OBSTRUCTIVE SLEEP APNEA / HYPOPNEA SYNDROME IN RAILWAY WORKERS WITH RISK FACTORS FOR CORONARY HEART DISEASE

Author(s):  
S. Gorokhova ◽  
◽  
N. Belozerova ◽  
M. Buniatyan ◽  

Abstract: Obstructive sleep apnea/hypopnea syndrome (OSA) is a common condition that may lead to excessive daytime sleepiness, cognitive disturbance, and a decreased concentration that are associated with the risk of workplace accidents and injuries. It is difficult to diagnose OSA due to low severity and specificity of its symptoms and special requirements in respect of medical resources. We assumed that it would be more effective and cost-efficient to diagnose OSA in railway workers with such risk factors f coronary heart disease as arterial hypertension and metabolic disorders since this group receives comprehensive medical attention. However, no studies on the prevalence of OSA in railway workers specifically considered the risk factors for coronary artery disease. The aim of the study was to assess the prevalence of OSA in railway workers with confirmed cardiovascular and metabolic disorders that did not disqualify them from their job. Material and methods. The study included 967 railway workers (locomotive drivers and their assistants). On Stage 1, a group of participants suspected OSA was selected; and on Stage 2, a group of participants with confirmed OSA was formed. Polysomnography or cardiorespiratory monitoring were used to diagnose OSA. Results. We developed a two-step algorithm of OSA diagnosis that included a preliminary assessment of the probability of OSA. 236 (24.4%) participants with a probability of OSA were selected among the initial 967 persons with risk factors for coronary artery disease. Further assessment confirmed OSA in 141 (60%) participants in this group. The analysis of distribution of risk factors for coronary artery disease and OSA showed that 125 (53.0%) of patients with BMI ≥ 30 kg/m², 115 (48.7%) of patients with AH, and 26 (11.0%) of patients with type 2 diabetes had OSA; most of them had some combination of these risk factors. Conclusions: OSA is prevalent in the group of professionally active locomotive drivers and their assistants with risk factors for coronary heart disease; every second worker in a target group with BMI ≥ 30 kg/m², AH or with both risk factors was diagnosed with OSA. The proposed two-step algorithm with a pre-test assessment of OSA probability and subsequent instrumental examination (cardiorespiratory monitoring, polysomnography) allows to accurately diagnosis OSA and allocate medical resources in a cost-effective manner.

Background: Omentin-1 is a novel adipocytokine expressed from visceral adipose tissues and is closely associated with obesity, inflammation and coronary artery disease. Central or abdominal obesity has a dynamic role in the development of coronary heart disease by enviably effecting conventional risk factors. Waist circumference is a sensitive, reliable and specific anthropometrical indicator of central obesity. Thus, the present study aimed to evaluate the correlation between central obesity measured by waist circumference and plasma omentin-1 in patients with coronary heart disease. Methods: The study was performed in cardiac unit of Civil Hospital Karachi and Karachi Institute of Heart Diseases (KIHD), Pakistan from January 2016-August 2016. A total of 250 patients (92 females, 158 males) with coronary artery disease were evaluated. Waist circumference was measured at the level of umbilicus. Determination of Omentin-1 was done by an enzyme-linked immunosorbent assay (ELISA). Data was evaluated by SPSS and one way ANOVA was performed to determine the baseline characteristics of study population. Pearson’s correlation was used for association between waist circumference and plasma omentin-1. Results: There was a negative association between waist circumference and plasma omentin-1 (R = -0.68, p < 0.01) in males and (R= – 0.50, p < 0.01) in female patients of coronary heart disease. Waist circumference was found an independent determinant of circulating omentin-1 while performing multivariate logistic regression analysis, after adjusting cardio-metabolic risk factors like age, body mass index, lipid profile, blood sugar levels and smoking. Conclusion: There was a negative correlation of plasma omentin-1 and central obesity in coronary heart disease. Keywords: Central Obesity; Coronary Heart Disease; Omentin-1; Waist Circumference.


