Blood Pressure Changes in a Chinese Population Have a Greater Impact on Short-Term Outcomes Rather Than Long-Term Outcomes of Major Adverse Cardiovascular Events

2020 ◽  
pp. 101053952095508
Author(s):  
Qianyi Xu ◽  
Yali Wang ◽  
Yanxia Xie ◽  
Jia Zheng ◽  
Rongrong Guo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Stroke Risk ◽  
Rural China ◽  
Major Adverse Cardiovascular Events ◽  
Long Term Outcomes ◽  
Short Term ◽  
Initial Examination ◽  
The Difference

The purpose of our study was to explore the association of blood pressure (BP) changes on short-and long-term outcomes of major adverse cardiovascular events (MACEs) in rural China. This study was designed to learn the effects of BP changes (2004-2008) on short-term (2008-2010, within 2 years of the initial examination) and long-term (2008-2017) outcomes of MACE, including 24 285 and 27 290 participants, respectively. In this study, 423 (short-term) and 1952 (long-term) MACEs were identified. For prehypertension to hypertension, the risk of long-term stroke was increased (hazard ratio [HR] = 1.18 [1.00-1.39]). For hypertension to prehypertension, the short-term MACE risk (0.65 [0.47-0.90]), short-term stroke risk (0.45 [0.26-0.76]), and long-term stroke risk (0.83 [0.70-0.99]) all decreased. Short-term outcomes conferred a stronger impact than long-term outcomes (Fisher Z test, measured as the difference of β coefficients, all P < .05).

Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification

Angiology ◽  
2020 ◽  
Vol 71 (8) ◽  
pp. 677-688 ◽  
Author(s):  
George Kassimis ◽  
Matthaios Didagelos ◽  
Giovanni Luigi De Maria ◽  
Nestoras Kontogiannis ◽  
Grigoris V. Karamasis ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Cardiovascular Events ◽  
Percutaneous Intervention ◽  
Advanced Technology ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Short And Long Term

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested. Intravascular lithotripsy (IVL) offers a novel option for lesion preparation of severely calcified plaques in coronary and peripheral vessels. It is unique among all technologies in its ability to modify calcium circumferentially and transmurally, thus modifying transmural conduit compliance. In this article, we summarize the currently available evidence on this technology, and we highlight its best clinical application through appropriate patient and lesion selection, with the main objective of optimizing stent delivery and implantation, and subsequent improved short- and long-term outcomes. We believe that the IVL balloon will transform the market, as it is easy to use, with predictable results. However, cost-effectiveness of such advanced technology will need to be considered.

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

2020 ◽  
Vol 83 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Naveed Akhtar ◽  
Mahesh Kate ◽  
Saadat Kamran ◽  
Rajvir Singh ◽  
Zain Bhutta ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Contributory Factors ◽  
Short Term Outcome

Background: Sex differences may determine presentation, utility of treatment, rehabilitation, and occurrences of major adverse cardiovascular events (MACEs) in acute stroke (AS). Objective:The purpose of the study was to evaluate the short-term prognosis and long-term outcomes in MACEs in Qatari nationals admitted with AS. Methods: All AS patients admitted between January 2014 and February 2019 were included. We evaluated the preadmission modified Rankin scale (mRS) score, etiology and severity of symptoms, complications, and functional recovery at discharge and 90 days. MACEs were recorded for 5 years. Results: There were 891 admissions for AS (mean age 64.0 ± 14.2 years) (male, n = 519 [mean age ± SD 62.9 ± 14.1 years]; female, n = 372 [mean age ± SD 65.6 ± 14.2 years] p = 0.005). There were no differences in the preadmission mRS and severity of symptoms as measured on National Institute of Stroke Scale. At discharge, the outcome was better (mRS 0–2) in men (57.8 vs. 46.0%), p = 0.0001. This difference persisted at the 90-day follow-up (mRS 0–2, male 69.4% vs. female 53.2%, p = 0.0001). At the 90-day follow-up, more women died (total deaths 70; women 38 [10.2%] versus men 32 [6.2%], p = 0.03). MACEs occurred in 25.6% (133/519) males and 30.9% (115/372) females over the 5-year follow-up period (odds ratio 0.77, 95% confidence interval 0.57–1.0, p = 0.83). Conclusions: Female patients have a poor short-term outcome following an AS when corrected for age and comorbidities. While our study cannot explain the reasons for the discrepancies, higher poststroke depression and social isolation in women may be important contributory factors, and requires further studies are required to confirm these findings.

scholarly journals Elevated Pulse Pressure and Recurrent Hemorrhagic Stroke Risk in Stroke With Cerebral Microbleeds or Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Jong‐Ho Park ◽  
Juneyoung Lee ◽  
Sun U. Kwon ◽  
Hyuk Sung Kwon ◽  
Min Hwan Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Cardiovascular Events ◽  
Operating Characteristic ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Characteristic Curve ◽  
Cerebral Microbleeds ◽  
Major Adverse Cardiovascular Events

