scholarly journals The Incidence of Ischemic Heart Disease and Mortality in People with Subclinical Hypothyroidism: Reanalysis of the Whickham Survey Cohort

2010 ◽  
Vol 95 (4) ◽  
pp. 1734-1740 ◽  
Author(s):  
Salman Razvi ◽  
Jola U. Weaver ◽  
Mark P. Vanderpump ◽  
Simon H. S. Pearce
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Subclinical Hypothyroidism ◽  
Subsequent Treatment ◽  
Hazard Ratio ◽  
Community Dwelling ◽  
Ischemic Heart ◽  
Vascular Events ◽  
Thyroid Autoantibody

Abstract Context: The Whickham Survey evaluated vascular events over 20 yr in community-dwelling subjects stratified by thyroid function and thyroid autoantibody status. No association between ischemic heart disease (IHD) and a composite autoimmune thyroid disease group, comprising individuals with subclinical hypothyroidism (SCH), with positive thyroid antibodies or those using levothyroxine, was found. This result appears to be at odds with the findings of other cohort studies. Objective: The objective of the study was to evaluate incident IHD and mortality in participants in relation to their thyroid status. Outcomes, Design, and Participants: Data were reanalyzed assessing incident IHD events and mortality during 20 yr of follow-up in individuals with endogenous SCH (n = 97; TSH 6.0–15 mIU/liter) vs. the euthyroid group (n = 2279), who were IHD free at baseline. Results: Incident IHD was significantly higher in the SCH group [adjusted hazard ratio 1.76 (95% confidence interval 1.15–2.71); P = 0.01]. IHD mortality was also increased in the SCH group [hazard ratio of 1.79 (1.02–3.56); P = 0.05]. These findings lost their significance when subsequent treatment with levothyroxine was excluded from the regression model. There was no difference in all-cause mortality between the groups. Conclusion: In the Whickham Survey, there is an association between incident IHD events and IHD-related mortality with SCH over the 20 yr of follow-up. Furthermore, subsequent treatment of SCH with levothyroxine appears to attenuate IHD-related morbidity and mortality, and this may explain why some other longitudinal studies of SCH have not shown such an association; properly designed controlled trials of treatment of SCH are required to answer this question definitively.

scholarly journals Increased Remnant Cholesterol Explains Part of Residual Risk of All-Cause Mortality in 5414 Patients with Ischemic Heart Disease

2016 ◽  
Vol 62 (4) ◽  
pp. 593-604 ◽  
Author(s):  
Anne-Marie K Jepsen ◽  
Anne Langsted ◽  
Anette Varbo ◽  
Lia E Bang ◽  
Pia R Kamstrup ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Hazard Ratio ◽  
Residual Risk ◽  
Ischemic Heart ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Remnant Cholesterol

Abstract BACKGROUND Increased concentrations of remnant cholesterol are causally associated with increased risk of ischemic heart disease. We tested the hypothesis that increased remnant cholesterol is a risk factor for all-cause mortality in patients with ischemic heart disease. METHODS We included 5414 Danish patients diagnosed with ischemic heart disease. Patients on statins were not excluded. Calculated remnant cholesterol was nonfasting total cholesterol minus LDL and HDL cholesterol. During 35836 person-years of follow-up, 1319 patients died. RESULTS We examined both calculated and directly measured remnant cholesterol; importantly, however, measured remnant cholesterol made up only 9% of calculated remnant cholesterol at nonfasting triglyceride concentrations <1 mmol/L (89 mg/dL) and only 43% at triglycerides >5 mmol/L (443 mg/dL). Multivariable-adjusted hazard ratios for all-cause mortality compared with patients with calculated remnant cholesterol concentrations in the 0 to 60th percentiles were 1.2 (95% CI, 1.1–1.4) for patients in the 61st to 80th percentiles, 1.3 (1.1–1.5) for the 81st to 90th percentiles, 1.5 (1.1–1.8) for the 91st to 95th percentiles, and 1.6 (1.2–2.0) for patients in the 96th to 100th percentiles (trend, P < 0.001). Corresponding values for measured remnant cholesterol were 1.0 (0.8–1.1), 1.2 (1.0–1.4), 1.1 (0.9–1.5), and 1.3 (1.1–1.7) (trend, P = 0.006), and for measured LDL cholesterol 1.0 (0.9–1.1), 1.0 (0.8–1.2), 1.0 (0.8–1.3), and 1.1 (0.8–1.4) (trend, P = 0.88). Cumulative survival was reduced in patients with calculated remnant cholesterol ≥1 mmol/L (39 mg/dL) vs <1 mmol/L [log-rank, P = 9 × 10−6; hazard ratio 1.3 (1.2–1.5)], but not in patients with measured LDL cholesterol ≥3 mmol/L (116 mg/dL) vs <3 mmol/L [P = 0.76; hazard ratio 1.0 (0.9–1.1)]. CONCLUSIONS Increased concentrations of both calculated and measured remnant cholesterol were associated with increased all-cause mortality in patients with ischemic heart disease, which was not the case for increased concentrations of measured LDL cholesterol. This suggests that increased concentrations of remnant cholesterol explain part of the residual risk of all-cause mortality in patients with ischemic heart disease.

