Estimation of the increased risk associated with recurrent events or polyvascular atherosclerotic cardiovascular disease in the United Kingdom

2020 ◽  
pp. 204748731989921 ◽  
Author(s):  
Mark D Danese ◽  
Peter Pemberton-Ross ◽  
David Catterick ◽  
Guillermo Villa
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
United Kingdom ◽  
Ischemic Stroke ◽  
Event History ◽  
Atherosclerotic Cardiovascular Disease ◽  
Risk Equation ◽  
Increased Risk ◽  
Event Histories

Aims The aims of this study were to re-estimate the international REduction of Atherothrombosis for Continued Health (REACH) risk equation using United Kingdom data and to distinguish different relative hazards for specific atherosclerotic cardiovascular disease event histories. Methods and results Patients in the UK Clinical Research Practice Datalink (CPRD) were included as of 1 January 2005 if they were 40 years or older, had 2 or more years of prior data, received one or more moderate or high-intensity statin in the previous year, and had a history of myocardial infarction, ischemic stroke, or other atherosclerotic cardiovascular disease. Patients were followed until a composite endpoint of myocardial infarction, ischemic stroke or cardiovascular death, loss to follow-up, or end of observation. We re-estimated the REACH risk equation hazard ratios (HRs) using CPRD data (re-estimated REACH model). Our event history model replaced the REACH vascular bed variables with more specific event histories. There were 60,838 patients with 5.25 years of mean follow-up. In the validation model, HRs were in the same direction, and generally greater than REACH. In the event history model, HRs compared to other atherosclerotic cardiovascular disease alone included: recurrent myocardial infarction (HR 1.19, 95% confidence interval (CI) 1.05–1.34), recurrent ischemic stroke (HR 1.36, 95% CI 1.03–1.80), myocardial infarction and other atherosclerotic cardiovascular disease (HR 1.31, 95% CI 1.23–1.38), ischemic stroke and other atherosclerotic cardiovascular disease (HR 1.40, 95% CI 1.23–1.60), myocardial infarction and ischemic stroke (HR 1.94, 95% CI 1.23–3.04), and myocardial infarction, ischemic stroke and other atherosclerotic cardiovascular disease (HR 1.93, 95% CI 1.47–2.54). Conclusion A detailed cardiovascular event history may be useful for estimating the relative risk of future cardiovascular events.

scholarly journals Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes

2019 ◽  
Vol 12 (4) ◽  
pp. 530-537
Author(s):  
Talar W Markossian ◽  
Holly J Kramer ◽  
Nicholas J Burge ◽  
Ivan V Pacold ◽  
David J Leehey ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atherosclerotic Cardiovascular Disease ◽  
Risk Equation ◽  
Diabetes Status ◽  
Increased Risk ◽  
Ascvd Risk ◽  
Risk Equivalent ◽  
Statin Use

Abstract Background Both reduced glomerular filtration rate and increased urine albumin excretion, markers of chronic kidney disease (CKD), are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). However, CKD is not recognized as an ASCVD risk equivalent by most lipid guidelines. Statin medications, especially when combined with ezetimibe, significantly reduce ASCVD risk in patients with nondialysis-dependent CKD. Unless physicians recognize the heightened ASCVD risk in this population, statins may not be prescribed in the absence of clinical cardiovascular disease or diabetes, a recognized ASCVD risk equivalent. We examined statin use in adults with nondialysis-dependent CKD and examined whether the use differed in the presence of clinical ASCVD and diabetes. Methods This study ascertained statin use from pharmacy dispensing records during fiscal years 2012 and 2013 from the US Department of Veterans Affairs Healthcare System. The study included 581 344 veterans aged ≥50 years with nondialysis-dependent CKD Stages 3–5 with no history of kidney transplantation or dialysis. The 10-year predicted ASCVD risk was calculated with the pooled risk equation. Results Of veterans with CKD, 62.1% used statins in 2012 and 55.4% used statins continuously over 2 years (2012–13). Statin use in 2012 was 76.2 and 75.5% among veterans with CKD and ASCVD or diabetes, respectively, but in the absence of ASCVD, diabetes or a diagnosis of hyperlipidemia, statin use was 21.8% (P < 0.001). The 10-year predicted ASCVD risk was ≥7.5% in 95.1% of veterans with CKD, regardless of diabetes status. Conclusions Statin use is low in veterans with nondialysis-dependent CKD in the absence of ASCVD or diabetes despite high-predicted ASCVD risk. Future studies should examine other populations.

scholarly journals Plasma Resistin Levels and Risk of Myocardial Infarction and Ischemic Stroke

2008 ◽  
Vol 93 (7) ◽  
pp. 2647-2653 ◽  
Author(s):  
Cornelia Weikert ◽  
Sabine Westphal ◽  
Klaus Berger ◽  
Jutta Dierkes ◽  
Matthias Möhlig ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Confidence Interval ◽  
High Plasma ◽  
Case Control Studies ◽  
Blood Draw ◽  
Increased Risk ◽  
Aged Subjects

