scholarly journals Nocturnal Hypoxemia Predicts Incident Cardiovascular Complications in Dialysis Patients

2002 ◽  
Vol 13 (3) ◽  
pp. 729-733
Author(s):  
Carmine Zoccali ◽  
Francesca Mallamaci ◽  
Giovanni Tripepi
Keyword(s):  
Risk Factor ◽  
Cardiovascular Risk ◽  
Sleep Apnea ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
Cox Model ◽  
Dialysis Patients ◽  
Model Average ◽  
Nocturnal Hypoxemia

ABSTRACT. Nocturnal hypoxemia secondary to sleep apnea has long been implicated as a cardiovascular risk factor in renal failure, but to date there is no study that links nocturnal hypoxemia to cardiovascular outcomes in end-stage renal disease. Fifty uremic patients on regular dialysis treatment without primary sleep apnea, pulmonary diseases, or other illnesses that may cause sleep apnea underwent pulse oximetry studies during night and were followed up for 32 mo. Average nocturnal SaO2, minimal SaO2, and the number of episodes of hypoxemia were similar in patients who died during the follow-up and in patients who survived, and none of these parameters predicted all-cause mortality. Average nocturnal SaO2 was significantly lower (P = 0.006) in patients who had cardiovascular events during the follow-up (94.7 ± 2.9%) than in event-free patients (97.1 ± 1.3%). In a Cox model, average nocturnal SaO2 was the second factor in rank explaining these outcomes. In this model a 1% decrease in average nocturnal SaO2 was associated with a 33% increase in the incident risk of fatal and nonfatal cardiovascular events. Furthermore the risk of cardiovascular events was 5.05 times higher in patients with average nocturnal SaO2 <95% (95% CI 1.61 to 15.86) than in those above this threshold (P = 0.005). This study adds weight to the hypothesis that nocturnal hypoxemia in dialysis patients represents an important cardiovascular risk factor.

Abstract 12127: Integrated Flow-Mediated Vasodilation Response Predicts Cardiovascular Events in Elderly Patients at Cardiovascular Risk Factor

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Yukiyo Ogata ◽  
Kazuo Eguchi ◽  
Kazuomi Kario
Keyword(s):  
Risk Factor ◽  
Cardiovascular Risk ◽  
Elderly Patients ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Detection Algorithm ◽  
Younger Patients ◽  
Flow Mediated Vasodilation

Introduction: The integrated flow-mediated vasodilation (FMD) response was shown to be associated with cardiovascular risk factors, but the association between the integrated FMD response and consequent cardiovascular events has been unclear. Hypothesis: We assessed the hypothesis that the integrated FMD response predicts consequent cardiovascular events. Methods: We enrolled 575 patients who had at least one cardiovascular risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the FMD magnitude of the percentage change in peak diameter (ΔFMD), and we measured the integrated FMD response calculated as the area under the dilation curve during a 120-sec dilation period (FMD-AUC 120 ) using a semiautomatic edge-detection algorithm. The primary outcome was defined as any cardiovascular event (a composite of cardiovascular death, and hospitalization for myocardial infarction, stroke, or heart failure). Results: The mean duration of follow-up was 35±22 months (range: 1-74 months). During the follow-up period, 34 cardiovascular events were recorded. Among the elderly patients (age[[Unable to Display Character: &#8201;]]≥[[Unable to Display Character: &#8201;]]65 yrs, n[[Unable to Display Character: &#8201;]]=[[Unable to Display Character: &#8201;]]281), the patients with the lowest tertile of FMD-AUC 120 (FMD-AUC 120 <[[Unable to Display Character: &#8201;]]5.6) suffered a higher incidence of cardiovascular events compared with the patients with the higher two tertiles (FMD-AUC 120 ≥[[Unable to Display Character: &#8201;]]5.6) (log rank 4.16, p=0.041). The association remained significant after adjusting for age, gender and office systolic blood pressure (hazard ratio 1.25, p=0.039). In the younger patients (age[[Unable to Display Character: &#8201;]]<[[Unable to Display Character: &#8201;]]65 yrs, n[[Unable to Display Character: &#8201;]]=[[Unable to Display Character: &#8201;]]294), cardiovascular events were similar among the patients with the lowest tertile and those with the higher two tertiles of FMD-AUC 120 . Cardiovascular events were also similar in the patients with the lowest tertile and the higher two tertiles of ΔFMD in both the elderly and younger patients. Conclusions: The integrated FMD response, but not ΔFMD, predicted cardiovascular events in elderly patients with a cardiovascular risk factor.

