A new model to implement a structured enhanced education and follow-up program in primary prevention for coronary artery disease

Abstract Background Primary prevention programs for coronary artery disease (CAD) may be effective in improving health-related behavioral outcomes. However, the implementation and especially the maintanance of these programs can be very challenging mainly due to staffing cost. Thus, the present study was designed to assess the feasibility and effectiveness of a longitudinally structured, enhanced education and follow-up program for CAD prevention in an area where the diverse population and economy are major problems. Methods SANKO Coronary Artery Disesae Prevention Project (SCAD-PPI) was designed as a longitudinal study and utilized medical school students to conduct the entire project under the supervision of professors. It started in 2014 and had 2 different education and training phases. In the first phase; every school year, 2nd year Medical students underwent a one-year, specially designed training program on primary prevention for CAD. In the second phase, which took place in the 2nd year of the study, a series of conferences on primary prevention for CAD were organized by the University and local municipalities for underserved populations. Participants were prospectively assigned to an intervention where pre and post conference knowledge were collected and assessed. Every intervention was conducted by specially trained 3rd year Medical students and an education booklet which was specifically designed for this study was given to the participants. Every other month thereafter, for 6 months, each participant was followed by phone. At the 6 month follow -up, data was collected to assess the impact of enhanced education and follow-up program on behavioral outcomes. Results A total of 135 participant were enrolled; 79% were women, mean age was 41±13 years, only 29% had a graduate school degree; 56% were not working. Mean BMI was 28.3±5.1kg/m2. Overall knowledge on CAD risk factors, primary prevention measures, diet and daily exercise habits were very poor. After the enhanced education and follow-up program there was a significant improvement on the knowledge of CAD risk factors and primary prevention measures (p<0.001). More importantly, the follow-up program led participants to implement those positive changes into their lives and maintain a healthy life style. A separate cost analysis showed significant savings. Conclusion This is the first study which showed that a longitudinally structured training program of medical students could be utilized to implement an enhanced education and follow–up program for primary prevention of CAD in an economically challenged, underserved population with successful outcomes. This model program is not only cost-effective and beneficial for public interest but also enhances active interaction of medical students with patients at a very early stage of their career. Funding Acknowledgement Type of funding source: None

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The gender differences in the implementation and maintenance of a structured-enhanced education and follow-up program in primary prevention for coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.1410 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

O Soran ◽

P G Karadeniz ◽

M Uygunlar ◽

B Hengirmen ◽

T Durak ◽

...

Keyword(s):

Risk Factors ◽

Medical Students ◽

Primary Prevention ◽

Training Program ◽

Behavioral Outcomes ◽

Prevention Measures ◽

Second Year ◽

Artery Disease ◽

Cad Risk

Abstract Background Primary prevention programs for coronary artery disease (CAD) may be effective in improving health-related behavioral outcomes. However, successful implementation and maintenance of these programs can vary amongst genders. The primary aim of this study is to assess the gender differences in a structured, enhanced education and follow-up program for CAD prevention in an area where the diverse population and economy are major problems. Methods SANKO CAD Prevention Project (SCAD-PPI) was designed as a longitudinal study and utilized medical school students to conduct the project under the supervision of professors. It began in 2014 and had two different education and training phases. In the first phase, every school year for second year Medical students underwent a year-long, especially designed training program on primary prevention for CAD. In the second phase, which took place in the second year of the study, a series of conferences regarding the primary prevention for CAD were organized by the University and local municipalities for underserved populations. Participants were prospectively assigned to an intervention where pre- and post-conference knowledge was collected and assessed. Every intervention was conducted by specially trained third year Medical students and an education booklet, which was specially designed for the study, was given to the participants. Every other month thereafter, for 6 months, each participant was followed-up via phone calls. At the 6 months follow -up, data was collected to assess the impact of the program on behavioral outcomes. Every year a new class assigned to undergo the same training program and serve to the local population at different locations within the same city and suburbs. Results A total of 172 participant were enrolled; 61% were women, mean age was 40±11.9 years with no significant difference in between the groups.; 67% of women were not working (p<0.001). While BMI rates were higher in women (27.9±5.5 kg/m2, p<0.016), smoking rates were higher in men (p<0.001). Overall, knowledge on CAD risk factors, primary prevention measures, diet, and daily exercise habits were poor in both groups. After the enhanced education and follow-up program there was a significant improvement on the knowledge of CAD risk factors and primary prevention measures in both groups (p<0.001). Importantly, the follow-up program led both groups to implement those positive changes into their lives and maintain a healthy lifestyle. Conclusion This is the first study which showed that a longitudinally structured training program of medical students could be utilized to implement an enhanced education and follow–up program for primary prevention of CAD in an economically challenged, underserved population with successful outcomes in both genders. This model program is not only beneficial for public interest, but also enhances active interaction of medical students with patients at a very early stage of their career. FUNDunding Acknowledgement Type of funding sources: None.

