Defecation Patterns and Cardiovascular Outcomes in Acute Coronary Syndrome: The Influence of Stimulant Laxative Use.

Background Gut function is vital for human health and cardiovascular diseases, and defecation frequency including various abnormal patterns serve as a fundamental marker. Purpose We aimed to investigate whether abnormal defecation patterns during hospitalization are independent predictors of future cardiovascular events in patients with acute coronary syndrome (ACS). Methods This two-center retrospective observational cohort study initially enrolled 2119 patients hospitalized for ACS, and after exclusions, 1949 patients remained as the study subjects. We examined three indicators: "frequency of non-defecation days," "consecutive non-defecation days," and "maximum daily defecation frequency," and cutoff values were determined with Youden’s index. The primary outcome was a composite of all-cause mortality, myocardial infarction, ischemic stroke, and hemorrhagic stroke. Results During the follow-up period of median 48 months, 405 of 1949 (20.8%) patients developed the primary outcome. Analysis of continuous variables revealed that only "frequency of non-defecation days" showed an independent association with the primary outcome (hazard ratio [HR] per 10% increase 1.095; 95% confidence interval [CI], 1.044–1.149; p<.0001). When analyzed as categorical variables, "frequent non-defecation days" (≥33.5%) (HR, 1.507; 95% 95%CI, 1.191–1.907; p=0.0006, Figure 1-A) and high "maximum daily defecations frequency" (≥5 times / day) (HR, 1.670; 95%CI, 1.203–2.317; p=0.002, Figure 1-B) were associated with an increased risk of cardiovascular events in the multivariate models. Conclusions Among patients with ACS abnormal defecation patterns as assessed by increased frequency of non-defecation days and high-frequency defecations within a single day during their general ward stay, were associated with an elevated risk of developing future cardiovascular events.

Troponin T as a risk marker for recurrent cardiovascular events in the post-discharge setting one month after acute coronary syndrome: a TRACER substudy

Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome.

To investigate the relationship between anti-citrullinated protein antibodies (ACPAs), specific ACPA subspecificities, rheumatoid factor (RF) isotypes, and incident cardiovascular (CV) events in patients with rheumatoid arthritis (RA). Serum samples from Swedish patients with new-onset RA (diagnosed within 1 year of symptom onset between 1996 and 2009) were centrally typed for anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies, 20 ACPA subspecificities, and RF isotypes. Patients were followed up longitudinally in nationwide registers to monitor the occurrence of acute coronary syndrome (ACS), stroke, CV-related death, and major adverse CV events (MACE). The association between each serologic marker and CV outcome, and the impact of adjustment for the Disease Activity Score in 28 joints (DAS28), smoking status, and income at baseline, were assessed using Cox proportional hazards models. In addition, associations of serologic markers with all-cause mortality were explored. In total, 2,814 patients with RA were included in the study. The median follow-up was 13 years, during which the CV end points of ACS, stroke, or CV-related death were reported to occur in 375 patients. Occurrence and/or levels of anti-CCP2 were associated with risk of incident ACS (hazard ratio [HR] 1.46, 95% confidence interval [95% CI] 1.03-2.06), stroke (HR 1.47, 95% CI 1.03-2.10), CV-related death (P = 0.024 for association with anti-CCP2 levels), and MACE (HR 1.34, 95% CI 1.06-1.70). Similarly, an association with the number of ACPA subspecificities was observed; however, this could not be attributed to any individual or group of ACPA subspecificities. Presence of IgM-RF was associated with all CV end points except ACS, and IgA-RF was exclusively associated with CV-related death. Adjustment for smoking status, income, and DAS28 scores decreased most of the HRs, whereas IgA-RF remained associated with CV-related death (HR 1.61, 95% CI 1.05-2.48). All of the assessed serologic makers were associated with all-cause mortality. RF isotypes and ACPAs are associated with future CV events in patients with RA. ACPA levels and number of subspecificities seem more important than the occurrence of particular subspecificities, and these associations were not explained by a history of ever smoking.

Tissue Inhibitor of Metalloproteinase-1: Actions beyond Matrix Metalloproteinase Inhibition

Background: Whether apolipoproteins B100 (ApoB) and ApoB/ApoA1 biomarkers can predict future cardiovascular events in patients with acute coronary syndrome (ACS) is unknown. We evaluated the association between these biomarkers and development of major adverse cardiovascular events within 12 months in patients with ACS. Methods: We used data from a prospective cohort study of 1149 patients (32% women) aged 55 years or less, hospitalized for ACS (January 2009-April 2013). Baseline ApoB and ApoA1 levels were measured within the first 4 days of hospitalization for ACS. Patients were followed for 12 months for the composite of death, recurrent ACS, need for recurrent revascularization, or re-hospitalization for cardiac causes. Results: After ACS, most patients had elevated ApoB levels (46% 0.8-1.1 g/L and 31% with >1.1 g/L). Patients with the lowest ApoB levels (<0.8 g/L) were more likely to be women, have a history of previous myocardial infarction, diabetes and to be prescribed statins compared with those with higher ApoB levels. There was no significant association with ApoB level and the risk of composite cardiovascular outcome after adjustment for age, sex, statin use, GRACE score, ACS severity and day of measurement (Hazard Ratio (HR) 0.79, 95% CI: 0.41-1.55). Increasing ApoB/ApoA1 ratio was also not associated with risk of developing composite cardiovascular events compared with lower ratios (HR 0.92 95% CI 0.45-1.87). Conclusion: ApoB level and ApoB/ApoA1 ratio do not predict future cardiovascular events post-ACS when measured in the first 4 days in patients aged less than 55 years.

