scholarly journals Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis

2018 ◽  
Vol 15 (10) ◽  
pp. 2082
Author(s):  
Shih-Ting Huang ◽  
Tung-Min Yu ◽  
Tai-Yuan Ke ◽  
Ming-Ju Wu ◽  
Ya-Wen Chuang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiovascular Events ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Study Cohort ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Increased Risk ◽  
The Impact ◽  
Overall Mortality

Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11–1.46), 2.05 (95% CI = 1.50–2.82), 1.48 (95% CI = 1.33–1.66), and 1.79 (95% CI = 1.67–1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.

scholarly journals First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Luciano A. Sposato ◽  
Melody Lam ◽  
Britney Allen ◽  
Salimah Z. Shariff ◽  
Gustavo Saposnik ◽  
...  
Keyword(s):  
Sex Differences ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Complications ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Increased Risk

Background and Purpose— Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke. Methods— We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk. Results— We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3–32.6]; men: aHR, 23.4 [95% CI, 17.2–31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8–6.0]; men: aHR, 4.2 [95% CI, 3.3–5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8–2.3]; men: aHR, 2.0 [95% CI, 1.7–2.3]). Conclusions— In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

scholarly journals Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

Heart ◽  
2019 ◽  
Vol 106 (9) ◽  
pp. 698-705 ◽  
Author(s):  
Sonali Rukshana Gnanenthiran ◽  
Austin C C Ng ◽  
Robert Cumming ◽  
David B Brieger ◽  
David Le Couteur ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
Community Dwelling ◽  
Major Adverse Cardiovascular Events ◽  
Study Cohort ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Statin Use

ObjectiveLow levels of total cholesterol (TC) are associated with adverse outcomes in older populations. Whether this phenomenon is independent of statin use is unknown. We investigated the association between low TC levels and long-term major adverse cardiovascular events (MACE) in a prospective study of men aged ≥70 years without ischaemic heart disease (IHD) and whether this was influenced by statin use.MethodsThe CHAMP (Concord Health and Ageing in Men Project) cohort is a prospective cohort study of community-dwelling men aged ≥70 years. The relationship between TC and long-term MACE was analysed using Cox-regression modelling adjusted for comorbidities and stratified by statin use.ResultsThe study cohort comprised 1289 men (mean (±SD) age, 77.0±5.5 years; mean follow-up, 6.4±2.7 years). Decreasing TC level was associated with increased comorbidity burden, frailty and MACE (linear trend p<0.001). In men not on statin therapy (n=731), each 1 mmol/L decrease in TC was associated with increased MACE (HR 1.27, 95% CI 1.10 to 1.45, p=0.001) and mortality (HR 1.22, 95% CI 1.03 to 1.44, p=0.02) adjusted for comorbidities. In contrast, low TC in men on statins (n=558) was not associated with MACE (HR 0.91, 95% CI 0.74 to 1.11) or mortality (HR 0.86, 95% CI 0.68 to 1.09).ConclusionLow TC is associated with increased risk of MACE in older men without IHD who are not taking statin therapy but not in those on statins.

Abstract 13434: Chronic Total Occlusions in Refractory Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ales Kral ◽  
Jan Belohlavek ◽  
Daniel Rob ◽  
Jana Smalcova
Keyword(s):  
Cardiac Arrest ◽  
Study Cohort ◽  
Chronic Total Occlusions ◽  
Neurologic Recovery ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Increased Risk ◽  
High Prevalence ◽  
Artery Disease ◽  
Long Term Prognosis

