scholarly journals The absence of standard modifiable cardiovascular risk factors does not predict better outcomes in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.I Gonzalez Del Hoyo ◽  
O.M Peiro Ibanez ◽  
K Vaquez-Nunez ◽  
F Dominguez Benito ◽  
M Ferrero ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Cox Regression ◽  
Coronary Syndrome

Abstract Introduction The standard modifiable cardiovascular risk factors (SMuRFs), like diabetes mellitus, hyperlipidemia,hypertension and smoking, are central elements of the well-established European Society of Cardiology SCORE calculator. However, acute coronary syndromes (ACS) in SMuRF-less individuals are not uncommon. Purpose Our study aimed to describe the population with and without SMuRFs attended for an ACS and study prognostic factors associated with mortality. Methods We identified 1347 ACS patients without prior history of cardiovascular disease (ACS, cerebrovascular or peripheral artery disease)attended in our university hospital between 2009 and 2012 and examined the proportion of SMuRF-less patients as well as outcomes.The primary outcome was 5-year all-cause death. Results Overall, the median age was 63 years, 73.4% were male and 52 patients (7%)had no SMuRFs. The most common SMuRF was hypertension (60%), followed by smoking (47%), dyslipidemia (48%) and diabetes mellitus (27%). In patients with and without SMuRFs there were no differences in the proportion of females (27% vs 28%), age (63.7 years [IQR 54–75] vs 62 years [IQR 53–71]), renal failure (4.7% vs 0%, p=0.159), prior heart failure (1.6% vs 1.9%, p=0.590) and pulmonary obstructive disease (11.3% vs 9.6%, p=0.707). SMuRF-less patients had substantially less angina in the previously month (1.9% vs 19.1%, p<0.001), were less treated previously with aspirin (3.9% vs 18.9%, p=0.006), betablockers (5.8% vs 16.6%, p=0.039)and ACEI/ARAII (0% vs 38.1%, p<0.001). Patients with SMuRFs presented significantly more frequently with a NSTEMI (63.1% vs 48.1%) and less frequently with STEMI (32.3% vs 44.2%) or a non-classifiable ACS (2.7% vs 7.7%), compared to those without SMurFS. In patients with and without SMuRFs, there were no significant differences in Killip I class (95.4% vs 98%, p=0.370)and GRACE risk score (105 vs 103, p=0.694). Patients with SMuRFS compared to those without had a higher systolic blood pressure (141 mmHg vs 131 mmHg, p=0,03) and a lower glomerular filtration rate (81.8 ml/min/m2 vs 94 ml/min/m2, p=0.04). There were no differences in those with and without SMuRFs in performance of angiography (83% vs 90%, p=0.160), but SMurF-less patients had lower proportion of multivessel disease (18.6% vs 38.2%, p=0.011), higher tendency to percutaneous angioplasty (70.6% vs 57.8%, p=0.073) or performance of CABG (6.1% vs 1.1%, p=0.028).At 5-year follow up (IQR 3–7),SMuRF-less patients had a lower mortality (11.5% vs 23.4%, p=0.049).On multivariable Cox Regression age, chronic renal failure, glomerular filtration rate and GRACE score were independent predictors of death. Coronary angioplasty was a strong protective risk factor of death.However, being SMuRF-less was not protective against mortality. Conclusion The absence of SMuRFs was not an independent predictor of mortality. Our study highlights the importance of the often-overlooked subgroup of ACS patients with atherosclerosis not predicted by SMuRFs. Funding Acknowledgement Type of funding source: None

scholarly journals Risk Factors for Cardiovascular and Renal Disease in Type 2 Diabetes Mellitus in Patients with Normal and Mildly Reduced Glomerular Filtration Rate

2021 ◽  
Vol 18 (2) ◽  
pp. 61-68
Author(s):  
Marcel Stoiţă ◽  
Amorin Remus Popa
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate

Abstract In this study are investigated the cardiovascular risk factors that as shown in literature also represent risk factors for early glomerular function alteration in type 2 diabetes mellitus patients. The patients were divided according to their glomerular filtration rate in 2 groups, one group of patients with GFR ≥90 mL/min/1.73 m (118 patients) and the other with GFR between 60-89 mL/min/1.73 m2 (126 patients). Older age, hypertension, poor glycemic control, increased BMI, high LDL-cholesterol, high triglyceride level, insulin resistance and high level of apolipoprotein-B appeared to be more prevalent in patients with type 2 diabetes mellitus with mildly reduced kidney function. Even patients with mildly reduced GFR (without confirmed diabetic kidney disease) have an important aggregation of cardiovascular risk factors and their early identification is important for controlling them in order to further prevent glomerular decline.

scholarly journals Association between genetic determinants of clopidogel metabolism and clinical cardiovascular risk indicators in Buryat patients

