scholarly journals Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease: A study from the Western Denmark Heart Registry

2020 ◽  
Vol 17 (4) ◽  
pp. 147916412094180
Author(s):  
Christine Gyldenkerne ◽  
Kevin KW Olesen ◽  
Pernille G Thrane ◽  
Morten Madsen ◽  
Troels Thim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Confidence Interval ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Hazard Ratio ◽  
Artery Disease

Background: Diabetes is considered a risk factor for myocardial infarction. However, we have previously found that diabetes was not a short-term risk factor for myocardial infarction in the absence of obstructive coronary artery disease. Methods: We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to coronary artery disease and diabetes. Endpoints included myocardial infarction, cardiac death, all-cause death and coronary revascularization. Results: 86,202 patients were included in total (diabetes: n = 12,652). Median follow-up was 8.8 years. Using patients with neither coronary artery disease nor diabetes as reference (cumulative myocardial infarction incidence 2.6%), the risk of myocardial infarction was low and not substantially increased for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% confidence interval 0.996−1.451), was increased for patients with coronary artery disease alone (9.3%; hazard ratio 2.75, 95% confidence interval 2.52−3.01) and was highest for patients with both coronary artery disease and diabetes (12.3%; hazard ratio 3.79, 95% confidence interval 3.43−4.20). Similar associations were observed for cardiac death and coronary revascularization. Conclusion: Diabetes patients without coronary artery disease by coronary angiography have a low risk of myocardial infarction, not substantially increased compared to patients with neither coronary artery disease nor diabetes. In the presence of coronary artery disease, however, diabetes increases the risk of myocardial infarction.

Diabetes is not a risk factor for myocardial infarction in patients without coronary artery disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Gyldenkerne ◽  
K.K.W Olesen ◽  
P.G Thrane ◽  
M Madsen ◽  
T Thim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Hazard Ratio ◽  
Funding Source ◽  
Artery Disease

Abstract Background Diabetes is considered a risk factor for myocardial infarction (MI). However, we have previously found that diabetes was not a short-term risk factor for MI in the absence of obstructive coronary artery disease (CAD). Purpose As long-term data are not available, we aimed to assess adverse cardiac events in patients with and without diabetes stratified by CAD up to 11 years after coronary angiography. Methods We conducted a cohort study of patients undergoing coronary angiography from 2003 to 2012 and followed them by cross-linking Danish health registries. Patients were stratified according to the presence/absence of CAD and diabetes. Outcomes included MI, cardiac death, all-cause death, and coronary revascularization. Results A total of 86,202 patients were included (diabetes: n=12,652). Median follow-up was 8.8 years. Using patients with neither CAD nor diabetes as reference (cumulative MI incidence 2.6%), the risk of MI was similar for patients with diabetes alone (3.2%; hazard ratio 1.202, 95% CI: 0.996–1.451), was increased for patients with CAD alone (9.3%; hazard ratio 2.75, 95% CI: 2.52–3.01), and was highest for patients with both CAD and diabetes (12.3%; hazard ratio 3.79, 95% CI: 3.43–4.20), see Figure. Similar associations were observed for cardiac death and coronary revascularization. Conclusions Diabetes patients without CAD by coronary angiography have a similar risk of MI compared to patients with neither CAD nor diabetes. In the presence of CAD, however, diabetes increases the risk of MI. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

scholarly journals Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease

2019 ◽  
Vol 16 (4) ◽  
pp. 351-359 ◽  
Author(s):  
Christine Gyldenkerne ◽  
Kevin Kris Warnakula Olesen ◽  
Morten Madsen ◽  
Troels Thim ◽  
Lisette Okkels Jensen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Obstructive Coronary Artery Disease ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Artery Disease ◽  
Glucose Lowering Therapy ◽  
Diabetes Patients

Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.

P6511CABG was associated with higher risk of periprocedural stroke than PCI in patients with complex coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Watanabe ◽  
H S Shiomi ◽  
T K Kimura
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Large Scale ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Hazard Ratio ◽  
Individual Patient Level ◽  
Artery Disease ◽  
Periprocedural Stroke

Abstract Background Periprocedural stroke was believed to occur more frequently after coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). However, few clinical data have endorsed it. Methods The CREDO-Kyoto registry Cohort-1 and Cohort-2 are large-scale registries enrolling consecutive patients undergoing first coronary revascularization in the BMS era (2000–2002) for Cohort-1, or in the DES era (2005–2007) for Cohort-2 in Japan. Using the pooled individual patient-level data, the current study population consisted of 7774 patients who received PCI (PCI group) and 4392 patients who received CABG (CABG group). Results The cumulative 30-day incidence of stroke was significantly lower in the PCI group than in the CABG group (0.5% versus 1.7%, P<0.0001). Even after adjusting for baseline characteristics, the excess 30-day risk of the PCI group relative to the CABG group for stroke remained significant (hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.23–0.52, P<0.0001). Similarly, the cumulative 10-year incidence of stroke was significantly lower in the PCI group than in the CABG group (13.2% versus 14.8%, P=0.046). However, after adjusting for confoundings, the excess 10-year risk of the PCI group relative to the CABG group for stroke was not higher than that of CABG (hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.68–1.04, P=0.11). Conclusions CABG was associated with higher risk of periprocedural stroke than PCI in patients with complex coronary artery disease. However, the risk of stroke during 10-year follow-up was similar between the groups.

