Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis

Abstract Objective Because carotid plaques predict the development of cardiovascular events in RA, we aimed to assess if the combined use of the systematic coronary risk evaluation (SCORE) and the QRISK3 algorithms allows for the identification of RA patients with carotid plaques in a defined population-based RA inception cohort. Methods A set of consecutive RA patients without a history of diabetes, chronic kidney disease or cardiovascular events were studied by carotid US between 2012 and 2019. Modified SCORE (mSCORE) for RA based on the 2015/2016 updated EULAR recommendations and QRISK3 algorithms were retrospectively tested using baseline data obtained at the time of the carotid US assessment. Results A total of 466 (54%) of 865 patients had carotid plaques. Using dichotomized QRISK3 and EULAR mSCORE, 73.2% (95% CI: 68.4.8, 77.6) of patients with QRISK ≥ 10% and EULAR mSCORE < 5% had plaque. In this group, the diagnostic odds ratio was 5.79 (95% CI: 4.14, 8.10). However, if both algorithms were above their thresholds of high cardiovascular risk (QRISK ≥ 10% and EULAR mSCORE ≥ 5%), the sensitivity increased up to 83.3% (95% CI: 72.1, 91.4) and the diagnostic odds ratio up to 10.6 (95% CI: 5.13, 22.0). When the risk charts scales were used as continuous variables, both QRISK3 and EULAR mSCORE were found positively associated with plaque. For each 1% QRISK3 or EULAR mSCORE increase, the probability of having plaques multiplied by 1.14 and 1.22, respectively. However, the effects of both algorithms did not multiply by each other. Conclusions . The combined use of QRISK3 and EULAR mSCORE allows for the identification of most RA patients at high risk of carotid plaques.

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Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

10.21203/rs.3.rs-21088/v1 ◽

2020 ◽

Author(s):

Maryam Kabootari ◽

Samaneh Asgari ◽

Seyedeh Maryam Ghavam ◽

Fereidoun Azizi ◽

Farzad Hadaegh

Keyword(s):

Cardiovascular Disease ◽

Glucose Tolerance ◽

Plasma Glucose ◽

Population Based ◽

Incident Diabetes ◽

Continuous Variables ◽

Newly Diagnosed ◽

History Of ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes

Abstract Background: To assess the association between fasting plasma glucose (FPG) and 2-h post challenge plasma glucose (2h-PCPG) as continuous or categorical variables with risk of recurrent cardiovascular disease (CVD) and incident diabetes among subjects with history of previous CVD. Methods: In a prospective population-based cohort, a total of 335 Iranians aged ≥30 years, with history of CVD and free of known diabetes were included. Prediabetes was defined as impaired fasting glucose (IFG) according to the criteria of the American Diabetes Association (ADA) [IFG-ADA; FPG: 5.6-6.9 mmol/L], the World Health Organization (WHO) expert group (IFG-WHO; FPG: 6.1-6.9 mmol/L) and impaired glucose tolerance [IGT: 2h-PCPG: 7.8-11.0 mmol/L]. Cox’s proportional hazard models adjusted for traditional risk factors were used to estimate the hazard ratio (HR) with 95% confidence interval (CI) of different glucose intolerance for outcomes of interest. Results: During a median follow-up of 15.8 (IQR, 10.7-16.5) years, 178 CVD (hard event including death, myocardial infarction and stroke=69) events occurred. Regarding FPG, only IFG-ADA was associated with significant higher risk of hard CVD in the fully adjusted model (HR, 1.73, 95% CI: 1.04-2.89). Moreover, newly diagnosed diabetes (FPG≥7 mmol/L) was an independent risk of CVD (2.11: 1.22-3.66). Focusing on 2h-PCPG, subjects with newly diagnosed diabetes (2h-PCPG ≥ 11.1 mmol/L) had moderately increased risk of hard coronary heart disease (2.02:0.91-4.47, P=0.08). The multivariate HRs (95% CI) associated with 1 SD increase in FPG and 2h-PCPG was 1.16 (1.01–1.33) and 1.19 (1.02–1.38) for CVD, respectively. Among population free of diabetes at baseline (n=270), IFG-ADA, IFG-WHO and IGT were significantly associated with incident diabetes in multivariate analysis (all HRs > 4, P< 0.001); significant associations were also found for FPG and 2h-PCPG as continuous variables (all HRs for 1-SD increase > 2, all P < 0.001). Conclusions: Among subjects with stable CVD, both FPG and 2h-PCPG as continuous variables was associated with higher risk of recurrent CVD. However, only IFG-ADA was independent predictor of hard CVD events. Also, newly diagnosed diabetes, using FPG criteria, was associated with a significant risk of CVD. IFG-ADA, IFG-WHO and IGT were all significant predictors of incident diabetes.

