scholarly journals P684 The effect of tofacitinib on serum lipids and cardiovascular safety in patients with ulcerative colitis: updated results from the tofacitinib ulcerative colitis clinical programme

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S557-S558 ◽  
Author(s):  
B E Sands ◽  
P R Taub ◽  
B G Feagan ◽  
A Armuzzi ◽  
A O Damião ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Ulcerative Colitis ◽  
Cerebrovascular Accident ◽  
Density Lipoprotein ◽  
Haemorrhagic Stroke ◽  
Lipid Levels ◽  
Phase 3 ◽  
Cerebellar Haemorrhage ◽  
Coronary Syndrome

Abstract Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). In the tofacitinib UC clinical programme, the majority of patients did not have cardiovascular (CV) risk factors at baseline (BL), and increases in lipid levels occurred primarily during induction and remained elevated to Week 61 during maintenance; lipid ratios were relatively unchanged.1 Here, we present updated results of lipid levels in the ongoing, open-label, long-term extension (OLE) study (NCT01470612) and major adverse CV events (MACE) in the Phase 3/OLE tofacitinib UC clinical programme. Methods Lipid levels were assessed at multiple time points, and changes from OLE study BL to Month 48 in the OLE study were evaluated. Lipid-lowering agent (LLA) use (proportion of patients) and adjudicated MACE (proportion of patients and incidence rate [IR; unique patients with events per 100 patient-years] with 95% confidence interval [CI]) were reported in patients with UC in two Phase 3, 8-week, placebo-controlled induction studies (OCTAVE Induction 1 and 2; NCT01465763, NCT01458951), a Phase 3, 52-week, placebo-controlled maintenance study (OCTAVE Sustain; NCT01458574) and the OLE study (data as of May 2019; database not locked). Results No major changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides, LDL-c:HDL-c and TC:HDL-c from OLE study BL were observed at Month 48 of the OLE study (Table). In the Phase 3/OLE programme (n = 1124), 7.7% of patients had a new LLA added and 1.9% of patients had their LLA dose increased. Seven MACE were reported (IR 0.26; 95% CI 0.11, 0.54; 2654.66 patient-years); the IR has remained stable since Dec 2016 (IR 0.24; 95% CI 0.07, 0.62).1 Reported MACE was one each of myocardial infarction, acute myocardial infarction, acute coronary syndrome, cerebrovascular accident, haemorrhagic stroke, cerebellar haemorrhage and aortic dissection. Both myocardial infarction events and the acute coronary syndrome event led to temporary tofacitinib discontinuation; the haemorrhagic stroke, cerebrovascular accident and cerebellar haemorrhage led to permanent tofacitinib discontinuation; and the aortic dissection resulted in death. Of the seven patients with MACE, five had CV risk factors at BL. Conclusion At Month 48 of the OLE study, lipid levels and ratios remained generally unchanged from OLE study BL following tofacitinib treatment. MACE were infrequent, with the IR remaining stable since the previous report.1 Limitations include low patient numbers and short tofacitinib exposure duration. Longer-term observation studies will further assess risk. Reference

scholarly journals Patient Characteristics, Risk Factors, and Disease Outcomes in Young Adults With St-Elevation Myocardial Infarction: Insights From The Kermanshah Acute Coronary Syndrome Registry

2021 ◽  
Author(s):  
Soraya Siabani ◽  
Leila Gholizadeh ◽  
Hossein Siabani ◽  
Nahid Saleh
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Density Lipoprotein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Younger Adults ◽  
Coronary Syndrome ◽  
Disease Outcomes ◽  
St Elevation

Abstract Background: Myocardial infarction in younger adults is an understudied research area. Objectives: This paper reports on characteristics, risk factors, and disease outcomes of young adults with St-elevation myocardial infarction (STEMI).Methods: This is a sub-analysis of data from the Kermanshah Acute Coronary Syndrome Registry, including all patients aged ≤45 with STEMI (n=247) registered in the registry from June 2017 to June 2019. Results: Patients aged ≤45 constituted 10.66% of all patients with STEM; the majority was male (91.8%), and the most common CVD risk factors included: smoking (56.7%), low high-density lipoprotein (55.5%), elevated triglyceride (44.4%), hypertension (38.2%), hypercholesterolemia (38.1%), elevated low-density lipoprotein (26.3%), and obesity (24.3%). Many patients (62.8%) received primary percutaneous coronary intervention (PCI), and in-hospital mortality was low at 0.8%. Conclusions: Younger adults should be screened for CVD risk factors, and are educated and supported to participate in programs that aim to reduce risk through risk factor modification.

