scholarly journals A patient with сoronary artery disease and multifocal atherosclerosis. How to optimize the prognosis?

2018 ◽  
pp. 32-38
Author(s):  
O. L. Barbarash ◽  
V. V. Kashtalap
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Clinical Study ◽  
Antithrombotic Therapy ◽  
Prognostic Significance ◽  
Review Article ◽  
Recent Clinical Study ◽  
Artery Disease ◽  
The Impact

The review article summarized the positions of experts on the clinical and prognostic significance of multifocal atherosclerosis in patients with different forms of coronary heart disease and the impact of this phenomenon on overall cardiovascular risk based on the foreign and domestic studies, the guidelines of the European and North American Cardiological and Surgical Associations. It also presents the review of the modern clinical guidelines for antithrombotic therapy in patients with peripheral atherosclerosis. The review presents prospects for the optimization of antithrombotic therapy based on a recent clinical study.

scholarly journals Coronary Heart Disease in Postmenopausal Women with Type II Diabetes Mellitus and the Impact of Estrogen Replacement Therapy: A Narrative Review

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Marouane Boukhris ◽  
Salvatore Davide Tomasello ◽  
Francesco Marzà ◽  
Sonia Bregante ◽  
Francesca Romana Pluchinotta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Type Ii Diabetes ◽  
Estrogen Replacement Therapy ◽  
Type Ii Diabetes Mellitus ◽  
Type Ii ◽  
Estrogen Replacement ◽  
The Impact

Coronary heart disease is the main cause of death in postmenopausal women (PMW); moreover its mortality exceeds those for breast cancer in women at all ages. Type II diabetes mellitus is a major cardiovascular risk factor and there is some evidence that the risk conferred by diabetes is greater in women than in men. It was established that the deficiency of endogenous estrogens promotes the atherosclerosis process. However, the impact of estrogen replacement therapy (ERT) on cardiovascular prevention remains controversial. Some authors strongly recommend it, whereas others revealed a concerning trend toward harm. This review tries to underlines the different components of cardiovascular risk in diabetic PMW and to define the place of ERT.

scholarly journals Do the patients with peripheral atherosclerosis need to a medical therapy before the revascularization?

2019 ◽  
Vol 91 (12) ◽  
pp. 129-134
Author(s):  
O L Barbarash ◽  
V V Kashtalap
Keyword(s):  
Clinical Trial ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Acetylsalicylic Acid ◽  
Medical Therapy ◽  
Antithrombotic Therapy ◽  
Review Article ◽  
Real Situation ◽  
Chronic Coronary Heart Disease

In the review article are provided the approaches to the therapy for improvement of prognosis in patients with peripheral and multifocal atherosclerosis which are available now; some limitations and a real situation are designated for the antithrombotic therapy in this category of patients. According to the clinical trial COMPASS the prospects of wide use of a combination of acetylsalicylic acid and a rivaroxsaban of 2.5 mg 2 times a day in the patients with chronic coronary heart disease and/or symptom peripheral atherosclerosis are designated.

scholarly journals Does coronary calcium scoring adds value to cardiovascular risk prediction in asymptomatic population?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Serrao ◽  
M Temtem ◽  
A Pereira ◽  
J Monteiro ◽  
M Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Cardiovascular Events ◽  
Cardiovascular Risk Prediction ◽  
Traditional Risk Factors ◽  
The Impact

