Cardiac Events In People Research Articles

Pitavastatin in the Prevention of Cardiovascular Disease in People Living with HIV: A Review.

HIV is associated with a wide array of pathophysiologic mechanisms that ultimately contribute to mortality. While HIV is traditionally known as a disease that attacks the immune system, it is now established that infection with HIV can cause cardiovascular disease (CVD). Through inflammation, atherogenesis, interactions with antiretroviral therapy/highly-active antiretroviral therapy (ART/HAART), and other mechanisms, HIV is an independent risk factor for the development of CVD. The treatment of the CVD risks associated with HIV is complicated, especially due to interactions with hyperlipidemic drugs and ART/HAART. There is a prompt need for a drug (or drug class) that is known to reduce the risk of CVD, specifically in people living with HIV. Recently, the randomized trial to prevent vascular events in HIV trial evaluated the usage of pitavastatin in preventing major cardiac events in people with HIV, showing a significant reduction in cardiac events among those taking the therapeutic. In this review, we evaluate the mechanisms by which HIV contributes to CVD, and the randomized trial to prevent vascular events in HIV trial, and postulate about future directions of the drug in treating people living with HIV.

SLCO1B1 and CYP3A4 allelic variants associated with pharmacokinetic interactions and adverse reactions induced by simvastatin and atorvastatin used in Peru: Clinical implications

Context: Statins reduce the risk of stroke and prevent cardiac events in people with atherosclerosis and diabetes mellitus; and could affect the proliferation, migration, and survival of cancer cells. Aims: To review the most up-to-date and available scientific evidence on the allelic variants of SLCO1B1 and CYP3A4 associated with pharmacokinetic interactions and adverse reactions induced by simvastatin and atorvastatin used in Peru, and their clinical implications. Methods: The bibliographic search was carried out in the PubMed/Medline, Google Scholar and Science Direct databases. The keywords were: “statin”, “atorvastatin”, “simvastatin” in combination with “pharmacokinetics”, “pharmacogenetics”, “CYP3A4”, “SLCO1B1” or “drug interactions” considering the eligibility criteria defined by the PRISMA-2020 international statement. Results: Scientific evidence indicates a significant association between SLCO1B1 rs4149056 c.521T>C (521CC and 521TC) and increased plasma levels, area under the plasma concentration curve (AUC) and maximum plasma concentration (Cmax) of simvastatin, compared to wild-type SLCO1B1*1/*1 521TT (p<0.05). SLCO1B1 521C is not associated with atorvastatin (p>0.05). Patients with SLCO1B1 521CC had a significantly higher risk of myopathy and rhabdomyolysis induced by simvastatin compared to TT (p<0.05). An association was also found between CYP3A4*1/*22/CYP3A4*3/*22 and increased pharmacokinetic parameters of simvastatin compared to CYP3A4*1/*1 (p< 0.05). Conclusions: Based on the review of the published scientific evidence, it is concluded that individuals carrying the allelic variants SLCO1B1 (c.521T>C), CYP3A4*1/*22 and CYP3A4*3/*22 could be associated with an increase in the pharmacokinetic parameters and with an increased risk of myopathy and rhabdomyolysis induced by simvastatin, and not by atorvastatin.

Non-alcoholic steatohepatitis and hepatic fibrosis are strongly associated with estimated 10-years cardiovascular risk in people living with severe obesity

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Cardiometabolic health, diabetes and obesity research network IUCPQ Foundation. Background Obesity (Body Mass Index [BMI] over 30 kg/m2) is associated with metabolic disturbances that promote the development and progression of cardiovascular diseases (CVD). However, the association between anthropometric indices of obesity (BMI, Waist Circumference [WC], Waist-to-Hip ratio [WHR] or Neck Circumference [NC]) and CVD risk factors has not always been observed in people living with severe obesity (BMI >35 kg/m2). Among obesity-related metabolic disorders, non-alcoholic ateatohepatitis (NASH) is associated with an increased risk of CVD and cardiac events. NASH has been shown to correlate with a degree of obesity, as defined by BMI or WC. The association between anthropometric parameters, NASH and CVD risk factors has not been explored yet in people living with severe obesity. Purpose The aim of this study was to explore the relationships between CVD risk score, anthropometric parameters and the presence of NASH (hepatic steatosis and fibrosis) in a population with severe obesity. Method A total of 2257 patients with severe obesity, who underwent bariatric surgery with concomitant liver biopsy were included. All biopsy specimens were classified according to the Brunt grading system. Pre-operative demographic and anthropometric data (age, sex, weight, height, BMI, WC, WHR, NC) were recorded. Comorbidities were assessed (type 2 diabetes, hypertension, dyslipidemia). The 10-year cardiovascular risk was calculated preoperatively in each patient using the Framingham risk score (FRS). Dependent variable FRS was compared using Kruskal Wallis H test and Chi2 exact test. Associations were tested using multivariate logistic regression analysis. Results In this specific population (mean age of 46.2 years old, mean BMI of 47.8 kg/m2, 69.1% female), FRS did not significantly increase with weight, BMI and WC, but was positively correlated with WHR and NC (p<0.05). A total of 47.3 % of patients with a histopathological diagnosis of NASH had a moderate-to-high FRS. Among NASH patients with histopathological evidence of grade-4 fibrosis, 69.3% had a moderate-to-high FRS. Presence of NASH and fibrosis were more strongly correlated with a moderate-to-high FRS (OR of 1.61 and 1.37, respectively), compared to all other anthropometric parameters (p<0.05), except WHR (OR of 1.99). Conclusion In people living with severe obesity, the presence of NASH and hepatic fibrosis is strongly associated with a high FRS but not more than WHR. Further research is needed to identify the best predictors of CVD and cardiac events in people living with NASH and severe obesity.