scholarly journals Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention

2021 ◽  
Vol 17 (1) ◽  
pp. 73-82
Author(s):  
M. V. Zykov ◽  
V. V. Butsev ◽  
R. R. Suleymanov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ischemic Stroke ◽  
Cerebrovascular Accident ◽  
Rare Complication ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Coronary Syndrome ◽  
The Cost

The present work is devoted to the analysis of modern publications on various aspects of the development and course of ischemic stroke in the presence of acute myocardial infarction. A literature search was conducted on the websites of cardiological and neurological societies, as well as on the PubMed, EMBASE, eLibrary databases using the keywords: myocardial infarction, acute coronary syndrome, stroke, acute cerebrovascular accident, myocardial infarction, acute coronary syndrome, stroke. The authors of this review found that although stroke is a relatively rare complication of myocardial infarction, its prevention is an extremely significant task, since it is associated with high mortality, disability and a significant increase in the cost of treatment. So, it is extremely important to detect thrombosis of the left ventricular cavity in a timely manner, to register preexisting atrial fibrillation that occurs earlier or for the first time, followed by the appointment of anticoagulant therapy. Timely reperfusion treatment, the use of statins and modern dual antithrombotic therapy can reduce the risk of developing cerebrovascular accident in patients with myocardial infarction. It is likely that a decrease in the activity of subclinical inflammation after myocardial infarction will also reduce the risk of stroke, as was recently shown in the COLCOT study. Currently, it remains relevant to search for new knowledge about the risk factors for stroke, which complicated the course of myocardial infarction, which will allow developing more effective and personalized preventive measures in a patient with acute coronary syndrome.

scholarly journals Pattern of Dyslipidemia in different type of Myocardial Infarction

2017 ◽  
Vol 5 (2) ◽  
pp. 106-109
Author(s):  
Md Zahid Alam ◽  
Aparna Rahman ◽  
Shabnam Jahan Hoque ◽  
SM Rezaul Irfan ◽  
Md Babul Miah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Prognostic Significance ◽  
Density Lipoprotein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Risk Factors ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Lipid Status ◽  
St Elevation

Background: Dyslipidemia is one of the main risk factors with prognostic significance in relation to coronary heart disease. Aggressive treatment has been recommended in acute coronary syndrome (ACS). We examined pattern of dyslipidemia in ST Elevation myocardial infarction (STEMI) and Non- ST elevation myocardial infarction (NSTEMI). We also compare the lipid status in between two types of myocardial infarction (MI).Methods: This cross sectional observational study was carried out enrolling 100 subjects with ST elevation and Non ST elevation Myocardial Infarction, in the Department of Cardiology, BIRDEM General Hospital, Shahbag, Dhaka, over a period of six months from January 2012 to June 2012. Fasting lipid profile was done in next morning of admission in both type of MI.Results: Mean age and gender difference was significant between STEMI and NSTEMI. Mean Cholesterol (chol), Triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were not statistically significant between male and female groups. All mean cholesterol, TG, HDL, LDL were significantly high in older age group. The Mean cholesterol (220.7±28.1Vs208.4±20.9), triglyceride (182.8±34.4 Vs 147.4±28.9), HDL (35.14±5.7 Vs 41.65±3.8) and LDL (160.7±26.2 Vs148.3±16.8)were also statistically significant between STEMI and NSTEMI groups (p<0.05).Conclusion: Dyslipidemia is the dominating coronary risk factors. It could be concluded that significant differences are observed between two types of MI. Lipid status is relatively more uncontrolled in ST elevated MI and must be managed with all possible therapeutic modules to minimize further complications.Bangladesh Crit Care J September 2017; 5(2): 106-109

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

scholarly journals Increased midlife triglycerides predict brain β-amyloid and tau pathology 20 years later

Neurology ◽  
2017 ◽  
Vol 90 (1) ◽  
pp. e73-e81 ◽  
Author(s):  
Katarina Nägga ◽  
Anna-Märta Gustavsson ◽  
Erik Stomrud ◽  
Daniel Lindqvist ◽  
Danielle van Westen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Healthy Population ◽  
Lipid Levels ◽  
Tau Pathology ◽  
Lipoprotein Subfractions ◽  
Cognitively Normal ◽  
Normal Individuals ◽  
Β Amyloid

