GENETIC FACTORS ASSOCIATED WITH NON-FATAL MYOCARDIAL INFARCTION AND HOSPITALIZED UNSTABLE ANGINA - A MARSHFIELD CLINIC CASE-COHORT STUDY

Abstract Aims This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. Methods and results A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274–0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280–0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164–1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181–0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183–0.353; P < 0.001). Conclusion The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.

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Clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2021-20-3-18-27 ◽

2021 ◽

Vol 20 (3) ◽

pp. 18-27

Author(s):

T. P. Pronko ◽

V. A. Snezhitskiy ◽

O. V. Gorchakova ◽

M. L. Gladkiy ◽

A. V. Kapytski

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Cerebral Infarction ◽

Blood Test ◽

Genetic Factors ◽

Polymorphic Locus ◽

Factors Associated ◽

Stent Restenosis ◽

Platelet Receptor ◽

Ischemic Events

The aim of the study was to assess the clinical and genetic factors associated with the risk of recurrent ischemic events in patients with stable stenocardia (SS). Materials and methods. A total of 100 patients with SS were examined and followed-up for 15.3±8.3 months. The patients were divided into subgroups (SG): SG1 (n=51) – persons without events, SG2 (n=49) persons with recurrent ischemic events (hospitalization due to the development of pain syndrome, re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes), SGB (n=11) – persons with «major» recurrent ischemic events (re-stenting due to stent restenosis, myocardial infarction, cerebral infarction and death from cardiovascular causes) , SGG (n=89) – persons without «major» events. The obtained survey data (general clinical, aggregometry, polymor phism of genes of platelet fibrinogen receptor ITGB3 (T1565C), platelet collagen receptor ITGA2 (C807T), ADP platelet receptor P2RY12, H1/H2 (T744C)) were analyzed using the STATISTICA 10.0 software. Results. In SG2, men predominated (χ2 =9.2; p<0.01), past MI was more common (χ2 =4.8; p<0.05), more stents were implanted (2.4±1.9 versus 1.7±1.1, p<0.05), TRAP-test values were higher (p<0.05) compared to SG1. In SGB, greater number of stents were implanted (3.1±2.2 versus 1.61±1.57, p<0.05), the carriage of the TC genotype of the ITGB3 gene was more common, (p<0.05), a combination of gene mutations ITGB3 and P2RY12 was more common, (p<0.05) compared to SGG. A logistic regression equation was constructed, including the presence of diabetes mellitus, the number of platelets in the blood test, the ASPI-test values, the carriage of the 1565C allele of the ITGB3 gene, the number of stents implanted, which makes it possible to determine the likelihood of developing «major» recurrent ischemic events with a cut-off threshold LP₀=0.0965, with sensitivity – 81.82 %, specificity – 78.48 %, overall accuracy – 78.89 %. Conclusions. The factors associated with the development of recurrent ischemic events are: male sex, previous MI, a greater number of implanted stents, and high TRAP-test values. The factors associated with the development of recurrent «major» ischemic events are: a greater number of implanted stents, carriage of the TC genotype of the ITGB3 gene, carriage of a combination of mutations of the H1/H2 polymorphic locus of the P2RY12 gene and the T1565C polymorphic locus of the ITGB3 gene, diabetes mellitus, the number of platelets in blood test, ASPI-test values.

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Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

BMC Cardiovascular Disorders ◽

10.1186/1471-2261-11-13 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 16

Author(s):

Audrey HH Merry ◽

Jolanda MA Boer ◽

Leo J Schouten ◽

Edith JM Feskens ◽

WM Monique Verschuren ◽

...

Keyword(s):

Physical Activity ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cohort Study ◽

Family History ◽

Alcohol Consumption ◽

Angina Pectoris ◽

Unstable Angina ◽

Prospective Cohort Study ◽

Prospective Cohort

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1349Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0049 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ardissino ◽

O M Moussa ◽

A R Tang ◽

T Heaton ◽

P Ziprin ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Bariatric Surgery ◽

Cohort Study ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

All Cause Mortality ◽

Secondary Endpoints ◽

Fatal Myocardial Infarction

Abstract Background Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined. Purpose The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity. Methods A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates. Results Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153). Table 1. Primary and secondary endpoints during follow-up Events No Bariatric Surgery Bariatric Surgery HR 95% CI p (n=3,701) (n=3,701) Primary endpoint 93 37 0.458 0.312–0.671 <0.001 Secondary endpoints All-cause mortality 182 45 0.254 0.183–0.353 <0.001 Heart failure 46 22 0.519 0.311–0.864 0.012 Fatal or non-fatal myocardial infarction 93 36 0.444 0.302–0.654 <0.001 Fatal or non-fatal ischaemic stroke 9 4 0.528 0.159–1.751 0.296 Adjusted primary endpoint rates Conclusion The results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducing the risk of major cardiovascular events, all-cause mortality and new onset of heart failure in patients with obesity.

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