Prospective Analysis after Coronary-artery Bypass Grafting: Platelet GP IIIa Polymorphism (HPA-1b /PlA2) Is a Risk Factor for Bypass Occlusion, Myocardial Infarction, and Death

2000 ◽  
Vol 83 (03) ◽  
pp. 404-407 ◽  
Author(s):  
Michael Klein ◽  
Hans Dauben ◽  
Christiane Moser ◽  
Emmeran Gams ◽  
Rüdiger Scharf ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Odds Ratio ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Hereditary Risk ◽  
Artery Disease

SummaryRecently, we have demonstrated that human platelet antigen 1b (HPA-1b or PlA2) is a hereditary risk factor for platelet thrombogenicity leading to premature myocardial infarction in preexisting coronary artery disease. However, HPA-1b does not represent a risk factor for coronary artery disease itself. The aim of our present study was to evaluate the role of HPA-1b on the outcome in patients after coronaryartery bypass surgery. We prospectively determined the HPA-1 genotype in 261 consecutive patients prior to saphenous-vein coronaryartery bypass grafting. The patients were followed for one year. Among patients with bypass occlusion, myocardial infarction, or death more than 30 days after surgery, the prevalence of HPA-1b was significantly higher than among patients without postoperative complications (60 percent, 6/10, vs. 24 percent, 58/241, p <0.05, odds ratio 4.7). Using a stepwise logistic regression analysis with the variables HPA1b, age, sex, body mass index, smoking (pack-years), hypertension, diabetes, cholesterol and triglyceride concentration, only HPA-1b had a significant association with bypass occlusion, myocardial infarction, or death after bypass surgery (p = 0.019, odds ratio 4.7). This study shows that HPA-1b is a hereditary risk factor for bypass occlusion, myocardial infarction, or death in patients after coronary-artery bypass surgery.

Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry

2018 ◽  
Vol 118 (12) ◽  
pp. 2162-2170 ◽  
Author(s):  
Kamilla Steensig ◽  
Kevin Olesen ◽  
Troels Thim ◽  
Jens Nielsen ◽  
Svend Jensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Ischaemic Stroke ◽  
Independent Risk Factor ◽  
Oral Anticoagulants ◽  
Increased Risk ◽  
Artery Disease

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

Screening for Coronary Artery Disease After Mediastinal Irradiation for Hodgkin's Disease

2007 ◽  
Vol 26 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Paul A. Heidenreich ◽  
Ingela Schnittger ◽  
H. William Strauss ◽  
Randall H. Vagelos ◽  
Byron K. Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Hodgkin's Disease ◽  
Cardiac Death ◽  
Stress Testing ◽  
Hodgkin’S Disease ◽  
Mediastinal Irradiation ◽  
Artery Disease

Purpose Incidental cardiac irradiation during treatment of thoracic neoplasms has increased risks for subsequent acute myocardial infarction or sudden cardiac death. Identifying patients who have a high risk for a coronary event may decrease morbidity and mortality. The objective of this study was to evaluate whether stress imaging can identify severe, unsuspected coronary stenoses in patients who had prior mediastinal irradiation for Hodgkin's disease. Patients and Methods We enrolled 294 outpatients observed at a tertiary care cancer treatment center after mediastinal irradiation doses ≥ 35 Gy for Hodgkin's disease who had no known ischemic cardiac disease. Patients underwent stress echocardiography and radionuclide perfusion imaging at one stress session. Coronary angiography was performed at the discretion of the physician. Results Among the 294 participants, 63 (21.4%) had abnormal ventricular images at rest, suggesting prior myocardial injury. During stress testing, 42 patients (14%) developed perfusion defects (n = 26), impaired wall motion (n = 8), or both abnormalities (n = 8). Coronary angiography showed stenosis ≥ 50% in 22 patients (55%), less than 50% in nine patients (22.5%), and no stenosis in nine patients (22.5%). Screening led to bypass graft surgery in seven patients. Twenty-three patients developed coronary events during a median of 6.5 years of follow-up, with 10 acute myocardial infarctions (two fatal). Conclusion Stress-induced signs of ischemia and significant coronary artery disease are highly prevalent after mediastinal irradiation in young patients. Stress testing identifies asymptomatic individuals at high risk for acute myocardial infarction or sudden cardiac death.