2019 ◽  
Vol 23 (3) ◽  
pp. 39
Author(s):  
E. M. Zelenskaya ◽  
K. Y. Nikolaev ◽  
O. S. Donirova ◽  
V. D. Altayev ◽  
K. V. Protasov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Conflict Of Interest ◽  
Filtration Rate ◽  
Coronary Syndrome ◽  
Polymorphic Variants

<p><strong>Background. </strong>In some patients, the metabolism of clopidogrel is altered because of the presence of polymorphic variants rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17) in the <em>CYP2C19 </em>gene. There is also evidence of decreased efficacy of clopidogrel in individuals with the T/T genotype in the variant rs2305948 of the <em>VEGFR-2 </em>gene. Nevertheless, this medication is used widely in Russia due to the availability of generic anticoagulants.</p><p><strong>Aim. </strong>To assess the prevalence of the following polymorphic variants of <em>CYP2C19</em>: rs4244285 (* 2), rs4986893 (* 3) and rs12248560 (* 17); assess the prevalence of the rs2305948 variant of <em>VEGFR-2</em>, and determine cardiovascular risk factors in patients of Buryat nationality.</p><p><strong>Methods. </strong>The study included 113 patients of Buryat nationality who underwent coronary stent placement due to acute coronary syndrome. Patients were stratified by the presence of the following alleles: <em>CYP2C19 </em>* 2, *3, *17 and <em>VEGFR-2 </em>rs2305948. The following laboratory parameters were measured for all patients: blood glucose, lipid spectrum, creatinine, and glomerular filtration rate. The severity of coronary atherosclerosis was evaluated.</p><p><strong>Results. </strong>The frequencies of the alleles and halotypes (<em>CYP2C19 </em>* 2, * 3 and *17) were determined. An association between the carriage of the C/C genotype in rs2305948 and a &lt;60 ml/min/1.73 m<!-- x-tinymce/html --><sup>2</sup> decrease in glomerular filtration rate (χ<!-- x-tinymce/html --><sup>2</sup> = 4.185, p = 0.032) were found. Additionally, the C/C genotype in rs2305948 was associated with higher blood pressure (χ<!-- x-tinymce/html --><sup>2</sup> = 12.593, p = 0.001). For men, we identified a positive correlation between the rs2305948 C/C allele and the number of significant coronary stenoses (R = 0.227, p &lt; 0.05).</p><p><strong>Conclusion. </strong>Among Buryat patients with acute coronary syndrome and percutaneous coronary intervention, the CYP2C19*2,*3 polymorphic variants were associated with a 46.0% decrease in the metabolic rate for clopidogrel. Furthermore, we identified several associations between the C/C genotype in the rs2305948 variant of VEGFR-2 with a number of cardiovascular risk factors.</p><p>Received 2 September 2019. Revised 24 October 2019. Accepted 30 October 2019.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><strong></strong></p><p>Conception and study design: V.D. Altayev, K.V. Protasov, G.I. Lifshits</p><p>Data collection and analysis: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. Lifshits</p><p>Drafting the article: Е.М. Zelenskaya</p><p>Critical revision of the article: Е.М. Zelenskaya</p><p>Final approval of the version to be published: Е.М. Zelenskaya, K.Y. Nikolaev, O.S. Donirova, V.D. Altayev, K.V. Protasov, E.N. Voronina, G.I. Lifshits</p>

scholarly journals Independent cardiovascular risk factors: hyperhomocysteinemia and vascular stiffness in patients with hypertension

HYPERTENSION ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 5-16
Author(s):  
O.L. Rekovets ◽  
Yu.M. Sirenko ◽  
O.O. Torbas ◽  
S.M. Kushnir ◽  
H.F. Prymak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Body Mass Index ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Arterial Stiffness ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate

