scholarly journals Secondary cardiovascular prevention in clinical practice: what do we need today?

2019 ◽  
Vol 89 (3) ◽  
Author(s):  
Gian Francesco Mureddu
Keyword(s):  
Cardiovascular Prevention ◽  
Referral Rate ◽  
Major Adverse Cardiovascular Events ◽  
Evidence Based ◽  
Pharmacological Management ◽  
Preventive Cardiology ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Acute Event ◽  
Secondary Cardiovascular Prevention

In the last decades, the post-hospital mortality from coronary artery disease (CAD) has significantly increased. This new trend in the epidemiology of CAD has been largely attributed to the improvement of survival from acute coronary syndromes that generated increasing incidence of population at high risk of recurrences and rehospitalization for major adverse cardiovascular events (MACE) and heart failure (HF). Thus, much longer after the acute event than we had thought, we have now been facing with higher complexity of “chronic” CAD phenotypes which deserve high clinical attention and more and more intricate pharmacological management. Although the guidelines recommend implementing secondary prevention programs through cardiac rehabilitation (CR) facilities in order to achieve a better outcome, i.e. decreased morbidity, re-hospitalization and increased adherence to evidence-based interventions, the referral rate to CR is paradoxically scarce. The Italian Association of Clinical Preventive Cardiology and Rehabilitation (AICPR) has been launching a survey involving the Network of Italian CR centers, which will make possible to observe trends, implement guidelines recommendations and then verify the effectiveness of the interventions and outcomes in post-acute and chronic CAD.

scholarly journals Multisite vascular disease in acute coronary syndromes: increased in-hospital mortality and no improvement over time

2018 ◽  
Vol 9 (7) ◽  
pp. 748-757 ◽  
Author(s):  
Marco Roffi ◽  
Dragana Radovanovic ◽  
Juan F Iglesias ◽  
Franz R Eberli ◽  
Philip Urban ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Evidence Based ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Over Time

Introduction: Limited data are available on the impact of multisite artery disease in patients with acute coronary syndromes. In particular, it is unknown whether the outcomes of those high-risk patients have improved over time. Therefore, we addressed the multisite artery disease patient population enrolled in the Swiss nationwide prospective acute coronary syndromes cohort study AMIS Plus over two decades. Methods: All patients enrolled from January 1999 to October 2016 were stratified according to the presence of isolated coronary artery disease or multisite artery disease, defined as coronary artery disease with known concomitant vascular disease (i.e. cerebrovascular disease and/or peripheral artery disease). Multisite artery disease 1 (MSAD1) and multisite artery disease 2 (MSAD2) defined patients with one and two additional vascular conditions, respectively. Primary outcome measures were in-hospital mortality and major adverse cardiovascular events (defined as re-infarction, stroke or death). Results: Among a total of 44,157 patients, 39,613 (89.7%) had coronary artery disease only while 4544 (10.3%) had multisite artery disease (4097 (9.3%) had MSAD1 and 447 (1.0%) had MSAD2). Compared with patients with coronary artery disease only, multisite artery disease patients were older, had a longer delay from symptom onset to hospital admission, had more frequently atypical presentation, presented more frequently with non-ST-segment elevation acute coronary syndromes, were more frequently in Killip class III/IV, had higher Charlson comorbidity index, more frequently had three-vessel coronary artery disease and were treated less frequently with evidence-based treatments such as aspirin, P2Y12 inhibitors, or beta-blockers. Similarly, multisite artery disease benefitted less frequently from coronary angiography as well as percutaneous coronary revascularisation. In-hospital mortality was 10.9% in multisite artery disease patients and 4.4% in coronary artery disease-only patients ( P<0.001). Corresponding major adverse cardiovascular events rates were 13.4% and 5.4% ( P<0.001). Cardiogenic shock, re-infarction and cerebrovascular events were significantly more frequent in multisite artery disease patients compared with coronary artery disease-only patients. In multivariable logistic regression analysis, multisite artery disease was identified as an independent predictor of in-hospital mortality (odds ratio 1.69, 95% confidence interval 1.47–1.94, P<0.001). Among multisite artery disease patients, mortality was the highest in MSAD2 individuals (15.4% vs. 10.4% among MSAD1 patients, P=0.001), the same was true for the major adverse cardiovascular events rates (19.1% in MSAD2 patients vs. 12.7% in MSAD1 patients, P<0.001). When stratified for the decade of enrollment, no improvement in mortality or major adverse cardiovascular events rates was observed in multisite artery disease patients. Conclusion: Patients presenting with multisite artery disease were less likely to receive evidence-based therapies than coronary artery disease-only patients and had increased in-hospital morbidity and mortality, with no improvement over time. The worse outcomes were observed among MSAD2 patients. These results should prompt awareness for multisite artery disease as a high-risk condition in the setting of multisite artery disease.