scholarly journals High Cardiovascular Risk in Older Men With Severe Peripheral Artery Calcification on High-Resolution Peripheral QCT Scans

2021 ◽  
Vol 41 (5) ◽  
pp. 1818-1829
Author(s):  
Pawel Szulc ◽  
Catherine Planckaert ◽  
Dominique Foesser ◽  
Janina Patsch ◽  
Roland Chapurlat
Keyword(s):  
Heart Disease ◽  
Cardiovascular Risk ◽  
Ischemic Heart Disease ◽  
Cardiovascular Event ◽  
Major Adverse Cardiovascular Event ◽  
Older Men ◽  
Hazard Ratio ◽  
Ischemic Heart ◽  
High Cardiovascular Risk ◽  
Adverse Cardiovascular Event

Objective: Arterial calcification is associated with high cardiovascular risk. Our aim was to assess the utility of peripheral arterial calcification (PAC) in distal forearm and distal leg for the prediction of acute coronary syndrome (ACS) and major adverse cardiovascular event in older men. Approach and Results: In 815 home-dwelling older men, PAC was assessed on the scans of distal forearm and leg obtained by high-resolution peripheral quantitative computed tomography. PAC score (0–12) was calculated on the basis of the number and severity in small peripheral arteries. The information on ACS and major adverse cardiovascular event was collected prospectively for 8 years. PAC severity increased with age and body mass index ( P <0.001). Median PAC score was higher in men with ischemic heart disease or pharmacologically treated diabetes ( P <0.001). After adjustment for confounders, the risk of ACS was higher in men with severe PAC (6+) versus men with lower PAC (0–5; hazard ratio, 3.86 [95% CI, 1.65–9.02], P <0.005). After adjustment for confounders, the risk of major adverse cardiovascular event was higher in men with severe PAC (6+) versus men with lower PAC (hazard ratio, 2.58 [95% CI, 1.41–4.72], P <0.005). In men who did not have cardiovascular risk factors, severe PAC was associated with higher risk of ACS, for example, in men who did not self-report ischemic heart disease (hazard ratio, 6.62 [95% CI, 2.16–20.23], P <0.001). Conclusions: Severe PAC is associated with higher risk of ACS and major adverse cardiovascular event in older home-dwelling men, also in men without known ischemic heart disease. Incidentally found severe PAC can be a serious warning indicating high cardiovascular risk.

scholarly journals Routine Revascularization Versus Initial Medical Therapy for Stable Ischemic Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (9) ◽  
pp. 841-857 ◽  
Author(s):  
Sripal Bangalore ◽  
David J. Maron ◽  
Gregg W. Stone ◽  
Judith S. Hochman
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Unstable Angina ◽  
Medical Therapy ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Cochrane Central Register ◽  
Stable Ischemic Heart Disease