Abstract Background Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction, in asymptomatic population. The inclusion of CAC scoring in traditional risk models may help in decision-make providing better cardiovascular risk stratification. Purpose The aim of our study is to estimate the impact of CAC scoring in cardiovascular events risk prediction in a model based on traditional risk factors (TRFs). Methods and results The study consisted of 1052 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for the CAC scoring assessment. A cohort of 952 was followed for a mean of 5.2±3.2 years for the primary endpoint of all-cause of cardiovascular events. The following traditional risk factors were considered: (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary heart disease. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high CAC (CAC≥400 or P>75). Two Cox regression models were created, the first only with TRFs and the second adding the CAC severity categories. When including CAC categories to the TRFs, the higher severity level presented a significant risk of MACE occurrence with an HR of 4.39 (95% CI 1.83–10.52; p=0.001). Conclusion Our results point to the importance of the inclusion of CAC in both primary and secondary prevention to an improved risk stratification. Larger prospective multicentre cohorts with longer follow-up should reproduce and validate these findings. Funding Acknowledgement Type of funding source: None

scholarly journals Target levels of blood pressure in patients with arterial hypertension and coronary heart disease

2020 ◽  
Vol 26 (1) ◽  
pp. 15-26
Author(s):  
M. S. Cherniaeva ◽  
O. D. Ostroumova
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Premature Death ◽  
Convincing Evidence ◽  
Major Cardiovascular Events ◽  
The Impact

High blood pressure (BP) is a leading risk factor for premature death and one of the important risk factors for coronary heart disease (CHD). A significant increase in risk is observed starting from the level of systolic BP of about 140 mm Hg. Tactics of antihypertensive therapy in patients with co-existent hypertension (HTN) and CHD are reviewed in the European and Russian recommendations for HTN. In spite of this, some uncertainty remains regarding the optimal target BP level in patients with HTN and clinically manifest CHD mainly due to the lack of convincing evidence arising from large and specially designed randomized clinical trials (RCTs) dedicated to this issue. Some observational studies, meta-analysis, special analysis of subgroups of patients with HTN and CHD from the large RCTs, showed a J-shaped relation between the achieved BP and an increased cardiovascular risk. Our paper reviews up-to-date literature in relation to the target BP level in patients with HTN and CHD, including patients with high cardiovascular risk and patients undergoing revascularization. We review data from large studies and meta-analysis, evaluating the impact of more intensive vs. less intensive control of BP on the risk of major cardiovascular events or mortality. The analysis of the literature confirmed a lack of evidence of benefits of lower target BP values in senile patients with co-existent HTN and CHD, thus indicating the need for well-planned RCTs.

PROGNOSTICALITY OF CARDIOVASCULAR FACTORS IN THE DEVELOPMENT OF GLAUCOMA IN THE ELDERLY

2021 ◽  
pp. 111-116
Author(s):  
Валерий Иванович Баранов ◽  
Татьяна Игоревна Субботина ◽  
Александр Викторович Иванов ◽  
Виктор Афанасьевич Иванов ◽  
Мария Сергеевна Митихина ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Open Angle Glaucoma ◽  
Prognostic Significance ◽  
The Elderly ◽  
Ophthalmological Examination ◽  
Primary Glaucoma