Introduction: Coronary artery disease (CAD) is the most frequent cause of cardiac arrest (CA) in adults. Coronary chronic total occlusions (CTOs) are associated with an increased risk CA and predict future malignant arrhythmias in CA survivors. Nevertheless, the prevalence of CTOs in patients with CA and especially refractory CA is poorly characterized. We sought to evaluate the frequency and characteristics of CTOs in refractory CA patients included in the Prague-OHCA study. Methods: From 256 patients with refractory CA randomized in the Prague-OHCA study, coronary angiography (CAG) was performed in 181 subjects. Of the 128 patients with significant CAD (defined as more than 50% diameter stenosis in at least one major coronary vessel), 14 had a different primary cause of CA, leading to a study cohort of 114 patients with CAD as the primary cause of CA. 41 patients had at least one coronary CTO, whereas 73 patients had significant CAD without CTOs. Clinical, angiographic parameters, initial management and outcome was compared between the CTO and non-CTO groups. Results: Patients in the CTO cohort were older (59 ±12 versus 54 ±11 years, p = 0.015) and had shorter CA durations (45 ± 25 versus 55 ± 24 minutes, p = 0.03) as compared to patients in the non-CTO cohort. The CTO cohort presented less frequently with an acute coronary syndrome (ACS) (51 versus 89%, p < 0.0001) and had a higher prevalence of multi-vessel disease (89 versus 51%, p < 0.0001), as compared to the non-CTO cohort. Acute index PCI was performed less frequently in the CTO group (61 versus 86%, p = 0.002). Patients in the CTO group experienced more frequent neurologic recovery (51 versus 32%, p = 0.04), whereas cardiac recovery (63 versus 51%, p = 0.19) and six month mortality (51 versus 59%, p = 0.43) did not differ between the CTO and non-CTO group. Conclusions: CTOs represent a frequent cause of refractory CA. Patients with refractory CA due to CTOs were older with a high prevalence of multi-vessel disease and presented less frequently with an ACS, as compared to patients with significant CAD without CTOs. The observed more frequent neurologic recovery in the CTO cohort is presumably due to shorter CA durations in these patients. Mid- and long-term prognosis did not differ between the CTO and non-CTO cohort.

scholarly journals Severe varicose veins and the risk of mortality: a nationwide population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034245
Author(s):  
Nan-Chun Wu ◽  
Zhih-Cherng Chen ◽  
I-Jung Feng ◽  
Chung-Han Ho ◽  
Chun-Yen Chiang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Varicose Veins ◽  
Systemic Disease ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk

ObjectiveVaricose veins (VVs) are common and although considered benign may cause morbidity. However, the association between VV severity and cardiovascular and mortality risks remains unknown. The aim of this study was to investigate the factors associated with overall mortality in patients with VV.MethodsA total of 4644 patients with newly diagnosed VV between 1999 and 2013 were identified from Taiwan’s National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. Moreover, 9497, 2541 and 5722 age-matched, sex-matched and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Enrolled patients were analysed using conditional Cox proportional hazards regression analysis to estimate risk of mortality and major adverse cardiovascular events (MACEs) in the VV and control groups.ResultsMost patients with VV were free from systemic disease. However, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p<0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p=0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p=0.0001) showed increased risk of mortality. Furthermore, compared with controls, patients with VV showed 2.05 times greater risk of MACE. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischaemic stroke and venous thromboembolism.ConclusionsThis nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Our findings suggest that presence of VV warrants close attention in terms of prognosis and treatment.

scholarly journals 313Long-acting bronchodilators and risk of acute coronary syndrome

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
Katrina Sharples ◽  
David Barson ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Conditional Logistic Regression ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Treatment Intensification ◽  
Cohort Entry ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Long Acting ◽  
The Impact

Abstract Background There is concern that long-acting bronchodilators (long-acting muscarinic antagonists [LAMAs]) and long-acting beta2-agonists [LABAs]) may further increase the already elevated risk of cardiovascular events in patients with chronic obstructive pulmonary disease (COPD). Guidelines recommend stepwise escalation from one to two long-acting bronchodilators in patients with uncontrolled symptoms, but information about the impact of this treatment intensification on acute coronary syndrome (ACS) risk is limited. Methods We undertook a nested case-control study using national administrative data to estimate the risk of ACS in users of dual LAMA and LABA therapy, and users of LABA monotherapy, relative to users of LAMA monotherapy. The underlying study cohort comprised patients aged &gt;45 years who initiated long-acting bronchodilator therapy for COPD between 2006 and 2013 (n = 83,417). Cases were patients diagnosed with fatal or non-fatal ACS after cohort entry (n = 5,399). Up to 10 controls per case, matched by age, sex, date of cohort entry, and COPD severity, were randomly selected from the study cohort using risk set sampling. Odd ratios and 95% confidence intervals were estimated using conditional logistic regression. Results Relative to current use of LAMA monotherapy, the adjusted odds ratios for current use of dual LAMA and LABA therapy, and of LABA monotherapy, were 1.28 (95% CI 1.13–1.44) and 1.0 (95% CI 0.91–1.10), respectively. Conclusions Use of two long-acting bronchodilators rather than LAMA monotherapy, is associated with a higher risk of ACS, while the risks associated with LAMA and LABA monotherapy are comparable. Key messages The clinical benefit of adding a second long-acting bronchodilator to LAMA or LABA monotherapy is modest and, at the same time, is associated with an increased risk of ACS in a patient group already at high risk.

