EFFECTS OF EXERCISE AND STRESS MANAGEMENT TRAINING ON MARKERS OF CARDIOVASCULAR RISK IN PATIENTS WITH ISCHEMIC HEART DISEASE

Objective: Arterial calcification is associated with high cardiovascular risk. Our aim was to assess the utility of peripheral arterial calcification (PAC) in distal forearm and distal leg for the prediction of acute coronary syndrome (ACS) and major adverse cardiovascular event in older men. Approach and Results: In 815 home-dwelling older men, PAC was assessed on the scans of distal forearm and leg obtained by high-resolution peripheral quantitative computed tomography. PAC score (0–12) was calculated on the basis of the number and severity in small peripheral arteries. The information on ACS and major adverse cardiovascular event was collected prospectively for 8 years. PAC severity increased with age and body mass index ( P <0.001). Median PAC score was higher in men with ischemic heart disease or pharmacologically treated diabetes ( P <0.001). After adjustment for confounders, the risk of ACS was higher in men with severe PAC (6+) versus men with lower PAC (0–5; hazard ratio, 3.86 [95% CI, 1.65–9.02], P <0.005). After adjustment for confounders, the risk of major adverse cardiovascular event was higher in men with severe PAC (6+) versus men with lower PAC (hazard ratio, 2.58 [95% CI, 1.41–4.72], P <0.005). In men who did not have cardiovascular risk factors, severe PAC was associated with higher risk of ACS, for example, in men who did not self-report ischemic heart disease (hazard ratio, 6.62 [95% CI, 2.16–20.23], P <0.001). Conclusions: Severe PAC is associated with higher risk of ACS and major adverse cardiovascular event in older home-dwelling men, also in men without known ischemic heart disease. Incidentally found severe PAC can be a serious warning indicating high cardiovascular risk.

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Modern statin therapy in clinical practice: The lower the better

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1302104s ◽

2013 ◽

Vol 141 (1-2) ◽

pp. 104-106 ◽

Cited By ~ 1

Author(s):

Edita Stokic

Keyword(s):

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Statin Therapy ◽

Meta Analysis ◽

Ischemic Heart ◽

Mortality And Morbidity ◽

Increased Risk ◽

Coronary Events ◽

Risk Treatment

Lipid and lipoprotein disorders are well known risk factors for atherosclerosis and its complications. The level of atherogenic LDL-cholesterol (LDL-C) is directly related to an increased risk of occurrence and progression of ischemic heart disease. Epidemiological and clinical studies have shown that the use of statin therapy to decrease LDL-C can significantly reduce the incidence of mortality, major coronary events and the need for revascularization procedures in the different groups of patients. The findings of a large meta-analysis conducted by the Cholesterol Treatment Trialists? (CTT) collaborators showed that every 1.0 mmol/l reduction of atherogenic LDL-C is associated with a 22% reduction in cardiovascular diseases mortality and morbidity. However, despite the impressive results of the benefits of statin therapy, the EUROASPIRE study showed that about 50% of patients with ischemic heart disease did not achieve target LDL-C levels. According to the new ESC/EAS Guidelines for the Management of Dyslipidaemias in patients with a very high cardiovascular risk, treatment goal should be to decrease LDL-C below 1.8 mmol/l or ?50% of initial values. In the majority of patients that can be achieved by statin therapy. For this reason an adequate choice of statins is of crucial importance, whereby the needed reduction in atherogenic LDL-C, after the identification of its target level based on the assessment of total cardiovascular risk, can be achieved.

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Role of Duke treadmill score in the diagnosis of ischemic heart disease in women

Romanian Journal Of Internal Medicine ◽

10.1515/rjim-2015-0020 ◽

2015 ◽

Vol 53 (2) ◽

pp. 146-152

Author(s):

Alexandra Dǎdârlat ◽

D. Zdrenghea ◽

Dana Pop

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Disease ◽

Cardiovascular Risk ◽

Ischemic Heart Disease ◽

Cardiovascular Risk Factors ◽

High Blood Pressure ◽

Ischemic Heart ◽

Risk Category ◽

Duke Treadmill Score

Abstract Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women. Material and method. 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time – 5 x (ST deviation expressed in mm–4 x Angina Index). Results. DTS was lower in women as compared to men: 2.54±5.36 vs. 6±4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03±4.8 vs. 5.8±4.28), hypercholesterolemia (1.14±4.51 vs. 6.24±4.13), diabetes mellitus (1.83 ± 3.73 vs. 6.13±4.8), and obesity (2.42±5.35 vs. 5.81±4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03±4.89 vs. 8.13 ±7.85) and hypercholesterolemia (2.31±4.76 vs. 3.89±5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.

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