scholarly journals CLOPIDROGEL INDUCED LEUKOCYTOCLASTIC VASCULITIS

2017 ◽  
Vol 10 (7) ◽  
pp. 9 ◽  
Author(s):  
Navin Patil ◽  
Balaji O ◽  
Karthik Rao ◽  
Talha A ◽  
Chaitan Chaitan
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Leukocytoclastic Vasculitis ◽  
Age Groups ◽  
Hospital Setting ◽  
Antiplatelet Drug ◽  
Drug Reactions ◽  
Drug Induced ◽  
Hypersensitivity Vasculitis ◽  
Artery Disease

Cutaneous adverse drug reactions are very common in a hospital setting while treating patients. Drug-induced vasculitis is a very common form of vasculitis affecting all age groups, and many drugs have been implicated in causing vasculitis. Clopidogrel is an antiplatelet drug used in the management as well as prevention of coronary artery disease. It is known to cause various side effects ranging from bleeding, gastrointestinal disturbances, to skin rashes. Leukocytoclastic vasculitis is a form of hypersensitivity vasculitis and is very rarely seen with clopidogrel. Hence, we report a case of clopidogrel-induced leukocytoclastic vasculitis in an old male patient after coronary stenting. 

scholarly journals Endometriosis and New-Onset Coronary Artery Disease in Taiwan: A Nationwide Population-Based Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chun-Hui Wei ◽  
Renin Chang ◽  
Yu Hsun Wan ◽  
Yao-Min Hung ◽  
James Cheng-Chung Wei
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Age Groups ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Increased Risk ◽  
Artery Disease ◽  
Stratified Analysis ◽  
New Onset

Endometriosis (EM) with chronic inflammation may accelerate the progression of atherosclerosis. Currently, no large or randomized clinical studies have assessed the incidence of cardiovascular events in patients with endometriosis in Asia to investigate whether incident EM is associated with a higher risk of new-onset coronary artery disease (CAD). In this study of a nationwide cohort in Taiwan, we identified 13,988 patients with newly diagnosed EM from 1 January, 2000, through 31 December, 2012. EM and non-EM groups were matched by propensity score at a ratio of 1:1. Of a total 27,976 participants, 358 developed CAD. The incidence rate in the EM group was higher than that in the non-EM group (1.8 per 1,000 person-years vs. 1.3 per 1,000 person-years) during the follow-up period. The adjusted hazard ratio (aHR) of CAD for the EM group was 1.52 with a 95% confidence interval (1.23–1.87, p < 0.001) after adjusting for demographic characteristics, comorbidities, surgical procedures, frequency of outpatient visits, and medications. Stratified analysis revealed that, among four age groups (20–39, 40–49, 50–54, and above 55 years), the 20–39 years sub-group was associated with a higher risk of CAD (aHR, 1.73; 95% CI, 1.16–2.59, p = 0.008). Several sensitivity analyses were conducted for cross-validation, and it showed consistent positive findings. In conclusion, this cohort study revealed that patients with symptomatic EM in Taiwan were associated with increased risk of subsequent CAD than patients without medical records of EM. Further prospective studies are needed to confirm this causal relationship.

scholarly journals Characteristic of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilation in young patients with acute coronary syndrome and ST elevation

2019 ◽  
Vol 26 (3) ◽  
pp. 35-44
Author(s):  
O. M. Parkhomenko ◽  
Ya. M. Lutay ◽  
O. I. Irkin ◽  
D. O. Bilyi ◽  
A. O. Stepura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular System ◽  
Age Groups ◽  
Young Patients ◽  
Coronary Syndrome ◽  
Elder Patients ◽  
St Elevation ◽  
Artery Disease