Longitudinal association of electrocardiogram abnormalities with major adverse cardiac events in people with Type 2 diabetes: the Hoorn Diabetes Care System cohort.

To investigate the association of (changes in) electrocardiogram (ECG) abnormalities with incident major adverse cardiac events (MACE) in people with Type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD). A prospective longitudinal study of 11 993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998-2018), included cardiovascular risk factors, over 70 000 ECG, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors, and medication use [hazard ratios (HRs) with 95% confidence intervals (CIs)]. During a median follow-up of 6.6 (IQR, 3.1-10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3-10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 coronary heart disease (CHD), 250 heart failure (HF), and 126 sudden cardiac arrest (SCA)). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration [HR, 4.01 (95% CI, 2.67-6.03)], QS pattern [2.68 (0.85-8.49)], ST-segment/T-wave abnormalities [4.26 (2.67-6.80)], and tall R-wave [2.23 (1.33-3.76)]. Only QS pattern [2.69 (1.20-6.03)] and ST-segment/T-wave abnormalities [2.11 (1.48-3.02)] were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups. In people with T2D without pre-existing CVD, ECG abnormalities related to decelerated conduction, ischaemia, and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischaemic disorders are signs of CHD.

Semaglutide: Charting New Horizons in GLP-1 Analogue Outcome Studies.

The growing epidemic of obesity and diabetes represents a growing health emergency, exemplified by a marked increase in cardiovascular and renal disease. As such, healthcare systems are increasingly focussing on therapeutic approaches to address these challenges. Cardiovascular outcome trials (CVOTs) evaluating glucagon-like peptide-1 (GLP-1) analogues have previously observed significant improvements in major adverse cardiac events in people with type 2 diabetes (T2D). However, their impact in obese people without T2D is unknown. The SELECT study is the first pharmacotherapy study in obesity powered for cardiovascular superiority and investigates the impact of semaglutide on cardiovascular disease outcomes in overweight and obese people without T2D. The results of this study will potentially redefine obesity management, especially as secondary outcomes of the study will include evaluation of health-related quality of life and incident diabetes rates. In another potentially evolutionary therapeutic step for the incretin class of therapeutic agents, the FLOW study is the first dedicated study to investigate the effects of GLP-1 receptor analogues on renal and cardiovascular outcomes in people with renal impairment and T2D. Post-hoc analyses of GLP-1 analogue CVOTs have demonstrated reduced adverse renal outcomes associated with their use. In this review we discuss the known impact of GLP-1 analogues on cardiovascular, weight and renal outcomes in previous CVOTs. We further discuss the importance of the ongoing SELECT and FLOW studies on shifting the paradigm of obesity pharmacotherapy and in adding to our understanding of renal disease management in people with T2D.

Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis

ObjectiveTo examine the association of comorbid occurrence of diabetes and depression with risk of cardiovascular endpoints including cardiovascular mortality, coronary heart disease and stroke. Research design and methodsA systematic review and metaanalysis. We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models. ResultsNine studies met the inclusion criteria. The combined pooled hazard ratios showed a significant association of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p = 0.001, for coronary heart disease 1.37 (1.165, 1.605), p < 0.001 and for stroke 1.33 (1.291, 1.369), p < 0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed that depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p < 0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies. ConclusionsWe have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes.