Background Which type of recurrent stroke is associated with pulse pressure (PP) remains uncertain in ischemic stroke with cerebral microbleeds or intracerebral hemorrhage. Methods and Results The (PICASSO) Prevention of Cardiovascular Events in Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage database involving 1454 subjects was analyzed. Subjects were stratified into quartiles according to the distribution of mean PP (mm Hg) during follow‐up (mean, 1.9 years): <47 (first quartile), 48 to 53 (second quartile), 54 to 59 (third quartile), and ≥60 mm Hg (fourth quartile). The primary end point was hemorrhagic stroke, and the secondary end points were ischemic stroke, stroke of any type, and major adverse cardiovascular events. Adjusted time‐dependent area under the receiver operating characteristic curve analysis was performed to assess the prediction accuracy of mean PP. The mean frequency of visit for blood pressure checkup was 9.4±5.5 times. The stroke incidence rate per 100 person‐years was 3.14, 2.24, 5.52, and 6.22, respectively in increasing quartile of mean PP, and the rate of major adverse cardiovascular events was 3.82, 2.84, 6.37, and 7.14, respectively. In the presence of mean arterial pressure, hemorrhagic stroke risk was higher in the highest quartile (adjusted hazard ratio, 6.03; 95% CI, 1.04–34.99) versus the lowest quartile, which was evident at higher mean systolic blood pressure. Higher mean PP as a continuous variable was also a predictor of hemorrhagic stroke (1.09, 1.03−1.15). The time‐dependent area under the receiver operating characteristic curve for hemorrhagic stroke was 0.79. Conclusions Long‐term elevated PP with higher systolic blood pressure confers a greater risk of subsequent hemorrhagic stroke among stroke patients with cerebral microbleeds or intracerebral hemorrhage. Registration URL: https://www.clinicaltrials.gov ; Unique identifier, NCT01013532.

Early glycaemic changes after initiation of oral antidiabetic medication and risk of major adverse cardiovascular events: results from a large primary care population of patients with type 2 diabetes

2020 ◽  
Author(s):  
Jonas Ghouse ◽  
Paul Blanche ◽  
Morten W Skov ◽  
Bent Lind ◽  
Allan Vaag ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Short Term ◽  
Oral Antidiabetic ◽  
Steep Decline ◽  
Pre Treatment ◽  
First Time

Abstract Aims To determine the risk of major adverse cardiovascular events (MACE) and death, associated with an early large and rapid decline in glycated haemoglobin (HbA1C) following first time initiation of an oral antidiabetic drug (OAD). Methods and results We included 10 518 primary care patients with type 2 diabetes, who initiated an OAD for the first time. For each individual, we measured a decline in HbA1C, as the difference between the pre-treatment HbA1C (within 3 months before OAD initiation) and the post-treatment HbA1C (within 1.5–4.5 months after OAD initiation), divided by the time between the two measurements. The decline was reported in mmol/mol change per 3 months in HbA1C and categorized by the median decline into levels of steep [≥9 mmol/mol (≥0.8%)] and flat decline [&lt;9 mmol/mol per 3 months (&lt;0.8%)]. Pre-treatment HbA1C was categorized by the median, into levels of low (48–62 mmol/mol) and high (&gt;62 mmol/mol). Multiple Cox regression was used to study the effect of decline (steep vs. flat) on the outcome hazard rates separately for patients with low and high pre-treatment HbA1C. Analyses were adjusted for age, sex, traditional cardiovascular risk factors, severe comorbidities, and concomitant medication treatment. During a median follow-up time of 7.7 years, 1625 developed MACE and 2323 died. We found that a steep decline vs. a flat decline was significantly associated with a decreased hazard for MACE, both in individuals with high [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.69–0.94; P = 0.005] and low pre-treatment HbA1C (HR 0.79; 95% CI 0.66–0.96; P = 0.015). The hazard of MACE was more pronounced on the short-term vs. long-term in individuals with high pre-treatment HbA1C. We found no significant association between combinations of pre-treatment HbA1C and decline categories and hazard of all-cause mortality. However, a combination of a low pre-treatment HbA1C and steep decline was associated with increased 1-year mortality (HR 1.52; 95% CI 1.00–2.29; P = 0.048) and hypoglycaemia (HR 1.82; 95% CI 1.11–2.98; P = 0.017). Conclusion A combination of a high pre-treatment HbA1C and a steep decline in HbA1C was associated with a decreased short-term risk of MACE. A low pre-treatment HbA1C and a steep decline was associated with a long-term reduced risk of MACE, but a short-term increased risk of death and hypoglycaemia.

