scholarly journals POS1019 INCONSISTENCY OF THE DEGREE OF CARDIOVASCULAR RISK WHEN ASSESSED USING DIFFERENT INDICES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 777.1-777
Author(s):  
E. Vasilenko ◽  
A. Dadalova ◽  
R. Samigullina ◽  
V. Mazurov
Keyword(s):  
Cardiovascular Risk ◽  
Risk Evaluation ◽  
Axial Spondyloarthritis ◽  
Inflammatory Diseases ◽  
Mean Value ◽  
Low Risk ◽  
Assessment Index ◽  
Risk Algorithm ◽  
Asas Criteria ◽  
Very High

Background:Evaluation of indicators of cardiovascular risk is one of the main tasks facing a rheumatologist in the tactics of choosing a therapy for patients (pts) with axial spondyloarthritis (axSpA). It is known that pts suffering from axSpA are characterized by a significant increase in cardiovascular risk (CVR). However, there are still no recommendations regulating risk assessment scales in pts with axSpA.Objectives:were to assess the CVR in pts with axSpA and to compare different cardiovascular risk scales in these pts.Methods:The study included 55 pts at the age of 45-65 years with diagnosis of axSpA fulfilling ASAS criteria (2009) from St. Petersburg’ axSpA register. Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated. Risk gradation: low risk (<1%), medium (1.0-4.9%), high (5.0-9.9%), very high (> 10%).Results:Mean age of the pts was 45.8±10.3 years; males - 37 (67.3%) pts, HLA-B27 positive – 34 (61.8%); mean disease duration 12.5±8.7 years. Mean value of SCORE was 2.83±1.89%, of RRS – 5.04±3.98%, of QRISK3 – 7.91±4.91%.The gradation of the degree of risk depending on the applied assessment index is presented in Table 1.IndexResultsRisk degreeSCORERRSQRISK3Low21 (38,2%)8 (14,5%)0 (0,0%)Medium26 (47,3%)23 (41,8%)17 (30,9%)High8 (14,5%)17 (30,9%)22 (40,0%)Very high0 (0,0%)7 (12,7%)16 (29,1%)Particular attention is drawn to the 100% discrepancy of low risk values when comparing SCORE and QRISK3. A similar trend persisted when comparing medium, high and very high risk. Thus, the assessment of the risks of 10-year significant cardiovascular events in pts with axSpA using the SCORE index does not coincide with the QRISK3 index data in 87.27% of cases, and with the RRS data - in 58.18% of cases. In 84.3% of cases, the mismatch between the SCORE and RRS indexes was due to the presence of an increased CRP level.Conclusion:When assessing cardiovascular risk in pts with axial spondyloarthritis, a discrepancy was found between the degrees of risk when assessed using different scales. SCORE scores were significantly different from Reynolds’ and QRISK3 scores. These features can be interrelated with a small number of factors assessed when calculating the SCORE, even though there is a correction factor for rheumatic diseases. For pts with axial spondyloarthritis, it is necessary to use additional indicators that influence cardiovascular risk, such as CRP.Disclosure of Interests:None declared.

scholarly journals SAT0393 DISCREPANCY IN THE CARDIOVASCULAR RISK SEVERITY CALCULATED USING DIFFERENT RATING SCALES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1145.2-1146
Author(s):  
E. Vasilenko ◽  
V. Mazurov ◽  
R. Samigullina ◽  
A. Dadalova ◽  
I. Gaydukova
Keyword(s):  
Cardiovascular Risk ◽  
Risk Evaluation ◽  
Rating Scales ◽  
Axial Spondyloarthritis ◽  
Inflammatory Diseases ◽  
Mean Value ◽  
Risk Algorithm ◽  
Asas Criteria ◽  
Score Index ◽  
Reynolds Risk Score

