Diverticular disease increases the risk of acute myocardial infarction.

Acute myocardial infarction (AMI) is one of the most important perioperative complications of total knee arthroplasty (TKA). Although risk-stratification tools exist for the prediction of cardiac complications including AMI after noncardiac surgery, such stratification does not differentiate the patients with a coronary stent alone, AMI without a stent, or AMI with a stent. The risk of postoperative AMI in these patient groups may vary. Several studies have recommended suitable times for noncardiac surgery in patients with a coronary stent; however, they do not differentiate between the patients with AMI and no AMI. The suitable time of noncardiac surgery for patients with AMI and stent may vary from those with a stent alone. Moreover, a study to evaluate the risk of AMI within 1 year in an Asian population with a history of AMI or coronary stent who underwent TKA has not been reported. (1) What are the risks of AMI within 1 year of TKA in patients who have had a stent alone, AMI without a stent, or AMI with a stent as compared with patients without an AMI/stent? (2) For patients with AMI/stent placement, when can TKA be performed where the risk of subsequent AMI normalizes? (3) What comorbidities are associated with post-TKA AMI? (4) Is the risk of AMI within 1 year after surgery in patients undergoing TKA without a history of AMI/stent higher than that in patients with no surgery? This study is a retrospective study of the medical claim records of 128,216 patients who underwent TKA between 1997 and 2010 in Taiwan. The records were retrieved from the research database of the Bureau of National Health Insurance in Taiwan, which maintains the records of 99.68% of the Taiwan population. The patients who had a history of AMI or coronary stent placement within the year before TKA were compared with the patients who had not experienced AMI or stent placement before TKA. The control subjects were matched according to sex, age, Charlson score, and year of surgery. There were 2413 patients in each group. The patients with a history of AMI or stent placement and the timing of TKA after coronary event were further stratified as with a coronary stent alone, AMI without a stent, and AMI with a stent. The effects of the comorbidities of renal failure, diabetes, liver failure, and hypertension were also analyzed individually. The risk of AMI within 1 year after TKA was investigated using bivariate analysis and the Cox proportional hazard model. To compare the risk of AMI within 1 year of surgery in the patients with a history of TKA and no AMI/stent with the population without a history of surgery, a similar bivariate analysis and the Cox proportional hazard model were applied to their matched case and control groups, each containing 110,980 patients. In the adjusted model, using no AMI/stent before TKA as a reference, patients having undergone AMI + stent had the highest risk (hazard ratio [HR], 5.23; 95% confidence interval [CI], 1.81-15.14; p = 0.002), AMI alone without a stent had less risk (HR, 4.88; 95% CI, 1.49-16.01; p = 0.009), and stent alone with AMI had the lowest risk (HR, 3.16; 95% CI, 1.29-7.71; p = 0.012). In all patients, risk of AMI after TKA was not different than reference values after 1 year of initial AMI or stent (stent: HR, 1.67; 95% CI, 0.71-3.94; p = 0.239; AMI: HR, 1.88; 95% CI, 0.42-8.49; p = 0.412; AMI + stent: HR, 1.91; 95% CI, 0.53-6.89; p = 0.321). The risk of post-TKA AMI was elevated within 1 year of the previous episode of AMI/stent (0-180 days: HR, 8.42; 95% CI, 3.03-23.41; p < 0.001; 181-365 days: HR, 7.52; 95% CI, 2.47-22.88; p < 0.001). Only chronic renal failure under hemodialysis was associated with increased risk of AMI within 1 year of TKA (adjusted HR, 4.34; 95% CI, 1.22-15.43; p = 0.023). Patients undergoing TKA with no history of AMI/stent had a lower risk of AMI within 1 year of TKA compared with the patients with no history of surgery (adjusted HR, 0.92; 95% CI, 0.86-0.99; p = 0.016). This study found the risk of post-TKA AMI remains high within 1 year in patients with a history of AMI/stent. It is recommended that an elective TKA should be performed at least 1 year after an episode of AMI or stent placement. Stents do not provide protection against post-TKA AMI within 6 months of the AMI and patients with AMI + stent have a higher risk of AMI than those with only AMI. Patients of AMI/stent on hemodialysis have a very high risk of post-TKA AMI. However, the risk of AMI is lower in post-TKA patients compared with those with no TKA. Level III, prognostic study.

