Diabetes Mellitus and Vitamin D Deficiency: Comparable Effect on Survival and a Deadly Association after a Myocardial Infarction

Survivors after a myocardial infarction (MI), especially those with diabetes mellitus (DM), remain at high risk of further events. Identifying and treating factors that may influence survival may open new therapeutic strategies. We assessed the impact on prognosis of DM and hypovitaminosis D (hypovitD), alone or combined. In this prospective, observational study, 1081 patients were enrolled surviving an MI and divided into four groups according to their diabetic and VitD status. The primary end-point was composite of all-cause mortality, angina/MI and heart failure (HF). Secondary outcomes were mortality, HF and angina/MI. During a follow-up of 26.1 months (IQR 6.6–64.5), 391 subjects experienced the primary end-point. Patients with DM or hypovitD had similar rate of the composite end-point. Patients with only hypovitD or DM did not differ regarding components of composite end-point (angina p = 0.97, HF p = 0.29, mortality p = 0.62). DM and VitD deficiency had similarly adjusted risks for primary end-point (HR 1.3, 95%CI 1.05–1.61; HR 1.3, 95% CI 1.04–1.64). The adjusted HR for primary composite end-point for patients with hypovitD and DM was 1.69 (95%CI 1.25–2.29, p = 0.001) in comparison to patients with neither hypoD nor DM. In conclusion, DM and hypovitD, individually and synergistically, are associated with a worse outcome after MI.

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Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

BMJ Open ◽

10.1136/bmjopen-2017-018719 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018719 ◽

Cited By ~ 17

Author(s):

Nuria Farré ◽

Josep Lupon ◽

Eulàlia Roig ◽

Jose Gonzalez-Costello ◽

Joan Vila ◽

...

Keyword(s):

Ejection Fraction ◽

Prospective Observational Study ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

End Point ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Baseline Characteristics

ObjectivesThe aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%–49%) and the effect of 1-year change in LVEF in this group.SettingMulticentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.ParticipantsFourteen per cent (n=504) of the 3580 patients included had HFmrEF.InterventionsBaseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.ResultsMedian follow-up was 3.66 (1.69–6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%–49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).ConclusionsPatients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

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The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

The Moldovan Medical Journal ◽

10.52418/moldovan-med-j.64-5.21.03 ◽

2021 ◽

Vol 64 (5) ◽

pp. 16-20

Author(s):

Alina Malic ◽

◽

Evelina Lesnic ◽

Keyword(s):

Diabetes Mellitus ◽

Prospective Study ◽

Treatment Effectiveness ◽

Similar Rate ◽

Control Group ◽

Diabetic Patients ◽

A Prospective Study ◽

Prospective Longitudinal ◽

The Impact

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

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P632Long-term benefits of cardiac rehabilitation in patients with diabetes mellitus after percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehz747.0240 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M J Romero Reyes ◽

R Rodriguez Delgado ◽

I Esteve Ruiz ◽

C Otte Alba ◽

J A Mora Pardo ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Heart Failure ◽

Coronary Intervention ◽

Cardiac Mortality ◽

Heart Failure Hospitalization ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Patients With Diabetes

Abstract Introduction After percutaneous coronary intervention (PCI), patients with diabetes have a worse prognosis than non-diabetics and are at increased risk of recurrent cardiovascular events, hospitalization and higher mortality. Purpose The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) in this high-risk group of patients. Methods We performed a retrospective cohort study of 318 consecutive patients with type 2 diabetes mellitus (DM2) who underwent PCI in our hospital between 2004 and 2011. We classified the patients in two cohorts according to their participation (n=154) or not (n=164) in a CR programme. We collected the events ocurring during a median follow-up of 9 years. Results Using multivariate logistic regression, we found that CR participation was associated with significantly reduced all-cause mortality (53% vs 23%, OR 2.10; IC 95%; 1.16–3.82; p 0.014) and cardiac mortality (3.9% vs 23.8%, OR 8.69; IC95% 2.80–26.99; p<0.0005). CR aslo associated with a singnificant decrease in a heart failure hospitalization (26.6% vs 10.6%, OR 2.4; IC 95% 1.06–5.52; p<0.035). No significant differences were observed in non fatal myocardial infarction, stent restenosis and non fatal stroke. Basal characteristics Rehabilitation (n=153) No Rehabilitation (n=164) P vaule Male sex 138 (86.4%) 100 (61.0%) <0.0005 Age (years) 59 (38–74) 65 (47–74) <0.0005 Hypertension 113 (73.9%) 111 (67.7%) NS Hypercholesterolemia 112 (73.7%) 115 (70.1%) NS HbA1c ≥7% 88 (66.2%) 73 (64.6%) NS Prior myocardial infarction 24 (15.6%) 32 (19.5%) NS Chronic kidney disease 6 (3.9%) 19 (11.6%) 0.012 FEVI <50% 30 (20%) 39 (25%) NS Three vessel disease 53 (34.4%) 58 (35.4%) NS Incomplete revascularization 80 (51.9%) 81 (49.4%) NS Drug-eluting stent 110 (78.6%) 127 (80.4%) NS Stent length 22.4±11.9 24.6±14.8 NS Stent diameter 2.7±0.3 2.8±0.4 NS Conclusion CR participation after PCI is associated with lower all-cause mortality, cardiac mortality and heart failure hospitalization rates in patients with DM2 during long-term follow-up.

