scholarly journals An Attempt to Accord the Quality of Therapy of Stable Coronary Heart Disease Patients with Current Clinical Guidelines (ALIGN study): Design and the First Results

2020 ◽  
Vol 16 (1) ◽  
pp. 75-81
Author(s):  
S. Yu. Martsevich ◽  
E. D. Zharkova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
S. N. Tolpygina ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Guidelines ◽  
Ldl Cholesterol ◽  
Quality Of Therapy ◽  
Stable Coronary Heart Disease ◽  
Target Values ◽  
History Of ◽  
First Time

Aim. To assess the quality of therapy in stable coronary heart disease (CHD) patients, who first sought consultation in the specialized cardiology department of the research center, and try to adjust the therapy in accordance with current clinical guidelines, paying special attention to achieving the target levels of blood pressure, low-density lipoprotein cholesterol (LDL), and glycosylated hemoglobin (in patients with diabetes mellitus), increasing exercise tolerance and improving the quality of life (QL).Material and methods. The ALIGN study is an integral part of the PROFILE outpatient registry. ALIGN study included all patients with verified coronary heart disease who came for consultation to the specialized institution for the first time or for the first time in more than the last 3 years. Patients have been recruited from December 01, 2017 to December 31, 2019. The study consisted of 4 visits: the first-time visit – inclusion in the study (V0), when drug therapy, QL, and adherence were evaluated, and therapy correction was made in accordance with clinical guidelines. In 3 months (V1) the target values of clinical and laboratory parameters were estimated. The third visit (V2) was planned to take place 1 year after the first visit with reevaluation of QL and patients' adherence to treatment, and effectiveness of the therapy. The fourth visit (V3)/telephone contact was planned in 2 years after the first visit to assess life status, get information about complications and therapy.Results. 389 people were included in the PROFILE registry for the specified period of time, 79 had a verified diagnosis of CHD, and 71 patients were included in the ALIGN study: 55 men (aged of 68.7±8.96 years) and 16 women (aged of 67.5±8.08 years). Arterial hypertension was registered in 90.1% of patients, stable angina class I-III – in 62%, 47.9% of patients had a history of acute myocardial infarction (AMI), 52.1% had percutaneous coronary intervention, 15.5% of patients had coronary artery bypass graft, chronic heart failure was detected in 40.8%, diabetes mellitus – in 21.1%, atrial fibrillation – in 15.5% of patients. Lipid-lowering drugs were taken by 53 (74.6%) patients, but only 21 (29.6%) achieved the target values of LDL cholesterol. Angiotensin-converting enzyme inhibitors were taken by 34 patients (47.9%), and angiotensin receptor blockers by 15 (21%) of patients, 47 (66.2%) patients took beta-blockers, antiplatelet agents were taken by 61 people, and anticoagulants by 10 patients. Patients who had a history of AMI had been prescribed BB in 88%, statins – in 90%, and renin-angiotensin-aldosterone system (RAAS) blockers – in 80% of cases.Conclusions. Initial quality of therapy for patients with stable CHD did not fully match the clinical guidelines: a quarter of patients did not receive lipidlowering therapy, and target levels of LDL cholesterol were achieved only in one third of patients. Among patients who had a history of AMI, every fifth patient did not receive RAAS blockers.

Mood disorders impaired quality of life but not the mortality or morbidity risk in stable coronary heart disease patients

2019 ◽  
Vol 75 (7) ◽  
pp. 667-675 ◽  
Author(s):  
Otto Mayer ◽  
Jan Bruthans ◽  
Jitka Seidlerová ◽  
Petra Karnosová ◽  
Markéta Mateřánková ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Mood Disorders ◽  
Stable Coronary Heart Disease ◽  
Morbidity Risk ◽  
Impaired Quality

Development of information panels for laboratory diagnosis of myocardial infarction risk in patients with stable ischemic heart disease

2019 ◽  
Vol 1 (9) ◽  
pp. 33-37
Author(s):  
Yu. A. Kotova ◽  
A. A. Zuykova ◽  
N. V. Strakhova ◽  
O. N. Krasnorutskaya
Keyword(s):  
Oxidative Stress ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Atherosclerosis ◽  
Chaperone Activity ◽  
Reactive Protein ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
Group 2