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Coronary artery disease risk among obese metabolically healthy young men

Acta Endocrinologica ◽

10.1530/eje-15-0284 ◽

2015 ◽

Vol 173 (3) ◽

pp. 305-312 ◽

Cited By ~ 11

Author(s):

Gilad Twig ◽

Hertzel C Gerstein ◽

Dana Ben-Ami Shor ◽

Estela Derazne ◽

Dorit Tzur ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Fasting Glucose ◽

Young Men ◽

Historical Cohort ◽

Metabolically Healthy ◽

Artery Disease ◽

Cad Risk

ObjectiveThe aim of this study was to assess coronary artery disease (CAD) risk among obese young men without metabolic risk factors.DesignA longitudinal study in a historical cohort.MethodsIncident CAD during a median follow-up of 6.1 years was assessed among 31 684 young men (mean age 31.2±5.7 years) of the Metabolic, Lifestyle and Nutrition Assessment in Young Adults (MELANY) cohort. Participants were categorized by BMI and the number of metabolic abnormalities (based on the Adult Treatment Panel-III). Metabolically healthy (MH) obesity was defined as BMI ≥30 kg/m2 in the presence of normal blood pressure (BP) and normal levels of fasting glucose, triglyceride, and HDL-cholesterol (HDL-c) levels (n=599; 1.9%). Cox proportional hazard models were applied.ResultsThere were 198 new cases of CAD that were diagnosed during 209 971 person-years of follow-up, of which six cases occurred among MH obese. The incidence of CAD among MH lean, overweight, and obese participants was 0.23, 0.45, and 1.0/1000 person-years respectively. In a multivariable model adjusted for clinical and biochemical CAD risk factors, a higher CAD risk was observed among MH-obese (hazard ratio=3.08; 95% CI=1.10–8.68, P=0.033), compared to MH-normal weight subjects. This risk persisted when BMI was treated as a time-dependent variable, or when fasting glucose, HDL-c, triglycerides, or BP were added to the model. Similar results were also obtained when a more permissive definition of MH was used.ConclusionsObesity may continue to contribute to increased risk for incident CAD in young men even in the presence of a healthy metabolic profile.

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Abstract P101: Predictors of Coronary Artery Disease in Type 1 Diabetic Subjects With and Without Microalbuminuria: A 20 Year Follow Up Study

Circulation ◽

10.1161/circ.125.suppl_10.ap101 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Trevor J Orchard ◽

