scholarly journals Risk Factor Burden and Long‐Term Prognosis of Patients With Premature Coronary Artery Disease

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Michel Zeitouni ◽  
Robert M. Clare ◽  
Karen Chiswell ◽  
Jawan Abdulrahim ◽  
Nishant Shah ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Premature Cad ◽  
Artery Disease ◽  
Long Term Prognosis

Background Coronary artery disease (CAD) is increasing among young adults. We aimed to describe the cardiovascular risk factors and long‐term prognosis of premature CAD. Methods and Results Using the Duke Databank for Cardiovascular Disease, we evaluated 3655 patients admitted between 1995 and 2013 with a first diagnosis of obstructive CAD before the age of 50 years. Major adverse cardiovascular events (MACEs), defined as the composite of death, myocardial infarction, stroke, or revascularization, were ascertained for up to 10 years. Cox proportional hazard regression models were used to assess associations with the rate of first recurrent event, and negative binomial log‐linear regression was used for rate of multiple event recurrences. Past or current smoking was the most frequent cardiovascular factor (60.8%), followed by hypertension (52.8%) and family history of CAD (39.8%). Within a 10‐year follow‐up, 52.9% of patients had at least 1 MACE, 18.6% had at least 2 recurrent MACEs, and 7.9% had at least 3 recurrent MACEs, with death occurring in 20.9% of patients. Across follow‐up, 31.7% to 37.2% of patients continued smoking, 81.7% to 89.3% had low‐density lipoprotein cholesterol levels beyond the goal of 70 mg/dL, and 16% had new‐onset diabetes mellitus. Female sex, diabetes mellitus, chronic kidney disease, multivessel disease, and chronic inflammatory disease were factors associated with recurrent MACEs. Conclusions Premature CAD is an aggressive disease with frequent ischemic recurrences and premature death. Individuals with premature CAD have a high proportion of modifiable cardiovascular risk factors, but failure to control them is frequently observed.

Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110280
Author(s):  
Sukru Arslan ◽  
Ahmet Yildiz ◽  
Okay Abaci ◽  
Urfan Jafarov ◽  
Servet Batit ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vessel Diameter ◽  
Side Branch ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Long-term prognosis after percutaneous or surgical revascularization in patients with diabetes mellitus and complex coronary artery disease- a systematic review and meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Mandava ◽  
S Pothuru ◽  
S Adeel Hassan ◽  
D Missael Rocha Castellanos ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Main ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background-Whether Coronary artery bypass grafting (CABG) confers a survival benefit in patients with diabetes mellitus(DM) and complex coronary artery disease (CAD), including left main CAD and multivessel coronary disease (MVD) after a follow up period ≥ 5 years remains unknown. Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to December 12th 2020. Using a generic invariance weighted random effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) which was defined as a composite of death, myocardial reinfarction and stroke at ≥ 5 years. Results-A total of 8 studies with 13336 participants(PCI = 6783, CABG = 6553)were included in our analysis. Mean age was 54.6 and 55.3 in the PCI-DES and CABG groups respectively. The 5-yr follow-up outcomes including all-cause mortality (HR 1.37; 95%CI 1.15-1.65; p = 0.0006, I2 = 0)and MACCE (HR 1.48; 95%CI 1.29-1.69; p < 0.00001, I2 = 0) were significantly higher with PCI as compared to CABG. Furthermore, at >5 year follow-up, all-cause mortality (HR 1.35; 95%CI 1.10-1.66; p = 0.004, I2 = 37) and MACCE (HR 1.98; 95%CI 1.85-2.12; p < 0.00001, I2 = 0) had similar outcomes. Conclusion-Amongst patients with DM and Complex CAD ( left main/MVD), CABG was associated with improved long-term mortality and freedom from MACCEs as opposed to PCI-DES. CABG is the preferred revascularization strategy in patients with complex anatomic disease and concurrent diabetes. Abstract Figure.

scholarly journals Diabetes mellitus and other cardiovascular risk factors in lower-extremity peripheral artery disease versus coronary artery disease: an analysis of 1,121,359 cases from the nationwide databases

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Mitsuyoshi Takahara ◽  
◽  
Osamu Iida ◽  
Shun Kohsaka ◽  
Yoshimitsu Soga ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Lower Extremity ◽  
Cardiovascular Risk Factors ◽  
Clinical Profile ◽  
Peripheral Artery ◽  
Artery Disease

Abstract Background Lower-extremity peripheral artery disease (LE-PAD) and coronary artery disease (CAD) are both pathologically rooted in atherosclerosis, and their shared clinical features regarding the exposure to cardiovascular risk factors have been emphasized. However, comparative data of the two cardiovascular diseases (CVDs) were so far lacking. The purpose of this study was to directly compare the clinical profile between cases undergoing endovascular therapy (EVT) for LE-PAD and those undergoing percutaneous coronary intervention (PCI). Methods Data were extracted from the nationwide procedural databases of EVT and PCI in Japan (J-EVT and J-PCI) between 2012 and 2017. A total of 1,121,359 cases (103,887 EVT cases for critical limb ischemia [CLI] or intermittent claudication and 1,017,472 PCI cases for acute coronary syndrome [ACS] or stable angina) were analyzed. Heterogeneity in clinical profile between CVDs was evaluated using the C statistic of the logistic regression model for which dependent variable was one CVD versus another, and explanatory variables were clinical profile. When two CVDs were completely discriminated from each other by the developed model, the C statistic (discrimination ability) of the model would be equal to 1, indicating that the two CVDs were completely different in clinical profile. On the other hand, when two CVDs were identical in clinical profile, the developed model would not discriminate them at all, with the C statistic equal to 0.5. Results Mean age was 73.5 ± 9.3 years in LE-PAD patients versus 70.0 ± 11.2 years in CAD patients (P < 0.001). The prevalence of diabetes mellitus and end-stage renal disease was 1.96- and 6.39-times higher in LE-PAD patients than in CAD patients (both P < 0.001). The higher prevalence was observed irrespective of age group. The exposure to other cardiovascular risk factors and the likelihood of cardiovascular risk clustering also varied between the diseases. The between-disease heterogeneity in patient profile was particularly evident between CLI and ACS, with the C statistic equal to 0.833 (95% CI 0.831–0.836). Conclusions The current study, an analysis based on nationwide procedural databases, confirmed that patient profiles were not identical but rather considerably different between clinically significant LE-PAD and CAD warranting revascularization.