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Impact of Thrombus Aspiration one-year Cardiac Mortality During Primary PCI in STEMI Patients with total Occlusion; from Korea Acute Myocardial Infarction Registry National Institute of Health

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/032 ◽

2020 ◽

Vol 3 (3) ◽

pp. 01-06

Author(s):

Kye Taek Ahn ◽

Seok-Woo Seong ◽

Mijoo Kim ◽

Jin-Ok Jeong ◽

Seon-Ah Jin

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Primary Pci ◽

Thrombus Aspiration ◽

Total Occlusion ◽

End Point ◽

Timi Flow ◽

All Cause Mortality ◽

One Year

Background: The clinical impact of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated to evaluate whether TA during primary PCI reduces one-year mortality. Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI who were undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) and shown pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and November 2015 during one-year follow up. The patients were divided into two groups according to TA during primary PCI: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac events (MACE), defined as the composite of cardiovascular death (CVD), stroke or recurrent MI at one-year. The secondary efficacy end-point were all-cause of mortality and CVD at one-year. Results: PCI with TA did not reduce the risk of MACE (OR: 0.598, 95% CI: 0.737-1.160, p=0.499), all-cause mortality (OR: 0.898, 95% CI: 0.705-1.144, p=0.383) and CVD (OR: 0.893, 95% CI: 0.683-1.168, p=0.408) in all patients during one-year follow up. The trend did not change after propensity score matching. In subgroup analysis, there was no efficacy of clinical outcome during one-year follow up. Conclusions: Primary PCI with TA did not reduce MACE and all-cause mortality among patients with STEMI and pre-procedural TIMI flow 0,1 during one-year follow up.

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Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.755822 ◽

2021 ◽

Vol 8 ◽

Author(s):

Audrey A. Y. Zhang ◽

Nicholas W. S. Chew ◽

Cheng Han Ng ◽

Kailun Phua ◽

Yin Nwe Aye ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

All Cause Mortality ◽

Safety Endpoint ◽

The Impact

Background: Infectious control measures during the COVID-19 pandemic have led to the propensity toward telemedicine. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients.Methods: This study included 288 patients admitted 1 year before the pandemic (October 2018–December 2018) and during the pandemic (January 2020–March 2020) eras, and survived their index STEMI admission. The follow-up period was 1 year. One-year primary safety endpoint was all-cause mortality. Secondary safety endpoints were cardiac readmissions for unplanned revascularisation, non-fatal myocardial infarction, heart failure, arrythmia, unstable angina. Major adverse cardiovascular events (MACE) was defined as the composite outcome of each individual safety endpoint.Results: Despite unfavorable in-hospital outcomes among patients admitted during the pandemic compared to pre-pandemic era, both groups had similar 1-year all-cause mortality (11.2 vs. 8.5%, respectively, p = 0.454) but higher cardiac-related (14.1 vs. 5.1%, p < 0.001) and heart failure readmissions in the pandemic vs. pre-pandemic groups (7.1 vs. 1.7%, p = 0.037). Follow-up was more frequently conducted via teleconsultations (1.2 vs. 0.2 per patient/year, p = 0.001), with reduction in physical consultations (2.1 vs. 2.6 per patient/year, p = 0.043), during the pandemic vs. pre-pandemic era. Majority achieved guideline-directed medical therapy (GDMT) during pandemic vs. pre-pandemic era (75.9 vs. 61.6%, p = 0.010). Multivariable Cox regression demonstrated achieving medication target doses (HR 0.387, 95% CI 0.164–0.915, p = 0.031) and GDMT (HR 0.271, 95% CI 0.134–0.548, p < 0.001) were independent predictors of lower 1-year MACE after adjustment.Conclusion: The pandemic has led to the wider application of teleconsultation, with increased adherence to GDMT, enhanced medication target dosing. Achieving GDMT was associated with favorable long-term prognosis.