General remarks

2015 ◽  
Author(s):  
Pantaleo Giannuzzi
Keyword(s):  
Healthy Eating ◽  
Health Professionals ◽  
Cardiovascular Prevention ◽  
Evidence Based ◽  
Effective Management ◽  
High Quality ◽  
Physically Active ◽  
Risk Factor Management ◽  
Preventive Cardiology ◽  
Clinical Benefits

Cardiac patients should be advised about and have the opportunity to access a comprehensive cardiovascular prevention and rehabilitation programme, addressing all aspects of lifestyle—smoking cessation, healthy eating, and being physically active—together with more effective management of blood pressure, lipids, and glucose. To achieve the clinical benefits of a multidisciplinary and multifactorial prevention programme we need to integrate professional lifestyle interventions with effective risk factor management and evidence-based drug therapies, appropriately adapted to the medical, cultural, and economic setting of a country. The challenge is to engage and motivate cardiologists, physicians, and health professionals to routinely practise high-quality preventive cardiology and promote a healthcare system which invests in prevention.

scholarly journals ANTIPLATELET ADEQUACY OF CYCLOPENTYL TRIAZOLOPYRIMIDINE VERSUS CLOPIDOGREL IN-PATIENTS WITH CORONARY HEART DISEASE

2018 ◽  
Vol 11 (12) ◽  
pp. 536
Author(s):  
Feryal Hashim Rada
Keyword(s):  
Platelet Aggregation ◽  
Stable Angina ◽  
Platelet Reactivity ◽  
Stable Coronary Artery Disease ◽  
Light Transmittance ◽  
Reactivity Index ◽  
Major Adverse Cardiovascular Events ◽  
Vasp Phosphorylation ◽  
Coronary Syndromes ◽  
Artery Disease

Objective: Ticagrelor, cyclopentyl triazolopyrimidine drug, and Clopidogrel, second-generation thienopyridine drug are antiplatelet drugs indicated for the prevention of thrombotic events in patients with acute or chronic coronary syndromes. The aim of this study is to assess efficacy and safety outcomes of ticagrelor treatment versus Clopidogrel treatment in patients with stable coronary artery disease (stable angina) using maximal platelet aggregation percent (MPAP) method and platelet reactivity index percent (PRIP) method.Methods: A total of 42 patients (27 male and 15 female), their ages ranging (48±8) years with stable angina enrolled from Ibn Albitar Center for Cardiac Surgery for this crossover study. After satisfying, the properties of inclusion criteria they screened for clopidogrel treatment 75 mg daily for 2 weeks than after 2 weeks periods of wash off they treated with ticagrelor 90 mg twice daily for another 2 weeks. Platelet reactivity was tested at baseline (before treatment), after 2 weeks treatment with clopidogrel and after another 2 weeks treatment with ticagrelor. Platelet reactivity measured by light transmittance aggregometry test and by vasodilator-stimulated phosphoprotein (VASP) phosphorylation test.Results: The results of MPAP after 2 weeks treatment with clopidogrel or ticagrelor showed high significant reduction in platelet aggregation in patients with ticagrelor treatment as compared to clopidogrel treatment (30±6% vs. 44±8%). As well, the results of PRIP using VASP-phosphorylation after 2 weeks treatment with clopidogrel or ticagrelor showed high significant reduction in platelet aggregation in patients with ticagrelor treatment as compared to clopidogrel treatment (22±5% vs. 36±7%).Conclusion: Treatment with ticagrelor produced a reduction in platelet reactivity consistent with the reduction in major adverse cardiovascular events and improved survival without increasing major bleeding.