Constipation is commonly seen among patients with cardiovascular diseases and is linked to adverse outcomes. However, the association between constipation and the risk of acute myocardial infarction (AMI) remains conflicting. Therefore, we aimed to conduct a systematic review and meta-analysis to summarize the available data on this topic. We identified potentially eligible studies from the MEDLINE and EMBASE databases, searching from inception to May 2024, to investigate the association between constipation and the risk of developing AMI. To be included, studies needed to compare incidence of AMI between cohorts with and without constipation. Effect size and 95% confidence intervals (CIs) were combined using the generic inverse variance method. All statistical analyses were performed by Review Manager 5.4. Our meta-analysis included seven studies that met the eligibility criteria. There were 5,351,976 participants, with a mean age of 57.8 years and 74% were males. We found that patients with constipation had a 14% increased risk of AMI with a pooled risk ratio (RR) of 1.14 (95%CI: 1.08-1.14; I²=85%; p<0.001) compared to those without constipation. Our study revealed that constipation is associated with a higher risk of AMI. Emphasizing and addressing gastrointestinal health, including constipation, as an important issue is essential for comprehensive cardiovascular care.

Has the excess risk of acute myocardial infarction in rheumatoid arthritis relative to the general population declined? A population study of trends over time

* Use of beta(2) agonists has been associated with tachycardia, an abnormal ECG and atrial fibrillation. * Previous observational studies of the association between use of beta(2) agonists and the risk of acute myocardial infarction (MI) have demonstrated conflicting results. * Instead of a causal effect, the positive association between beta(2) agonist use and MI may be explained by latent ischaemic heart disease, which has symptoms that appear similar to respiratory complaints in chronic obstructive pulmonary disease. * The majority of beta(2) agonist users in our study population did not have an increased risk of nonfatal acute MI. * Only patients with ischaemic heart disease and who had recently started beta(2) agonists had an increased risk of acute MI. * It is likely that this increased risk was related to latent cardiovascular disease rather than direct effects of beta(2) agonists. Observational retrospective studies of the association between use of beta(2) agonists and the risk of acute myocardial infarction (MI) have demonstrated conflicting results, particularly among first-time users. The aim of this study was to examine the association between beta(2) agonist use and first nonfatal acute MI. We conducted a case-control study (2476 cases) nested in a cohort of antihypertensive drug users in the Dutch PHARMO RLS database. PHARMO RLS consists of drug dispensing linked to the national hospitalizations register. Each case of nonfatal acute MI was matched with up to 12 control patients by gender, age and region. Drug and disease history and the severity of the underlying respiratory disease were adjusted for. Risk of acute MI was increased in current beta(2) agonist users [crude odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61]. However, this excess risk was reduced after adjustment for severity of asthma and chronic obstructive pulmonary disease (adjusted OR 1.18, 95% CI 0.93, 1.49). The risk was highest in patients with ischaemic heart disease and low cumulative dose of beta(2) agonists (adjusted OR 2.47, 95% CI 1.60, 3.82). Most users of beta(2) agonists did not have an increased risk of acute MI. Only patients with ischaemic heart disease with low cumulative exposure to beta(2) agonists had an increased risk of acute MI. It is likely that this increased risk was related to latent cardiovascular disease rather than to the direct effects of beta(2) agonists.