Background:Cardiovascular risk (CVR) in patients (pts) with axial spondyloarthritis (axSpA) exceed the populational level. However, it remains unclear, which of the cardiovascular risk assessment systems is the most accurate in cases of chronic inflammation..Objectives:of the current study were to assess the CVR in pts with axSpA and to compare different cardiovascular risk scales in these pts.Methods:The study included 118 patients at the age of 25-65 years with diagnosis of axSpA fulfilling ASAS criteria (2009) from St. Petersburg’ axSpA register. Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated. For the pts below 40 years old only QRISK3 was calculated.Results:Mean age of the pts was 44.3±11.1 years; 91(77.1%) pts were males, HLA-B27 positive – 83 (70.3%) of the pts; mean disease duration 13.0±8.3 years. Mean value of SCORE was 2.78±1.89%, of RRS – 5.28±3.31%, of QRISK3 – 7.91±3.8% (figure 1). Cronbach’s alpha for the scales was 0.873.Figure 1.Cardiovascular risk evaluation indices in patients with axial spondyloarthritis, n=118 for QRISK3, n=72 for SCORE and RRS.High CVR (≥5 %) was found in 14 (11,7%) of the pts according to the SCORE, in 65 (55,1%) of the pts according to the RRS, and in 81 (69%) of the pts according to the QRISK3. Ranking of CVR severity did not match in SCORE and QRISK3 indices in 83.72% of cases, in SCORE and RRS – in 51.16% of cases, and in QRISK3 and RRS in 8% of cases. The SCORE index showed the lower values of the expected risk as compared to the QRISK3 and RRS (figure1).In axSpA pts at age 25-40 years old (n=46, mean age 32.6±4.0 years, males 36 (78.3%)), mean value of QRISK3 was 1.16±0.99 %; in 14 from 46 (30.4%) of those pts increased CVR was registered (figure 2).Figure 2.QRISK3 index in axSpA patients 25-40 years old, n=46Conclusion:There was a discrepancy in the severity of CVR calculated using different rating scales in axSpA patients. The SCORE index showed lower values of CVR as compared to the QRISK3 and RRS, which hypothetically could be the consequence of CVR underestimation. QRISK3 demonstrated the highest CVR and was the only index useful in pts below 40 years old. To exclude hyper- or underestimation of CVR calculation more data about CVR calculations and frequency of CV events, occurring in axSpA patients are needed.Disclosure of Interests:Elizaveta Vasilenko: None declared, V Mazurov: None declared, Ruzana Samigullina: None declared, Anna Dadalova: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi

Disease activity trajectories in early axial spondyloarthritis: results from the DESIR cohort

2016 ◽  
Vol 76 (6) ◽  
pp. 1036-1041 ◽  
Author(s):  
Anna Molto ◽  
Sophie Tezenas du Montcel ◽  
Daniel Wendling ◽  
Maxime Dougados ◽  
Antoine Vanier ◽  
...  
Keyword(s):  
Disease Activity ◽  
Axial Spondyloarthritis ◽  
High Disease Activity ◽  
Inactive Disease ◽  
Joint Involvement ◽  
Asas Criteria ◽  
Very High ◽  
Trajectory Modelling ◽  
Over Time

BackgroundDisease activity may change over time in axial spondyloarthritis (axSpA). The objectives were to identify patterns of disease activity evolution in patients with early axSpA.MethodsPatients from the prospective early axSpA cohort (DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR)) who fulfilled the Assessment in SpondyloArthritis Society (ASAS) criteria for axSpA at baseline and with at least three Ankylosing Spondylitis Disease Activity Score (ASDAS) values available over the 3 years of follow-up were analysed. Statistical analyses: trajectories were estimated by group-based trajectory modelling; predisposing baseline factors for such trajectories were identified by univariate and multivariable multinomial (logit) regression; work disability over time was compared between the trajectories by Cox hazard model.ResultsIn all, 370 patients were analysed: mean disease duration was 1.6 (±0.9) years. The five distinct trajectories of disease activity over the 3 years were (t1) ‘persistent moderate disease activity’ (n=134 (36.2%)); (t2) ‘persistent inactive disease’ (n=66 (17.8%); (t3) ‘changing from very high disease activity to inactive disease’ ((n=29 (7.8%)); (t4) ‘persistent high disease activity’ (n=126 (34.1%)) and (t5) ‘persistent very high disease activity’ (n=15 (4.1%)). After adjustment for other characteristics, t2 was associated with a white-collar job (OR=2.6 (95% CI 1.0 to 6.7)) and t3 with male gender (OR=7.1 (1.6 to 32.2)), higher education level (OR=9.4 (1.4 to 63.4)) and peripheral joint involvement (OR=6.2 (1.23 to 31.32)). Patients from (t4) and (t5) were more often declared work disabled over follow-up (HR=5.2 (1.5 to 18.0) and HR=8.0 (1.3 to 47.9), respectively).ConclusionsTrajectory modelling of disease activity was feasible in early axSpA: more than 30% patients (141/370) were in a trajectory with a persistent high disease activity. Persistent high disease activity trajectories were significantly associated with consequences on work.Trial registration numberNCT01648907.