Abstract 16954: Effect of a Multifaceted Quality Improvement Intervention on the Prescription of Cardiovascular Prevention Treatments in Patients With Coronary Artery Disease Insights From the Bridge Cardiovascular Prevention Cluster Randomized Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
M. Julia Machline Carrion ◽  
Rafael M Soares ◽  
Helio P Penna Guimaraes ◽  
Renato H Nakagawa ◽  
Lucas P Damiani ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Quality Improvement ◽  
Coronary Artery ◽  
Odds Ratio ◽  
Cardiovascular Prevention ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Significant Difference ◽  
Artery Disease ◽  
Improvement Intervention

Introduction: Moving toward evidence-based care protocols is key to reduce the burden of cardiovascular diseases. Hypothesis: We assessed the hypothesis that a multifaceted intervention could improve the adherence to evidence-based therapies for coronary artery disease patients. Methods: The BRIDGE Cardiovascular Prevention study was a cluster randomized trial including 1,619 patients with ischemic stroke, coronary artery disease or peripheral artery disease from 40 outpatient clinics in Brazil. Clusters were randomized to receive a multifaceted quality improvement intervention or to routine practice. The intervention included reminders, care algorithms, training of a case manager, audit and feedback reports, and distribution of educational materials to health care providers. The primary endpoint was the adherence to combined use of statins, antiplatelets and ACEi or ARBs, using an “all or none” approach at 12 months in patients without contra-indications. Results: Among the 1619 patients enrolled in the original sample, 1327 (81.9%) were coronary artery disease patients. The mean age was 65.7 (SD=10.4) and 880 (66.3 %) were men. There was a significant difference in the combined prescription of evidence-based therapies between the intervention and the control groups (75.4% versus 61.8 % respectively, Odds Ratio, 2.33 [95% CI, 1.29 - 4.21], p<0.01). Patients in the intervention group were more likely to receive statins (94.4% vs. 84.7%; Odds Ratio 4.15 [95% CI, 1.62 - 10.61], p<0.01) and antiplatelet (95.3% vs. 89.0%; Odds Ratio 3.32 [95% CI, 1.45 - 7.58], p<0.01). There was no significant difference in the occurrence of major cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and mortality) between groups (2.34 % vs. 3.08%; Hazard Ratio 0.76 [95%CI, 0.39-1.49, p=0.42]. For patients with myocardial infarction the combined prescription of evidence-based therapies was increased in the intervention group as compared to the control group (75.6% versus 62.3 % respectively, Odds Ratio, 2.12 [95% CI, 0.99 - 4.54], p=0.02). Conclusions: Among coronary artery disease patients treated in Brazil, a quality improvement intervention resulted in improved prescription of evidence-based therapies for cardiovascular prevention.

scholarly journals Antioxidants Effect Changes in Systemic Parasympathetic and Sympathetic Nervous System Responses and Improve Outcomes

2020 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Ventricular Arrhythmias ◽  
Evidence Based ◽  
Alpha Lipoic Acid ◽  
Pharmacological Management ◽  
Nervous Systems ◽  
Β Blockers ◽  
Sympathetic Nervous ◽  
Artery Disease ◽  
Positive Effect