There is conflicting evidence on whether the type of atrial fibrillation (AF) is associated with risk of cardiovascular events, including acute myocardial infarction (MI) and ischemic stroke. The aim of the present study was to investigate whether the risk of MI and ischemic stroke differs between individuals with first-diagnosed paroxysmal vs. non-paroxysmal AF treated with anticoagulants. De-identified electronic medical records from the TriNetX federated research network were used. Individuals with a new diagnosis of paroxysmal AF who had no evidence of other types of AF in their records were 1:1 propensity score-matched with individuals with non-paroxysmal AF, defined as persistent or chronic AF, who had no evidence of other types of AF in their records. All patients were followed for three years for the outcomes of MI and ischemic stroke. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). In the propensity-matched cohort, among 24 848 well-matched AF individuals [mean age 74.4 ± 10.4; 10 101 (40.6%) female], 410 (1.7%) were diagnosed with acute MI and 875 (3.5%) with ischemic stroke during the three-year follow-up. Individuals with paroxysmal AF had significantly higher risk of acute MI (HR: 1.65, 95%CI: 1.35-2.01) compared to those with non-paroxysmal AF. First diagnosed paroxysmal AF was associated with higher risk of non-ST elevation MI (nSTEMI) (HR: 1.89, 95%CI: 1.44-2.46). No significant association was observed between the type of AF and risk of ischemic stroke (HR: 1.09, 95%CI: 0.95-1.25). Patients with first-diagnosed paroxysmal AF had higher risk of acute MI compared to individuals with non-paroxysmal AF, attributed to the higher risk of nSTEMI among patients with first-diagnosed paroxysmal AF. There was no significant association between type of AF and risk of ischemic stroke.

Background: The cardiovascular risk associated with the newer epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), osimertinib, in non-small cell lung cancer (NSCLC) is being reported. While more than half of patients with NSCLC are aged 65 or older, whether the cardiovascular risk increases in older patients treated with osimertinib compared to traditional EGFR-TKIs has not been clearly identified. Objectives: We aimed to identify the risk of major adverse cardiovascular events (MACEs) in older patients treated with osimertinib and traditional EGFR-TKIs, stratifying by sex, age, and race/ethnicity. Design: A retrospective cohort study. Methods: Using the 2006–2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare, older patients with advanced NSCLC prescribed EGFR-TKIs were included. Hazard ratio (HR) and 95% confidence interval (CI) of incident MACEs were calculated using Cox proportional hazard model. Results: Osimertinib had a significantly higher risk of heart failure (HF) [HR, 1.20 (95% CI, 1.01–1.42)] and a lower risk of angina [HR, 0.36 (95% CI, 0.20–0.64)] than first/second-generation EGFR-TKI. The risk of HF and acute myocardial infarction (AMI) was significantly elevated in female [HR, 1.40 (95% CI, 1.13–1.73)] and male [HR, 1.98 (95% CI, 1.13–3.48)] subgroups, respectively, when used osimertinib than first/second-generation EGFR-TKIs. Within osimertinib users, the risk of HF was higher in patients aged ⩾75 ( versus aged 65–74) [HR, 1.71 (95% CI, 1.07–2.71)], White patients ( versus Asian/Pacific Islanders patients) [HR, 1.80 (95% CI, 1.04–3.12)]. The risk of AMI within osimertinib users was higher in White [HR, 3.23 (95% CI, 1.34–7.80)] and Black [HR, 5.63 (95% CI, 1.23–25.87)] than Asian/Pacific Islanders patients. Conclusion: Increased risk of HF was observed in patients who are female, White, and aged ⩾75 while male patients had a higher risk of AMI when treated with osimertinib than first/second-generation EGFR-TKIs. The in-depth examination of osimertinib-induced cardiotoxicity provides evidence for individualized cardiotoxicity surveillance, prevention, and treatment for osimertinib users.