Georgia Pambianco

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Pulse Rate ◽

Diabetes Duration ◽

Major Predictor ◽

Artery Disease ◽

Cad Risk

The incidence of nephropathy, a major predictor of coronary artery disease (CAD) in type 1 diabetes (T1D), has been strongly declining over the past several years. However, CAD rates do not appear to be declining commensurately. To identify similarities and differences in the CAD risk factor profile in subjects with and without microalbuminuria or worse (MA+), 20 year follow up data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset T1D (mean baseline age 28 and duration 19 yrs) were examined. MA+ was determined by kidney disease-related death, dialysis, transplant, or AER>20 μg/mL in 2 of 3 timed urine collections. CAD was defined as angina, ischemic ECG changes, revascularization, confirmed MI, or CAD death. Cox proportional hazard models, adjusted for all the significant univariate risk factors, were determined separately for subjects who developed MA+ before their incident CAD event and for those who had CAD without preceding MA (MA-). As we have previously shown that CAD risk factors to vary by sex, we performed sex specific analyses within each MA group to determine if the predictors of CAD differ by sex and MA status. The results of the sex-specific analysis are listed in the table below. MA- MA+ Men (n=15 cases/84 β (CI) Men (n=65 cases/165) β (CI) nonHDL (mg/dl) 1.02 (1.0-1.04) Diabetes Duration (years) 1.12 (1.1-1.2) WHR 3.05 (.98-9.5) AER (log) 1.34 (1.2-1.5) Women (n=20 cases/92) Women (n=56 cases/172) Diabetes Duration (years) 1.11 (1.0-1.2) Diabetes Duration (years) 1.11 (1.07-1.15) Pulse Rate (bpm) 1.06 (1.0-1.1) Hypertension 1.85 (1.0-3.2) nonHDL (mg/dl) 1.01 (1.0-1.01) In the MA+ group, diabetes duration predicted CAD in both sexes, with AER (men) and hypertension and nonHDL (women) also contributing. However, in the MA- group, duration was only predictive in women, where pulse rate (p=0.016) was also predictive, while in men nonHDL, and to a small extent WHR (p=.054) predicted CAD. In conclusion, these data suggest that further factors beyond standard risk factors and renal disease are operative in T1D, particularly pulse rate in women.

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Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽

10.1177/00033197211028024 ◽

2021 ◽

pp. 000331972110280

Author(s):

Sukru Arslan ◽

Ahmet Yildiz ◽

Okay Abaci ◽

Urfan Jafarov ◽

Servet Batit ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Vessel Diameter ◽

Side Branch ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

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Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

Medicina ◽

10.3390/medicina57060605 ◽

2021 ◽

Vol 57 (6) ◽

pp. 605

Author(s):

Hanna K. Al-Makhamreh ◽

Mohammed Q. Al-Sabbagh ◽

Ala’ E. Shaban ◽

Abdelrahman F. Obiedat ◽

Ayman J. Hammoudeh

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Antiplatelet Agents ◽

Retrospective Case ◽

Increased Risk ◽

Artery Disease ◽

Epidemiological Characteristics ◽

Cad Risk

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24–0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8–3.4), smoking (OR = 1.7, 95% CI: 1.1–2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4–1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3–2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.

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Primary prevention of coronary artery disease among middle aged men in Prague: Twenty-year follow-up results

Atherosclerosis ◽

10.1016/j.atherosclerosis.2005.02.011 ◽

2006 ◽

Vol 184 (1) ◽

pp. 86-93 ◽

Cited By ~ 8

Author(s):

F. Boudík ◽

J. Reissigová ◽

K. Hrach ◽

M. Tomečková ◽

J. Bultas ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Primary Prevention ◽

Middle Aged ◽

Artery Disease

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Mendelian randomization analyses reveal mediating factors of the causal effect of height on coronary artery disease

10.1101/2021.12.16.21267869 ◽

2021 ◽

Author(s):

Daniel Hui ◽

Christopher S. Thom ◽

Kimberly Lorenz ◽

Scott M. Damrauer ◽

Themistocles L. Assimes ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Lung Function ◽

Mendelian Randomization ◽

Causal Effect ◽

Multivariable Analysis ◽

Inverse Correlation ◽

Artery Disease ◽

Cad Risk

An inverse correlation between stature and risk of coronary artery disease (CAD) has been observed in several epidemiologic studies, and recent Mendelian randomization (MR) experiments have suggested evidence that this association may be causal. However, the extent to which the effect estimated by MR can be explained by established cardiovascular risk factors is unclear, with a recent report suggesting that lung function traits could fully explain the height-CAD effect. To clarify this relationship, we utilized the largest set of genetic instruments for human stature to date, comprising >2,000 genetic variants for height and CAD. In univariable analysis, we confirmed that a one standard deviation decrease in height (~6.5 cm) was associated with a 12.0% increase in the risk of CAD, consistent with previous reports. In multivariable analysis accounting for effects from up to 12 established risk factors, we observed a >3-fold attenuation in the causal effect of height on CAD susceptibility (3.7%, p = 2.1x10-2). We observed minimal effects of lung function traits on CAD risk in our analyses, indicating that these traits are unlikely to explain the residual association between height and CAD risk. In sum, these results suggest that height does not add meaningful clinical impact on CAD risk prediction beyond established risk factors.

