Correlation of Pre-Hypertension with Carotid Artery Damage in Middle-Aged and Older Adults

The intima–media thickness (IMT), luminal diameters (LDs), flow velocities (FVs), compliance, and β-stiffness of the carotid artery (CA) are considered as independent risk factors for cardiovascular diseases (CVDs). Pre-hypertension (PHT) is also an independent CVD risk factor. This study investigated the association between CA damage (CAD) and PHT. A total of 544 adults participated; their blood pressures (BPs) and CA characteristics were measured using a mercury-free sphygmomanometer and ultrasound. Analysis of covariance (ANCOVA) was performed to assess the differences in the CA characteristics according to the BPs, multinomial logistic regression to evaluate the risk of CAD associated with PHT. In ANCOVA, the CA characteristics of PHT were significantly different from normotensive. The odds ratios (ORs) of IMTmax, LDmax, LDmin, peak-systolic FV (PFV), end-diastolic FV (EFV), PFV/LDmin, EFV/LDmax, compliance, and β-stiffness of PHT were 4.20, 2.70, 3.52, 2.41, 3.06, 3.55, 3.29, 2.02, and 1.84 times higher than those of the normotensive, respectively, in Model 2. In Model 3 adjusted for age, the ORs of LDmax, LDmin, EFV, PFV/LDmin, and EFV/LDmax of PHT were 2.10, 2.55, 1.96, 2.20, and 2.04 times higher than those of the normotensive, respectively. Therefore, the present study revealed that CAD is closely correlated with pre-hypertensive status in adults.

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Ischemic Stroke and its Association with Risk Factors at Nepalgunj Medical College Teaching Hospital Kohalpur

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i2.38897 ◽

2021 ◽

Vol 18 (2) ◽

pp. 48-50

Author(s):

Shyam Kumar BK ◽

Sushil Baral ◽

Nabin Paudel ◽

Hitesh Neupane

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Carotid Artery ◽

College Teaching ◽

Intima Media Thickness ◽

Cerebrovascular Diseases ◽

Media Thickness ◽

Number Of Patients ◽

Carotid Doppler

Introduction: Incidence of stroke increases with age and growing elderly population worldwide, the number of patients with stroke are likely to increase. It is the third most common cause of death in world in that 85% are ischemic in nature. Atherosclerosis is a major risk factor in cerebrovascular diseases. Carotid Intima Media thickness (CIMT) is a surrogate marker of atherosclerosis and provides a non-invasive method for the risk assessment of cerebrovascular diseases. Aims: To study the atherosclerotic risk profile of patients admitted with ischemic stroke in medical ward with study of the carotid artery intima-media thickness in patients with acute ischemic stroke. Methods: 92 patients with ischemic strokes were studied in this observational study. Carotid Doppler was performed in all patients with emphasis on carotid artery stenosis and intima thickening. Analysis of Association of various risk factors was done in detail. Study period was from June 2019 to May 2020. Results: Higher degree of stenosis was associated with hypoechoic plaques and cortical strokes. Hypertension was the most common and most significant risk factor. Multiple risk factors also appear to have synergistic actions. Conclusion: Various modifiable risk factors provide valuable target for primary and secondary prevention of stroke. Carotid Doppler is a very cheap and highly effective tool for further management of stroke patients. Most of the asymptomatic patients, risk factors may warrant precautionary carotid Doppler, and may result in significant reduction in disease burden on the families and the community and should be encouraged.

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Sex modifies the association between body mass index and carotid artery intima media thickness in the multi-ethnic Singapore population

European Heart Journal ◽

10.1093/eurheartj/ehab724.2525 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Dalan ◽