scholarly journals Lipoprotein(a): the underutilized risk factor for cardiovascular disease

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
T Z Khan ◽  
S R Bornstein ◽  
M Barbir
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
Adverse Outcomes ◽  
Lipoprotein A ◽  
Diagnosis And Management ◽  
Randomised Controlled

Raised lipoprotein(a) [Lp(a)] is an important independent cardiovascular risk factor and predictor of adverse outcomes. Challenges remain with regards to the screening, diagnosis and management of this condition. Although further prospective randomised controlled data is required, there is growing evidence suggesting that lowering Lp(a) may reduce the risk of cardiovascular events and ameliorate symptoms.

Abstract P368: Risk Factor Interventions are Effective for Preventing Cardiovascular Events in HIV-Infected Patients on Antiretroviral Therapy: A Systematic Review and Meta-analysis

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Chidozie Nduka ◽  
Kandala Ngianga-Bakwin ◽  
Gaurav Suri ◽  
Saverio Stranges
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
Antiretroviral Treatment ◽  
Clinical Effectiveness ◽  
Lipid Lowering ◽  
Hiv Positive

Introduction: The declining rate of HIV-related deaths has become rather slow in recent times, largely because of the rising incidence of cardiovascular events associated with the disease and its long-term treatment with anti-retroviral drugs. While conclusive evidences support the effectiveness of cardiovascular risk factor interventions in the general population, there is a dearth of such evidence of clinical effectiveness in certain high-risk subgroups, particularly HIV-infected patients on antiretroviral treatment. Objective: To evaluate the clinical effectiveness of risk factor interventions in preventing cardiovascular disease in HIV-positive patients on antiretroviral treatment (ART) and summarize the effect size. Design and methods: Systematic review of randomized controlled trials investigating the effects of interventions in modifying ART-associated risk factors for cardiovascular disease. Trials were eligible for inclusion if they were published in the last 12 years [2000 to June 2012] and participants were HIV-positive, on ART and having more than one ART-associated cardiovascular risk factor. Results: In total, 2,071 HIV-positive participants from 10 randomized trials were included in the review. The interventions evaluated comprised lifestyle modification, lipid-lowering treatment and smoking cessation. Overall, the main results showed significant improvements in total cholesterol [P<0.0001], LDL cholesterol [P<0.0001], HDL cholesterol [P<0.002], triglycerides [P<0.001], apolipoprotein B levels [P=0.036], adiposity [<0.001], anthropometry [P<0.001], insulin sensitivity [P<0.05], HbA1c levels [P<0.001], FBG levels [P=0.017], adiponectin levels [P<0.05], dietary intake [P<0.001], smoking abstinence [P<0.0001] and Framingham score [P=0.03]. The results also showed improvements in systolic [from 145.6±14.5 mmHg to 122.8±5.2 mmHg] and diastolic blood pressure [from 84.7±1.7 mmHg to 80.1±3.8 mmHg]; however, there was no improvement in carotid intima-media thickness [P=0.61] or inflammatory biomarkers [P=0.973 to 0.110]. Conclusion: In conclusion, this review presents evidence suggesting that cardiovascular risk factor interventions are effective in HIV-infected persons on ART. However, cardiovascular screening programs targeting people living with HIV and primary studies assessing the effectiveness (clinical and cost) of multiple risk factor interventions in this sub-group are needed.

Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care

2015 ◽  
Vol 23 (11) ◽  
pp. 1195-1201
Author(s):  
Anna W de Boer ◽  
Renée de Mutsert ◽  
Martin den Heijer ◽  
Frits R Rosendaal ◽  
Johan W Jukema ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Factor Screening ◽  
Advantages And Disadvantages ◽  
Risk Factor Screening
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