Background. Identification of risk factors and preliminary assessment of overall cardiovascular risk in patients with hypertension is the most important task in clinical practice. Most patients, in addition to high blood pressure (BP), have other cardiovascular risk factors that aggravate each other, leading to an increase in overall cardiovascular risk. One of the cardiovascular risk factors is an increased arterial stiffness. Arterial stiffness is evaluated using pulse wave velocity (PWV). The other independent risk factor for cardiovascular diseases is elevated level of total homocysteine in the blood. The purpose was to evaluate the relationship between hyperhomocysteinemia (HHc) and vascular stiffness in patients with hypertension. Materials and methods. Our research was carried out as a part of the ХІПСТЕР trial in Ukraine. The study included 40 patients with hypertension stage 1 and 2 (average office systolic (SBP)/diasto-lic blood pressure (DBP) was 155.88/92.60 ± 1.63/1.43 mmHg, heart rate — 71.40 ± 1.29 bpm). The average age of the patients was 55.85 ± 2.09 (26–74) years. Individuals with homocysteine levels ≥ 10 μmol/l were referred to as those with HHc (H-type hypertension). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % of patients (30 individuals with mild and moderate hypertension) had H-type hypertension with an increased level of homocysteine. Patients with H-type hypertension (HHc) and hypertension without HHc did not differ in terms of age, duration of hypertension. At the same time, patients with H-type hypertension had higher body weight and body mass index. Office SBP in patients with H-type hypertension at baseline and after 6 months of treatment was higher compared to patients without HHc (156.45 ± 1.04 mmHg and 152.55 ±1.41 mmHg (p < 0.05) at baseline vs 130.65 ± 0.96 mmHg and 126.97 ± 1.08 mmHg (p < 0.05) in 6 months). At the beginning of the study, body mass index was 30.72 ± 0.39 kg/m2 in patients with H-type hypertension vs 28.34 ± 0.69 kg/m2 in those without HHc (p < 0.05). Patients with H-type hypertension less often achieved target blood pressure levels during treatment and initially had higher blood pressure values. Individuals with H-type hypertension compared to patients without HHc had a more severe insulin resistance (according to the homeostatic model assessment), lower glomerular filtration rate, both at baseline and by the end of treatment. According to ambulatory blood pressure monitoring data, before the start of treatment, patients with H-type hypertension compared to those with hypertension without HHc had a significantly higher SBP level. After regression analysis, homocysteine level was associated with PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, b = 0.307, P = 0.001). Conclusions. Male gender, body mass index, glomerular filtration rate, blood glucose, office and central blood pressure were associated with elevated serum homocysteine levels.

scholarly journals Traditional cardiovascular risk factors and glomerular filtration rate in patients with rheumatoid arthritis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.B Madrakhimov ◽  
U.M Shukurov ◽  
S.A Ubaydullaev
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Comparison Group ◽  
Cardiovascular Complications

Abstract   The leading cause of premature death in rheumatoid arthritis (RA) is cardiovascular complications associated with vascular atherosclerosis. Even a slight decrease in glomerular filtration rate (GFR) is an important independent risk factor for cardiovascular complications. The purpose of the study: to determine GFR in patients with RA, to identify the relationship between GFR and traditional risk factors for the development of cardiovascular complications. Methods The study included 58 patients with RA aged 21 to 60 years, who do not have concomitant kidney diseases, arterial hypertension (AH) of stage III, and diseases accompanied by the development of secondary nephropathy. GFR was calculated using the CKD-EPI formula. All patients were evaluated for traditional cardiovascular risk factors: hypertension, dyslipidemia, a complicated hereditary history of early development of cardiovascular diseases, overweight, and smoking. The European SCORE scale and the Reynolds Risk Score (RRS) predictive scale in the EULAR modification were used to assess the total risk of cardiovascular complications. Results Women predominated among the patients – 61 (86.6%). The mean age of patients is 45 years. Seropositive patients with rheumatoid factor prevailed, with moderate and high activity of the process, III x-ray stage according to Steinbroker. In 36 (62%) patients, GFR was in the range from 60 to 89 ml/min/1.73m2, in 38% of patients-more than 90 ml/min/1,73m2. The average GFR in patients with RA was 88.43±16.13 ml/min/1.73m2, in the comparison group-83.54±15.22 ml/min/1.73m2 (p=0.063). Arterial hypertension was diagnosed in 40 (68.9%) patients with RA: 70.2% of women and 55.3% of men. The level of total cholesterol in patients with RA is significantly higher than in the comparison group (p&lt;0.001), even in patients younger than 40 years, the level of total cholesterol is higher than in those without arthritis (5±1.15 and 4.14±0.21 mmol/l, p=0.027). The average value of the SCORE scale in RA patients and in the comparison group is generally comparable, and when compared by age periods. In patients younger than 40 years who suffer from hypertension, GFR is lower than in patients of the same age, but without hypertension: 86 [79; 101.5] and 104.5 [101; 112] ml/min/1.73m2, respectively, p=0.043. Relationships between GFR and traditional cardiovascular risk factors were identified: body mass index (r=−0.414; p&lt;0.001), total cholesterol levels (r=−0.402; p&lt;0.001), low-density lipoproteins (r=−0.331; p=0.013), triglycerides (r=−0.283, p=0.028), systolic BP (r=−0.257; p=0.027), diastolic BP (r=−0.255; p=0.029) at the time of the study, the value of the Score scale (r=−0.529; p&lt;0.001) and RRS (r=−0.341; p=0.031). Conclusion Most patients with rheumatoid arthritis showed a decrease in glomerular filtration rate, and GFR is associated with traditional risk factors for cardiovascular events. Funding Acknowledgement Type of funding source: None

Two Cardiovascular Risk Factors in One? Homocysteine and Its Relation to Glomerular Filtration Rate

2008 ◽  
Vol 31 (4) ◽  
pp. 259-267 ◽  
Author(s):  
Jan T. Kielstein ◽  
Shelley R. Salpeter ◽  
Nicholas S. Buckley ◽  
John P. Cooke ◽  
Danilo Fliser
Keyword(s):  
Risk Factors ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Glomerular Filtration ◽  
Filtration Rate
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