Background: Revascularization is often performed in patients with stable ischemic heart disease. However, whether revascularization reduces death and other cardiovascular outcomes is uncertain. Methods: We conducted PUBMED/EMBASE/Cochrane Central Register of Controlled Trials searches for randomized trials comparing routine revascularization versus an initial conservative strategy in patients with stable ischemic heart disease. The primary outcome was death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), heart failure, stroke, unstable angina, and freedom from angina. Trials were stratified by percent stent use and by percent statin use to evaluate outcomes in contemporary trials. Results: Fourteen randomized clinical trials that enrolled 14 877 patients followed up for a weighted mean of 4.5 years with 64 678 patient-years of follow-up fulfilled our inclusion criteria. Most trials enrolled patients with preserved left ventricular systolic function and low symptom burden, and excluded patients with left main disease. Revascularization compared with medical therapy alone was not associated with a reduced risk of death (relative risk [RR], 0.99 [95% CI, 0.90–1.09]). Trial sequential analysis showed that the cumulative z-curve crossed the futility boundary, indicating firm evidence for lack of a 10% or greater reduction in death. Revascularization was associated with a reduced nonprocedural MI (RR, 0.76 [95% CI, 0.67–0.85]) but also with increased procedural MI (RR, 2.48 [95% CI, 1.86–3.31]) with no difference in overall MI (RR, 0.93 [95% CI, 0.83–1.03]). A significant reduction in unstable angina (RR, 0.64 [95% CI, 0.45–0.92]) and increase in freedom from angina (RR, 1.10 [95% CI, 1.05–1.15]) was also observed with revascularization. There were no treatment-related differences in the risk of heart failure or stroke. Conclusions: In patients with stable ischemic heart disease, routine revascularization was not associated with improved survival but was associated with a lower risk of nonprocedural MI and unstable angina with greater freedom from angina at the expense of higher rates of procedural MI. Longer-term follow-up of trials is needed to assess whether reduction in these nonfatal spontaneous events improves long-term survival.

Diabetes Incidence: A Two-year Follow-up of 10,000 Men in a Survey of Ischemic Heart Disease in Israel

Diabetes ◽  
1970 ◽  
Vol 19 (12) ◽  
pp. 938-943 ◽  
Author(s):  
J. B. Herman ◽  
J. H. Medalie ◽  
H. A. Kahn ◽  
H. N. Neufeld ◽  
E. Riss ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Diabetes Incidence

Symptoms of fatigue and depression in ischemic heart disease are driven by personality characteristics rather than disease stage: a comparison of CAD and CHF patients

2008 ◽  
Vol 15 (5) ◽  
pp. 583-588 ◽  
Author(s):  
Otto R.F. Smith ◽  
Susanne S. Pedersen ◽  
Ron T. Van Domburg ◽  
Johan Denollet
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Type D Personality ◽  
Ischemic Heart ◽  
Disease Stage ◽  
Type D ◽  
The Impact

Background Symptoms of fatigue and depression are prevalent across stages of ischemic heart disease (IHD). We examined (i) the effect of both the IHD stage and type-D personality on fatigue and depressive symptoms at 12-month follow-up, and (ii) whether the effect of type-D personality on these symptoms is moderated by IHD stage. Methods Two different samples of patients were included to represent IHD stage: 401 percutaneous coronary intervention patients (early-stage IHD) and 105 ischemic chronic heart failure patients (end-stage IHD) completed the DS14 Type-D Scale at baseline. Logistic regression analysis was used to examine the impact of IHD stage and type-D personality on fatigue and depression at follow-up. Results Disease stage was neither associated with symptoms of fatigue ( P = 0.99) nor depression ( P = 0.29) at 12 months. In contrast, type-D personality was shown to predict both symptoms of fatigue [odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.92–4.58, P < 0.001] and depression (OR = 4.91; 95% CI: 3.16–7.65, P < 0.001) at follow-up; the effect of type-D personality on these symptoms was not moderated by disease stage. In multivariable analysis, type-D remained a significant predictor of symptoms of fatigue (OR = 3.14; 95% CI: 1.98–4.99, P < 0.001) and depression (OR = 5.90; 95% CI: 3.60–9.67, P < 0.001), also after controlling for symptom levels at baseline. Conclusion Type-D personality but not disease stage predicted symptoms of fatigue and depression at 12-month follow-up.