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Abstract 17288: Clinical Outcomes of Hyponatremia in Patients Undergoing TAVR - A National Inpatient Sample Database

Circulation ◽

10.1161/circ.142.suppl_3.17288 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

yasar sattar ◽

Waqas Ullah ◽

Salman Zahid ◽

Houman Moussa Pacha ◽

Uneza Rauf Khawaja ◽

...

Keyword(s):

Odds Ratio ◽

Cardiopulmonary Arrest ◽

Continuous Variables ◽

National Inpatient Sample ◽

International Classification Of Disease ◽

Transcatheter Aortic Valve ◽

Cerebral Herniation ◽

History Of ◽

Outcome Differences ◽

New Onset

Introduction: The in-hospital outcomes and complications of hyponatremia in patients who are undergoing transcatheter aortic valve replacement (TAVR) remains uncertain. Hypothesis: Hyponatremia effect on TAVR outcomes Methods: We queried National Inpatient Sample (NIS) (2011-2014) using the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes for TAVR and hyponatremia (level<135 mEq/L). Categorical and continuous variables were reported as percentages and weighted means and were compared using unadjusted odds ratio (OR) and t-test, respectively. Univariate and multiple logistic regression analyses were used to control the outcomes variables. Results: A total of 33790 (no-hyponatremia 31683, hyponatremia 2107; ,mean age = 81 year) patients were included. The unadjusted odds for in-hospital mortality (5.7% vs. 3.8%, uOR 0.43, 95% CI, 0.23-0.618, p=<0.001) and new-onset seizures (0.5% vs. 0.2%%, uOR 2.15; 95% CI, 1.02-4.18, P = 0.037) were significantly higher for patients with hyponatremia compared to no-hyponatremia, respectively. Intriguingly, patients with hyponatremia had significantly higher odds of developing cardiopulmonary arrest (4.9% vs. 3.0%, uOR 0.53; 95% CI, 0.33-0.74, P=<0.001) compared to patients without hyponatremia. The odds for cerebral herniation and in-hospital new-onset coma (0.2% vs 0.2%, uOR 0.31 ;95% CI, 0.60-1.2, P = 0.69) did not differ significantly between the two groups. The adjusted odds ratio based on baseline comorbidities (hypertension, renal failure, diabetes, history of seizures), demographics (race, hospital, month of admission) and age followed the unadjusted odds ratios. Outcome differences of complications of TAVR with or without hypernatremia are shown in figure 1. (bue= without hyponatremia; red=hyponatremia). Conclusions: Patients with hyponatremia undergoing TAVR have higher odds of all-cause mortality, seizures and cardiopulmonary arrest.

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Infection in infancy and subsequent risk of developing lymphoma in children and young adults

Blood ◽

10.1182/blood-2010-09-306274 ◽

2011 ◽

Vol 117 (5) ◽

pp. 1670-1672 ◽

Cited By ~ 6

Author(s):

Lynn R. Goldin ◽

Ola Landgren ◽

Sigurdur Y. Kristinsson ◽

Magnus Björkholm ◽

Ora Paltiel

Keyword(s):

Older Adults ◽

Young Adults ◽

Odds Ratio ◽

Surrogate Marker ◽

Population Based ◽

Increased Risk ◽

History Of ◽

Children And Young Adults ◽

Immune Defects ◽

Subsequent Risk

Abstract There is evidence that certain infections and autoimmunity predispose to the development of non-Hodgkin lymphomas (NHLs). A previous study reported that hospitalization for infections in infancy led to an increased risk of NHL. By using population-based registries in Sweden, we compared the rate of hospitalization for infections in infancy between lymphoma cases and matched controls for patients born since 1964. A history of infection was associated with a significantly increased risk of aggressive B-cell lymphomas (odds ratio 2.1, 95% confidence interval 1.11-4.04, P = .02). The specific infections involved were respiratory and intestinal. No effects were observed among cases of Hodgkin lymphoma. This association could result from the infection, its treatment, or could be a surrogate marker for underlying immune defects. Further studies are needed to determine whether this association is present among NHL occurring in older adults and if improved survival of patients with immune defects has contributed to the secular increases in incidence of NHLs.