scholarly journals POS1017 CARDIOVASCULAR RISK IN DIFFERENT CLINICAL VARIANTS OF SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 776.2-776
Author(s):  
A. Dadalova ◽  
E. Vasilenko ◽  
R. Samigullina ◽  
V. Mazurov
Keyword(s):  
Risk Assessment ◽  
New York ◽  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Risk Evaluation ◽  
Cardiovascular Events ◽  
Assessment Scales ◽  
Very High ◽  
Score Index

Background:Numerous studies have shown that the life expectancy of patients with spondyloarthritis (SPA) is, on average, 5-7 years less compared to the population, and the overall mortality rate is 1.6-1.9 times higher than the population, while mortality from cardiovascular disease increases by 20-40%.Objectives:of the current study were to assess the cardiovascular risk in pts with with ankylosing spondylitis, psoriatic arthritis and psoriatic spondyloarthritis and to compare different cardiovascular risk scales in these pts.Methods:The study included 54 patients with SpA aged 45 to 65 years. The patients were divided into 3 groups: patients with ankylosing spondylitis (AS) who meet the modified New York criteria for AS (1984) (n = 14), patients with psoriatic arthritis (PsA) who meet the CASPAR criteria (Classification criteria of Psoriatic Arthritis, 2006) (n = 18) and patients with psoriatic spondyloarthritis (PsSpA) meeting the modified New York criteria for AS and CASPAR criteria for PsA (n = 22).The average age in the AS group was 55.5 ± 6.43 years, in the PsA group - 57.4 ± 5.76 years, in the PsSpA group - 55.0 ± 6.45 years. Men made up 64.3% in the AC group, 50% in the PsA group, and 49% in the PsSpA group.Three indices of cardiovascular risk evaluation (Systematic COronary Risk Evaluation (SCORE) with increasing coefficient 1.5 for inflammatory diseases, Reynolds Risk Score (RRS), and the third modification of QRESEARCH Cardiovascular Risk Algorithm (QRISK3) were calculated.After the numerical assessment of the indicators, each patient was graded in the degree of CVR with the allocation of low, medium, high and very high degree. To stratify the degrees, an estimate of the total risk on the SCORE scale was used: with a value of less than 1%, the risk was considered low, from> 1% to 5% - medium or moderately increased, from> 5% to 10% - high, and> 10% - very high.Results:The values of the indices were in the AS group SCORE – 3,05±2,41%, RRS – 5,05±2,67%, QRISK3 – 6,68±3,11%, in pts with PsA SCORE - 4,11±2,22%, RRS - 5.72 ± 2.46%, QRISK3 - 7.25 ± 2.51% and in pts with PsSpA SCORE - 4.78 ± 2.65%, RRS - 6.35 ± 2.34 %, QRISK3 - 8.02 ± 3.25%.Table 1.The number of pts corresponding to different degrees of risk depending on the used CVD risk assessment scale, n = 54Degrees of riskSCORERRSQRISK3Low920Medium322616High122328Very high1310When assessing CVR using various risk assessment scales (RRS, QRISK3, SCORE), the highest values were obtained in the PsSpA group.When comparing the results obtained, it was found that the majority of the surveyed belonging to a low degree of CVR according to SCORE (9 people), when evaluated using other scales, fell into the group of medium or high risk. The assessment of the risks of 10-year significant cardiovascular events in patients with SPA using the SCORE index does not coincide with the QRISK3 index data in 70.4% of cases, with the RRS data - in 42.6% of cases, and the SCORE index shows lower values of the expected risk. The highest values were obtained when assessing CVR using the scale QRISK3.Conclusion:The highest CVR values were obtained in the PsSpA group using various risk assessment scales (RRS, QRISK3, SCORE). There was a discrepancy in the severity of CVR calculated using different rating scales in SpA patients. The largest values were obtained when using the scale QRISK3, and the smallest when calculating the CVR using the scale SCORE.References:[1]Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013;27 Suppl 3:12–29.[2]Bengtsson K, Forsblad-d’Elia H, Lie E, et al. Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther. 2017 May 18;19(1):102. doi: 10.1186/s13075-017-1315-zDisclosure of Interests:None declared.

