Abstract 63: The Smoking Paradox in Patients Hospitalized with Coronary Artery Disease: Findings from Get With The Guidelines - CAD

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Eric E Smith ◽  
Deepak L Bhatt ◽  
Wenqin Pan ◽  
Gregg C Fonarow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Multivariable Model ◽  
History Of ◽  
Artery Disease ◽  
Get With The Guidelines

Introduction: Despite evidence of smoking as a potent risk factor for coronary artery disease (CAD), there have been reports of lower in-hospital mortality among smokers hospitalized for CAD events. Method: We analyzed all consecutive CAD admissions (n=158,054) without a prior history of Stroke/TIA from 2002-2008 in Get With The Guidelines (GWTG)-CAD. Categorical data were analyzed by Pearson Chi-square and continuous data by Wilcoxon test. Multivariable models with generalized estimating equations for in-hospital clustering were used to estimate odds ratios of in-hospital mortality. All significant predictors on univariate analysis were included in the multivariable model. Results: Among all CAD patients, 30.4% were current smokers, defined as any cigarette use in the past year. Smokers were substantially younger (12 years), more often male and less often had pre-existing hypertension, dyslipidemia, heart failure, renal failure and atrial fibrillation, and more often had COPD/Asthma. Smokers were more likely to be admitted to large, academic hospitals, and more often in the South. Smokers had shorter length of stay in hospital and were more often discharged home. In-hospital mortality was lower in smokers as compared to non-smokers (Table 1). The significant univariate mortality difference attenuated dramatically after adjusting for age and other covariates in the multivariable model, OR increased from 0.57 (0.53, 0.61) on univariate analysis to 0.88 (0.81, 0.95) on multivariable model. Other independent predictors of mortality were increasing age [1.51 (1.46, 1.56)], history of diabetes mellitus [1.25 (1.18, 1.33)], Asthma/COPD [1.30 (1.23, 1.38)], peripheral vascular disease [1.34 (1.24, 1.44)], heart failure [1.48 (1.38, 1.58)] and renal insufficiency [1.61 (1.48, 1.74)]. Conclusion: Smoking continues to be a major risk factor for presenting with CAD at a much younger age and with fewer risk factors. It is likely that the continued modest association with lower in-hospital mortality in smokers in this analysis after adjustment reflects residual or unmeasured confounding. This apparent smoker’s paradox in CAD should not be interpreted as a benefit of cigarette smoking.

Relationship between Aortic Atherosclerosis and Dental Loss in an Inner-City Population

Angiology ◽  
2008 ◽  
Vol 60 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Ricardo Castillo ◽  
Aurora Fields ◽  
Ghazanfar Qureshi ◽  
Louis Salciccioli ◽  
John Kassotis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Inner City ◽  
Univariate Analysis ◽  
Ethnically Diverse ◽  
Intima Media Thickness ◽  
City Population ◽  
History Of ◽  
Artery Disease ◽  
Aortic Intima

Prior studies have suggested an association between atherosclerosis and periodontal disease, both of which are more prevalent in certain minority and economically disadvantaged groups. Few studies have addressed the relationship between cardiovascular disease and dentition among ethnically diverse populations. We studied 131 subjects (60% females, age 59 ± 15 years) who were referred for clinically indicated transesophageal echocardiography. Dental loss was more severe in patients with hypertension ( P < .001), diabetes ( P = .05), coronary artery disease ( P = .04), and calcium channel blocker use ( P = .04). On univariate analysis, maximal aortic intima—media thickness (MAIMT) was significantly correlated with dental loss ( r = .40; P < .001). Age was correlated with MAIMT ( R = .41; P < .001) and with dental loss ( r = .57; P < .001). On multivariate analysis, dental loss ( P = .03) and history of coronary artery disease ( P = .04) were independent predictors of MAIMT ( R 2 = .44). In this inner-city predominantly African American population, atherosclerosis and dental loss are age dependent and are interrelated independent of age.