T Mina ◽

N A Nur Azizah ◽

T Tong ◽

M Loh ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Cardiovascular Risk ◽

Carotid Artery ◽

Cardiovascular Risk Factors ◽

Body Mass ◽

Intima Media Thickness ◽

Cvd Risk ◽

Media Thickness ◽

Healthy Participants

Abstract Background and aims Globally cardiovascular disease (CVD) risk is higher in men than in women in the younger age group but the risk is attenuated in later life with an unexpected higher risk in women in some populations. A better understanding of sex differences in CVD is needed. Carotid artery intima-media thickness (CIMT) has been proposed for CVD risk assessment in individuals at intermediate risk. We study the gender interactions in the associations of the traditional cardiovascular risk factors with CIMT. Methods We performed carotid ultrasonography in the large population health study-HELIOS conducted in Singapore. Measurements were performed as per Mannheim consensus, at the far wall of bilateral common carotid artery at 8 sites in each participant. We report the average of all measurements (avgCIMT) and maximum value (maxCIMT). We analysed 2061 healthy participants recruited between 2018–2020. Inclusion criteria for this analysis: non-smokers, not known to have diabetes, hypertension, hyperlipidemia or ischemic heart disease. Individuals with systolic blood pressure >160 mm Hg or fasting glucose >7.0 mmol/L on recruitment were excluded. Multivariable linear regression analysis was performed to examine the association between CIMT and cardiovascular risk factors in the healthy population adjusting for age, sex and ethnicity. All analysis was performed using Stata version 16.0. Results After exclusion, 1407 healthy participants were included in the analysis. Median (IQR) avgCIMT: 0.56 (0.50, 0.65) in men; 0.54 (0.50, 0.58) in women. Median (IQR) maxCIMT: 0.64 (0.57, 0.76) in men; 0.61 (0.54, 0.70) in women. The avgCIMT and the maxCIMT were higher in males when compared to women and all traditional cardiovascular risk factors associated with CIMT after adjustment for age, sex and ethnicity (P<0.05) (Table 1). Interaction tests in multivariable model adjusted for age, ethnicity, pulse pressure, non HDL-C and HbA1c showed a significant interaction between sex and body mass index (BMI) with predicted effects on avgCIMT and maxCIMT being relatively higher in males at the same BMI when compared to females (P-interaction <0.01) (Figure 1). Conclusion Sex modifies the relationship between BMI and CIMT in Singapore's multi-ethnic population. Understanding the intermediary mechanisms involved will help in developing personalized preventive strategies. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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POS0528 SCORES OF CARDIOVASCULAR RISK CALCULATORS AS PREDICTORS OF EARLY ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1787 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 498.1-498

Author(s):

E. Gerasimova ◽

T. Popkova ◽

D. Gerasimova ◽

S. Glukhova ◽

E. Nasonov ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Carotid Artery ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Atherosclerotic Plaques ◽

