P3422Contrasting the risk for atherosclerotic cardiovascular disease events among individuals with lower extremity peripheral artery disease, coronary heart disease and cerebrovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Hubbard ◽  
L D Colantonio ◽  
R S Rosenson ◽  
T M Brown ◽  
E A Jackson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Lower Extremity ◽  
Cerebrovascular Disease ◽  
Event Rate ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
History Of ◽  
Artery Disease

Abstract Background Having more vascular conditions, including coronary heart disease (CHD), cerebrovascular disease and lower extremity artery disease (LEAD), may increase the risk for atherosclerosis cardiovascular disease (ASCVD) events. Specific vascular conditions may increase the ASCVD event rate more than others. Purpose To compare the risk for future ASCVD events associated with the number and type of vascular conditions among adults with a history of CHD, cerebrovascular disease and/or LEAD. Methods We analyzed data from US adults ≥19 years of age with commercial or Medicare health insurance who had a history of CHD, cerebrovascular disease and/or LEAD as of December 31, 2014 (N=901,391). Individuals were followed through December 31, 2016 (median follow-up: 2 years) for ASCVD events, including myocardial infarction, coronary revascularization, stroke, carotid revascularization and lower extremity amputation or revascularization. Results Among individuals included in the current analysis (mean age 63 years, 45% female), 70%, 23% and 7% had 1, 2 and 3 vascular conditions, respectively. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratio for ASCVD among individuals with 2 and 3 versus 1 vascular conditions was 1.88 (1.85, 1.92) and 2.93 (2.86, 3.00), respectively. Among individuals with 1 vascular condition, the rate of ASCVD events per 1,000 person-years was 46.5 (95% CI 44.1, 49.0), 29.6 (95% CI 29.0, 30.1) and 19.9 (95% CI 19.2, 20.8) for those with LEAD, CHD and cerebrovascular disease, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD events comparing individuals with LEAD only and CHD only versus those with cerebrovascular disease only was 1.84 (1.77, 1.92) and 1.12 (1.08, 1.16), respectively. Among individuals with 2 vascular conditions, the ASCVD event rate per 1,000 person-years was higher in those with LEAD and CHD (122.0, 95% CI 112.5, 132.2) and with LEAD and cerebrovascular disease (92.4, 95% CI 79.9, 106.4), versus those with CHD and cerebrovascular disease (59.1, 95% CI 54.8, 63.6). The multivariable-adjusted hazard ratio (95% CI) comparing individuals with LEAD and CHD and those with LEAD and cerebrovascular disease versus those with CHD and cerebrovascular disease was 1.48 (1.44, 1.53) and 1.49 (1.41, 1.58), respectively. Conclusion Among adults with vascular disease, having LEAD confers a higher risk for future ASCVD events than CHD or cerebrovascular disease and this group may benefit from more intensive risk reduction treatment. Acknowledgement/Funding Amgen Inc.

Abstract P253: Proton Pump Inhibitor Use is Positively Associated with Incidence of Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Elizabeth J Bell ◽  
Jennifer L St. Sauver ◽  
Veronique L Roger ◽  
Nicholas B Larson ◽  
Hongfang Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Language Processing ◽  
Proton Pump ◽  
Hazard Ratio ◽  
Time Varying ◽  
Increased Risk ◽  
The Impact

Introduction: Proton pump inhibitors (PPIs) are used by an estimated 29 million Americans. PPIs increase the levels of asymmetrical dimethylarginine, a known risk factor for cardiovascular disease (CVD). Data from a select population of patients with CVD suggest that PPI use is associated with an increased risk of stroke, heart failure, and coronary heart disease. The impact of PPI use on incident CVD is largely unknown in the general population. Hypothesis: We hypothesized that PPI users have a higher risk of incident total CVD, coronary heart disease, stroke, and heart failure compared to nonusers. To demonstrate specificity of association, we additionally hypothesized that there is not an association between use of H 2 -blockers - another commonly used class of medications with similar indications as PPIs - and CVD. Methods: We used the Rochester Epidemiology Project’s medical records-linkage system to identify all residents of Olmsted County, MN on our baseline date of January 1, 2004 (N=140217). We excluded persons who did not grant permission for their records to be used for research, were <18 years old, had a history of CVD, had missing data for any variable included in our model, or had evidence of PPI use within the previous year.We followed our final cohort (N=58175) for up to 12 years. The administrative censoring date for CVD was 1/20/2014, for coronary heart disease was 8/3/2016, for stroke was 9/9/2016, and for heart failure was 1/20/2014. Time-varying PPI ever-use was ascertained using 1) natural language processing to capture unstructured text from the electronic health record, and 2) outpatient prescriptions. An incident CVD event was defined as the first occurrence of 1) validated heart failure, 2) validated coronary heart disease, or 3) stroke, defined using diagnostic codes only. As a secondary analysis, we calculated the association between time-varying H 2 -blocker ever-use and CVD among persons not using H 2 -blockers at baseline. Results: After adjustment for age, sex, race, education, hypertension, hyperlipidemia, diabetes, and body-mass-index, PPI use was associated with an approximately 50% higher risk of CVD (hazard ratio [95% CI]: 1.51 [1.37-1.67]; 2187 CVD events), stroke (hazard ratio [95% CI]: 1.49 [1.35-1.65]; 1928 stroke events), and heart failure (hazard ratio [95% CI]: 1.56 [1.23-1.97]; 353 heart failure events) compared to nonusers. Users of PPIs had a 35% greater risk of coronary heart disease than nonusers (95% CI: 1.13-1.61; 626 coronary heart disease events). Use of H 2 -blockers was also associated with a higher risk of CVD (adjusted hazard ratio [95% CI]: 1.23 [1.08-1.41]; 2331 CVD events). Conclusions: PPI use is associated with a higher risk of CVD, coronary heart disease, stroke and heart failure. Use of a drug with no known cardiac toxicity - H 2 -blockers - was also associated with a greater risk of CVD, warranting further study.

