Long-term prognostic role of cerebrovascular disease and peripheral arterial disease across the spectrum of acute coronary syndromes

OBJECTIVE: To review the current evidence for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional lipid-related applications, including acute coronary syndromes, peripheral arterial disease, stroke, and renal disease, and to describe ongoing trials evaluating the role of statins in these conditions. DATA SOURCES: Clinical literature was identified by a MEDLINE search (1990–November 2002) using ≥1 of the following search terms: acute coronary syndrome(s), angina pectoris, atherosclerosis, atorvastatin, clinical trials, diabetes mellitus, end-stage renal disease, fluvastatin, lovastatin, myocardial infarction, peripheral arterial disease, pravastatin, simvastatin, statins, and stroke. Treatment guidelines issued by professional and governmental organizations, such as the American Diabetes Association, American Heart Association, National Cholesterol Education Program, National Kidney Foundation, and National Stroke Foundation, were reviewed. STUDY SELECTION AND DATA EXTRACTION: Articles identified from the data sources were included if they pertained to the conditions described in the objectives and provided unique information concerning use of statins. DATA SYNTHESIS: Substantial evidence exists for the use of statins in acute coronary syndromes. Meta-analyses of data from major clinical trials indicate that statins prevent first and recurrent stroke, and large-scale trials are underway to evaluate the efficacy of statins in this setting. Accumulating evidence suggests that statins may be beneficial in reducing the morbidity and mortality associated with peripheral arterial disease and end-stage renal disease, and results from ongoing trials may confirm these benefits. Statins may also have a future role in amelioration of other conditions associated with atherosclerosis, such as diabetes mellitus. CONCLUSIONS: A large body of evidence supports the evaluation of statins in clinical settings beyond primary and secondary prevention of morbidity and mortality associated with coronary atherosclerosis.

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Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.082 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

H Santos ◽

M Santos ◽

I Almeida ◽

H Miranda ◽

C Sa ◽

...

Keyword(s):

Body Mass Index ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Peripheral Arterial Disease ◽

Arterial Hypertension ◽

Acute Coronary Syndromes ◽

Arterial Disease ◽

Coronary Syndromes ◽

Peripheral Arterial ◽

New Onset

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation. Objective Evaluate the impact of the CVRF in HF during the hospitalization for ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients. Results 14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p < 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p < 0.001), arterial hypertension (68.7 vs 78.2%, p < 0.001), diabetes mellitus (28.5 vs 43.1%, p < 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p < 0.001), neoplasia (4.4 vs 7.0%, p < 0.001), peripheral arterial disease (5.2 vs 15.8%, p < 0.001) and chronic kidney disease (4.6 vs 10.0%, p < 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p < 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p < 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p < 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p < 0.001, CI 0.59-0.78) in new onset HF in ACS patients. Conclusions Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.

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Long-Term Prognostic Role of Flow-Mediated Dilatation of the Brachial Artery After Acute Coronary Syndromes Without ST Elevation

The American Journal of Cardiology ◽

10.1016/j.amjcard.2006.06.043 ◽

2006 ◽

Vol 98 (11) ◽

pp. 1424-1428 ◽

Cited By ~ 83

Author(s):

Emmanouil N. Karatzis ◽

Ignatios Ikonomidis ◽

Georgia D. Vamvakou ◽

Theodore G. Papaioannou ◽

Athanassios D. Protogerou ◽

...

Keyword(s):

Brachial Artery ◽

Acute Coronary Syndromes ◽

Prognostic Role ◽

Flow Mediated Dilatation ◽

Coronary Syndromes ◽

St Elevation

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Peripheral arterial disease, acute coronary syndromes, and early invasive management: The TACTICS TIMI 18 trial

Clinical Cardiology ◽

10.1002/clc.4960280508 ◽

2005 ◽

Vol 28 (5) ◽

pp. 238-242 ◽

Cited By ~ 22

Author(s):

James L. Januzzi ◽

Jacqueline Buros ◽

Christopher P. Cannon

Keyword(s):

Peripheral Arterial Disease ◽

Acute Coronary Syndromes ◽

Arterial Disease ◽

Coronary Syndromes ◽

Peripheral Arterial ◽

Invasive Management

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Impact of Prior Peripheral Arterial Disease and Stroke on Outcomes of Acute Coronary Syndromes and Effect of Evidence-Based Therapies (from the Global Registry of Acute Coronary Events)

The American Journal of Cardiology ◽

10.1016/j.amjcard.2007.02.046 ◽

2007 ◽

Vol 100 (1) ◽

pp. 1-6 ◽

Cited By ~ 91

Author(s):

Debabrata Mukherjee ◽

Kim A. Eagle ◽

Eva Kline-Rogers ◽

Laurent J. Feldman ◽

Jean-Michel Juliard ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Acute Coronary Syndromes ◽

Arterial Disease ◽

Evidence Based ◽

Coronary Syndromes ◽

Coronary Events ◽

Peripheral Arterial ◽

Global Registry

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Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease

European Journal of Internal Medicine ◽

10.1016/j.ejim.2018.08.010 ◽

2019 ◽

Vol 59 ◽

pp. 70-76 ◽

Cited By ~ 5

Author(s):

Leonardo De Luca ◽

Giuseppe Di Pasquale ◽

Lucio Gonzini ◽

Francesco Chiarella ◽

Antonio Di Chiara ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Acute Coronary Syndromes ◽

Arterial Disease ◽

Coronary Syndromes ◽

St Elevation ◽

Peripheral Arterial

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The Role of Circulating Biomarkers in Peripheral Arterial Disease

International Journal of Molecular Sciences ◽

10.3390/ijms22073601 ◽

2021 ◽

Vol 22 (7) ◽

pp. 3601

Author(s):

Goren Saenz-Pipaon ◽

Esther Martinez-Aguilar ◽

Josune Orbe ◽

Arantxa González Miqueo ◽

Leopoldo Fernandez-Alonso ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Lower Limb ◽

Prediction Models ◽

Arterial Disease ◽

Cardiac Damage ◽

Thrombotic Occlusion ◽

Medical Treatments ◽

Peripheral Arterial ◽

Inflammatory Molecules

Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.

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