The aim – to reveal features of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilatation in ST-elevation acute coronary syndrome (STEMI) patients of different age groups. Materials and methods. We analyzed the data of instrumental examination of patients who were admitted to the emergency departments from 2000 to 2015, with STEMI. Patients were distributed into two groups depending on age: 1 group – patients < 45 years, 2 group ≥ 45 years. Coronary angiography (CAG) was performed within the first hours after the admission. Endothelium-dependent, flow-mediated vasodilation (FMD) test and echocardiography were performed within 24 hours of admission and again on the 7th day. Results and discussion. According to сoronary angiography, elder patients were more likely to have infarction-dependent coronary artery disease (33.3 vs. 20.3 %; p=0.037), and multi-vessel coronary artery disease (12.0 vs. 4.8 %; p=0.048). Patients in the 1st group demonstrated a lower frequency of hemodynamically significant lesions of coronary vessels (p<0.001) and less marked disorders of the lipid spectrum. Patients of the group 1 had less thickness of the interventricular septum. 10.7±1.5 mm versus 11.6±1.6 mm, p=0.024). Young patients had initially better diastolic function (Е/А) (1.29±0.40 versus 1.00±0.52, p=0.008). At day 7 in patients of the 1st group there was a more marked increase in the left ventricular ejection fraction and end-diastolic diastolic index of the left ventricle (7.6 versus 3.4 %; p<0.05) than in the patients of the 2nd group. Young patients demonstrated a tendency to increase of end-diastolic index > 10 %, in dynamics, at 39.7 versus 27.8 % elder patients (p=0.053), lower growth of the diameter of the brachial artery (4.7±4.1 vs. 6.7±5.1 %; p<0.05), but more rapid improvement of endothelial function in the dynamics of observation (104 vs. 23 %; p<0.05). Conclusions. The percentage of damage of coronary artery disease in STEMI young patients did not differ from elder patients but insignificant coronary artery stenosis is detected more often (р<0.001) and acute myocardial infarction in the right coronary artery is less common (р<0.037). Young patients with multi-vessel coronary disease have significant violations of the lipid blood spectrum (increased levels of total cholesterol, low density lipoprotein cholesterol). Indicators of intracardiac hemodynamic did not differ between age groups initially, however, the course of acute myocardial infarction in young patient was characterized by the tendency to develop early post-infarction dilatation (p=0.053). According to the FMD test young patients at the onset had a worse indicator of than elder patients (p<0.043), however the diameter of the brachial artery in the dynamics of observation, significantly increased (p<0.05).

Abstract P457: Age Dependence of Genetic Risk Scores in Relation to Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chang Liu ◽  
Yunfeng Huang ◽  
Qin Hui ◽  
Arshed A QUYYUMI ◽  
Yan Sun
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Genetic Risk ◽  
Regression Models ◽  
Age Of Onset ◽  
Age Groups ◽  
Density Lipoprotein ◽  
Onset Age ◽  
Artery Disease ◽  
Cad Risk

Background: Coronary artery disease (CAD) is an age-related multi-factorial disease with a high public health burden. Genetic loci for CAD have been discovered and collectively predict CAD risk independent of traditional risk factors. It remains unclear whether age modifies the genetic predisposition to CAD. Methods: A total of 173,315 Caucasian subjects from the UK Biobank were included in this study, including 26,472 CAD patients with age of onset ranging from 32 to 78 years old, and 146,843 control subjects > 60 years old without CAD. CAD diagnosis was extracted from in-patient Hospital Episode Statistics (HES) and National Death Registry based on ICD-10 and OPCS-4 codes. CAD genetic risk score (GRS) was calculated based on the 161 known CAD loci. Sub-GRSs for body mass index (BMI, 16 loci), blood pressure (BP, 26 loci) and lipids (17 loci) were constructed to examine the genetic risk for CAD from certain intermediate trait. The CAD GRSs among onset age groups were compared to the controls using linear regression models, controlling for sex, BMI, creatinine, c-reactive protein, high density lipoprotein, low density lipoprotein, triglyceride, diabetes, heart failure history, hypertension and smoking status. The sub-GRSs were compared using the same models, excluding sub-GRS specific intermediate traits. Interactions of age groups and GRSs were tested using logistic regression models for CAD status, controlling for the same variables described above. Association analyses of each GRS were performed within each category of CAD age at onset comparing to controls. Results: Compared to the controls, the mean CAD GRS in CAD patients with age of onset ≤ 50 years was 0.58 standard deviations (SD) higher (95% CI 0.53-0.63), followed by CAD age of onset between 50 and 60 years (0.50 SD higher, 95% CI 0.48-0.52), between 60 and 70 years (0.35 SD higher, 95% CI 0.33-0.37), and > 70 years (0.25 SD higher, 95% CI 0.21-0.29). The sub-GRSs showed the similar trend. Age of onset stratified analysis revealed a significant CAD GRS-age interaction (p<0.001) on CAD risk where genetic effect is stronger among those early onset CAD patients - the odds ratios (OR) per CAD GRS SD among subjects with CAD onset age ≤ 50, 50 to 60, 60 to 70, > 70 years were 1.80 (95% CI 1.71-1.89), 1.66 (95% CI 1.62-1.70), 1.44 (1.41-1.47), 1.29 (95%CI 1.24-1.35), respectively. Among the three sub-GRSs, significant GRS-age interactions were observed for BP sub-GRS and lipids sub-GRS but not BMI sub-GRS. Conclusion: The observed gene-age interaction indicates that the genetic susceptibility for CAD decreases for older subjects. The contribution of the CAD GRS to CAD risk is almost 64% lower in those developing CAD at age > 70 years compared to those ≤ 50 years. Future considerations and applications of CAD genetic risk in precision medicine needs to include age of onset to accurately evaluate the genetic contribution.