Abstract 3118: Combined Assessment of Intima-Media Thickness and Echolucency of an Atherosclerotic Plaque in Carotid Artery has an Additive Value on Prediction of Future Coronary Events in Patients with Coronary Artery Disease and Carotid Atherosclerosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mitsumasa Hirano ◽  
Takamitsu Nakamura ◽  
Yoshinobu Kitta ◽  
Isao Takishima ◽  
Aritaka Makino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Artery ◽  
Unstable Angina ◽  
Cardiac Death ◽  
Intima Media Thickness ◽  
Ultrasound Assessment ◽  
Coronary Events ◽  
Artery Disease

Single ultrasound assessment of either intima-media thickness (IMT) or plaque echolucency of carotid artery is considered a surrogate for systemic atherosclerotic burden and provides prognostic information for coronary events. The assessment of IMT and plaque echolucency of carotid artery has the advantage of obtaining structural and compositional information on atherosclerotic plaques in a single session. This study examined the hypothesis that the combined ultrasound assessment of IMT and echolucency in a carotid artery may have an additive effect on the prediction of coronary events in patients with coronary artery disease (CAD). Ultrasound assessment of carotid IMT and plaque echolucency with integrated backscatter (IBS) analysis (intima-media IBS value minus adventitia IBS) was performed in 411 patients with CAD and carotid plaques (IMT ≥ 1.1 mm). The plaque with the greatest axial thickness in carotid arteries was the target for measurement of maximum IMT (plaque-IMTmax) and echolucency (lower IBS reflects echolucent plaque). All patients were prospectively followed up for 70 months or until the occurrence of one of the following coronary events: cardiac death, nonfatal myocardial infarction, or unstable angina pectoris requiring revascularization. During follow-up, 49 coronary events occurred (cardiac death in 2, myocardial infarction in 10, unstable angina in 37). In a multivariate Cox hazards analysis, plaque-IMTmax and plaque echolucency (lower IBS value) were significant predictors of coronary events (HR; 1.82 and 0.85, 95% CI 1.2 – 2.9 and 0.80 – 0.91, respectively, both p < 0.01) independently of age, LDL-C levels, and diabetes. When outcomes were stratified according to plaque-IMTmax and plaque echolucency in combination or alone, the combination of plaque-IMTmax and plaque echolucency was the strongest predictor of events, followed by plaque echolucency and plaque-IMTmax, on the basis of the c -statistic (area under the ROC curve; 0.80, 0.73, and 0.71, respectively). Combined ultrasound assessment of IMT and echolucency of carotid plaque had an additive value on the prediction of coronary events, and these simultaneous ultrasound measurements may be useful for risk stratification in CAD.

UPSTROKE TIME PER CARDIAC CYCLE IS ASSOCIATED WITH CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES

2019 ◽  
Vol 25 (11) ◽  
pp. 1109-1116 ◽  
Author(s):  
Li-Hsin Chang ◽  
Chii-Min Hwu ◽  
Chia-Huei Chu ◽  
Justin G.S. Won ◽  
Harn-Shen Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Cardiac Cycle ◽  
Hazard Ratio ◽  
All Cause Mortality ◽  
Composite Events ◽  
Artery Disease

Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [ P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 ( P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 ( P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle

scholarly journals Association of Lipoprotein-Associated Phospholipase A2 with Coronary Artery Disease in African-Americans and Caucasians

2010 ◽  
Vol 95 (5) ◽  
pp. 2376-2383 ◽  
Author(s):  
Erdembileg Anuurad ◽  
Zeynep Ozturk ◽  
Byambaa Enkhmaa ◽  
Thomas A. Pearson ◽  
Lars Berglund
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
African American ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
African Americans ◽  
Coronary Angiography ◽  
Pla2 Activity ◽  
Artery Disease

Abstract Context: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is bound predominately to low-density lipoprotein and has been implicated as a risk factor for coronary artery disease (CAD). Objective: We investigated the association between Lp-PLA2 and CAD in a biethnic African-American and Caucasian population. Design: Lp-PLA2 mass, activity, and index, an integrated measure of mass and activity, and other cardiovascular risk factors were determined in 224 African-Americans and 336 Caucasians undergoing coronary angiography. Main Outcome Measures: We assessed the distribution of Lp-PLA2 levels and determined the predictive role of Lp-PLA2 as a risk factor for CAD. Results: Levels of Lp-PLA2 mass and activity were higher among Caucasians compared with African-Americans (293 ± 75 vs. 232 ± 76 ng/ml, P &lt; 0.001 for mass and 173 ± 41 vs. 141 ± 39 nmol/min/ml, P &lt; 0.001 for activity, respectively). However, Lp-PLA2 index was similar in the two groups (0.61 ± 0.17 vs. 0.64 ± 0.19, P = NS). In both ethnic groups, Lp-PLA2 activity and index was significantly higher among subjects with CAD. African-American subjects with CAD had significantly higher Lp-PLA2 index than corresponding Caucasian subjects (0.69 ± 0.20 vs. 0.63 ± 0.18, P = 0.028). In multivariate regression analyses, after adjusting for other risk factors, Lp-PLA2 index was independently (odds ratio 6.7, P = 0.047) associated with CAD in African-Americans but not Caucasians. Conclusions: Lp-PLA2 activity and index was associated with presence of CAD among African-Americans and Caucasians undergoing coronary angiography. The findings suggest an independent impact of vascular inflammation among African-Americans as contributory to CAD risk and underscore the importance of Lp-PLA2 as a cardiovascular risk factor.

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