scholarly journals The Association of Sleep Disordered Breathing with Heart Failure and Other Cardiovascular Conditions

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth Stopford ◽  
Karthik Ravi ◽  
Vikrant Nayar
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Clinical Implication ◽  
Sleep Disordered Breathing ◽  
Primary And Secondary Prevention ◽  
Disease Entities ◽  
Disordered Breathing

An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.

scholarly journals Use of Cardiovascular Drugs for Primary and Secondary Prevention of Cardiovascular Disease Among Rural-Dwelling Older Chinese Adults

2020 ◽  
Vol 11 ◽  
Author(s):  
Lin Cong ◽  
Yifei Ren ◽  
Tingting Hou ◽  
Xiaolei Han ◽  
Yi Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Lipid Lowering ◽  
Hypoglycemic Agents ◽  
Primary And Secondary Prevention ◽  
Lipid Lowering Agents

Cardiovascular risk factors and related disorders are common among older adults, and use of various classes of cardiovascular (CV) drugs could reduce the risk of cardiovascular disease (CVD). However, data are sparse with regard to the use of CV drugs among rural-dwelling older adults in China. Therefore, this population-based study aimed to describe use of CV drugs among older adults living in the rural communities in China, while taking into account the use of CV drugs for primary and secondary prevention of CVDs. This study included 5,246 participants (age ≥65 years; 57.17% women; 40.68% illiteracy) in the baseline examination of the MIND-China study. In March-September 2018, data on health-related factors, CVDs (ischemic heart disease, atrial fibrillation, heart failure, and stroke), and CV drug use were collected via face-to-face survey, clinical examination, and laboratory tests. We classified CV drugs according to the Anatomical Therapeutic Chemical classification system for western medications and specific cardiovascular effects for the products of traditional Chinese medicine (TCM). We conducted descriptive analysis. The overall prevalence of major cardiovascular risk factors ranged from 14.30% in diabetes and 23.81% in dyslipidemia to 66.70% in hypertension, and CVDs affected 35.07% of all participants (36.28% in women vs. 33.47% in men, p = 0.035). In the total sample, calcium channel blockers (C08) were most commonly used (10.39%), followed by TCM products (7.64%), hypoglycemic agents (A10, 4.73%), renin-angiotensin system (RAS)-acting agents (C09, 4.61%), and lipid-lowering agents (C10, 4.17%). The proportions of CV drugs for primary prevention (i.e., use of CV drugs among people without CVD) were 3.14% for antithrombotic agents (mainly aspirin), 1.38% for lipid-lowering agents, and 3.11% for RAS-acting agents; the corresponding figures for secondary prevention (i.e., use of CV drugs among people with CVD) were 13.97%, 9.35%, and 7.39%. In conclusion, despite highly prevalent cardiovascular risk factors and CVDs, a fairly low proportion of the rural-dwelling older adults take CV medications for primary and secondary prevention. Notably, TCM products are among the most commonly used CV drugs. These results call for additional efforts to promote implementation of the evidence-based recommendations for prevention of CVDs in the primary care settings.

scholarly journals Effect of Dapagliflozin on Clinical Outcomes in Patients with Chronic Kidney Disease, With and Without Cardiovascular Disease

Circulation ◽  
2020 ◽  
Author(s):  
John J.V. McMurray ◽  
David C. Wheeler ◽  
Bergur V. Stefánsson ◽  
Niels Jongs ◽  
Douwe Postmus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Secondary Prevention ◽  
Cardiovascular Death ◽  
Composite Outcome ◽  
Primary And Secondary Prevention ◽  
History Of ◽  
End Stage

Background: Dapagliflozin reduces the risk of end-stage renal disease in patients with chronic kidney disease. We examined the relative risk of cardiovascular and kidney events in these patients and the effect of dapagliflozin on either type of event, taking account of history of cardiovascular disease. Methods: In the DAPA-CKD trial (Dapagliflozin And Prevention of Adverse Outcomes in Chronic Kidney Disease), 4304 participants with chronic kidney disease were randomized to dapagliflozin 10 mg once daily or placebo. The primary endpoint was a composite of sustained decline in estimated GFR ≥50%, end-stage kidney disease, or kidney or cardiovascular death. The secondary endpoints were a kidney composite outcome (primary endpoint, minus cardiovascular death), the composite of hospitalization for heart failure or cardiovascular death and all-cause death. In a prespecified subgroup analysis, we divided patients into primary and secondary prevention subgroups according to history of cardiovascular disease. Results: Secondary prevention patients (n=1610; 37.4%) were older, more often male, had a higher blood pressure and body-mass index, and were more likely to have diabetes. Mean estimated glomerular filtration rate and median urinary albumin-to-creatinine ratio was similar in the primary and secondary prevention groups. The rates of adverse cardiovascular outcomes were higher in the secondary prevention group, but kidney failure occurred at the same rate in the primary and secondary prevention groups. Dapagliflozin reduced the risk of the primary composite outcome to a similar extent in both the primary (HR, 0.61 [95% CI, 0.48-0.78]) and secondary (0.61, 0.47-0.79) prevention groups (P-interaction=0.90). This was also true for the composite of heart failure hospitalization or cardiovascular death (0.67, 0.40-1.13 versus 0.70, 0.52-0.94, respectively, P-interaction=0.88), and all-cause (0.63, 0.41-0.98 versus 0.70, 0.51-0.95, respectively, P-interaction=0.71). Rates of adverse events were low overall and did not differ between patients with and without cardiovascular disease. Conclusions: Dapagliflozin reduced the risk of kidney failure, death from cardiovascular causes or hospitalization for heart failure, and prolonged survival, in people with chronic kidney disease, with or without type 2 diabetes, independently of the presence of concomitant cardiovascular disease Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT03036150