ObjectiveTo evaluate the effect of midlife lipid levels on Alzheimer brain pathology 20 years later in cognitively normal elderly individuals.MethodsThis is a longitudinal cohort study of 318 cognitively normal individuals with data on fasting lipid levels at midlife (mean age 54 years). Presence of β-amyloid (Aβ) and tau pathologies 20 years later (mean age 73 years) were detected by quantifying Alzheimer disease (AD) biomarkers in CSF. In a subset (n = 134), Aβ (18F-flutemetamol) PET was also performed.ResultsCSF Aβ42 and Aβ PET revealed Aβ pathology in approximately 20% of the cognitively healthy population and CSF Aβ42/phosphorylated tau (p-tau) ratio indicated both Aβ and tau pathology in 16%. Higher levels of triglycerides in midlife were independently associated with abnormal CSF Aβ42 (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.03–1.75, p = 0.029) and abnormal Aβ42/p-tau ratio (OR 1.46, 95% CI 1.10–1.93; p = 0.009) adjusting for age, sex, APOE ε4, education, and multiple vascular risk factors. Triglycerides were also associated with abnormal Aβ PET in multivariable regression models, but the association was attenuated in the fully adjusted model. Increased levels of medium and large low-density lipoprotein subfractions were significantly associated with abnormal Aβ PET and large high-density lipoprotein particles were associated with decreased risk of abnormal Aβ PET.ConclusionsIncreased levels of triglycerides at midlife predict brain Aβ and tau pathology 20 years later in cognitively healthy individuals. Certain lipoprotein subfractions may also be risk factors for Aβ pathology. These findings further support an involvement of lipids in the very early stages of AD development.

scholarly journals Low HDL Cholesterol, Smoking and IL-13 R130Q Polymorphism are Associated with Myocardial Infarction in Greek Cypriot Males. A Pilot Study

2008 ◽  
Vol 2 (1) ◽  
pp. 52-59 ◽  
Author(s):  
Stavroulla Xenophontos ◽  
Marilena Hadjivassiliou ◽  
Alexandros Karagrigoriou ◽  
Nafsika Demetriou ◽  
George Miltiadous ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipoprotein Cholesterol ◽  
Greek Cypriot ◽  
Low Hdl ◽  
First Time ◽  
Control Study

This study was carried out in Greek Cypriot males to identify risk factors that predispose to myocardial infarction (MI). Genetic and lipid risk factors were investigated for the first time in a Greek Cypriot male case-control study.Contrary to other studies, mean low density lipoprotein cholesterol did not differ between cases and controls. High density lipoprotein cholesterol on the other hand, although within normal range in cases and controls, was significantly higher in the control population. In agreement with many other studies, smoking was significantly more prevalent in cases compared with controls. In pooled cases and controls, smokers had a significantly lower HDL-C level compared with non-smokers. The frequency of the IL-13 R130Q homozygotes for the mutation (QQ), as well as the mutant allele were significantly higher in cases compared with controls. The IL-13 R130Q variant, or another locus, linked to it, may increase the risk of MI.

scholarly journals Acute Myocardial Infarction In Systemic Mastocytosis: Case Report With Literature Review Of The Role Of Inflammatory Process In Acute Coronary Syndrome

2020 ◽  
Vol 16 ◽  
Author(s):  
Ayman Battisha ◽  
Khalid Sawalha ◽  
Bader Madoukh ◽  
Omar Sheikh ◽  
Karim Doughem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plasma Lipids ◽  
Plaque Rupture ◽  
Systemic Mastocytosis ◽  
Cardiac Risk ◽  
Control Group ◽  
Coronary Syndrome

: Systemic Mastocytosis (SM) is a disorder of excessive mast cell infiltration in multiple organ tissues. Atherosclerosis is a major risk factor for developing acute coronary syndrome [1]. In addition to lipid accumulation in the arterial wall, inflammation plays an important role in the pathogenesis of plaque rupture and activating the thrombosis cascade [2]. The Mast cells contribution to plaque destabilization has been well established in multiple animal and human studies [3]. In a recent study, SM has been proven to be associated with a higher incidence of acute coronary syndrome even with lower plasma lipids level [4]. The study showed that 20% of patients with SM had cardiovascular events compared to only 6% in the control group with adjustment to all cardiac risk factors. Here, we present a case of acute myocardial infarction in a patient with SM with limited risk factors other than age.

