Factors: A Growing Global Health Concern.

Cardiovascular disease has become a growing global and public health concern among non-communicable diseases (NCDs). The purpose of the study was to focus on the increasing prevalence of the risk factors of cardiovascular diseases (CVD), irrespective of age and gender, and its effect on public health worldwide. A literature search was done in the electronic database: Medline, PubMed, Web of Science, Google Scholar, and the World Health Organization (WHO) website, based on recent research and the prevalence of the risk factors of cardiovascular diseases. Moreover, a manual search for published work has also been done. The coronary heart disease studies were not restricted during the search by sample size because of the limited number of studies in selected countries. The study reviews the potential risk factors responsible for coronary heart disease globally. Smoking was highly prevalent among the United States and Pakistani populations, but hypertension and diabetes were more common in Tanzania and the United Kingdom. However, dyslipidaemia and obesity were common in almost all the selected countries. CVD risk factors are highly prevalent in some countries, varying socioeconomic, gender, and educational levels. Furthermore, there has always been a need for awareness in the public and educational programs for a healthy lifestyle, intake of nutritional food, and increased physical activity to improve health conditions and reduce the risk of cardiovascular diseases.