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Abstract 5070: Progression of Urine Albumin Excretion Despite of Optimized Therapies to Reduce Atherosclerotic Risk Factors has an Adverse Outcome in Patients with Coronary Artery Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_1139-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yoshinobu Kitta ◽

Mitsumasa Hirano ◽

Takamitsu Nakamura ◽

Yasushi Kodama ◽

Keita Sano ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Adverse Outcome ◽

Coronary Risk Factors ◽

Urine Albumin Excretion ◽

Albumin Excretion ◽

Urine Albumin ◽

Artery Disease ◽

Cad Risk

Although microalbuminuria is considered a strong risk factor of future cardiovascular disease (CVD), it remains unclear whether changes in urine albumin excretion (UAE) in response to a reduction of coronary risk factors may provide prognostic information in patients with coronary artery disease (CAD). Thus, this study assessed the hypothesis that changes in UAE in response to optimized therapy for reduction of CAD risk may predict future CVD events in patients with CAD. This study enrolled of 213 patients with newly diagnosed CAD who had microalbuminuria (30 mg/day ≤ UAE < 300 mg/day) at entry. Patients with late-stage chronic kidney disease (GFR < 60 ml/min/1.73 m 2 ) at entry were excluded. All patients had individualized, optimized therapies including medications and recommended life style changes to reduce risk factors for CAD according to AHA guidelines. All patients had a repeated test of UAE at 6 months (2 nd test) after the 1 st UAE test. Thereafter, all patients were prospectively followed up for 3 years or until the occurrence of 1 of the following events: CVD death, nonfatal myocardial infarction, unstable angina pectoris requiring revascularization, or ischemic stroke. Progression of UAE at the 2 nd test was defined as > 50% increase from the UAE at the 1 st test. UAE at 2 nd test was progressed in 62 (29%) patients, while it was not progressed in the remaining 151 (71%) patients. UAE at entry was comparable between patients with and without progression of UAE (52 ± 6.2 vs.61 ± 4.7 mg/day, respectively, p = ns). During follow-up period, events occurred in 15 (24%) of the 62 patients with progression of UAE and in 16 (10%) of the 151 patients without progression of UAE (p < 0.01 by chi-square test). Using a multivariate Cox hazards analysis, progression of UAE was a predictor of future CVD events that was independent of UAE at 1 st test, use of medications, age, and traditional CAD risk factors (HR 2.5, 95%CI 1.2 – 4.8, p = 0.01). Progression of urine albumin excretion despite individualized and optimized therapies to reduce CAD risk factors represents an adverse outcome in CAD patients. Periodic measurement of urine albumin excretion may be useful for risk stratification in CAD.

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Breast artery calcium noted on screening mammography is predictive of high risk coronary calcium in asymptomatic women: a case control study

VASA ◽

10.1024/0301-1526/a000312 ◽

2013 ◽

Vol 42 (6) ◽

pp. 429-433 ◽

Cited By ~ 19

Author(s):

Martin E. Matsumura ◽

Crystal Maksimik ◽

Matthew W. Martinez ◽

Michael Weiss ◽

James Newcomb ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Coronary Artery Calcium ◽