The high incidence of stable coronary heart disease, the increasing frequency of myocardial infarction, disability and mortality determine the relevance of the search for new risk markers and laboratory criteria for predicting this severe complication. The aim of the study was to develop an information panel for diagnosing the risk of myocardial infarction in patients with stable coronary heart disease, including significant generally accepted and potentially possible new laboratory parameters characterizing various pathogenetic links of coronary atherosclerosis. The study included 168 patients who were divided into 2 groups: Group 1 - with a history of myocardial infarction, Group 2 - without a history of myocardial infarction. In addition to the standard laboratory and instrumental examination, all patients were identified parameters of endothelial dysfunction, oxidative stress and chaperone activity as potential markers of myocardial infarction in patients with stable coronary heart disease. Assessment of the risk of myocardial infarction in patients with stable coronary heart disease was carried out using a logical and mathematical model, which combined the most informative laboratory indicators of oxidative stress, endothelial dysfunction, and chaperone activity, which are important in the occurrence and progression of coronary atherosclerosis, according to the results of preliminary comparative and correlation analysis. The basis for the development of the information panel was the method of decision trees. The study confirmed the relationship between the severity of coronary atherosclerosis and the occurrence of myocardial infarction. Comparative analysis of the selected groups of patients showed a higher level of oxidative stress, serum homocysteine concentrations and lower values of chaperone activity in Group 1. In patients with a history of myocardial infarction, C-reactive protein was significantly higher than in Group 2, indicating a more pronounced inflammatory response in patients with large atherosclerotic lesions. The study suggests the possibility of using mathematical information panels based on decision trees as a system for assessing the risk of acute myocardial infarction in patients with stable coronary heart disease. As a result of the analysis of the obtained model, laboratory biochemical factors of high risk of myocardial infarction were identified. Such factors were chaperone activity, serum homocysteine level, serum C-reactive protein concentration and superoxide dismutase activity.

Reflections

2009 ◽  
Author(s):  
Jie Jack Li
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Pharmaceutical Industry ◽  
Ldl Cholesterol ◽  
Bone Fractures ◽  
High Standard ◽  
Heart Attacks ◽  
Wide Range ◽  
The World ◽  
History Of

The story of statins is a success story for science (both basic and applied) and scientists (in both academia and industry). It contains one of the classic scientific and marketing battles in the history of the pharmaceutical industry. More important, it has been a great boon for the millions of patients who have benefited from statins in preventing coronary heart disease. The story of the statins is a triumph of the heart. Statins, a class of cholesterol-lowering drugs, have revolutionized the landscape of coronary heart disease treatment. Since Merck’s marketing of Mevacor in 1987, the world has benefited from statins in numerous ways. As a class of drugs, statins have set standards on numerous fronts in helping manage LDL cholesterol, one of the major risk factors for coronary heart disease. Statins set a high standard in efficacy, a high standard in safety, and a high standard in financial success for the patients, payers, and the pharmaceutical industry. Not only do statins greatly reduce cholesterol and lower mortality in people at risk for heart attacks, but some studies also suggest that they might help prevent or treat a wide range of ailments, including Alzheimer’s disease, multiple sclerosis, bone fractures, some types of cancer, macular degeneration, and glaucoma. The world has already benefited from the statins in many ways. Low is good, but lower is even better. Fifty years ago, the connection between cholesterol and coronary heart disease was still in question. Twenty years ago, the merit of lowering LDL cholesterol was not even unanimously agreed upon. Cholesterol drugs before the statins, such as resins, niacin, and fibrates, worked to some extent but were also seriously limited by their side effects. Thanks to the emergence of the statins, with Mevacor as the first on the market in 1987, all these questions on the relationship between cholesterol and coronary heart disease are answered beyond any shadow of doubt. Today, the statins have annual sales of more than $20 billion. Hundreds of millions of patients have benefited from statins by delaying and even preventing coronary heart disease.