scholarly journals The potential impact of systemic anti-inflammatory therapies in psoriasis on major adverse cardiovascular events: a Korean nationwide cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joo Ran Hong ◽  
Hojin Jeong ◽  
Hyeongsu Kim ◽  
Hyun Suk Yang ◽  
Ji Youn Hong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Population Based ◽  
University Hospital ◽  
Treatment Modalities ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Comorbidities ◽  
Anti Inflammatory ◽  
The Impact ◽  
Systemic Agents

AbstractThis nationwide population-based cohort study aimed to investigate the impact of systemic anti-inflammatory treatment on the major adverse cardiovascular events (MACE) risk in patients with psoriasis from January 2006 to December 2018, using a database provided by the Korean National Health Insurance Service. Patients were grouped based on the following treatment modalities: biologics, phototherapy, methotrexate, cyclosporine, and mixed conventional systemic agents. Patients who had not received any systemic treatment were assigned to the control cohort. The incidence of MACE per 1000 person-year was 3.5, 9.3, 12.1, 28.4, 39.5, and 14.5 in the biologic, phototherapy, methotrexate, cyclosporine, mixed conventional systemic agents, and control cohorts, respectively. During the 36-month follow-up, the cumulative incidence of MACE in the phototherapy and biologic cohorts remained lower than that of other treatment modalities. Cyclosporine (hazard ratio (HR) = 2.11, 95% confidence interval (CI) = 1.64–2.71) and mixed conventional systemic agents (HR = 2.57, 95% CI = 2.05–3.22) treatments were associated with increased MACE risk. Methotrexate treatment was not associated with MACE. Our finding demonstrates that treatment modalities may affect cardiovascular comorbidities in patients with psoriasis. Thus, an appropriate combination of anti-psoriatic therapies should be considered to manage patients with high cardiovascular risk.IRB approval status: Waiver decision was obtained by the institutional review board, Konkuk University Hospital, Seoul, Republic of Korea (KUH1120107).

scholarly journals Hyperarousal Symptoms in Survivors of Cardiac Arrest Are Associated With 13 Month Risk of Major Adverse Cardiovascular Events and All-Cause Mortality

2020 ◽  
Vol 54 (6) ◽  
pp. 413-422
Author(s):  
Alex Presciutti ◽  
Jonathan Shaffer ◽  
Jennifer A Sumner ◽  
Mitchell S V Elkind ◽  
David J Roh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Cox Proportional Hazards ◽  
Survival Models ◽  
Major Adverse Cardiovascular Events ◽  
Ptsd Symptoms ◽  
Standard Deviation Increase ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Key dimensions of cardiac arrest-induced posttraumatic stress disorder (PTSD) symptoms include reexperiencing, avoidance, numbing, and hyperarousal. It remains unknown which dimensions are most predictive of outcome. Purpose To determine which dimensions of cardiac arrest-induced PTSD are predictive of clinical outcome within 13 months posthospital discharge. Methods PTSD symptoms were assessed in survivors of cardiac arrest who were able to complete psychological screening measures at hospital discharge via the PTSD Checklist-Specific scale, which queries for 17 symptoms using five levels of severity. Responses on items for each symptom dimension of the four-factor numbing model (reexperiencing, avoidance, numbing, and hyperarousal) were converted to Z-scores and treated as continuous predictors. The combined primary endpoint was all-cause mortality (ACM) or major adverse cardiovascular events (MACE; hospitalization for myocardial infarction, unstable angina, heart failure, emergency coronary revascularization, or urgent defibrillator/pacemaker placements) within 13 months postdischarge. Four bivariate Cox proportional hazards survival models evaluated associations between individual symptom dimensions and ACM/MACE. A multivariable model then evaluated whether significant bivariate predictors remained independent predictors of the primary outcome after adjusting for age, sex, comorbidities, premorbid psychiatric diagnoses, and initial cardiac rhythm. Results A total of 114 patients (59.6% men, 52.6% white, mean age: 54.6 ± 13 years) were included. In bivariate analyses, only hyperarousal was significantly associated with ACM/MACE. In a fully adjusted model, 1 standard deviation increase in hyperarousal symptoms corresponded to a two-times increased risk of experiencing ACM/MACE. Conclusions Greater level of hyperarousal symptoms was associated with a higher risk of ACM/MACE within 13 months postcardiac arrest. This initial evidence should be further investigated in a larger sample.