scholarly journals Cardiovascular Risk Factors - Association with Lower Extremity Versus Coronary Artery Disease

2021 ◽  
Vol 26 (1) ◽  
pp. 9-12
Author(s):  
Cornel Ioan Bitea ◽  
Ioan Maniţiu ◽  
Georgiana Bălţat ◽  
Oana Stoia
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Lower Extremity ◽  
Cardiovascular Risk Factors ◽  
Diabetic Patients ◽  
Reactive Protein ◽  
Artery Disease

Abstract Atherosclerosis is the main cause of lower extremity artery disease (LEAD) and coronary artery disease (CAD). These two arterial territories share the major cardiovascular risk factors: smoking, hypertension, dyslipidaemia and diabetes. Current guidelines draw attention to other possible risk factors: homocysteine level, inflammation markers (e.g. high-sensitive C reactive-protein (CRP), interleukin 6) and chronic kidney disease (CKD.) The objective of this study was to evaluate the cardiovascular risk factors strength association with LEAD and CAD on a study population of 203 patients. Our study concluded that smoking seems to be the most powerful risk factor for LEAD, especially for significant lesion in femoral arteries, while diabetes mellitus, hypertension and CKD were significantly associated with CAD. The highest chance of association with multivessel-CAD is for diabetes mellitus compared to hypertension and CKD respectively. Moreover, in diabetic patients the percent of multivessel-CAD was significantly higher than the percent of single-CAD and non-significant CAD.

scholarly journals The LDL-C/HDL-C ratio and 4-year risk of coronary artery disease: a retrospective study

2020 ◽  
Author(s):  
shaohui zhang ◽  
Yongliang Zhao ◽  
Xiangting Li ◽  
Wen Dai ◽  
Xueying Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Syntax Score ◽  
Artery Disease

Abstract BackgroundNumerous studies have demonstrated that the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio can reflect the positive correlation index LDL-C and the negative index HDL-C of coronary artery disease (CAD) at the same time, which is increasingly considered as a novel marker to evaluate the risk of CAD. However, whether the short-term evaluation effect of the LDL-C/HDL-C ratio can be maintained during long-term follow-up is unclear. In addition, it is not clear whether the value of LDL-C/HDL-C ratio in the risk assessment of major adverse cardiac events (MACE) varies with different treatments. Our aim of the study was to investigate the link between LDL-C/HDL-C ratio and long-term risk of CAD and find out whether the LDL-C/HDL-C ratio could effectively evaluate the occurrence of MACE in CAD patients under different treatments. MethodsFrom May 2013 to November 2015, a total of 2409 patients who underwent coronary angiography (CAG) with or without revascularization therapy were enrolled in this study. They were divided into two groups based on the LDL-C/HDL-C ratio and three groups based on the treatments: medical therapy alone (MTA), percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).ResultsIn total, 1784 patients (74.1%) were followed for health outcome and 625 patients (25.9%) experienced a MACE event. The median follow-up time was 4.27 years (1560 days). The patients with a higher LDL-C/HDL-C ratio (≥ 2.33) also had a significantly higher incidence of MACE (HR: 1.47, 95% CI: 1.25 to 1.72, p < 0.001). The cumulative incidence of rehospitalization for UA (HR: 1.53, 95% CI: 1.27 to 1.84, p < 0.001) and rehospitalization for HF (HR: 3.70, 95% CI: 1.22 to 22.25, p = 0.021) were significantly higher in high group than in low group. There were no significant differences in MI (HR: 1.25, 95% CI: 0.63 to 2.48, P = 0.521), TLR (HR: 0.98, 95% CI: 0.62 to 1.55, p = 0.947), Stroke (HR: 1.65, 95% CI: 0.64 to 4.25, p = 0.301) and 4-year all-cause death (HR: 1.45, 95% CI: 0.58 to 3.61, p = 0.423). Kaplan-Meier cumulative curve showed that patients with higher LDL-C/HDL-C ratio had a significantly lower MACE-free survival (p < 0.001). Multivariate Cox regression analysis demonstrated that LDL-C/HDL-C ratio (HR: 1.34, 95% CI: 1.14 to 1.60, p < 0.001) together with age, smoking, hypertension, diabetes mellitus, Syntax score and TG were independent predictors of 4-year MACE in the total CAD population (all p < 0.05). Further subgroup analysis showed that age, smoking, Syntax score, TG and LDL-C/HDL-C ratio were the independent predictors of MACE in MAT group (all p < 0.05); However, Syntax score and diabetes mellitus were the only independent predictor of MACE in PCI group and the CABG group, respectively (both p < 0.05). ConclusionsIn this study, we found that LDL-C/HDL-C ratio was an independent predictor of 4-year MACE in the total CAD population. The value of LDL-C/HDL-C ratio in assessing MACE risk varied among CAD patients with different treatments.

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