Lipoprotein-associated phospholipase A2 does not predict mortality or new ischaemic events in acute coronary syndrome patients

Changes in serum cholesterol levels determine future risk of cardiovascular events in patients with acute coronary syndrome in the Japanese Coronary Artery Disease (JCAD) Study

Patients with type 2 diabetes mellitus (T2DM) face a heightened risk of future cardiovascular events. It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis. Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters. However, further evidence is required for widespread clinical application. To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM. This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants. To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events, including major adverse cardiovascular events (MACEs) and congestive heart failure (CHF). We employed univariable and multivariable-adjusted Cox proportional hazards regression models. Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models. Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses. After adjustment for confounding factors, all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM. In comparison with patients in the lowest quartile, the hazard ratios (95% confidence intervals) of those in the highest quartile were 1.50 (1.29-1.73), 1.51 (1.30-1.74), 1.50 (1.29-1.73), and 1.30 (1.12-1.50) for total cholesterol/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. Similar findings were noted for CHF. Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed, with threshold values of 7.29, 6.29, and 2.15 for total cholesterol/HDL-C, non-HDL-C/HDL-C, and remnant cholesterol/HDL-C, respectively. However, no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF. Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.

The cardiovascular disease is the main cause of death among diabetic patients, which makes it crucial to identify the individuals at higher risk of cardiovascular events. To evaluate the prognostic value of scintigraphy with gated single photon emission computed tomography (SPECT) in patients with diabetes mellitus (DM) and suspected coronary artery disease. Retrospective study with 232 diabetic patients submitted to scintigraphy with gated SPECT. Perfusion Gated SPECT (scores and number of altered segments) as well as ventricular function parameters (ejection fraction, left ventricle (LV) volume and contractility) were evaluated. Cardiac death, acute ischemic coronary syndrome, revascularization procedures or encephalic vascular accident were considered future cardiovascular events. The uni- and multivariate analyses were carried out by the multiple logistic regression model (p< 0.05). At the univariate analysis, age (p=0.02), chest angina (p=0.01), insulin therapy (p=0.02), myocardial perfusion abnormalities (p<0.0001), the number of segments involved (p=0.0001), the perfusion scores (p=0.0001), the ejection fraction (p=0.004), the final systolic volume (p=0.03) and the finding of segmental alteration at the left ventricle contractility (p<0.0001) were associated with future events at the univariate analysis. At the multivariate analysis, the male sex (p=0.007), age (p=0.03), angina (p=0.001), insulin therapy (p=0.007) and the SDS > 3 (p=0.0001) and the number of altered segments > 3 (p=0.0001) were predictors of cardiovascular events. The myocardial scintigraphy with gated SPECT adds independent information to the stratification of the risk of future cardiovascular events in patients with DM and suspected coronary artery disease.

Introduction: Heart failure (HF) is a clinical syndrome associated with diverse metabolic disturbances. Recent studies suggest that failing heart through secretion of soluble myostatin may induce skeletal muscle wasting in HF patients and skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic HF. However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear. Hypothesis: We hypothesized that low appendicular skeletal muscle mass could predict the occurrence of future cardiovascular (CV) events in patients with ADHF. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 96 patients with ADHF (age 72±11, left ventricular ejection fraction (LVEF) 38±15%, B-type natriuretic peptide (BNP) levels on admission 752 [377-1398] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height 2 ) was defined according to the Asia Working Group for Sarcopenia criteria (&lt;7.0kg/m 2 in male, &lt;5.4kg/m 2 in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, or HF re-hospitalization). Results: ASMI significantly correlated with age (r=-0.51, P&lt;0.001), male sex (r=0.53, P&lt;0.001), body mass index (r=0.63, P&lt;0.001), systolic blood pressure on admission (r=0.21, P=0.04), and BNP levels on admission (r=-0.39, P=0.04). ADHF patients with low ASMI (n=54, 56%) had higher BNP levels (968 [552-1773] versus 498 [273-943], p=0.001) and higher rate of clinical scenario 2-3 (48% versus 12%, p=0.001) than those with normal ASMI. 42 patients developed CV events (median follow-up, 16months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in the normal ASMI group (54% vs. 29%, log-rank test, P=0.02). Multivariate Cox hazard analysis identified low ASMI as an independent predictor of the CV events in patients with ADHF (hazard ratio 2.1, 95%-confidence interval 1.1-4.2, P=0.03). Conclusions: Low ASMI could predict the future CV events in patients with ADHF, irrespective of LV systolic function and other clinical profile.