Cvd Risk ◽

Media Thickness ◽

Traditional Risk Factors ◽

Early Atherosclerosis

Background:Rheumatoid arthritis (RA) is a systemic inflammatory disease leading to significant increase in cardiovascular morbidity and mortality. Development of cardiovascular diseases (CVD) in RA patients is associated with the accumulation of traditional risk factors and immunological disorders. Carotid Artery Doppler Ultrasound (DUS) Exam is the gold standard to identify early atherosclerosis.Objectives:To evaluate the cardiovascular risk and analyze its relationship with detection of early carotid artery atherosclerotic lesion in patients with rheumatoid arthritis (RA).Methods:One hundred and nine RA patients (female/male 93/16), aged 45 to 60 without established CVD were included in the study. The median age was 52 [48; 54] years, duration of RA was 120 [36; 204] months, DAS28 was 4,7 [3,5; 5,6] points. 54% (n=59) of patients received methotrexate (median dose 20 [15;27]mg/week), 12% - leflunomide (20mg/day), 12% - sulfasalazine (2000mg/day), 40% - glucocorticoids (median dose 4 [2;8]mg/day), 44% - non-steroidal anti-inflammatory drugs. None of study participants had biologics or statins in their therapeutic regiments at the time of inclusion. CVD risk was calculated with mSCORE, RRS, ASSIGN, QRISK3, ERS-RA scales and results of Carotid Artery DUS imaging in all patients.Results:Traditional risk factors were highly among RA patients without CVD, including: arterial hypertension - in 73%, dyslipidemia - 68%, overweight - 53%, family history of CVD - 43% and smoking - 39% patients. A combination of three traditional risk factors was found in 60% of patients with RA, and combination of two – in 25%. High risk was found in 5, 5, 14, 6, and 38% of patients according to mSCORE, RRS, ASSIGN, QRISK3, ERS-RA scales, respectively. Carotid atherosclerotic plaques were found in 30% of patients, more often in men (48%) than in women (28%, p=0,049), with similar prevalence regardless RA activity or stage od disease. Positive correlations of carotid intima-media thickness were established with scores of all CVD risk calculators: mSCORE (R = 0,50), RRS (R = 0,40), ASSIGN (R = 0,40), QRISK3 (R = 0,36), ERS-RA (R = 0,26), p <0,05 in all cases, as well as with age (R = 0,41; p = 0,04), the level of total cholesterol (R = 0,23; p = 0,01), systolic blood pressure (R = 0,66; p = 0,02), diastolic blood pressure (R = 0,33; P = 0,03), erythrocyte sedimentation rate (R = 0,26; p = 0,04), IL-6 levels (R = 0,65; p = 0,01). The sensitivity and specificity of the CVR algorithms in prognostication of atherosclerotic carotid artery lesions were 73 and 67% for mSCORE, 64 and 63% for RRS, 64 and 56% for ASSIGN, 73 and 49% for QRISK3, respectively, p<0.05 in all cases, 67 and 50% for ERS-RA, p=0,06.Conclusion:RRS, mSCORE, ASSIGN, QRISK 3 calculators equally predicted the presence of carotid atherosclerotic plaques in RA patients. The optimal ratio of specificity and sensitivity is shown for the mSCORE scale. Stratification of CVR in RA patients should include assessment of the carotid intima-media thickness. mSCORE calculation and carotid intima-media thickness were the most informative methods identify CVR assessment in RA patients.Disclosure of Interests:None declared

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Abstract 409: The Association Between Carotid Artery Plaqus and Cardiovascula Risk Factor in Japanese Individuals

Hypertension ◽

10.1161/hyp.62.suppl_1.a409 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Mikio Arita ◽

Hiroto Tanaka ◽

Maasa Takahashi ◽

Shiori Nagano ◽

Keiko Sasabe ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Carotid Artery ◽

Cardiovascular Risk Factors ◽

Intima Media Thickness ◽

Health Examination ◽

High Tendency ◽

Comprehensive Health ◽

Sodium Ingestion

Introduction: Patients with many cardiovascular risk factors develop the carotid artery plaques(CAP) at the early atherosclerotic change. In this study, we performed the comparison between the individuals with CAP and without CAP and investigated the characteristics of cardiovascular risk factors. Subjects and methods: A total of 310 individuals matched-age(mean age 67.6± 3.7 years) underwent the comprehensive health examination such as Body mass index(BMI), AIP75, blood pressure(BP), Sodium ingestion, Pulse wave velocity(PWV) and serum data. Carotid artery ultrasound was done to all individuals and CAP and the intima-media thickness(IMT) were shown. Results: The prevalence of CAP was 20%(62/310) and that of CAP in men and women was 24.6%(35/142) and 16.1%(27/168), respectively. PWV and IMT of the individuals with CAP (CAP group) was significantly higher, compared with those without CAP (not CAP group). BMI and sodium ingestion of CAP group was significantly lower, compared with those of not CAP group. In addition, systolic BP and G-GTP of CAP group showed the high tendency (p=0.085, p=0.056, respectively) and diastolic BP and HDL-C of CAP group showed the low tendency (p=0.097, p=0.052, respectively), compared with those of not CAP group. PWV of CAP group in man was significantly higher, compared with that of not CAP group in man. However, HDL-C of CAP group in woman showed the low tendency, compared with that of that of not CAP group in woman. Conclusion: It has been suggested that the development of CAP is associated with the cardiovascular risk factor such as PWV, IMT, HDL-C , G-GTP and BP.