Abstract 102: Major Adverse Cardiovascular Events in U.S. Coronary Heart Disease and Acute Coronary Syndrome Patients

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Rinat Ariely ◽  
Jennifer S Korsnes ◽  
Debanjali Mitra ◽  
Keith L Davis ◽  
Christopher Bell
Keyword(s):  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
Cardiovascular Events ◽  
Bypass Graft ◽  
Major Adverse Cardiovascular Events ◽  
Administrative Claims ◽  
Coronary Syndrome

Background: Healthcare resource utilization and costs associated with cardiovascular events among patients with coronary heart disease (CHD) and acute coronary syndrome (ACS) are needed to assess the value of treatments. Methods: A retrospective analysis of a large US administrative claims database (1/1/2006-12/31/2011) was conducted to describe episodes of major adverse cardiovascular events (MACE: hospitalization for stroke, myocardial infarction (MI), or cardiac arrest) in adults with CHD and ACS, respectively. The CHD cohort (n=245,185) had either a diagnosis of MI, a percutaneous coronary intervention (PCI) procedure or coronary artery bypass graft (CABG), or both, a CHD diagnosis and a multiple vessel coronary procedure, at a minimum. The ACS cohort (N= 75,231, not mutually exclusive with CHD) had ≥1 ACS-related hospitalization. The index date was the first observed cohort-specific disease claim and the 30-day period following the service date of the index episode or discharge date (for hospitalizations). Patients were required to have continuous health plan enrollment for 12 months +/- the index episode. HF, MI, and cardiac arrest diagnoses did not specify whether they were fatal or not. Results: Mean age in both cohorts was ~65 years and ~66% were male. The overall MI rate during the 12-month follow-up period was 15.6 and 26.4 per 1,000 person years for CHD and ACS patient, respectively. Among patients with at least one MACE, 286 CHD patients (4.8% of those with an event) and 137 ACS patients (5.5% of those with an event) experienced a second event during the 12-month follow-up period. Mean (SD) total episode-related costs per patient were $19,230 ($34,983) for CHD patients and $23,490 ($36,749) for ACS patients. Inpatient hospitalization represented the highest proportion of costs at 86.9% of CHD and 95.0% of ACS episode-related costs, while CVD-related pharmacotherapy mean costs (SD) were only $226 ($293) and $228 ($294) per patient for CHD and ACS, respectively. Conclusions: CHD and ACS are resource intensive diseases in the first year after index episode, with most costs related to hospitalizations. Outpatient cardiovascular drug costs make up a small proportion of the total costs.

scholarly journals The Potential Impact of Systemic Anti-Inflammatory Therapies on Major Adverse Cardiovascular Events: A Korean Nationwide Cohort Study

2020 ◽  
Author(s):  
Joo Ran Hong ◽  
Hojin Jeong ◽  
Hyeongsu Kim ◽  
Hyun Suk Yang ◽  
Ji Youn Hong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Population Based ◽  
Treatment Modalities ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Comorbidities ◽  
Anti Inflammatory ◽  
And Control ◽  
The Impact ◽  
Systemic Agents

Abstract This nationwide population-based cohort study aimed to investigate the impact of systemic anti-inflammatory treatment on the major adverse cardiovascular events (MACE) risk in patients with psoriasis from January 2006 to December 2018, using a database provided by the Korean National Health Insurance Service. Patients were grouped based on the following treatment modalities: biologics, phototherapy, methotrexate, cyclosporine, and mixed conventional systemic agents. Patients who had not received any systemic treatment were assigned to the control cohort. The incidence of MACE per 1,000 person-year was 3.5, 9.3, 12.1, 28.4, 39.5, and 14.5 in the biologic, phototherapy, methotrexate, cyclosporine, mixed conventional systemic agents, and control cohorts, respectively. During the 36-month follow-up, the cumulative incidence of MACE in the phototherapy and biologic cohorts remained lower than that of other treatment modalities. Cyclosporine (hazard ratio (HR) = 2.11, 95% confidence interval (CI) = 1.64–2.71) and mixed conventional systemic agents (HR = 2.57, 95% CI = 2.05–3.22) treatments were associated with increased MACE risk. Methotrexate treatment was not associated with MACE. Our finding demonstrates that treatment modalities may affect cardiovascular comorbidities in patients with psoriasis. Thus, an appropriate combination of anti-psoriatic therapies should be considered to manage patients with high cardiovascular risk.

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