Cytokines play an important role in ischemic injury and repair. However, little is known about their prognostic value in cardiovascular disease. The aim of this study was to investigate the prognostic importance of chemokines CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC for the risk of future cardiovascular events in patients with acute coronary syndromes (ACS). Baseline levels of CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC were determined in ACS patients from the Bad Nauheim ACS II registry (n = 609). During the following 200 days, patients were monitored for the occurrence of fatal and non-fatal cardiovascular events. Patients with CCL3/MIP1α, CCL5/RANTES and CCL18/PARC concentrations in the highest tertile were associated with an increased risk of a fatal event during follow-up (HR: 2.19, 95%CI: 1.04–4.61 for CCL3/MIP1α, HR: 3.45, 95%CI: 1.54–7.72 for CCL5/RANTES and HR: 3.14, 95%CI: 1.33–7.46 for CCL18/PARC). This risk was highest for patients with all three biomarkers concentrations in the upper tertile (HR: 2.52, 95%CI: 1.11–5.65). Together with known risk predictors of cardiovascular events, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC combined improved the c-statistics from 0.74 to 0.81 (p = 0.007). In conclusion, CCL3/MIP-1α, CCL5/RANTES and CCL18/PARC are independently associated with the risk of short-term mortality in ACS patients. Combining all three biomarkers further increased their prognostic value.

BackgroundThe extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.Methods and ResultsIncluded were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end‐point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11–1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99–1.14, P=0.11), and total primary end‐point events (adjusted risk ratio 1.08, CI 1.01–1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06–1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21–1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13–1.34, P<0.001).ConclusionsPatients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

The TRUTH trial demonstrated that 8-month statin therapy alters the composition of coronary artery plaque using virtual histology (VH)-intravascular ultrasound (IVUS). The extended TRUTH study was conducted to evaluate the relationship between changes in coronary atherosclerosis and mid-term clinical outcomes and identify the factors associated with cardiovascular events. Of 164 patients with angina pectoris who participated in the TRUTH trial, 119 subjects with analyzable IVUS data at both enrollment and the 8-month follow-up were enrolled and observed for at least two years. The primary end point was the time to first occurrence of cardiovascular composite events, including cardiovascular death, nonfatal myocardial infarction, nonfatal cerebral infarction, unstable angina and ischemic-driven revascularization, except for target lesion revascularization. The frequency of reaching the primary end point was 13% (16/119), with a mean follow-up period of 41.9±9.4 months. Although plaque regression and changes in plaque composition were not associated with future cardiovascular events, the serum high-sensitivity C-reactive protein (hs-CRP) levels at the start of the extended TRUTH study were significantly higher in the event group than in the event-free group (1.43 mg/L vs. 0.58 mg/L, p=0.01). A multivariate logistic regression analysis showed that the hs-CRP level was an independent significant predictor of cardiovascular events (odds ratio: 1.69; 95% confidence interval: 1.14-2.50, p=0.01). Coronary artery plaque regression and changes in plaque composition during statin therapy do not predict future cardiovascular events in patients with angina pectoris. Instead, the serum hs-CRP level can be used as a predictor of cardiovascular events.

IntroductionProspective studies assessing the relation between endodontic inflammatory disease and subsequent cardiovascular events are few. The present aim was to explore associations between endodontic variables and future cardiovascular events in patients with myocardial infarction and matched controls participating in the PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study. MethodsEight-hundred five patients hospitalized for a first myocardial infarction and 805 controls were recruited between 2010 and 2014. Signs of endodontic inflammatory disease were assessed in panoramic radiographs taken at baseline. Mortality and morbidity data during the approximately 8 years of follow up were obtained from national registries. The risk for future cardiovascular events (first of mortality and nonfatal myocardial infarction, stroke, or hospitalization for heart failure) was analyzed with the log-rank test and Cox proportional hazards regression adjusted for the following confounders: sex, age, smoking, myocardial infarction, diabetes, education, marital status, family history of cardiovascular disease, and marginal periodontitis. ResultsIn total, 285 future events were observed during the follow-up period. Unadjusted analyses revealed that ≥1 root-filled tooth increased the risk of a future event. After adjustment, the number of remaining teeth and non–root-filled teeth decreased the risk of future events, whereas a higher Decayed, Missing and Filled Teeth score increased the risk and ≥1 primary apical periodontitis decreased the risk of suffering cardiovascular events. A higher Decayed, Missing and Filled Teeth score and decayed teeth increased the risk of all-cause mortality. ConclusionsTooth loss is a strong indicator of an increased risk for future cardiovascular events. Root-filled teeth seem of limited value as a risk indicator when accounting for other risk factors. The potential effect of dental interventions on future events should be assessed in future research.