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A comprehensive, contemporary assessment of the association between hepatosteatosis and coronary artery calcium scoring

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.234 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Heseltine ◽

SW Murray ◽

RL Jones ◽

M Fisher ◽

B Ruzsics

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Coronary Artery ◽

Regression Model ◽

Coronary Artery Calcium ◽

Logistic Regression Model ◽

Prediction Models ◽

Multinomial Logistic Regression ◽

Cvd Risk ◽

Male Sex

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf Liverpool Multiparametric Imaging Collaboration Background Coronary artery calcium (CAC) score is a well-established technique for stratifying an individual’s cardiovascular disease (CVD) risk. Several well-established registries have incorporated CAC scoring into CVD risk prediction models to enhance accuracy. Hepatosteatosis (HS) has been shown to be an independent predictor of CVD events and can be measured on non-contrast computed tomography (CT). We sought to undertake a contemporary, comprehensive assessment of the influence of HS on CAC score alongside traditional CVD risk factors. In patients with HS it may be beneficial to offer routine CAC screening to evaluate CVD risk to enhance opportunities for earlier primary prevention strategies. Methods We performed a retrospective, observational analysis at a high-volume cardiac CT centre analysing consecutive CT coronary angiography (CTCA) studies. All patients referred for investigation of chest pain over a 28-month period (June 2014 to November 2016) were included. Patients with established CVD were excluded. The cardiac findings were reported by a cardiologist and retrospectively analysed by two independent radiologists for the presence of HS. Those with CAC of zero and those with CAC greater than zero were compared for demographic and cardiac risks. A multivariate analysis comparing the risk factors was performed to adjust for the presence of established risk factors. A binomial logistic regression model was developed to assess the association between the presence of HS and increasing strata of CAC. Results In total there were 1499 patients referred for CTCA without prior evidence of CVD. The assessment of HS was completed in 1195 (79.7%) and CAC score was performed in 1103 (92.3%). There were 466 with CVD and 637 without CVD. The prevalence of HS was significantly higher in those with CVD versus those without CVD on CTCA (51.3% versus 39.9%, p = 0.007). Male sex (50.7% versus 36.1% p= <0.001), age (59.4 ± 13.7 versus 48.1 ± 13.6, p= <0.001) and diabetes (12.4% versus 6.9%, p = 0.04) were also significantly higher in the CAC group compared to the CAC score of zero. HS was associated with increasing strata of CAC score compared with CAC of zero (CAC score 1-100 OR1.47, p = 0.01, CAC score 101-400 OR:1.68, p = 0.02, CAC score >400 OR 1.42, p = 0.14). This association became non-significant in the highest strata of CAC score. Conclusion We found a significant association between the increasing age, male sex, diabetes and HS with the presence of CAC. HS was also associated with a more severe phenotype of CVD based on the multinomial logistic regression model. Although the association reduced for the highest strata of CAC (CAC score >400) this likely reflects the overall low numbers of patients within this group and is likely a type II error. Based on these findings it may be appropriate to offer routine CVD risk stratification techniques in all those diagnosed with HS.

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Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention

European Heart Journal ◽

10.1093/ehjci/ehaa946.1315 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

X.F Tang ◽

Y Yao ◽

S.D Jia ◽

Y Liu ◽

B Xu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Coronary Intervention ◽

Premature Coronary Artery Disease ◽

Minor Bleeding ◽

Bleeding Events ◽

Cerebrovascular Events ◽

Independent Risk Factors ◽

Artery Disease

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P<0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P>0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P<0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P<0.001; HR=1.758, 95% CI: 1.365–2.264, P<0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China

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Cardiovascular Disease Risk in Bears and Other Gay Men: A Descriptive Study from Poland

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031044 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1044

Author(s):