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The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02261-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Salvatore Soldati ◽

Mirko Di Martino ◽

Alessandro Cesare Rosa ◽

Danilo Fusco ◽

Marina Davoli ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Medication Adherence ◽

Cardiac Rehabilitation ◽

Hospital Readmission ◽

Lazio Region ◽

All Cause Mortality ◽

St Elevation ◽

The Impact

Abstract Background Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI). Methods This is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period. Results A total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91). Conclusions Our findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients.

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Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

SSRN Electronic Journal ◽

10.2139/ssrn.3557992 ◽

2020 ◽

Author(s):

Erico Castro-Costa ◽

Jerson Laks ◽

Cecilia Godoi Campos ◽

Josélia OA Firmo ◽

Maria Fernanda Lima-Costa ◽

...

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Cognitive Impairment ◽

Old Age ◽

All Cause Mortality ◽

The Impact

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Safety of High-Dose Dabigatran in Elderly and Younger Patients with a Low Bleeding Risk: A Prospective Observational Study

Cardiology ◽

10.1159/000516368 ◽

2021 ◽

pp. 1-5

Author(s):

Aharon Erez ◽

Gregory Golovchiner ◽

Robert Klempfner ◽

Ehud Kadmon ◽

Gustavo Ruben Goldenberg ◽

...

Keyword(s):

Observational Study ◽

Elderly Patients ◽

Prospective Observational Study ◽

Bleeding Risk ◽

The Elderly ◽

High Dose ◽

World Population ◽

Younger Patients ◽

End Point

Introduction: In patients with atrial fibrillation (AF) at risk for stroke, dabigatran 150 mg twice a day (DE150) is superior to warfarin for stroke prevention. However, there is paucity of data with respect to bleeding risk at this dose in elderly patients (≥75 years). We aimed to evaluate the safety of DE150 in comparison to warfarin in a real-world population with AF and low bleeding risk (HAS-BLED score ≤2). Methods: In this prospective observational study, 754 consecutive patients with AF and HAS-BLED score ≤2 were included. We compared outcome of elderly patients (age ≥75 tears) to younger patients (age <75 years). The primary end point was the combined incidence of all-cause mortality, stroke, systemic emboli, and major bleeding event during a mean follow-up of 1 year. Results: There were 230 (30%) elderly patients, 151 patients were treated with warfarin, and 79 were treated with DE150. Fifty-two patients experienced the primary endpoint during the 1-year follow-up. Among the elderly, at 1-year of follow-up, the cumulative event rate of the combined endpoint in the DE150 and warfarin was 8.9 and 15.9% respectively (p = 0.14). After adjustment for age and gender, patients who were treated with DE150 had a nonsignificant difference in the risk for the combined end point as patients treated with warfarin both among the elderly and among the younger population (HR 0.58, 95% C.I = 0.25–1.39 and HR = 1.12, 95% C.I 0.62–2.00, respectively [p for age-group-by-treatment interaction = 0.83). Conclusions: Our results suggest that Dabigatran 150 mg twice a day can be safely used among elderly AF patients with low bleeding risk.

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Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

Journal of Clinical Medicine ◽

10.3390/jcm10153375 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3375

Author(s):

Atsushi Kimura ◽

Katsushi Takeshita ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Takashi Hirai ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cervical Spine ◽

Postoperative Complications ◽

Spine Surgery ◽

Posterior Longitudinal Ligament ◽

Lower Extremity Function ◽

Cervical Spine Surgery ◽

The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

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Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz143 ◽

2019 ◽

Vol 105 (4) ◽

pp. e1299-e1306 ◽

Cited By ~ 3

Author(s):

Salman Razvi ◽

Owain Leng ◽

Avais Jabbar ◽

Arjola Bano ◽

Lorna Ingoe ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thyroid Function ◽

Thyroid Dysfunction ◽

Reference Interval ◽

Reference Ranges ◽

Diagnosis And Prognosis ◽

Time Period ◽

All Cause Mortality ◽

The Impact

Abstract Objective The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). Patients, Design, and Main Outcome Measures Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. Results Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend <.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period–specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01–5.19), P = .04. Conclusions Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

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