Развитие первичной открытоугольной глаукомы определяется множеством факторов риска, в том числе сердечно-сосудистыми, изучение которых выполняется крайне редко. Цель исследования - определение прогностической значимости системных сердечно-сосудистых факторов риска в развитии первичной открытоугольной глаукомы у пожилых людей. В клинических условиях проведено комплексное офтальмологическое обследование 250 пациентов 45-59 лет с первичной глаукомой, 260 пациентов 60-74 лет без первичной глаукомы, 280 пациентов 60-74 лет с первичной глаукомой. По единой методике проведено изучение в трёх вышеуказанных клинических группах сердечно-сосудистых факторов риска с определением прогностической значимости с учётом общепринятых требований. Установлена высокая распространённость среди факторов риска первичной открытоугольной глаукомы артериальной гипертензии, ишемической болезни сердца и атеросклероза сонных артерий. У пациентов основной группы в возрасте 60-74 лет, представленных больными первичной открытоугольной глаукомой, артериальная гипертензия, по данным анамнеза и анализа медицинской документации, встречается наиболее часто - в 78,6±2,5 на 100 обследованных, что значительно выше по сравнению с возрастным контролем, то есть пациентами 60-74 лет без вышеуказанной нозологии офтальмопатологии, где она зарегистрирована у существенно меньшей части - в 55,8±3,1 случаев на 100 обследованных со статистически значимым различием. Артериальная гипертензия реже по сравнению с пациентами с первичной открытоугольной глаукомой диагностируется в среднем возрасте пациентов с первичной открытоугольной глаукомой - в 44,8±3,1 случаев на 100 обследованных. Вторым наиболее часто встречающимся сердечно-сосудистым заболеванием, рассматриваемым нами в качестве сердечно-сосудистого фактора риска, является атеросклероз сонных артерий (внутренней и общей), который выявлен у 71,8±2,7 случаев на 100 обследованных. Это значительно выше, чем распространенность данной кардиоваскулярной патологии в пожилом возрасте, не имеющих первичной открытоугольной глаукомы. Однако распространенность атеросклероза у пациентов 45-59 лет с первичной открытоугольной глаукомой по сравнению с пациентами пожилого возраста без первичной открытоугольной глаукомы практически одинакова и не имеет статистически значимых различий. Значительно часто у больных пожилого возраста распространена ишемическая болезнь сердца, достигающая 60,7±2,9 случаев на 100 обследованных, что практически в 2 раза выше, чем в двух других группах. Однако наибольшей прогностической значимостью в отношении развития первичной глаукомы в пожилом возрасте обладают хроническая сердечная недостаточность, инфаркт миокарда в анамнезе и ишемическая болезнь сердца, что необходимо использовать при индивидуальном прогнозировании The development of primary open-angle glaucoma (POAG) determined by a variety of risk factors, including cardiovascular ones, which are rarely studied. The aim of the study was to determine the prognostic significance of systemic cardiovascular risk factors in the development of POAG in the elderly. In clinical conditions, a comprehensive ophthalmological examination of 250 patients 45-59 years old with primary glaucoma, 260 patients 60-74 years old without primary glaucoma, 280 patients 60-74 years old with primary glaucoma performed. According to a single methodology, the study of cardiovascular risk factors in the three above-mentioned clinical groups carried out, with the determination of prognostic significance taking into account generally accepted requirements. The high prevalence of arterial hypertension, coronary heart disease and carotid artery atherosclerosis among the risk factors for POAG was established. However, chronic heart failure, a history of myocardial infarction, and coronary heart disease have the greatest prognostic significance for the development of primary glaucoma in the elderly, which be used for individual prognosis

scholarly journals Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up

2012 ◽  
Vol 48 (3) ◽  
pp. 435-446 ◽  
Author(s):  
Camila Pedro Plaster ◽  
Danilo Travassos Melo ◽  
Veraci Boldt ◽  
Karla Oliveira dos Santos Cassaro ◽  
Fernanda Campos Rosetti Lessa ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Health System ◽  
Pharmaceutical Care ◽  
Control Group ◽  
Chd Risk ◽  
The Impact

The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometric and biochemical parameters were measured before and after PF. The Framingham scoring method was used to estimate changes in 10-year coronary heart disease risk scores in all patients. Ninety-six of 120 patients had characteristics of MS and were randomized into two groups (G): the control group (CG: 36) and the intervention group (IG: 38). Among the MS patients, 100% were taking a glucose-lowering drug; many were also taking anti-hypertensive drugs (CG: 72%; IG: 73%), and some patients were also taking hypolipemic drugs (CG: 12.0%; IG: 14.7%). Only 20.7% of the IG patients were considered adherent to their prescribed drugs. In the CG, an increase of coronary heart disease (CHD) risk (22±2 to 26±3; p<0.05) was observed, while in the IG, there was a reduction in CHD risk (22±2 to 14±2%; p<0.01). The PC program administered to patients with MS monitored through the primary healthcare services of the Brazilian public health system improved patient health, resulting in clinical improvements and a decrease in cardiovascular risk in IG patients over a period of ten years.

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