We aimed to examine the prospective association between plasma FAs, oxylipins, and risk of acute myocardial infarction (AMI) in a Singapore Chinese population. A nested case-control study with 744 incident AMI cases and 744 matched controls aged 47-83 years was conducted within the Singapore Chinese Health Study. Nineteen plasma FAs and 12 oxylipins were quantified using MS. These were grouped into 12 FA clusters and 5 oxylipin clusters using hierarchical clustering, and their associations with AMI risk were assessed. Long-chain n-3 FAs [odds ratio (OR) = 0.67 per SD increase, 95% confidence interval (CI): 0.53-0.84, P < 0.001] and stearic acid (OR = 0.65, 95% CI: 0.44-0.97, P = 0.03) were inversely associated with AMI risk, whereas arachidonic acid (AA) was positively associated with AMI risk (OR = 1.25, 95% CI: 1.03-1.52, P = 0.02) in the multivariable model with adjustment for other FAs. Further adjustment for oxylipins did not substantially change these associations. An inverse association was observed between AA-derived oxylipin, thromboxane (TX)B2, and AMI risk (OR = 0.81, 95% CI: 0.71-0.93, P = 0.003). Circulating long-chain n-3 FAs and stearic acid were associated with a lower and AA was associated with a higher AMI risk in this Chinese population. The association between the oxylipin TXB2 and AMI requires further research.

Should COVID-19 be considered cardiovascular disease risk equivalent?

To determine if hyperuricemia and gouty arthritis are independent risk factors for acute myocardial infarction (MI) and, if so, whether they are independent of renal function, diuretic use, metabolic syndrome, and other established risk factors. We performed multivariable logistic and instrumental variable probit regressions on data from the Multiple Risk Factor Intervention Trial (MRFIT). Overall, there were 12,866 men in the MRFIT who were followed up for a mean of 6.5 years. There were 118 events of acute MI in the group with gout (10.5%) and 990 events in the group without gout (8.43%; P = 0.018). Hyperuricemia was an independent risk factor for acute MI in the multivariable regression models, with an odds ratio (OR) of 1.11 (95% confidence interval [95% CI] 1.08-1.15, P < 0.001). In multivariable regressions in which the above risk factors were used as covariates, gout was found to be associated with a higher risk of acute MI (OR 1.26 [95% CI 1.14-1.40], P < 0.001). Subgroup analyses showed that a relationship between gout and the risk of acute MI was present among nonusers of alcohol, diuretics, or aspirin and among those who did not have metabolic syndrome, diabetes mellitus, or obesity. In separate analyses, a relationship between gout and the risk of acute MI was evident among those with and without those hyperuricemia. The independent risk relationship between hyperuricemia and acute MI is confirmed. Gouty arthritis is associated with an excess risk of acute MI, and this is not explained by its well-known links with renal function, metabolic syndrome, diuretic use, and traditional cardiovascular risk factors.

Background: The impact of cannabis use on diabetes mellitus and associated cardiovascular events remains understudied. Rising trends in recreational cannabis use in the young prompted us to evaluate the risk and outcomes of acute myocardial infarction (AMI) in young diabetics with cannabis use disorder (CUD). Methods: We queried the National Inpatient Sample (2015 October-2017) to identify young adult admissions with diabetes. Demographically (age, sex, and race) matched (1:1) cohorts (CUD+ vs. CUD) were compared for comorbidities and risk of AMI and subsequent inpatient outcomes among young diabetics. Multivariable regression analysis was performed adjusting for confounders. Results: Of young adults admitted with diabetes (median 35 [29-40] years, 59.3% male, 42.3% white), demographically matched CUD+ (n=32170) and CUD- (n=32170) cohorts were obtained (Table 1). The CUD+ cohort often consisted of non-elective admissions (91.7% vs. 85.45%), Medicaid enrollees (51.6% vs. 38.7%), patients from lower household income quartile (47.9% vs. 43.1%) vs. CUD- cohort and had higher burden of smoking, alcohol abuse, chronic pulmonary disease, depression, psychosis and neurological disorders (p&lt;0.001). On adjusted multivariable analysis, the risk of AMI was 25% higher (OR:1.25, 95%CI:1.02-1.51, p=0.03) in CUD+ cohort, however, there was no significant difference in the subsequent inpatient mortality. Male sex (aOR1.35), non-elective admission (aOR2.46), Medicaid/self-pay enrollment (aOR 2.0/3.8), AIDS (aOR6.24), coagulopathy (aOR1.85), peripheral vascular disease (aOR 1.82), hypertension (aOR 2.12), hyperlipidemia (aOR2.53), smoking (aOR1.78), and obesity (aOR1.36) were independent predictors of AMI. Conclusion: Young diabetics with CUD may have 25% higher risk of AMI hospitalizations. Male sex, cardiovascular comorbidities, tobacco smoking, AIDS and coagulopathy independently predicted higher risk of AMI among young diabetics with CUD.