Abstract MP26: Silent Small-vessel Cerebrovascular Disease In Individuals With A Family History Of Coronary Heart Disease: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Michelle C Johansen ◽  
Paul A Nyquist ◽  
Kevin Sullivan ◽  
Myriam Fornage ◽  
Rebecca F Gottesman ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Family History ◽  
Cerebrovascular Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Cerebral Microbleeds ◽  
Lacunar Infarct ◽  
White Matter Hyperintensity ◽  
Linear Regression Models ◽  
History Of

Background: It is established that a family history of coronary heart disease (FHCHD) is associated with coronary atherosclerosis in healthy first-degree relatives, but the extent to which FHCHD is associated with silent cerebrovascular disease (cSVD) is unknown. We hypothesized a higher prevalence of cSVD in healthy persons with FHCHD, independent of traditional risk factors, compared to those without FHCHD. Methods: ARIC is a community-based cohort study with self-reported family history data and brain magnetic resonance imaging (visit 5; 2011-13). The association between binary markers of cSVD (lacunar infarcts and/or cerebral microbleeds), or log-transformed white matter hyperintensity volume (WMH), and FHCHD (parent and/or sibling), or number of relatives was examined using separate adjusted multivariable logistic or linear regression models respectively. Sensitivity analysis (N=183) excluded prevalent CHD. Race interaction terms were included. Results: Of 1828 participants (76±5yo, 60% female, 28% black), 787 had FHCHD (699 parental, 209 sibling FHCHD). There were increased adjusted odds of lacunar infarct among those with parental FHCHD (Table). An increased odds of cerebral microbleeds were seen among those with sibling history but not parental. Effect estimates were similar when excluding those with prevalent CHD (Table). Greater number of siblings affected was associated with higher odds of lacunar infarct (OR 1.35, CI 1.04-1.74), lobar (OR 1.53, CI 1.12-2.09) and subcortical microbleeds (OR 1.30, CI 1.01-1.66). Odds of a lacunar infarct being present were higher among blacks (p-interaction 0.04) with paternal FHCHD (OR 2.20, CI 1.35-3.58) compared to whites (OR 1.17, CI 0.87-1.56). Neither FHCHD nor number of affected relatives was associated with WMH. Conclusions: Our results suggest that some cSVD manifestations are associated with FHCHD, potentially representing shared mechanisms in different vascular beds, and perhaps a genetic propensity for vascular disease.

Abstract 13769: Assessing the Risk for Cardiovascular Diseases According to Lipoprotein(a) Levels

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Narek A Tmoyan ◽  
Marat V Ezhov ◽  
Olga I Afanasieva ◽  
Uliana V Chubykina ◽  
Elena A Klesareva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Carotid Artery ◽  
Lower Extremity ◽  
Carotid Artery Disease ◽  
Lipoprotein A ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Introduction: There is no common opinion about threshold lipoprotein(a) [Lp(a)] concentration for atherosclerotic cardiovascular diseases (ASCVD) risk. Different clinical guidelines and consensus documents postulated cut-off Lp(a) level as 30 mg/dL or 50 mg/dL. We assessed the concentration of Lp(a) that associated with ASCVD of different locations. Methods: The study included 1224 patients with ASCVD. Lp(a) concentration was measured by enzyme-linked immunosorbent assay in serum. Patients were divided into 3 groups: group I - Lp(a)<30 mg/dL, group II - 30≤Lp(a)<50 mg/dL, group III - Lp(a)≥50 mg/dL (table). Results: Coronary heart disease, carotid artery disease, lower extremity artery disease, myocardial infarction and ischemic stroke were diagnosed in 61%; 34%; 23%; 42% and 11% patients, respectively. Lower extremity artery disease, carotid artery disease and myocardial infarction were more frequent in patients with Lp(a) concentration from 30 to 50 mg/dL compared to patients with Lp(a) <30 mg/dL: 36%, 41%, 48% vs. 17%, 30%, 36% respectively, p<0.01 for all. Subjects with Lp(a) 30-50 mg/dL (n=182, 15%) had a greater odds ratio of lower extremity artery disease, carotid artery disease and myocardial infarction compared to patients with Lp(a) <30 mg/dL (table). ROC analysis demonstrated that Lp(a) cut-off levels for lower extremity artery disease, carotid artery disease, coronary heart disease and myocardial infarction were 26; 21; 37 and 36 mg/dL, respectively. Conclusions: Our results demonstrate that in case of Lp(a) cut-off level of 50 mg/dL about 15% of patients are underestimated for the risk of ASCVD. Lp(a) cut-off level for ASCVD is between 20 and 40 mg/dL regarding the atherosclerosis location.

Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

2019 ◽  
Vol 90 (7) ◽  
pp. 792-795
Author(s):  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Brittany A Ricci ◽  
Brian MacGrory ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Wall Motion ◽  
Cardiac Evaluation ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

scholarly journals Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 439-448 ◽  
Author(s):  
Catherine M Bulka ◽  
Martha L Daviglus ◽  
Victoria W Persky ◽  
Ramon A Durazo-Arvizu ◽  
James P Lash ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cerebrovascular Disease ◽  
Organic Solvents ◽  
Occupational Exposures ◽  
Latino Workers ◽  
Prevalence Ratios

ObjectiveCardiovascular disease (CVD) is a leading cause of mortality and morbidity in the USA. The role of occupational exposures to chemicals in the development of CVD has rarely been studied even though many agents possess cardiotoxic properties. We therefore evaluated associations of self-reported exposures to organic solvents, metals and pesticides in relation to CVD prevalence among diverse Hispanic/Latino workers.MethodsCross-sectional data from 7404 employed individuals, aged 18–74 years, enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analysed. Participants from four US cities provided questionnaire data and underwent clinical examinations, including ECGs. CVD was defined as the presence of at least one of the following: coronary heart disease, atrial fibrillation, heart failure or cerebrovascular disease. Prevalence ratios reflecting the relationship between each occupational exposure and CVD as well as CVD subtypes were calculated using Poisson regression models.ResultsHispanic/Latino workers reported exposures to organic solvents (6.5%), metals (8.5%) and pesticides (4.7%) at their current jobs. Overall, 6.1% of participants had some form of CVD, with coronary heart disease as the most common (4.3%) followed by cerebrovascular disease (1.0%), heart failure (0.8%) and atrial fibrillation (0.7%). For individuals who reported working with pesticides, the prevalence ratios for any CVD were 2.18 (95% CI 1.34 to 3.55), coronary heart disease 2.20 (95% CI 1.31 to 3.71), cerebrovascular disease 1.38 (95% CI 0.62 3.03), heart failure 0.91 (95% CI 0.23 to 3.54) and atrial fibrillation 5.92 (95% CI 1.89 to 18.61) after adjustment for sociodemographic, acculturation, lifestyle and occupational characteristics. Metal exposures were associated with an almost fourfold (3.78, 95% CI 1.24 to 11.46) greater prevalence of atrial fibrillation. Null associations were observed for organic solvent exposures.ConclusionsOur results suggest that working with metals and pesticides could be risk factors for CVD among Hispanic/Latino workers. Further work is needed to evaluate these relationships prospectively.

The vulnerable myocardium

2015 ◽  
Vol 35 (01) ◽  
pp. 17-24 ◽  
Author(s):  
C. Bode ◽  
H. Bugger
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Diabetic Cardiomyopathy ◽  
Cardiac Complications ◽  
Artery Disease ◽  
Increased Susceptibility

SummaryCardiovascular disease is the major cause of morbidity and mortality in subjects suffering from diabetes mellitus. While coronary artery disease is the leading cause of cardiac complications in diabetics, it is widely recognized that diabetes increases the risk for the development of heart failure independently of coronary heart disease and hypertension. This increased susceptibility of the diabetic heart to develop structural and functional impairment is termed diabetic cardiomyopathy. The number of different mechanisms proposed to contribute to diabetic cardiomyopathy is steadily increasing and underlines the complexity of this cardiac entity.In this review the mechanisms that account for the increased myocardial vulnerability in diabetic cardiomyopathy are discussed.

scholarly journals Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

2020 ◽  
Vol 9 (8) ◽  
pp. 2367 ◽  
Author(s):  
Sandro Ninni ◽  
Gilles Lemesle ◽  
Thibaud Meurice ◽  
Olivier Tricot ◽  
Nicolas Lamblin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Real Life ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Outpatient Visits ◽  
History Of ◽  
Artery Disease

Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.

P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L D Colantonio ◽  
Y Dai ◽  
D Hubbard ◽  
R S Rosenson ◽  
T M Brown ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Peripheral Artery Disease ◽  
High Intensity ◽  
Prevalence Ratio ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease ◽  
Multivariable Adjustment ◽  
Statin Use

Abstract Background Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD). Purpose To compare the use of statins among US adults with a history of PAD versus those with a history of CHD. Methods We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors. Results Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only. Conclusion Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted. Acknowledgement/Funding This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).

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