Abstract P118: Machine Learning Algorithm For Improving Classification Of Myocardial Infarction Across A Diverse Population Using US Veteran Electronic Health Record Data

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Kelly Cho ◽  
Nicholas Link ◽  
Petra Schubert ◽  
Zeling He ◽  
Jacqueline P Honerlaw ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Density Lipoprotein ◽  
Health Record ◽  
Female Veterans ◽  
Black And White ◽  
Code Algorithm ◽  
Billing Code

Introduction: The majority of population-based studies of myocardial infarction (MI) rely on billing codes for classification. Classification algorithms employing machine learning (ML) increasingly used for phenotyping using electronic health record (EHR) data. Hypothesis: ML algorithms integrating billing and information from narrative notes extracted using natural language processing (NLP) can improve classification of MI compared to billing code algorithms. Improved classification will improve power to compare risk factors across population subgroups. Methods: Retrospective cohort study of nationwide Veterans Affairs (VA) EHR data. MI classified using 2 approaches: (1) published billing code algorithm, (2) published phenotyping pipeline incorporating NLP and ML. Results compared against gold standard chart review of MI outcomes in 308 Veterans. We also tested known association between high density lipoprotein cholesterol (HDL-C) and MI outcomes classified using the 2 approaches among Black and White Veterans, stratified by sex and race; prior study showed HDL-C less protective for Black compared to White individuals. Results: We studied 17,176,658 million Veterans, mean age 69 years, 94% male, 12% self-report Black, 71% White. The billing code algorithm classified MI at positive predictive value (PPV) 0.64 compared to the published ML approach, PPV 0.90; the latter classified a modestly higher percentage of non-White Veterans. Using ML algorithm for MI, we replicated a reduced protective effect of HDL-C in Black vs White male and female Veterans (Table); with the billing code algorithm no association was observed between low density lipoprotein cholesterol (LDL-C) or HDL-C with MI among Black female Veterans. Conclusions: Using nationwide VA data, application of an ML approach improved classification of MI particularly among non-White Veterans, resulting in improved power to study differences in association for MI risk factors among Black and White Veterans.

Abstract P494: Association of Lipid Components With Mortality,Myocardial Infarction, and Stroke in Statin-Naïve Young Adults: A Nationwide Cohort Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Heesun Lee ◽  
Jun-bean Park ◽  
Hyo Eun Park ◽  
Su-yeon Choi ◽  
Kyungdo Han ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Young Adults ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Study Endpoint ◽  
Lipid Levels ◽  
Lipid Management ◽  
Risk Of Death ◽  
Clinical Events ◽  
Lipid Components

Background: Dyslipidemia is a modifiable cardiovascular risk factor with prognostic implications. Current strategies for lipid management in young adults are largely based on expert recommendations. We sought to investigate the risk of death and cardiovascular disease in relation to lipid components to establish evidence for primary prevention in young adults. Methods: In a nationwide cohort using the National Health Insurance claims database, we analyzed 5,688,055 statin-naïve subjects, aged 20-39 years, undergoing health check-up between 2009 and 2014. The study endpoint was a composite of clinical events, including death, myocardial infarction (MI), and stroke. We compared the incidence and the risk of clinical events according to lipid variables, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides. Results: During follow-up (median 7.1 years), clinical events occurred in 30,330 subjects (0.53%); 16,262 deaths (0.29%), 8,578 MIs (0.15%), and 5,967 strokes (0.10%). The risk of clinical events gradually increased with increasing TC and triglycerides, and decreasing HDL-C, with a great contribution by MI. LDL-C had a J-shaped association with the study endpoint, showing the lowest risk in LDL-C of 84-101 mg/dL. Among lipid variables, triglycerides remained the sole independent predictor (adjusted HR 1.20, p <0.001), after adjusting for conventional risk factors. Conclusions: In ‘statin-naïve’ young adults aged 20-39 years, the risk of clinical events was proportional to lipid levels; positively with TC and triglycerides, negatively with HDL-C, and J-shaped with LDL-C. Triglycerides had the strongest and independent association with clinical events. Screening and intervention of abnormal lipid levels, particularly triglycerides, from an early age might be required.

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