P3407Genetic predisposition and QRISK3 algorithm are promising cardiovascular risk scoring tools in young patients with axial spondyloarthritis (Bechterew's disease)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Vasilenko ◽  
A Dadalova ◽  
O Nikolaeva ◽  
M Korolev ◽  
V Mazurov ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Gene Polymorphisms ◽  
Axial Spondyloarthritis ◽  
Young Patients ◽  
Inactive Disease ◽  
Major Cardiovascular Events ◽  
Asas Criteria ◽  
Tnf Α ◽  
Risk Scoring ◽  
Similar Gene

Abstract Introduction Major cardiovascular events (CVE) are frequently registered in patients with axial spondyloarthritis (axSpA) at age 35–55 years old. However, assessment of cardiovascular risk (CVR) in these age is complicated, as in pts <40 years conventional CVR scales (SCORE, ets.) are not recommended. Aim of the study To show capability of QRISK3 in assessment of CVR in young pts with axSpA and its association with gene polymorphisms, responsible for the inflammation and neoangiogenesis. Materials and methods The study included 46 pts 25–40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was assessed with ASDAS and BASDAI, CVR with QRISK3 (https://qrisk.org/three/). Gene polymorphisms to cytokines, responsible for inflammation and neoangiogenesis were measured (IL17A-197, IL17F7 His/Arg, IL17F-11139 c/g, TNF-863, TNF-308, TNF-238, IL1B-31, IL4–590, IL6–174, IL10–1082, IL10–592, VEGF-2578, VEGF936, MMP2–1306, MMP3–5A6A, and MMP9–1562). Results Mean age of axSpA pts was 32.5±3.87 years, 36 (78.3%) pts were male, axSpA duration 8.71±4.72 years, duration of the treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8, QRISK3 score 1.18±1.64%. 34 (75.6%) of the pts had a low CVR and 11 (23.9%) had increased CVR. All the patients with increased CVR had strong associations with some alleles of TNFα, IL17F and IL6, p<0.ehz745.0282 for all the correlations (table 1). Interrelations of CVR with another gene polymorphisms were not significant (R<0.25, p≥0.05, data are not present). Coefficient of correlation of QRISK3 and Gene polymorphisms (results of exploratory factor analysis with “varimax” rotation) QRISK3 IL17F-11139 CC IL17F-11139 CG IL17F7 His/His IL17F7 His/Arg IL6–174 CC IL6–174 CG TNF-308 GA TNF-308 GG 0.486 0.830 −0.830 −0.824 0.809 −0.564 0.545 0.935 −0.935 Conclusion A quarter of axSpA pts in age <40 years have an increased CVR. Similar gene polymorphisms in IL-6, IL17F, and TNF-α are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA, acceptable in any age. Conflict of interests Not declared.

scholarly journals AB0730 RECLASSIFICATION INTO VERY HIGH CARDIOVASCULAR RISK AFTER CAROTID ULTRASOUND IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS

2019 ◽  
Author(s):  
Juan Carlos Quevedo-Abeledo ◽  
Javier Rueda-Gotor ◽  
Fernanda Genre ◽  
Alfonso Corrales ◽  
Vanessa Hernández-Hernández ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Axial Spondyloarthritis ◽  
Carotid Ultrasound ◽  
High Cardiovascular Risk ◽  
Very High

scholarly journals AB0518 ATHEROSCLEROTIC RISK IN PATIENTS WITH ANKYLOSING SPONDYLITIS: BIOMARKERS VERSUS SCORE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1285.3-1286
Author(s):  
R. Dhahri ◽  
S. Miri ◽  
M. Slouma ◽  
B. Louzir ◽  
L. Metoui ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Ankylosing Spondylitis ◽  
High Risk ◽  
Apolipoprotein B ◽  
Mean Value ◽  
Apo B ◽  
Markers Of Inflammation ◽  
The Mean ◽  
Hs Crp ◽  
Very High

Background:Chronic inflammatory rheumatic diseases are associated with a high cardiovascular risk. However, data in ankylosing spondylitis (AS) are still limited.Objectives:The aim of our study was to assess the atherosclerotic risk in patients with AS, by comparing the Systematic coronary risk evaluation: SCORE, with biomarkers of atherosclerosis: High sensitivity C-reactive protein (Hs-CRP), LDL/HDL ratio and apoliprotein A1 (Apo A) /apolipoprotein B (Apo B) ratio.Methods:We conducted a cross-sectional observational study of 40 patients with AS, over a period of 3 months. Socio-demographic data, clinical characteristics of the disease, as well as biological, radiological and therapeutic data were collected for each patient. Coagulated blood samples were collected following a 12-hour fast. Cardiovascular risk was considered high for Hs-CRP>3.0 mg/L [1], LDL/HDL> 3.5 in men and 3.0 in women [2], and ApoB/ApoA level>0.9 [3,4]. SCORE was calculated for all patients.Results:The mean age of our population was 44±10 years. Male predominance was noted with a sex ratio =11.1. The mean ASDAS-CRP and BASDAI levels were 2.1±0.95 and 2.25±1.33. Thirty-two percent of the patients had a high risk of cardiovascular diseases according to Hs-CRP level, with an average of 10.7 mg/L. The mean LDL/HDL ratio was high in twenty-two percent of the patients. The mean value of ApoA1 and ApoB was respectively 1.3 g/l. and 0.9 g/l. Low values of Apo A1 were determined in 12.5% of the subjects, and high values of ApoB were found in 15% of subjects. The mean value of ApoA/ApoB ratio was 0.7. Ten percent of the studied subjects had an unfavourable ApoB/ApoA1. The predicted 10-year risk of CV mortality according to SCORE was high in 5% of the patients, very high in 2.5% and moderate in 35% of them. Over 17 patients with moderate, high and very high risk according to SCORE: Four patients (23.5%) had high LDL/HDL ratio, 8 (47%) had high waist/hip ratio, 5 (29.4%) had high Hs-CRP level, and 2 (11.7%) had high ApoB/ApoA ratio.We found ApoB/ApoA to be positively correlated with Hs-CRP (r=0.31, p=0.05). The SCORE was correlated to the age at the onset of the disease (r=0.78, p<10-3).Conclusion:The atherosclerotic risk in our population ranged from 10 to 43%. SCORE presented with the highest percentage, making it more suitable for mass screening. Biomarkers on the other hand are more precise. Hs-CRP is biomarker to be included in daily practice, even when AS is in remission. Accuracy of the apoB/apoA ratio is significantly great and appears to be associated with inflammation.References:[1]Myers GL, Rifai N, Tracy RP, Roberts WL, Alexander RW, Biasucci LM, et al. CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: Report From the Laboratory Science Discussion Group. Circulation [Internet]. 2004 Dec 21 [cited 2020 Oct 20];110(25).[2]Munoz. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. VHRM. 2009 Sep;757.[3]Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. The Lancet. 2001 Dec;358(9298):2026–33.Disclosure of Interests:None declared.