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Predisposing, enabling and need factors associated with increased use and ongoing increased use of inpatient mental health care: A population-based longitudinal study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867420976848 ◽

2020 ◽

pp. 000486742097684

Author(s):

Bianca Suesse ◽

Luise Lago ◽

Victoria Westley-Wise ◽

Jose Cuenca ◽

Nagesh Pai

Keyword(s):

Mental Health ◽

Confidence Interval ◽

Odds Ratio ◽

Service Use ◽

Population Based ◽

Mental Health Service Use ◽

History Of ◽

Self Harm ◽

History Of Depression ◽

Hospital Use

Objective: The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. Methods: A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. Results: A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. Conclusion: Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.

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Study of Symptomatic vs. Silent Brain Infarctions on MRI in Elderly Subjects

Frontiers in Neurology ◽

10.3389/fneur.2021.615024 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sheelakumari Raghavan ◽

Jonathan Graff-Radford ◽

Eugene Scharf ◽

Scott A. Przybelski ◽

Timothy G. Lesnick ◽

...

Keyword(s):

Odds Ratio ◽

Right Hemisphere ◽

Image Data ◽

Clinical History ◽

Population Based ◽

Elderly Subjects ◽

Symptomatic Carotid ◽

Factors Associated ◽

Medical Chart Review ◽

History Of

Brain infarctions are closely associated with future risk of stroke and dementia. Our goal was to report (i) frequency and characteristics that differentiate symptomatic vs. silent brain infarctions (SBI) on MRI and (ii) frequency and location by vascular distribution (location of stroke by major vascular territories) in a population based sample. From Mayo Clinic Study of Aging, 347 participants (≥50 years) with infarcts detected on their first MRI were included. Infarct information was identified visually on a FLAIR MRI image and a vascular territory atlas was registered to the FLAIR image data in order to identify the arterial territory of infarction. We identified the subset with a clinical history of stroke based on medical chart review and used a logistic regression to evaluate the risk factors associated with greater probability of a symptomatic stroke vs. SBI. We found that 14% of all individuals with infarctions had a history of symptomatic stroke (Silent: n = 300, symptomatic: n = 47). Factors associated with a symptomatic vs. SBI were size which had an odds ratio of 3.07 (p < 0.001), greater frequency of hypertension (odds ratio of 4.12, p = 0.025) and alcohol history (odds ratio of 4.58, p = 0.012). The frequency of infarcts was greater in right hemisphere compared to the left for SBI. This was primarily driven by middle cerebral artery (MCA) infarcts (right = 60%, left = 40%, p = 0.005). While left hemisphere strokes are more common for symptomatic carotid disease and in clinical trials, right hemispheric infarcts may be more frequent in the SBI group.

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Diagnostic Accuracy of 64-Slice Computed Tomography Angiography in Patients with Chest Pain vs. SPECT in the Assessment of Significant Coronary Artery Disease: A Systematic Review and Meta-analysis

Health Technology Assessment in Action ◽

10.18502/htaa.v4i2.6230 ◽

2021 ◽

Author(s):

Maryam Jamali ◽

Rajabali Daroudi ◽

Masih Tajdini ◽

Ali Akbari Sari ◽

Sajad Alaei ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Odds Ratio ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