Abstract Context: Resistin is a hormone that has been linked to insulin resistance, inflammatory processes, and coronary heart disease in case-control studies; however, prospective data on the association between plasma resistin levels and future risk of cardiovascular disease are lacking. Objective: The objective of the study was to investigate the association between plasma resistin levels and risk of future myocardial infarction (MI) and ischemic stroke (IS) in a large prospective cohort. Methods: We investigated the association between plasma resistin levels and risk of MI and IS in a case-cohort design among 26,490 middle-aged subjects from the European Investigation into Cancer and Nutrition-Potsdam Study without history of MI or stroke at time of blood draw. Plasma resistin levels were measured in baseline blood samples of 139 individuals who developed MI, 97 who developed IS, and 817 individuals who remained free of cardiovascular events during a mean follow-up of 6 yr. Results: After multivariable adjustment for established cardiovascular risk factors including C-reactive protein, individuals in the highest compared with the lowest quartile of plasma resistin levels had a significantly increased risk of MI (relative risk 2.09; 95% confidence interval 1.01–4.31; P for trend = 0.01). In contrast, plasma resistin levels were not significantly associated with risk of IS (relative risk 0.94; 95% confidence interval 0.51–1.73; P for trend = 0.88). Conclusion: Our data suggest that high plasma resistin levels are associated with an increased risk of MI but not with risk of IS. Further studies are needed to evaluate the predictive value of plasma resistin levels for cardiovascular disease.

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

P2555Efficacy and safety of oral anticoagulant versus antiplatelet therapy for secondary prevention of cardiovascular disease in patients without atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Ricci ◽  
U Ianni ◽  
F Forcucci ◽  
A Fedorowski ◽  
M Zimarino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Sinus Rhythm ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Anticoagulation is the mainstay of prevention of arterial thromboembolism in patients with atrial fibrillation, but it could be effective also in secondary prevention of patients who are in sinus rhythm. Purpose We performed this meta-analysis to determine relative efficacy and safety of oral anticoagulant therapy (OAC) as compared with antiplatelet therapy (APT) in patients with prevalent cerebro-cardiovascular disease without atrial fibrillation. Methods Our systematic review of the literature published through January 31st, 2019 sought all phase III randomized controlled trials which compare OAC with APT in patients with sinus rhythm and report at least one of the following outcomes: ischemic stroke, death, myocardial infarction, and major bleeding, assessed at the longest available follow-up. We used random-effects models to estimate summary relative risk reduction (RRR) and 95% confidence intervals (95% CI). Results We identified a total of 9 randomized controlled trials including a total of 34,912 patients (ASA, n=17,726; adjusted-dose warfarin, n=4,460; rivaroxaban, n=12726), with a mean follow-up of 2.2 years. When compared with antiplatelet therapy, OAC was associated with reduced risk of ischemic stroke (RRR 38%, 95% CI: 1; 47; P=0.04; I2=72%) and myocardial infarction (RRR 13%, 95% CI: 0,23; P=0.05, I2=0%), but increased risk of major bleeding (RRR −52%, 95% CI: −129; −1; P=0.04; I2=76%). Compared to antiplatelet treatment, OAC did not significantly affect the risk of all-cause death (RRR 1%, 95% CI: −9; 10; P=0.86; I2=12%). Conclusions In sinus rhythm patients with prevalent cardiovascular disease, OAC reduces risk of ischemic stroke and myocardial infarction, but significantly increases risk of major bleeding. The choice of antithrombotic treatment does not appear to influence all-cause mortality.

scholarly journals The association of nine amino acids with cardiovascular events in Finnish men in a 12-year follow-up study

2021 ◽  
Author(s):  
Raimo Jauhiainen ◽  
Jagadish Vangipurapu ◽  
Annamaria Laakso ◽  
Teemu Kuulasmaa ◽  
Johanna Kuusisto ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Amino Acids ◽  
Ischemic Stroke ◽  
Amino Acid ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Artery Disease

Abstract Background and aims To investigate the significance of nine amino acids as risk factors for incident cardiovascular disease events in 9,584 Finnish men. Materials and Methods A total of 9,584 men (age 57.4±7.0 years, body mass index 27.2±4.2 kg/m 2) from the METSIM study without cardiovascular disease and type 1 diabetes at baseline were included in this study. A total of 662 coronary artery disease (CAD) events, 394 ischemic stroke events, and 966 cardiovascular disease (CVD, CAD and stroke combined) events were recorded in a 12.3-year follow-up. Amino acids were measured using nuclear magnetic resonance platform. Results In Cox regression analysis phenylalanine and tyrosine were significantly associated with increased risk of CAD and CVD events, and phenylalanine with increased risk of ischemic stroke after the adjustment for confounding factors. Glutamine was significantly associated with decreased risk of stroke and CVD events and nominally with CAD events. Alanine was nominally associated with CAD events. Conclusion We identified alanine as a new amino acid associated with increased risk of CAD and glutamine as a new amino acid associated with decreased risk of ischemic stroke. We also confirmed that phenylalanine and tyrosine were associated with CAD, ischemic stroke, and CVD events.