scholarly journals Serum Level of Vitamin D Is Associated with Severity of Coronary Atherosclerosis in Postmenopausal Women

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1139
Author(s):  
Ewelina Anna Dziedzic ◽  
Wiktor Smyk ◽  
Izabela Sowińska ◽  
Marek Dąbrowski ◽  
Piotr Jankowski
Keyword(s):  
Coronary Artery Disease ◽  
Vitamin D ◽  
Risk Factor ◽  
Coronary Artery ◽  
Serum Level ◽  
Postmenopausal Women ◽  
Coronary Atherosclerosis ◽  
History Of ◽  
Artery Disease ◽  
The Impact

Background: Postmenopausal women experience rapid progression of coronary artery disease. Vitamin D deficiency appears to be a modifiable risk factor for cardiovascular diseases. This study aimed to analyze the impact of 25-hydroxyvitamin D3 (25(OH)D) level on the severity of coronary atherosclerosis and its potential cardioprotective effect in postmenopausal women. Material and Methods: The study prospectively recruited 351 women in postmenopausal age undergoing coronary angiography. The severity of coronary atherosclerosis was assessed using the Coronary Artery Surgery Study Score (CASSS). A level of 25(OH)D was measured with electrochemiluminescence. Results: Women with more severe coronary atherosclerosis have significantly lower 25(OH)D serum level (p = 0.0001). Vitamin D (β = −0.02; p = 0.016), hypertension (β = 0.44; p = 0.025), age (β = 0.02; p = 0.003), and history of MI (β = 0.63; p < 0.0001), were shown as CASSS determinants. Age, hyperlipidemia, and history of MI were found to determine the level of vitamin D (all p < 0.05). Women with a three-vessel disease hospitalized due to ACS, with a history of MI, hyperlipidemia and hypertension presented the lowest vitamin D level. Conclusions: Our study showed that lower serum 25(OH)D in postmenopausal women is associated with more significant stenosis in the coronary arteries. Therefore, we suggest considering low vitamin D level as a potential risk factor for coronary artery disease.

scholarly journals Acute Coronary Syndrome in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Artery Disease

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P&lt;0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P &lt;0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P &lt;0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P &lt;0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

Sleep apnoea: definition, prevalence, and role in cardiovascular diseases

ESC CardioMed ◽  
2018 ◽  
pp. 1058-1062
Author(s):  
Olaf Oldenburg
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Negative Impact ◽  
Intrathoracic Pressure ◽  
Sleep Apnoea ◽  
Stroke Severity ◽  
Artery Disease

The two main forms of sleep apnoea are obstructive (OSA) and central (CSA) sleep apnoea. In the presence of cardiovascular disease, CSA can manifest as Cheyne–Stokes respiration. OSA and CSA both can cause substantial oxygen desaturations, alterations in sympathovagal balance, neurohumoral activation, and endothelial dysfunction; OSA also causes marked negative intrathoracic pressure swings, which have a number of undesirable cardiovascular consequences (e.g. increased cardiac transmural pressure gradients, sympathetic activation). OSA is the most common type of sleep apnoea in the general population, but rates are higher in cardiovascular disease. CSA is particularly prevalent in patients with underlying cardiac, neurological, or renal disease. Typical OSA risk factors include obesity, male gender, smoking, and age, while the severity of heart failure is predictive of the prevalence and severity of CSA. Recognition and diagnosis of sleep apnoea can be difficult because patients often do not present with typical symptoms. Sleep apnoea is an important co-morbidity in cardiovascular disease because of links with a number of conditions. OSA is an independent risk factor for the development of hypertension and heart failure, and has a negative impact on the effectiveness of treatments for atrial fibrillation. OSA has also been linked with the development of coronary artery disease, worse outcomes after acute myocardial infarction, and higher event rates in patients with coronary artery disease. CSA with Cheyne–Stokes respiration has important links with heart failure and is a risk factor for poor outcome even when other therapies are optimized. Cheyne–Stokes respiration has also been documented in stroke patients, increasing stroke severity and worsening prognosis.