Sensitivity Analyses ◽

Likelihood Ratios ◽

History Of ◽

Artery Disease ◽

Sensitivity Specificity

Context: This systematic review and meta-analysis intended to investigate the diagnostic accuracy of computed tomography angiography (CTA) in comparison with single-photon emission computed tomography (SPECT) for the diagnosis of coronary artery disease (CAD) in chest pain patients with no history of cardiovascular diseases (CVDs). Methods: Invasive angiography was considered as the reference test with a stenosis threshold of ≥ 50%. Cochrane, Scopus, Science Direct, PubMed, and Embase databases were comprehensively searched from the time of inception of these databases to May 15, 2018. A manual search in Google Scholar, a reference review of the obtained studies, and a review of gray literature (including those presented in conferences and congresses) regarding diagnostic performances of CTA and SPECT techniques were performed independently by two researchers. A meta-analysis was performed to determine pooling estimates of sensitivity, specificity, diagnostic odds ratio, and positive as well as negative likelihood ratios in CTA and SPECT tests. According to the 2 × 2 contingency table of each study, at 0.95 confidence interval, the diagnostic accuracy of CTA and SPECT was meta-analyzed by pooling estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratios based on DerSimonian-Laird’s random-effects model. Heterogeneity was assessed by calculating I2. Analyses were performed using MetaDiSc version 1.4 and Stata version 11. The qualities of the selected studies were assessed independently by two researchers according to the quality assessment of diagnostic accuracy studies (QUADAS) questionnaire. Sensitivity analyses were performed by the Jackknife method. Publication bias was evaluated by Deeks’ funnel plot. Results: Fourteen studies related to CTA (1206 individuals) and 15 related to SPECT (1638 individuals) were eligible for meta-analysis. The pooled sensitivity and the specificity of CTA for CAD diagnosis were 91% (95% CI, 88% - 94%) and 87% (95% CI, 84% - 98%), respectively. The pooled positive and negative likelihood ratios, the diagnostic odds ratio, and the area under the ROC curve for CTA were 7.93 (95% CI, 5.11 - 12.29), 0.1 (95% CI, 0.06 - 0.17), 95.71 (95% CI, 59.81 - 153.15), and 0.96, respectively. The pooled sensitivity and the specificity of SPECT for CAD diagnosis were 81% (95% CI, 79% - 83%) and 74% (95% CI, 71% - 78%), respectively. The pooled positive and negative likelihood ratios, the diagnostic odds ratio, and the area under the ROC curve for SPECT were 3.03 (95% CI, 2.34 - 3.91), 0.25 (95% CI, 0.21 - 0.30), 13.56 (95% CI, 10.60 - 12.34), and 0.86, respectively. According to the sensitivity analyses, the removal of any single study at a time did not change the effect size of the remaining studies. We observed symmetry in the Deeks’ funnel plot, indicating that there was ignorable publication bias for CTA and SPECT studies. Conclusions: This study demonstrated that the diagnostic accuracies of CTA and SPECT tests lie in the ‘excellent’ and the ‘very good’ ranges, respectively. CTA is stronger evidence, than SPECT, to rule out CVDs in patients with low and intermediate risks of CAD with no history of cardiovascular diseases.

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Pregnancy, Estrogen Exposure, and the Development of Otosclerosis: A Case-Control Study of 1196 Women

Otolaryngology ◽

10.1177/0194599820966295 ◽

2020 ◽

pp. 019459982096629

Author(s):

Robert J. Macielak ◽

John P. Marinelli ◽

Douglas J. Totten ◽

Christine M. Lohse ◽

Brandon R. Grossardt ◽

...

Keyword(s):