Comorbid Depression and Risk of Cardiac Events and Cardiac Mortality in People with Diabetes: A Systematic Review and Meta-Analysis

Objective: To examine the comorbid occurrence of diabetes and depression with clinical CVD endpoints, by conducting a systematic review and meta-analysis of observational studies. Research Design and Methods: We searched PUBMED/MEDLINE, Medscape, Cochrane Library, CINAHL, EMBASE and Scopus databases assessing cardiac events and mortality associated with depression in diabetes up until 1 December 2018. Pooled hazard ratios were calculated using random- effects models. Results: Nine studies met the inclusion criteria. The combined pooled hazard ratios all showed a significant risk of cardiac events in people with depression and type 2 diabetes, compared to those with type 2 diabetes alone. For cardiovascular mortality the pooled hazard ratio was 1.48 (95% CI: 1.185, 1.845), p=0.001, for coronary heart disease 1.37 (1.165, 1.605), p<0.001 and for stroke 1.33 (1.291, 1.369), p<0.001. Heterogeneity was high in the meta-analysis for stroke events (I-squared = 84.7%) but was lower for coronary heart disease and cardiovascular mortality (15% and 43.4% respectively). Meta-regression analyses showed the impact of depression was not significantly associated with the study level covariates mean age, duration of diabetes, length of follow-up, BMI, sex and ethnicity (p<0.05 for all models). Only three studies were found that examined the association of depression in type 1 diabetes, there was a high degree of heterogeneity and data synthesis was not conducted for these studies. Conclusions: We have demonstrated a 47.9% increase in cardiovascular mortality, 36.8% increase in coronary heart disease and 32.9% increase in stroke in people with diabetes and comorbid depression. The presence of depression in a person with diabetes should trigger the consideration of evidence-based therapies for cardiovascular disease prevention irrespective of the baseline risk of cardiovascular disease or duration of diabetes. Funding Statement: The authors state: None. Declaration of Interests: The authors stated: None relevant to declare. Ethics Approval Statement: No separate ethical approval was required for the conduct of this study, as any necessary ethical approval was obtained for each of the individual studies contributing data to the meta-analysis. The authors conducted this literature-based review using a protocol registered in the PROSPERO International prospective register of systematic reviews (ID=CRD42017083968) and in accordance with guidelines of PRISMA.

Anhedonia predicts adverse cardiac events in people with acute coronary syndromes

ED FROM Davidson KW, Burg MM, Kronish IM, et al. Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Arch Gen Psychiatry 2010;67:480–8. Correspondence to: Karina Davidson, Department of Medicine, Columbia University College of Physicians and Surgeons, Room 948, PH9 Center, 622 W 168th Street, New York, NY 10032, USA; kd2124@columbia.edu Sources of funding: National Heart Lung and Blood Institute (grants HC-25197, HL-076857, HL-084034m HL-04458). OM M EN TA RY Davidson and colleagues build on recent research which tries to disentangle the association between symptoms of depression and cardio- vascular prognosis. For example, de Jonge and col- leagues1 showed that somatic/affective depressive symptoms predicted cardiovascular mortality, but that cognitive/affective symptoms did not. Davidson and colleagues’ results are more specifi c in that they con- centrated on two core diagnostic symptoms – anhedo- nia and depressed mood – with only anhedonia being a consistent predictor of prognosis. The results require replication, as other recent fi ndings are somewhat con- tradictory.2 The generalisability of the results may be affected by the lower participation rates of Hispanic and older patients, while the use of all-cause mortality as an end point could be a further biasing factor. Elimination of those with intermediate levels of depressive symp- toms is another acknowledged limitation. Innovatively, the authors showed that anhedonia remained predic- tive when controlling for the effects of major depression but also somatic depressive symptoms. While screening for anhedonia could easily be included in clinical practice, it is perhaps unlikely to be so, given the relatively ineffective interventions for depression available in this population.3 Furthermore, as the authors point out, it is unknown if these treatments affect anhedonia levels specifi cally. The results highlight the probability that the heterogeneity of major depres- sion criteria has hindered research into this area.2 3 Re-categorisation of the diagnostic criteria into more specifi c subsets may aid future research, for example, the use of categories such as ‘anhedonic depression’. Overall, information from such studies will likely inform more sophisticated, and hopefully successful, interven- tion trials in cardiac patients in the future.

Screening doesn′t prevent cardiac events in people with type 2 diabetes

Screening doesn′t prevent cardiac events in people with type 2 diabetes

Significant and increasing depressive symptoms are associated with increased risk of new cardiac events in people with a heart attack in the previous year

Significant and increasing depressive symptoms are associated with increased risk of new cardiac events in people with a heart attack in the previous year

The cardiovascular manifestations of rheumatic diseases

To review the cardiovascular manifestations of several more common rheumatic conditions in the light of the recent reported literature. Evidence that chronic inflammation is associated with the occurrence of cardiac events in people both with and without chronic inflammatory joint disease is emerging. Both atherosclerosis and rheumatic diseases, however, have a complicated cause, and it is likely that inflammation contributes to other environmental and host risk factors in these patients. Treatments used to suppress inflammation in many rheumatic conditions have the potential to reduce cardiovascular disease morbidity as well as improve musculoskeletal function. Cardiovascular morbidity and mortality have been found to be increased in association with many of the rheumatic diseases. In particular, coronary heart disease seems to be associated with inflammatory rheumatic conditions. Whilst it is likely that chronic systemic inflammation promotes accelerated atherosclerosis in these patients, the mechanisms by which this occurs are complex and the effects of treatment and other cardiovascular risk factors need to be considered.