Comparison of Non-radiographic Axial Spondyloarthritis and Ankylosing Spondyltis from a Single Rheumatology Hospital in Morocco

2020 ◽  
Vol 16 (3) ◽  
pp. 240-244 ◽  
Author(s):  
Nessrine Akasbi ◽  
Siar Nihad ◽  
Zoukal Sofia ◽  
El Kohen Khadija ◽  
Harzy Taoufik
Keyword(s):  
Disease Burden ◽  
Axial Spondyloarthritis ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Low Back ◽  
New Classification ◽  
Cross Sectional ◽  
Asas Criteria ◽  
History Of ◽  
High Level

Background: According to the new classification criteria developed by The Assessment of SpondyloArthritis International Society, patients with axial spondyloarthritis (axSpA) can be classified in 2 subgroups: Patients with radiographic axial spondyloarthritis: ankylosing spondylitis patients (AS) and those with non-radiographic axial spondyloarthritis (nr-axSpA). Objective: The aim of the present study is to describe and discuss the differences and similarities between the two subgroups. Patients and Methods: A cross-sectional study was conducted in a single rheumatology hospital in Morocco. These included patients diagnosed as having axial spondyloarthritis according to ASAS criteria 2010, during a period of 6 years. The AS and the nr-axSpA subgroups were compared for the various axSpA-related variables. Results: Of the 277 patients with a diagnosis of axial SpA who were included in this study, 160 had AS and 117 had nr-axSpA. AS and nr-ax-SpA shared a similar age at diagnosis, similar prevalence of low back pain, lumbar stiffness, extra-articular manifestations, BASDAI and BASFI. In the multivariate analysis, AS patients were mainly male with cervical stiffness, enthesitis, coxitis and high level of ESR (erythrocyte sedimentation rate). The females generally had a family history of SpA and arthritis and were associated to the nr-axSpA form in the univariate analysis. Conclusion: This was the first study to characterise patients with AS and nr-axSpA in Morocco. Consistent with other studies published, this study showed that patients with nr-axSpA and patients with AS shared a comparable degree of disease burden.

scholarly journals Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk

2019 ◽  
Vol 14 (6) ◽  
pp. 840-845
Author(s):  
O. Yu. Korennova ◽  
S. P. Podolnaya ◽  
E. P. Prihodko ◽  
E. A. Turusheva ◽  
S. N. Starinskaya ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Antihypertensive Efficacy ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Coronary Artery Stenting ◽  
History Of ◽  
Very High

Aim. To evaluate the antihypertensive efficacy and tolerability of a fixed combination of amlodipine and ramipril in hypertensive patients with very high cardiovascular risk. Material and methods. A retrospective cohort study of real clinical practice of prescribing antihypertensive drugs according to 255 medical records of outpatient hypertensive patients with a history of acute coronary syndrome (ACS) and coronary artery stenting was performed in the first part. An open observational study was performed in the second part. 69 people older than 18 years with a history of ACS and coronary artery stenting, without reaching the target blood pressure (BP) level while using free combinations of antihypertensive drugs and with indications for a fixed combination of ramipril and amlodipine were included into the study. Analysis of self-monitoring of BP, office BP, daily BP monitoring (ABPM) and patients’ adherence to treatment (Morisky-Green test) initially, after 4 and after 12 weeks of taking the fixed combination of ramipril and amlodipine was performed to assess the clinical efficacy of the studied drug. Results. It was found that 42.0% of patients did not follow the recommendations for regular intake of antihypertensive drugs. So, hypertension of all patients regarded as false-refractory, which was the basis for the prescription of the fixed combination of ramipril and amlodipine in accordance with clinical guidelines for the diagnosis and treatment of hypertension. After 4 weeks of therapy, there was significant decrease in office BP with the achievement and preservation of the target level by the 12th week, normalization to the 12th week of day and night BP variability in 54.9% of patients. 78.0% of patients followed medical recommendations for regular administration of antihypertensive drugs, none of the patients had adverse events. Conclusion. The use of fixed combinations of drugs, in particular, amlodipine and ramipril as a part of multicomponent therapy in hypertensive patients with very high cardiovascular risk, led to the achievement of target BP by the 4th week of therapy and stable preservation of antihypertensive effect in 12 weeks of treatment as well as gradual normalization of day and night BP variability in more than half of patients. Fixed combination of ramipril and amlodipine allowed to improve adherence of patients to cardiovascular diseases.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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