Disease Severity ◽

Odds Ratio ◽

Case Control Study ◽

Subsequent Development ◽

Population Based ◽

Case Control ◽

Bilateral Oophorectomy ◽

Estrogen Exposure ◽

History Of ◽

Control Study

Objective This study sought to determine whether a history of pregnancy or bilateral oophorectomy is associated with subsequent otosclerosis development or disease severity. Study Design Population-based case-control study. Setting Olmsted County, Minnesota. Methods Women diagnosed with otosclerosis were matched to 3 women without otosclerosis based on age and historical depth of medical records. Associations of prior delivery and bilateral oophorectomy with subsequent development of otosclerosis and with pure-tone average (PTA) at the time of otosclerosis diagnosis were evaluated. Results We studied 1196 women: 299 cases of otosclerosis and 897 matched controls. The odds ratio for the association of ≥1 delivery with otosclerosis was 1.16 (95% confidence interval [CI] 0.85-1.60; P = .35). Odds ratios for the associations of 1, 2, 3, or ≥4 deliveries with otosclerosis were 1.22 (0.83-1.80), 1.09 (0.71-1.68), 1.28 (0.77-2.12), and 1.00 (0.54-1.84), respectively. The odds ratio for the association of prior bilateral oophorectomy with otosclerosis was 1.12 (0.58-2.18; P = .73). In cases with otosclerosis, PTA at diagnosis was not significantly higher for women with ≥1 delivery as compared with those without (median 45 dB hearing loss [HL] [interquartile range {IQR} 36-55] vs 43 [IQR 34-53]; P = 0.18) but was significantly higher for women with bilateral oophorectomy compared with those without (median 54 dB HL [IQR 44-61] vs 44 [IQR 34-53]; P = .03). Conclusion These data do not support a relationship between endogenous estrogen exposure and development of otosclerosis. Women with otosclerosis who had a history of pregnancy did not have significantly worse hearing at the time of diagnosis, suggesting that pregnancy is not associated with disease severity.

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Abstract 857: Systolic Blood Pressure of 115 mmHg and Above is Associated with Worsening Cardiac Risk Profile in Normotensive Individuals

Circulation ◽

10.1161/circ.118.suppl_18.s_625-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Mohammed A Rafey ◽

Saud Butt ◽

Sorana Hila ◽

Robert Butler ◽

Marc A Pohl ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Cardiovascular Events ◽

Retrospective Chart Review ◽

Cardiac Risk ◽

Population Based ◽

Risk Profile ◽

Categorical Variables ◽

P Value ◽

Continuous Variables

Aim: To explore whether a systolic blood pressure (SBP) cut-off of ≥115 mmHg is associated with worsening in the cardiac risk profile of healthy, normotensive individuals. Background: Data from population based trials demonstrates an increase in cardiovascular events beginning with a SBP of 115mmHg. We sought to study the cardiac risk profile of healthy, normotensive individuals with SBP ≥115 mmHg. Methods: A retrospective chart review was performed on all 391 consecutive live donors who were found healthy and eventually donated kidney between April 1997 and December 2005 at our institution. Pre-kidney donation profile collected included age, gender, race, body mass index [BMI], office blood pressure readings, fasting glucose (FBS), uric acid (UA), lipid profile and iothalamate GFR [iGFR]. We stratified patients into two groups based on systolic blood pressure cut-off value of ≥115mmHg. Continuous variables were compared between groups using independent samples t test, categorical variables were compared using chi square and Fisher’s exact tests utilizing a 2 sided p value < 0.05. Results: The sample included 230 women (59%), 361 white patients (81%). Mean age was 41±9 years, SBP was 115.6 ± 15 mmHg, BMI 26.7 ± 4.24, UA 5.0 mg/dl ± 1, FBS of 87 ± 9 mg/dl and iGFR 106.47 ± 16.47 ml/min. Each of these risk factor variables was significantly elevated in the subgroup with SBP ≥115 mmHg when compared to those with lower SBP. Conclusion: These data suggest that in otherwise healthy living donors a SBP of ≥115 mmHg is associated with a more adverse cardiac risk profile in comparison to those with a SBP less than 115 mmHg. Further studies are needed to see if instituting early interventions would improve cardiac profile and prevent cardiovascular events.

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Abstract 044: Association Of Cardiovascular Comorbidities With Sars-cov-2 Seropositivity In A Population-based Cohort.

Circulation ◽

10.1161/circ.143.suppl_1.044 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Alexander Ivanov ◽

Rahul V Annabathula ◽

Aziz Hammoud ◽

David X Zhao ◽

Adolfo Correa ◽

...