P821Treatment patterns of lipid lowering therapy in patients with coronary artery disease above vs. below 75 years of age

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A A Mahabadi ◽  
D Wiefhoff ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Ldl Cholesterol ◽  
Age Groups ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cholesterol Levels ◽  
Lowering Therapy ◽  
Artery Disease

Abstract Introduction In patients with coronary artery disease (CAD), lipid lowering therapy is recommended as cornerstone of secondary prevention. Treatment of elderly patients inherits a medical challenge, as they experience higher absolute risk reduction with more intensive lipid lowering regimes but may be more prone to side effects by therapy. Purpose To evaluate the treatment patterns in lipid lowering therapy comparing CAD-patients above vs. below 75 years of age. Methods We retrospectively included patients with known CAD, admitted to the West German Heart and Vascular Center in the years of 2009–2010 (n=500), 2012–2013 (n=500), and 2015–2016 (n=500). LDL-cholesterol levels and intensity of stain therapy (based on dosage and type of statin) were assessed from all available hospital records. Lipid levels and treatment regimens were evaluated comparing patients ≥75 vs. <75 years of age. The analysis was approved by the local ethics committee (17–7458-BO). Results A total of 1,500 patients (mean age: 68.4±11.2 years, 75.8% male) from 813 referring treating primary care physicians in 98 cities of Germany were included in our analysis. 983 patients were <75, whereas 517 were ≥75 years of age. Elderly patients were less likely male (67.9% vs. 79.9%, p<0.0001), had lower BMI (26.8kg/m2 vs. 28.4kg/m2, p<0.0001), and less likely current smokers (7.6% vs. 19.2%, p<0.0001, for patients ≥75 vs. <75 years of age, respectively). LDL-cholesterol levels were not significantly different between age groups (≥75: 96.1±35.1 mg/dl; <75: 98.9±35.7mg/dl, p=0.14). In contrast, elderly patients had higher HDL-cholesterol levels (49.9±15.1 mg/dl vs. 46.7±15.2, p=0.0002) and markedly lower triglycerides (135.6±90.0mg/dl vs. 171.4±124.6mg/dl, p<0.0001). Simvastatin was most frequently prescribed in both age groups (54.9% vs. 50.7%, p=0.16), followed by Atorvastatin (31.6% vs. 33.3%, p=0.53). Elderly patients received significantly lower dosages of statin (28.8±12.8mg vs. 31.4±13.7mg, p=0.0007). Interestingly, patients ≥75 years of age archived LDL<70mg/dl slightly more frequently than younger patients (24.0% vs. 20.1%, p=0.09). Excluding patients with myocardial infarction at presentation, CK-levels were not relevantly different between age groups (131.9±450.0U/l vs. 127.5±111.4U/l, p=0.78). Excluding patients with signs of systemic inflammation, high-sensitive CRP levels did not differ when comparing patients ≥75 vs. <75 years of age (0.15±0.12mg/dl vs. 0.14±0.12mg/dl, p=0.33). Conclusion Evaluating lipid lowering treatment patters of 1500 patients from 813 treating physicians, we observed that patients ≥75 years of age receive lower doses of statin therapy, but reached slightly lower LDL-cholesterol-levels. However, the majority of elderly patients miss current recommendations regarding LDL-thresholds. Interestingly, no signs of a higher frequency of statin-induced myopathy in the elderly were observed in our analysis.

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