Percutaneous transluminal coronary angioplasty with stents versus coronary artery bypass grafting for people with stable angina or acute coronary syndromes.

Coronary artery bypass graft surgery (CABG) replaces obstructed vessels with ones from other parts of the body. Alternatively, obstructions are remodelled using catheter-based techniques such as percutaneous coronary angioplasty with the use of stents. Though less invasive, stenting techniques are limited by the re-narrowing of treated vessels (restenosis). We examined evidence on cardiac-related outcomes occurring after CABG or stenting, with implications for resource use, resource allocation and informing patient choice. To examine evidence from randomised controlled trials (RCTs) on benefit of stents or CABG in reducing cardiac events in people with stable angina or acute coronary syndrome (ACS). CENTRAL (Issue 2 2004), EMBASE (1990 to 2004), MEDLINE (1990 to 2004) and handsearching to July 2004. Only RCTs comparing stents used with PTCA with CABG were included. Participants were adults with stable angina or ACS and unstable angina and had either single or multiple vessel disease. Published and unpublished sources were considered. Outcomes included composite event rate (major adverse cardiac event, event free survival), death, acute myocardial infarction (AMI), repeat revascularisation and binary restenosis as well as information on design and baseline characteristics. Quality assessment was completed independently. Meta-analyses are presented as odds ratios, 95% confidence intervals (CI) using a fixed-effect model. Heterogeneity between trials was assessed. Nine studies (3519 patients) were included. Four RCTs included patients with multiple vessel disease, five focused on single vessel disease. Four studies reported beyond 1 year. No statistical differences were observed between CABG and stenting for meta-analysis of mortality or AMI, but there was heterogeneity. Composite cardiac event and revascularisation rates were lower for CABG than for stents. Odds ratios resulting from meta-analysis of event rate data at 1 year were, odds ratio 0.43 (95% CI 0.35 to 0.54) and at 3 years, odds ratio 0.37 (95% CI 0.29 to 0.48). Odds ratios for revascularisation at 1 year were, odds ratio 0.18 (95% CI 0.13 to 0.25) and at 3 years, odds ratio 0.09 (95% CI 0.02 to 0.34). Binary restenosis at 6 months (single vessel trials) favoured CABG, odds ratio 0.29 (95% CI 0.17 to 0.51). CABG is associated with reduced rates of major adverse cardiac events, mostly driven by reduced repeat revascularisation. However, the RCT data are limited by follow-up, unrepresentative samples and rapid development of both surgical techniques and stenting. Research on real-world patient population or patient level data meta-analyses may identify risk factors and groupings who may benefit most from one strategy over the other.

Clarithromycin may reduce the risk of ischemic cardiac events in people with acute non-Q-wave infarction or unstable angina

Clarithromycin may reduce the risk of ischemic cardiac events in people with acute non-Q-wave infarction or unstable angina

Twenty-four hour mean blood pressure predicts stroke and pulse pressure predicts cardiac events in people with essential hypertension

Twenty-four hour mean blood pressure predicts stroke and pulse pressure predicts cardiac events in people with essential hypertension

Sudden cardiac death triggered by an earthquake.

The earthquake that struck the Los Angeles area at 4:31 a.m. on January 17, 1994, was one of the strongest earthquakes ever recorded in a major city in North America. Once the life-threatening situation was over, the Northridge earthquake, so called because its epicenter was near Northridge, California, just north of Los Angeles, provided investigators an unusual opportunity to examine the relation between emotional stress and sudden cardiac death. We reviewed the records of the Department of Coroner of Los Angeles County for the week before the earthquake, the day of the earthquake, the six days after the earthquake, and corresponding control periods in 1991, 1992, and 1993. On the day of the earthquake, there was a sharp increase in the number of sudden deaths from cardiac causes that were related to atherosclerotic cardiovascular disease, from a daily average (+/- SD) of 4.6 +/- 2.1 in the preceding week to 24 on the day of the earthquake (z = 4.41, P < 0.001). Sixteen victims of sudden death had symptoms, usually chest pain, or died within the first hour after the initial tremor. Only three sudden deaths occurred during or immediately after unusual physical exertion. During the six days after the earthquake, the number of sudden deaths declined to below the base-line value, to an average of 2.7 +/- 1.2 per day. The Northridge earthquake was a significant trigger of sudden death due to cardiac causes, independently of physical exertion. This finding, along with the unusually low incidence of such deaths in the week after the earthquake, suggests that emotional stress may precipitate cardiac events in people who are predisposed to such events.