Related factors and incidence risk of acute myocardial infarction among the people with disability: A national population-based study.

Increased risk of acute myocardial infarction after COVID-19 recovery: A systematic review and meta-analysis

Effects of Long- and Intermediate-Acting Dihydropyridine Calcium Channel Blockers in Hypertension: A Systematic Review and Meta-Analysis of 18 Prospective, Randomized, Actively Controlled Trials.

Background: Epidemiologic studies suggest cadmium exposure is associated with hypertension, peripheral arterial disease, and risk of cardiovascular mortality. However, these associations may be confounded by tobacco smoking, a dominant source of cadmium exposure. To clarify cardiovascular risk of cadmium exposure independent of smoking, we investigated the association of urinary cadmium with risk of incident heart failure and acute myocardial infarction (AMI) in a case-cohort study of never-smokers.Methods: Between 1993-1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled in The Danish Diet, Cancer, and Health cohort. From the full cohort, we identified incident heart failure (n=958) and AMI (n=809) cases occurring between baseline and 2015 using the Danish National Patient Registry. We randomly selected a sub-cohort of 600 males and 600 females for comparison. We quantified cadmium and creatinine concentrations in urine samples collected at baseline. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios for heart failure and AMI in separate Cox proportional hazards models with age as the time scale, and stratified by sex.Results: Overall, participants had relatively low concentrations of urinary cadmium as expected for never smokers (median= 0.20; 25th, 75th= 0.13, 0.32 g cadmium/g creatinine). In adjusted models, higher urinary cadmium concentrations were associated with a higher risk for heart failure (HR=1.11 per interquartile range difference; 95% CI= 1.02-1.21). Furthermore, sex modified this association (Pheterogeneity=0.012). Higher urinary cadmium concentrations were associated with higher risk for heart failure among males (HR= 1.48; 95% CI= 1.18, 1.85), but not among females (HR= 1.06; 95%CI= 0.97, 1.17). Higher urinary cadmium concentrations were not associated with a higher risk of AMI (HR=1.02; 95% CI= 0.93, 1.12).Conclusion: Among never-smokers, urinary cadmium may be associated with higher risk for heart failure, especially among males. We did not observe an association between urinary cadmium and risk of AMI.

There are indications that beta-carotene, but not pre-formed vitamin A, is protective on the risk of acute myocardial infarction (AMI). The relationship between nonfatal AMI and the intake of beta-carotene and retinol was investigated in a case-control study conducted between 1983 and 1992 in northern Italy on 433 women with nonfatal AMI and 869 controls in hospital for acute, non-cardiovascular, non-neoplastic, non-digestive, non-hormone related conditions. Odds ratios (OR), with their 95% confidence intervals (CI), were computed by unconditional multiple logistic regression analysis, including terms for age, education, body mass index, smoking, alcohol and coffee drinking, menopausal status, hormone replacement therapy and history of diabetes, hypertension and hyperlipidemia. The risk of AMI was inversely related to beta-carotene intake, with an OR of 0.5 (95% CI: 0.3 to 0.8) for the highest quintile of intake compared to the lowest (chi2 trend = 10.53, p < 0.01). Retinol intake was not associated with AMI, with an OR of 0.9 (95% CI: 0.6 to 1.3) for the highest quintile of intake compared to the lowest. Analysis in separate strata of covariates indicated that the inverse association of beta-carotene intake with risk of AMI was appreciably stronger in younger, lean women with no history of diabetes or hypertension, and in current smokers. The results of this study indicate that the risk of nonfatal AMI in women is inversely related to intake of beta-carotene containing foods, but not foods containing retinol.