scholarly journals The Pathways to Increase the Efficacy of Drug Therapy in Patients with Ischemic Heart Disease after Coronary Artery Bypass Grafting

Kardiologiia ◽  
2019 ◽  
Vol 59 (6) ◽  
pp. 12-17
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap ◽  
M. V. Zykov ◽  
O. N. Hryachkova ◽  
I. A. Shibanova
Keyword(s):  
Heart Disease ◽  
Drug Therapy ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Ischemic Heart

Purpose: to assess drug therapy and achievement of target parameters of treatment in patients with ischemic heart disease (IHD) during 3–5 years of follow-up aſter coronary bypass surgery.Materials and methods. From the initial sample of the coronary bypass surgery registry (n=680) we selected for this study 111 men (mean age 61 [55; 65] years) hospitalized in 2011 with clinical picture of IHD for coronary artery bypass graſting (CABG).Results. Mean duration of follow-up was 4.2 years. Mortality was 11.7 % (n=13), 11 deaths were cardiovascular, 2 – from unknown causes. End points defined as repeat hospitalizations and IHD progression were registered in 18 of 98 patients (18.4 %). Only in 25 % of patients during 3–5 years of observation aſter CABG there were no clinical signs of angina. Five patients (5.1 %) developed new type 2 diabetes. Drug therapy: 80 patients (81.6 %) received acetylsalicylic acid, 60 (61.2 %) – angiotensin converting enzyme inhibitors, 80 (81.6 %) – β-adrenoblockers. Eighty-one men (82.6 %) received statins, but only 20 of 98 re-examined patients (20.4 %) took high doses. Target levels of low density lipoprotein cholesterolConclusion. Data of clinical practice illustrate insufficient quality of basic and antianginal therapy in patients with IHD aſter CABG. Indicators of control of angina, heart rate, achievement of target levels of parameters of lipid metabolism remain unsatisfactory.

scholarly journals Binge drinking and risk of ischemic heart disease and stroke: a study of pooled Norwegian health surveys

2021 ◽  
Author(s):  
Eirik Degerud ◽  
Gudrun Høiseth ◽  
Jørg Mørland ◽  
Inger Ariansen ◽  
Sidsel Graff-Iversen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Confidence Interval ◽  
Ischemic Heart Disease ◽  
Binge Drinking ◽  
Alcohol Intake ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Ischemic Heart ◽  
Average Alcohol ◽  
Binge Drinkers

Abstract Norwegian health survey data (1987 – 2003) were analysed to determine if binge drinking increases the risk of incident major events from ischemic heart disease (IHD) and stroke. Among current drinkers reporting average alcohol intakes between 2 to 60 g/day (n = 44,476), frequent binge drinking (5+ units ≥ once per month) was not associated with a greater risk of IHD (adjusted hazard ratio = 0.91, 95% confidence interval: 0.76, 1.09) nor stroke (adjusted hazard ratio = 0.98, 95% confidence interval: 0.81, 1.19), in comparison with participants who reported that they never or only infrequently (&lt;once per month) had episodes of binge drinking. Participants with an average alcohol intake between 2 – 60 g/day had a lower risk of IHD in comparison with participants with very low intakes (&lt;2 g/day) both among frequent binge drinkers (adjusted hazard ratio = 0.67, 95% confidence interval: 0.56, 0.80) and among never/infrequent binge drinkers (adjusted hazard ratio = 0.75, 95% confidence interval: 0.67, 0.84). The findings suggest that frequent binge drinking does not, independently of the average alcohol intake, increase the risk of incident IHD or stroke events. However, the findings should be interpreted in light of the limitations of the study design.

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