Abstract TMP76: Ischemic Stroke Location and Vascular Risk in Dizziness Visits and The Follow-up Period: A Population-based Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kevin A Kerber ◽  
James Burke ◽  
Lewis Morgenstern ◽  
Devin Brown ◽  
Thomas McLaughlin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Posterior Fossa ◽  
Population Based ◽  
Preventive Therapy ◽  
Atherosclerotic Cardiovascular Disease ◽  
Vascular Risk ◽  
Corpus Christi ◽  
Time Period ◽  
Increased Risk

Objective: Prior studies found a concerning frequency of missed ischemic stroke among Emergency Department (ED) dizziness visits. We aim to describe details about the location of infarction (identified at ED dizziness visits or in the follow-up time period) and vascular risk. These data could inform opportunities to identify index strokes or reduce the risk of subsequent events. Methods: From October 2016 to April 2018, ED visits for dizziness, vertigo, or imbalance were identified in Nueces County, Texas. Validated index or subsequent 90-day ischemic stroke events were identified by linkage to the Brain Attack Surveillance in Corpus Christi (BASIC) project. Infarct locations were classified using imaging reports. The proportion of the events associated with Atherosclerotic cardiovascular disease (ASCVD) score ≥0.10, a common trigger for preventive therapy, was summarized. Results: There were 55 ischemic strokes identified at the time of the ED dizziness visit and 33 ischemic strokes identified in the subsequent 90-days. The Figure displays infarct location, days since ED visit, and ASCVD score. Posterior fossa infarction comprised 47% (26/55) (17 cerebellar, 9 brainstem) of the strokes identified at the dizziness visit and 39% (13/33) (11 cerebellar, 5 brainstem) of the strokes in the follow-up period. Baseline ACSVD scores were ≥0.10 in 78% (43/55) of patients with stroke identified at the dizziness visit and 79% (26/33) of patients with stroke identified in the subsequent 90-days. Conclusions: Posterior fossa lesions account a minority of the ischemic strokes that present to the ED with dizziness or occur in the subsequent 90-days. A substantial majority of these strokes have ASCVD scores higher than a common threshold for preventative therapies. Vascular risk assessment during ED dizziness visits might help providers to both diagnose acute strokes and to prompt preventative strategies in presumed non-stroke cases at increased risk for short-term stroke.

scholarly journals Elevated blood pressure in the emergency department – a risk factor for incident cardiovascular disease: An EHR-based cohort study

2019 ◽  
Author(s):  
P. Oras ◽  
H. Häbel ◽  
P. H. Skoglund ◽  
P. Svensson
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Emergency Department ◽  
Cohort Study ◽  
Cox Regression ◽  
University Hospital ◽  
Atherosclerotic Cardiovascular Disease ◽  
Number Needed To Screen ◽  
Increased Risk

ABSTRACTObjectivesIn the emergency department (ED), high blood pressure (BP) is commonly observed but mostly used to evaluate patients’ health in the short-term. We aimed to study whether ED-measured BP is associated with incident atherosclerotic cardiovascular disease (ASCVD), myocardial infarction (MI), or stroke in long-term, and to estimate the number needed to screen (NNS) to prevent ASCVD.DesignElectronic Health Records (EHR) and national register-based cohort study. The association between BP and incident ASCVD was studied with Cox-regression.SettingTwo university hospital emergency departments in Sweden.Data sourcesBP data were obtained from EDs EHR, and outcome information was acquired through the Swedish National Patient Register for all participants.ParticipantsAll patients ≥18 years old who visited the EDs between 2010 to 2016, with an obtained BP (n=300,193).Main outcome measuresIncident ASCVD, MI, and stroke during follow-up.ResultsThe subjects were followed for a median of 42 months. 8,999 incident ASCVD events occurred (MI: 4,847, stroke: 6,661). Both diastolic and systolic BP (SBP) was associated with incident ASCVD, MI, and stroke with a progressively increased risk for SBP within hypertension grade 1 (HR 1.15, 95% CI 1.06 to 1.24), 2 (HR 1.35, 95% CI 1.25 to 1.47), and 3 (HR 1.63, 95% CI 1.49 to 1.77). The six-year cumulative incidence of ASCVD was 12% for patients with SBP ≥180 mmHg compared to 2% for normal levels. To prevent one ASCVD event during the median follow-up, NNS was estimated to 151, whereas NNT to 71.ConclusionsBP in the ED is associated with incident ASCVD, MI, and stroke. High BP recordings in EDs should not be disregarded as isolated events, but an opportunity to detect and improve treatment of hypertension. ED-measured BP provides an important and under-used tool with great potential to reduce morbidity and mortality associated with hypertension.

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