Magdalena Mijas ◽

Karolina Koziara ◽

Andrzej Galbarczyk ◽

Grazyna Jasienska

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Gay Men ◽

Disease Risk ◽

Older Age ◽

Analysis Of Covariance ◽

Control Group ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Wide Range

A risk of cardiovascular disease (CVD) is increased by multiple factors including psychosocial stress and health behaviors. Sexual minority men who identify as Bears form a subculture distinguished by characteristics associated with increased CVD risk such as elevated stress and high body weight. However, none of the previous studies comprehensively investigated CVD risk in this population. Our study compared Bears (N = 31) with other gay men (N = 105) across a wide range of CVD risk factors. Logistic regression and analysis of covariance (ANCOVA) models were performed to compare both groups concerning behavioral (e.g., physical activity), medical (e.g., self-reported hypertension), and psychosocial (e.g., depressiveness) CVD risk factors. Bears were characterized by older age and higher body mass index (BMI) than the control group. We also observed higher resilience, self-esteem, as well as greater prevalence of self-reported hypertension, diabetes, and hypercholesterolemia in Bears. None of these differences remained statistically significant after adjusting for age and, in the case of self-reported diagnosis of diabetes, both age and BMI. Our study demonstrates that Bears are characterized by increased CVD risk associated predominantly with older age and higher BMI. Health promotion interventions addressed to this community should be tailored to Bears’ subcultural norms and should encourage a healthier lifestyle instead of weight loss.

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Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

BMJ Global Health ◽

10.1136/bmjgh-2020-003499 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003499

Author(s):

Ryan G Wagner ◽

Nigel J Crowther ◽

Lisa K Micklesfield ◽

Palwende Romauld Boua ◽

Engelbert A Nonterah ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

South African ◽

Sub Saharan Africa ◽

African Countries ◽

Cvd Risk ◽

Genomic Studies ◽

Sub Saharan ◽

Context Specific ◽

The Impact

IntroductionCardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.MethodsIn the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.ResultsThe 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.ConclusionThe African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.

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Quantifying the contribution of established risk factors to cardiovascular mortality differences between Russia and Norway

Scientific Reports ◽

10.1038/s41598-020-77877-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Sergi Trias-Llimós ◽

Lisa Pennells ◽

Aage Tverdal ◽

Alexander V. Kudryavtsev ◽

Sofia Malyutina ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cvd Risk ◽

Risk Factor Profile ◽

Emerging Risk ◽

The Absolute ◽

Absolute Age ◽

Relative Differences ◽

Mortality Rate Ratio ◽

Cvd Mortality

AbstractSurprisingly few attempts have been made to quantify the simultaneous contribution of well-established risk factors to CVD mortality differences between countries. We aimed to develop and critically appraise an approach to doing so, applying it to the substantial CVD mortality gap between Russia and Norway using survey data in three cities and mortality risks from the Emerging Risk Factor Collaboration. We estimated the absolute and relative differences in CVD mortality at ages 40–69 years between countries attributable to the risk factors, under the counterfactual that the age- and sex-specific risk factor profile in Russia was as in Norway, and vice-versa. Under the counterfactual that Russia had the Norwegian risk factor profile, the absolute age-standardized CVD mortality gap would decline by 33.3% (95% CI 25.1–40.1) among men and 22.1% (10.4–31.3) among women. In relative terms, the mortality rate ratio (Russia/Norway) would decline from 9–10 to 7–8. Under the counterfactual that Norway had the Russian risk factor profile, the mortality gap reduced less. Well-established CVD risk factors account for a third of the male and around a quarter of the female CVD mortality gap between Russia and Norway. However, these estimates are based on widely held epidemiological assumptions that deserve further scrutiny.

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Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation

BioMed Research International ◽

10.1155/2018/5936180 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Handrean Soran ◽

Moulinath Banerjee ◽

Jamal B. Mohamad ◽

Safwaan Adam ◽

Jan Hoong Ho ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Left Atrial ◽

Control Group ◽

Left Atrial Size ◽

Direct Current Cardioversion ◽

Atrial Size ◽

Independent Risk Factors ◽

Lv Ejection Fraction

Introduction. Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods. Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results. DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P=0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P=0.007) at a median follow-up of 74.5 days (IQR 69.4–77.4). Multiple logistic regression analysis showed that the presence of T2DM (P=0.014), digoxin use (P=0.01), statin use (P=0.005), left-atrial size (P=0.01), and LV ejection fraction (P=0.008) were independent risk factors for immediate DCCV failure. T2DM (P=0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P=0.033), digoxin use (P=0.035), left-atrial size (P=0.01), LV ejection fraction (P=0.036), and HbA1c (P=0.011) predicted immediate failure of DCCV whilst digoxin use (P=0.026) was an independent risk factor for relapse of AF. Conclusion. T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.

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