Two-year course of cognitive function and mood in adults with congestive heart failure and coronary artery disease: the Heart-Mind Study

2011 ◽  
Vol 24 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Osvaldo P. Almeida ◽  
Christopher Beer ◽  
Nicola T. Lautenschlager ◽  
Leonard Arnolda ◽  
Helman Alfonso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Cognitive Function ◽  
Short Form ◽  
Verbal Learning ◽  
Left Ventricular ◽  
History Of ◽  
Artery Disease

ABSTRACTBackground: Congestive heart failure (CHF) has been associated with impaired cognitive function, but it is unclear if these changes are specific to CHF and if they get worse with time. We designed this study to determine if adults with CHF show evidence of cognitive decline compared with adults with and without coronary artery disease (CAD).Methods: A longitudinal study was carried out of 77 adults with CHF (ejection fraction, EF < 0.4), 73 adults with a clinical history of CAD and EF > 0.6, and 81 controls with no history of CAD. The Cambridge Cognitive Examination of the Elderly (CAMCOG) was the primary outcome measure. Secondary measures included the California Verbal Learning Test (CVLT), digit coding and copying, Hospital Anxiety and Depression Scale (HADS), and the short form health survey (SF36). Endpoints were collected at baseline and after 12 and 24 months.Results: The adjusted CAMCOG scores of CHF participants declined 0.9 points over two years (p = 0.022) compared with controls without CAD. There were no differences between the groups on other cognitive measures. Participants with CHF and with CAD experienced similar changes in cognitive function over two years. Left ventricular EF and six-minute walk test results could not explain the observed associations.Conclusions: The changes in cognitive function and mood associated with CHF over two years are subtle and not specific to CHF.

scholarly journals Family history of cardiovascular disease as a risk factor for coronary artery disease in adult offspring

2016 ◽  
Vol 70 (2) ◽  
Author(s):  
Kianoosh Hoseini ◽  
Saeed Sadeghian ◽  
Mehran Mahmoudian ◽  
Reza Hamidian ◽  
Ali Abbasi
Keyword(s):  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Family History ◽  
Positive Family History ◽  
Adult Offspring ◽  
Positive History ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Background and aims: There is controversy about the role of positive family history as an independent risk factor for coronary artery disease. The aim of this work was to investigate the influence of family history on presentation of coronary artery disease in adult offspring, and on its severity. Methods: In a retrospective cross-sectional study at Tehran Heart Center (University of Tehran Medical Sciences), 6399 patients with established coronary artery disease who underwent coronary angiography for standard indications were assessed. Coronary artery disease was defined as atherosclerotic involvement of more than 50% in at least one major coronary artery. Results: 953 patients (14.9%) had a verified positive family history of coronary artery disease, of whom 193 patients (20.2%) and 215 patients (22.5%) had paternal and maternal positive history, respectively. The mean age of clinical onset of ischemic heart disease in patients with a positive history was significantly lower than patients with no history (p &lt; 0.001). Left main coronary lesion was significantly more frequent in patients with positive history (p = 0.017). Multivariate logistic regression analysis demonstrated that presentation of coronary artery disease in the form of acute coronary syndrome was significantly more prevalent in the background of positive family history (odds ratio, OR = 1.44, 95% confidence interval, CI: 1.14-1.83, p = 0.002), especially above 45 years old. Conclusion: These findings indicate that positive family history is a major risk factor for coronary artery disease which strongly predisposes to the atherosclerotic process at younger ages; therefore, these patients should be evaluated and managed more intensively for other risk factors.

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.

Aging and Health

2016 ◽  
Author(s):  
Michael Snyder
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Macular Degeneration ◽  
Human Diseases ◽  
Aging And Health ◽  
Artery Disease

The number one risk factor for nearly all human diseases is age. The chances of developing cancer, diabetes, coronary artery disease, heart failure, macular degeneration, and dementia all increase with age. Aging is not a default process in which we “wear out” but rather...

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