Effectiveness of continuous unsupervised exercise therapy after above-knee femoropopliteal bypass

Vascular ◽  
2020 ◽  
pp. 170853812095748
Author(s):  
Taira Kobayashi ◽  
Masaki Hamamoto ◽  
Takanobu Okazaki ◽  
Tomoaki Honma ◽  
Kazutoshi Iba ◽  
...  
Keyword(s):  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Study Cohort ◽  
Secondary Patency ◽  
Femoropopliteal Bypass ◽  
Long Term Outcomes ◽  
Propensity Matching

Objective Exercise therapy has acceptable outcomes for patients with intermittent claudication, although few reports exist regarding the results of continuous exercise therapy after surgical reconstruction for intermittent claudication. This study aimed to analyze the long-term outcomes of unsupervised exercise therapy for patients after above-knee femoropopliteal bypass. Material and methods We retrospectively analyzed 69 patients (69 limbs, 69 grafts) who underwent above-knee femoropopliteal bypass from April 2009 to March 2018 in our hospital. At six months after above-knee femoropopliteal bypass, we evaluated the maintenance of unsupervised exercise therapy. Patients who continued unsupervised exercise therapy or discontinued unsupervised exercise therapy were assessed via 1:1 propensity matching. Long-term outcomes such as patency, survival, and major adverse cardiovascular events were compared between the groups after matching. We also analyzed the maintaining rate of unsupervised exercise therapy in a study cohort. Results Twenty-nine (42%) patients continued unsupervised exercise therapy until six months after above-knee femoropopliteal bypass. The discontinued unsupervised exercise therapy had higher proportions of female sex ( p =  0.015) and cerebrovascular disease ( p =  0.025) than did the continued unsupervised exercise therapy. The mean follow-up period was 65 ± 36 months. After propensity matching, the rates of the following factors were significantly higher in the continued unsupervised exercise therapy than in the discontinued unsupervised exercise therapy: primary patency (97% vs. 61%, p =  0.0041), secondary patency (100% vs. 69%, p =  0.0021), and freedom from major adverse cardiovascular events (61% vs. 24%, p =  0.0071) at five years. Both groups had a similar survival rate. The maintaining rate of unsupervised exercise therapy in the study cohort was 44% at six months, 41% at one year, 36% at three years, 25% at five years, and 25% at seven years. Conclusion The findings of this study suggested superior long-term outcomes, including graft patency and freedom from major adverse cardiovascular events, with unsupervised exercise therapy after open bypass than with the usual therapy. Unsupervised exercise therapy may be recommended for the patients after open bypass.

scholarly journals Blood Pressure Variability: Prognostic Value and Therapeutic Implications

2013 ◽  
Vol 2013 ◽  
pp. 1-16 ◽  
Author(s):  
Christian Höcht
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Renal Lesion ◽  
Short Term

Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.

scholarly journals Comparison of Long‐Term Outcomes for Responders Versus Non‐Responders Following Renal Denervation in Resistant Hypertension

2021 ◽  
Author(s):  
Karl Fengler ◽  
Paul Reimann ◽  
Karl‐Philipp Rommel ◽  
Karl‐Patrik Kresoja ◽  
Stephan Blazek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Blood Pressure Response ◽  
Sympathetic Denervation ◽  
Major Adverse Cardiovascular Events ◽  
Renal Sympathetic Denervation ◽  
Recent Trial ◽  
Renal Sympathetic

Background Recent trial results support the efficacy of renal sympathetic denervation in lowering blood pressure (BP). While BP reduction in general is associated with a clinically meaningful reduction in cardiovascular events and mortality, such a relationship has not been described for patients undergoing renal sympathetic denervation. Methods and Results Clinical events were assessed in patients who underwent renal sympathetic denervation at our center using telephone‐ and clinical follow‐up, interviews with general practitioners, as well as review of hospital databases. Event rates were compared between BP responders (≥5 mm Hg 24‐hour ambulatory BP reduction) and non‐responders; 296 patients were included. Compared with baseline, 24‐hour systolic ambulatory BP was reduced by 8.3±12.2 mm Hg and diastolic BP by 4.8±7.0 mm Hg ( P <0.001 for both) after 3 months. One hundred eighty patients were classified as BP responders and 116 as non‐responders. During a median follow‐up time of 48 months, significantly less major adverse cardiovascular events (cardiovascular death, stroke, myocardial infarction, critical limb ischemia, renal failure) occurred in responders than in non‐responders (22 versus 23 events, hazard ratio [HR], 0.53 [95% CI, 0.28 to 0.97], P =0.041). This was consistent after adjustment for potential confounders as well as confirmed by propensity‐score matching. A proportional relationship was found between BP reduction after 3 months and frequency of major adverse cardiovascular events (HR, 0.75 [95% CI, 0.58 to 0.97] per 10 mm Hg 24‐hour systolic ambulatory BP reduction). Conclusions Based on these observational data, blood pressure response to renal sympathetic denervation is associated with improved long‐term clinical outcome.

Outcomes of Chinese Rural Protest

Asian Survey ◽  
2019 ◽  
Vol 59 (3) ◽  
pp. 429-450 ◽  
Author(s):  
Bin Sun
Keyword(s):  
Rural China ◽  
Long Term Outcomes ◽  
Short Term ◽  
Protest Group ◽  
Rural Protest

There are many protests about loss of village land in rural China. By following both short-term and long-term outcomes of one such protest, in Wukan, Guangdong, this article illustrates the strategies Chinese governments employ to appease protesters, and the consequences of a local protest for individuals, the protest group, and the broader society.

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