Screening Mammography ◽

Artery Disease ◽

The Relationship ◽

Asymptomatic Women ◽

Cad Risk

Background: The relationship between breast artery calcification (BAC) noted on mammography and both coronary artery disease and cardiovascular risk remains controversial. Few studies have examined the clinical significance of BAC in asymptomatic women. In the present study we evaluated the relationship between BAC and coronary artery calcium (CAC) as identified by multi-slice CT scanning (MSCT). Patients and methods: Consecutive women (n = 98) with BAC noted on routine mammography but without known coronary artery disease (CAD) were assessed for CAD risk factors and had assessment of coronary calcium by MSCT. A control cohort of consecutive women who were BAC(-) (n = 104) underwent an identical assessment. Results: Women who were BAC(+) were older than those who were BAC(-); otherwise, there were no differences between the 2 groups with regard to traditional cardiac risk factors. Significantly more BAC(+) vs. BAC(-) women were found to have high risk CAC scores, defined as CAC > 400 (11.2 % vs. 1.0 %, p = 0.006). However, the rates of CAC scores of 0 were not different between the two groups (50.0 % vs. 54.8 % for BAC(+) and BAC(-) , respectively, p = 0.586). When examined in a multivariate model including the traditional risk factors of diabetes, increasing age, smoking, hyperlipidemia, and family history of CAD, the presence of BAC remained significantly associated with CAC > 400 (OR = 22.6, 95 % CI = 2.1 - 237.1). Conclusions: The presence of breast artery calcium on screening mammography was a strong independent predictor (odds ratio > 22) of high risk coronary artery calcium scores (defined as CAC > 400). The presence of BAC in those with significant CAD risk factors may warrant further evaluation.

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The Association Between Coronary 18F-Sodium Fluoride Uptake With Pro-Atherosclerosis Factors in Patients With Multivessel Coronary Artery Disease: A Mono-Centric Pilot Study

10.21203/rs.3.rs-568886/v1 ◽

2021 ◽

Author(s):

Wanwan Wen ◽

Mingxin Gao ◽

Mingkai Yun ◽

Jingjing Meng ◽

Ziwei Zhu ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sodium Fluoride ◽

Troponin I ◽

Cardiac Computed Tomography ◽

Serum Biomarkers ◽

Multivessel Coronary Artery Disease ◽

Artery Disease ◽

Cad Risk

Abstract Purpose: 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) is a novel approach to detect and quantify microcalcification in atherosclerosis. Peri-coronary adipose tissue (PCAT) is associated with vascular inflammation and high-risk atherosclerotic plaque. We aimed to assess the association between coronary 18F-NaF uptake with pro-atherosclerosis factors in patients with multivessel coronary artery disease (CAD) and to explore the systematic vascular osteogenesis in the coronary artery and aorta in these patients. Methods: Patients with multivessel CAD prospectively underwent cardiac computed tomography (CT) and 18F-NaF PET/CT. PCAT density was measured in the coronary artery and the average PCAT value was calculated from the three coronary arteries in each patient. 18F-NaF tissue-to-blood ratios (TBR) in the coronary artery (TBRCoronary) and aorta (TBRAorta) were calculated. Correlations between coronary 18F-NaF uptake with PCAT density, coronary artery calcium (CAC) burden, CAD risk factors, serum biomarkers, and aortic 18F-NaF uptake were evaluated, respectively. Patients were categorized by a median of TBRCoronary 2.49. Results: 100 multivessel CAD patients (64.00 [57.00 - 67.75] years; 76 men) were prospectively recruited. 6010 active aortic segments (TBR ≥ 1.6) were identified. TBRCoronary was significantly associated with the PCAT density (r = 0.56, p < 0.001) and CAC score (r = 0.45, p < 0.001). TBRCoronary was also significantly associated with the TBRAorta (r = 0.42, p < 0.001). In addition, patients with higher TBRCoronary showed elevated PCAT density (-75.89[-79.07 - -70.06] vs -84.54[-90.21 - -79.46]; p < 0.001) and CAC score (1495.20[619.80 - 2225.40] vs 273.75[116.73 - 1198.18]; p < 0.001) in comparsion patients with lower TBRCoronary. TBRCoronary was correlated with the age (r = 0.24, p = 0.019) and the serum troponin I levels (r = 0.22, p = 0.039). There were no significant correlations between TBRCoronary with other conventional CAD risk factors and other serum biomarkers.Conclusion: Coronary 18F-NaF uptake was correlated with the PCAT density. A significant correlation between 18F-NaF uptake in the coronary artery and aorta might indicate a systematic vascular osteogenesis in patients with multivessel CAD.

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