scholarly journals The role of markers of endothelial dysfunction, oxidative and cellular stress in the prediction of myocardial infarction in comorbid patients with stable coronary heart disease

2021 ◽  
Vol 12 (1) ◽  
pp. 23-27
Author(s):  
Yuliya A. Kotova ◽  
Anna A. Zuikova ◽  
Natalia V. Strahova ◽  
Olga N. Krasnorutskaya ◽  
Elena Y. Esina
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Endothelial Dysfunction ◽  
Average Strength ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
Modified Proteins ◽  
Hs Crp

Aim. To study the role of markers of endothelial dysfunction, oxidative and cellular stress in the prediction of myocardial infarction (MI) in comorbid patients with stable coronary heart disease (CHD). Material and methods. The study involved 336 patients with a diagnosis of CHD. The presence of CHD was confirmed by diagnostic coronary angiography with the calculation of the Gensini index. All patients were divided into 2 groups: group 1288 patients without a history of MI, group 248 patients with a history of MI. All patients were assessed for the levels of oxidized modified proteins, high-sensitivity C-reactive protein (hs-CRP), homocysteine, heat shock protein (HSP70), and superoxide dismutase activity. Results. All patients were comparable in age. For other clinical and anthropometric characteristics, we saw significant differences (according to the MannWhitney criterion): patients with previous MI had higher BMI, waist circumference, and blood pressure. The correlation analysis revealed positive significant average strength relationships between past MI and the Gensini index, low-density lipoprotein level, total cholesterol level, homocysteine level, hs-CRP level, and the level of oxidized modified proteins; and negative significant average strength relationships between past MI and SOD activity level (r=-0.374, p=6.4 E-07) and HSP70 level (r=-0.563, p=2.6 E-15). The ROC analysis revealed that not all markers were significant in predicting the risk of MI. It is shown that the most expected characteristics were shown by the hs-СRP. However, further analysis of the predictive significance of the markers demonstrated that the addition of HSP70 to hs-CRP increases the predictive significance of hs-CRP in relation to the risk of developing MI. Conclusion. We have demonstrated that a strategy using a cumulative risk assessment consisting of 2 biomarkers (individually involved in inflammation and stress-induced cellular responses) can identify patients with an established diagnosis of CHD who have an increased risk of acute MI.

Development and Validation of A Simplified Short-term Prognostic Evaluation Nomogram for Patients with Stable Coronary Heart Disease (Preprint)

2019 ◽  
Author(s):  
Qian Lin ◽  
Jianqing Ju ◽  
Zhuye Gao ◽  
Xuezhong Zhou ◽  
Hao Xu
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Total Population ◽  
Diastolic Pressure ◽  
Multivariate Logistic Regression Analysis ◽  
Prognostic Evaluation ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
One Year

UNSTRUCTURED Objective To predict the incidence of recurrent cardiovascular events in patients with stable coronary heart disease in one year, a simple and robust nomogram was established and validated. Method The predictive model was developed and validated in two prospective coronary artery disease cohorts. The total population was 3618, with 589 recurrent cardiovascular events. Seven-tenths of the total population were randomly selected for model development, and LASSO regression was used to extract features from the information needed for routine diagnosis and treatment. Multivariate logistic regression analysis was used to establish the prediction model, which was displayed by nomograph. Internal validation was conducted using the remaining three-tenths of the population.The performance of nomograph was evaluated according to its calibration, identification and clinical practicability. Result Prognostic factors consisting of 10 selected features were significantly associated with recurrent cardiovascular events. Predictors of prognostic evaluation model included age, heart rate, diastolic pressure, triglyceride, red blood cell count, grade of Hypertension， history of hyperlipidemia, history of revascularization, use of clopidogrel, use of ACEI or ARB. The model has good discrimination. The C index is 0.722 in the development set and 0.711 in the validation set. Nomograph also has good calibration. Decision curve analysis shows that radiography is useful in clinic. Conclusion This study developed a relatively accurate nomograph to predict the incidence of recurrent cardiovascular events in patients with stable coronary heart disease within one year.

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