Keyword(s):

Heart Failure ◽

Odds Ratio ◽

Serological Test ◽

Severe Disease ◽

Case Series ◽

Arterial Disease ◽

Population Based ◽

Community Research ◽

Increased Risk ◽

History Of

Background: Following the outbreak of SARS-COV2 > 7,750,000 Americans were diagnosed with COVID-19. Many comorbidities were found to be associated with increased risk of severe disease. Due to limited testing and high percent of asymptomatic cases the exact prevalence is unclear. Moreover, whether the presence of comorbidities is associated with an increased rate of COVID-19 remains unknown. Methods: COVID-19 Community Research Partnership (CCRP) is a prospective cohort designed to collect information about the community's coronavirus exposures, symptoms, and prevalence (NCT04342884). Serological substudy is a prospective case series evaluating development of IgM or IgG in randomly selected 5000 participants from the CCRP cohort. Serological test kits are shipped to the volunteers monthly. Prevalence of comorbidities was estimated using electronic health records. Results: There were 4902 patients included in the analysis (Figure). Of those, 2,832 (57.8%) were female, mean age±SD was 49.6±14.4. There were 3,871 (79%) Caucasians, 422 (8.6%) - African Americans and 242 (4.9%) - Hispanics (Table). From May 2020 to August 2020, 424 patients (8.7%) seroconverted (IgM or IgG positive): 327 (6.7%) were found to be IgM positive/ IgG negative, 38 (0.8%)- IgM negative/IgG positive and 59 (1.2%) - IgM positive/ IgG positive. Prevalence of comorbidities was low: 1,318 (26.9%) patients have hypertension, 1,379 (28.1%)- hyperlipidemia, 413 (8.4%)- diabetes, 217 (4.4%)- coronary artery disease, 156 (3.2%)- peripheral arterial disease, 132 (2.7%)- atrial fibrillation, 95 (1.9%)- history of deep venous thrombosis and pulmonary embolism, and 54 (1.1%)- history of heart failure (HF). Only the presence of HF was associated with an increased odds ratio of seroconversion OR 2.4, (1.21- 4.87), p<0.012. This association remained robust after controlling for age, sex and race. Conclusion: Prevalence of seroconversion was near 9%. Presence of heart failure was independently associated with an increased odds ratio of seroconversion.

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Abstract 2398: Polymorphisms of Angiotensin Converting Enzyme and Endothelial Nitric Oxide Synthase Genes Act Synergistically to Increase the Risk of Cardiovascular Events in Patients with Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.118.suppl_18.s_718 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Akiyoshi Ogimoto ◽

Hideki Okayama ◽

Tomoaki Ohtsuka ◽

Jun Suzuki ◽

Katsuji Inoue ◽

...

Keyword(s):

Nitric Oxide ◽

Hypertrophic Cardiomyopathy ◽

Endothelial Nitric Oxide Synthase ◽

Odds Ratio ◽

Cardiovascular Events ◽

Enos Gene ◽

Converting Enzyme ◽

History Of ◽

Oxide Synthase ◽

Endothelial Nitric Oxide

Background: Patients with hypertrophic cardiomyopathy (HCM) have a small left ventricular cavity size due to hypertrophy. Therefore, reduction of venous return and intravascular volume in patients with HCM leads to low cardiac output and hypotension. We reported that the angiotensin converting enzyme insertion/insertion (ACE I/I) genotype, which leads to inhibitory renin-angiotensin system, is a significant risk factor for cardiovascular events (CE) in patients with HCM. Recently, the endothelial nitric oxide synthase (eNOS) gene polymorphism (Glu298Asp), which plays an important role in the modulation of cardiovascular physiology, is reported to be associated with heart diseases. Methods and Results: Genotyping at these loci was performed in 150 patients with HCM. This study design was a nested case-control study. The cardiovascular events were defined as cardiac death and hospitalization for stroke or congestive heart failure. Patients were divided into two groups: group A of 44 patients (29%) with one or more history of the cardiovascular events and group B of 106 patients (71%) without history of the cardiovascular events. Logistic-regression methods were used to determine the potential effect of each genotype and the interaction between them on the risk of CE. The odds ratio for cardiovascular events among persons who had ACE I/I genotype as compared with those with the other ACE genotypes was 2.5 (P < 0.01). In a dominant Asp allele model of the eNOS gene polymorphism, there was a significant difference in genotypes between the two groups (p < 0.01). In addition, there was a marked increase in the risk of CE among persons who were homozygous for both genotypes (ACE I/I and eNOS 298Glu/Glu) (odds ratio, 2.7, P < 0.01). Conclusion: The ACE I/I and eNOS 298Glu/Glu act synergistically to increase the risk of CE in patients with HCM. Genotyping at these two loci may be a useful approach for identification of persons with HCM at risk for CE.

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