Abstract P315: Three-year Progression of Sleep-disordered Breathing is Associated with Cardiovascular Disease Risk Factors in Young Adults

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Christopher E Kline ◽  
Thomas B Rice ◽  
Patrick J Strollo ◽  
Emma Barinas-Mitchell
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Heart Rate ◽  
Body Weight ◽  
Weight Change ◽  
Sleep Disordered Breathing ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) is a common sleep disorder that is significantly associated with cardiovascular disease (CVD) risk. Less is known about the short-term cardiovascular implications of mild-severity SDB progression, as mild SDB is less commonly associated with CVD but often develops into more severe SDB over time if left untreated. Hypothesis: We hypothesized that worsening of SDB severity over 3 years would be associated with greater changes in common CVD risk factors (body weight, heart rate [HR], blood pressure [BP], insulin resistance, and C-reactive protein [CRP]). Methods: A sample of 32 adults (38.6±6.4 y; 31.9±4.0 kg/m2; 72% female) who previously had participated in a 1-year lifestyle intervention were followed from 1-year post-intervention (2Y) for an additional 3 years (5Y). At 2Y and 5Y, SDB was assessed with an ambulatory monitor (ResMed ApneaLink); the oxygen desaturation index (ODI; the number of times per hour of recording that the blood oxygen saturation [SaO2] level was reduced by ≥4%) and mean SaO2 served as the primary indices of SDB severity. At 2Y and 5Y, body weight and resting BP and HR were assessed using standard procedures and fasting blood samples were obtained and measured for glucose, insulin, and CRP. Insulin resistance was measured via the Homeostatic Model Assessment method. Multiple linear regression and analysis of covariance were used to examine the associations between changes in SDB severity and changes in CVD risk factors, adjusting for 2Y values of CVD risk factors. Results: ODI at 2Y was 5.3±6.6. At 5Y, ODI had changed (i.e., improved) by -0.2±4.9, with ODI worsening by ≥2 in 7 adults and improving by ≥2 in 11 adults. Mean SaO2 at 2Y was 95.5±1.6% and changed (i.e., improved) by +0.1±1.1% at 5Y; mean SaO2 worsened in 10 adults and improved in 12 adults. Three-year change in ODI, but not SaO2, was significantly associated with weight change (β=.42, P=.02). Compared to those whose ODI worsened or did not change, improved ODI was associated with more favorable changes in CRP (-1.8 vs. +0.8 mg/L; P=.04) and heart rate (-5.0 vs. +0.2 beats/min; P=.05); however, these associations were weakened after further adjustment for weight change (P=.16 and P=.07, respectively). Compared to those whose SaO2 remained unchanged or improved, worsened SaO2 was associated with increased insulin resistance (+1.1 vs. -0.4; P<.01); results were unchanged following adjustment for weight change (P=.01). Changes in ODI and SaO2 were not related to changes in BP. Conclusions: Even marginal worsening of SDB severity over 3 years is associated with elevation in some CVD risk markers. Treatment of mild SDB in young- to middle-aged adults may reduce risk for CVD.

scholarly journals DECLARE-TIMI 58 trial in the context of EMPA-REG OUTCOME and CANVAS

2020 ◽  
Vol 22 (6) ◽  
pp. 592-601
Author(s):  
Marina V. Shestakova
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Published Data ◽  
Cardiovascular Morbidity And Mortality ◽  
Cardiovascular Endpoint

The article discussed results of the DECLARE-TIMI 58 study in the aspects of the previously finished trials (EMPA-REG OUTCOME and CANVAS). All three SGLT2i demonstrated the reduction of the risk of hospitalization for heart failure, as well as the risk of progression chronic kidney disease. At the same time, the patient populations are different. In EMPA-REG OUTCOME almost all the patients had previously diagnosed cardiovascular disease; in CANVAS 44.4% of patients did not have a confirmed cardiovascular disease, but had cardiovascular risk factors, and in DECLARE TIMI 58 there were 59% of such patients. Assessment of the published data suggests that the risk of a combined cardiovascular endpoint, including death from cardiovascular causes, myocardial infarction, and stroke, seems to be most pronounced in patients who already have established cardiovascular disease, and this effect is achieved mainly by reducing cardiovascular mortality. In the population of patients with type 2 diabetes who do not have cardiovascular disease, but who have cardiovascular risk factors, this effect is not detected. Contrary, risk-reduction of hospitalization for CHF and slowing the progression of CKD is manifested both in a population of patients with established cardiovascular disease and in the population of patients with multiple cardiovascular risk factors. In this regard, DECLARE-TIMI 58, as well as previously published data, open up new option for an earlier start of SGLT-2i for primary prevention and/or slowing the progression of nephropathy, reducing the risk of heart failure, and its prevention, as well as reduction of cardiovascular morbidity and mortality in patients with type 2 diabetes, regardless of the presence or absence of cardiovascular pathology in the anamnesis.

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