Author(s):  
Abdul Ali

DOI: http://dx.doi.org/10.5915/30-1-16289Coronary heart disease is reaching epidemic proportions in women. Therefore, it is important that risk factors in women be recognized and that a correct diagnosis of coronary heart disease be made early. Treatment options should be discussed with each patient and guidelines for prevention of further disease should be established.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Xuan Wang ◽  
Dehao Yu ◽  
Junrui Wang ◽  
Junjie Huang ◽  
Wenqing Li

A combination of various risk factors results in the development of coronary heart disease. The earlier that one identifies and deals with reversible risk factors for coronary heart disease, the greater the chance of recovery. The main goal of this research is to learn whether risk variables are associated with greater extent of coronary artery disease in people with coronary heart disease. This article selects 290 patients who had had coronary angiography in our hospital from September 2018 to March 2019 using a retrospective research and analytic methodology. Coronary angiography split the patients into two groups: those with coronary heart disease and those without. To determine the correlation between risk factors and a score related to heart disease, computer-aided statistical analysis of data about the differences in those risk factors was performed. The results were analyzed using the Spearman correlation and partial correlation, and the relationship between risk factors and Gensini score was analyzed by multiple linear regression. For the analysis, binary logistic regression was used to calculate the correlation between the risk factors of coronary heart disease and the probability of developing coronary heart disease. The findings concluded that increased age, smoking, elevated hs-CRP, HbA1c, hypertension, diabetes, and hyperuricemia are all contributors to coronary heart disease. Coronary heart disease is an independent risk factor for this condition. Many of the factors that play a role in the long-term development of the severity of coronary artery disease, such as hypertension, diabetes, smoking, elevated hs-CRP, decreased HDL-C, raised LDL-C, and TG, are commonly found in men. hs-CRP is the primary risk factor for the degree of coronary artery stenosis and could contribute to the progression of the condition by playing a major role in creating more stenosis.


2017 ◽  
Vol 39 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Adam L. Ware ◽  
Paul C. Young ◽  
Cindy Weng ◽  
Angela P. Presson ◽  
L. LuAnn Minich ◽  
...  

1999 ◽  
Vol 80 (4) ◽  
pp. 296-297
Author(s):  
O. I. Pikuza ◽  
V. N. Oslopov ◽  
H. M. Vakhitov ◽  
A. A. Babushkina ◽  
S. E. Nikolsky

Cardiovascular diseases caused by atherosclerosis (coronary artery disease, cerebrovascular pathology, etc.) are responsible for 40-50% of all deaths in adults. Of particular concern to clinicians is the emerging unfavorable tendency to "rejuvenate" these diseases. Currently, the fact that atherosclerosis (AS) begins to form in childhood and adolescence is indisputable.


2021 ◽  
pp. 30-33
Author(s):  
L. A. Popova ◽  
N. L. Karpina ◽  
M. I. Chushkin ◽  
S. Y. Mandrykin ◽  
V. M. Janus ◽  
...  

The exercise ECG test is traditionally the first choice in patients with suspected CHD, as the most accessible, despite the fact that its sensitivity and specificity are 68 % and 77 %, respectively. Description of a clinical case of multivessel coronary artery disease in a patient with a negative result of exercise ECG test is presented.


Author(s):  
A.L. KOMAROV ◽  
A.YU. FEDOTKINA ◽  
E.V. MERKULOV ◽  
I.V. FEDOTENKOV ◽  
V.M. MIRONOV ◽  
...  

Представлен клинический разбор больного с ишемической болезнью сердца, многососудистым поражением коронарного русла и гигантской аневризмой коронарной артерии. Рассмотрены возможные подходы к выбору медикаментозного и инвазивного лечения.There was presented a clinical discussion of the patient with coronary heart disease, multivessel coronary artery disease and huge aneurysm of coronary artery. Potential approaches to selecting conservative and invasive treatment were discussed.


2009 ◽  
Vol 103 (10) ◽  
pp. 1445-1450 ◽  
Author(s):  
Georgios Giannakoulas ◽  
Konstantinos Dimopoulos ◽  
Reto Engel ◽  
Omer Goktekin ◽  
Zekeriya Kucukdurmaz ◽  
...  

2017 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.


2019 ◽  
Vol 90 (7) ◽  
pp. 792-795
Author(s):  
Shadi Yaghi ◽  
Andrew D Chang ◽  
Brittany A Ricci ◽  
Brian MacGrory ◽  
Shawna Cutting ◽  
...  

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.


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