Parasympathetic and Sympathetic (P&S) imbalance is associated with increased morbidity and mortality risk, including heart failure, coronary artery disease, atrial and ventricular arrhythmias, hypertension and orthostatic disorders, and syncope. Most cardiac medications effect only one or the other of the P&S nervous systems, including: β-blockers, α-blockers, α-agonists, and anti-cholinergics. Non-pharmaceutical treatments also affect the P&S nervous systems; however, nonpharmaceutical treatment is rarely addressed or studied, despite significant evidence-based data demonstrating normalization of Sympathovagal Balance. Fifty consecutive patients from a busy suburban cardiology practice were enrolled in a supplement study. Patients were provided supplements that included 200mg of Alpha-Lipoic Acid (ALA) and 100mg of Co-Enzyme Q10 (CoQ10) which they were instructed to take twice a day, one each with breakfast and dinner. P&S Monitoring (Physio PS, Inc., Atlanta, GA, USA) and Quality of Life (QoL) questionnaires were administered at three month intervals. The combination of supplements, ALA and CoQ10, had a positive effect on the P&S nervous systems as measured directly and also indicated by improvements in BP, HR and reported QoL. The study indicates these supplements help to improve both the resting and challenge P&S responses and resultant physiology. The results suggest antioxidant therapy is a potential complimentary therapy to pharmacological management of patients with poorly controlled BP (i.e., hypertension and possible hypotension) as well as in patients with tachycardia or palpitations. This is a hypothesis generating study of significant importance in an often neglected area of cardiovascular disease in which additional research and studies are needed.

Ambulatory preventive care: outpatient clinics and primary care

2017 ◽  
Author(s):  
Jean-Paul Schmid ◽  
Hugo Saner ◽  
Paul Dendale ◽  
Ines Frederix
Keyword(s):  
Primary Care ◽  
Interventional Cardiology ◽  
Asymptomatic Patients ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Acute Event

Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.

Ambulatory preventive care: outpatient clinics and primary care

2015 ◽  
Author(s):  
Jean-Paul Schmid ◽  
Hugo Saner
Keyword(s):  
Primary Care ◽  
Interventional Cardiology ◽  
Asymptomatic Patients ◽  
Stable Coronary Heart Disease ◽  
History Of ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Acute Event

Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.

scholarly journals The role of Neopterin in cardiovascular disease

2016 ◽  
Vol 68 (2) ◽  
Author(s):  
Mario Pacileo ◽  
Plinio Cirillo ◽  
Salvatore De Rosa ◽  
Grazia Ucci ◽  
Gianluca Petrillo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Chronic Coronary Artery Disease ◽  
Immune System Activation ◽  
Coronary Syndromes ◽  
Artery Disease

Inflammation plays a key role in the initiation and progression of atherosclerosis but also in the pathophysiology of atheromatous plaque disruption and the development of acute coronary syndromes. Neopterin is a marker of inflammation and of immune system activation, it is synthesized by macrophages, that, once activated, release this substance. Indeed, in clinical evaluation of patients, measurements of plasma levels of neopterin are usually used to evaluate progression of viral infections, renal transplant rejection, severe systemic inflammatory diseases, nephritic syndrome and several autoimmune diseases. This mediator is able to induce a pro-atherothrombotic phenotype in cells of the coronary circulation. Recent data indicate that serum levels of neopterin are elevated in patients with coronary and peripheral artery disease and seem to be a prognostic marker for major adverse cardiovascular events. In particular, neopterin levels predict future major cardiac and vascular adverse events in patients presenting with chronic coronary artery disease, with acute coronary syndromes, and in those with critical limb ischemia. This renders this molecule a useful marker of atherosclerotic plaque activity, permitting the identification of the subjects at highest risk for major adverse cardiovascular events. In line with the above mentioned evidences, patients with high neopterin levels may require aggressive risk factor modification and intensive medical treatment irrespective of the severity of their coronary artery disease. This data suggest a potential clinical use of neopterin as a marker for disease activity in patients with cardiovascular disease.

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