Cardiovascular Disease Mortality In Patients Research Articles

Elevated HbA1c level: a risk factor for cardiovascular disease mortality in patients with chronic heart failure?

This Practice Point commentary discusses a study by Gerstein et al. that found an independent relationship between HbA(1c) level and the risk of cardiovascular mortality, death from any cause, or worsening heart failure in patients with chronic heart failure. The magnitude of this risk increased by approximately 10-20% per 1% increase in HbA(1c) level. These findings add to a growing body of evidence that HbA(1c) levels predict cardiovascular disease mortality and morbidity in individuals with low, medium and high risks of cardiovascular disease. However, further research will be required to establish whether lowering HbA(1c) levels to <7% reduces the risk of cardiovascular events. Nevertheless, measurement of HbA(1c) level could identify and target effective therapies to individuals who are at high risk of cardiovascular disease. Improved understanding of the role of glycemic control in the development of cardiovascular disease might indicate new interventions for treatment and prevention.

Interpreting studies of cardiovascular mortality in rheumatoid arthritis: The importance of timing

Interpreting studies of cardiovascular mortality in rheumatoid arthritis: The importance of timing

Cardiovascular disease in dialysis patients: do some antihypertensive drugs have specific antioxidant effects or is it just blood pressure reduction? Does antioxidant treatment reduce the risk for cardiovascular disease?

Patients with end-stage renal disease have an extremely high cardiovascular disease mortality. Oxidative stress is one of the 'nontraditional' risk factors for cardiovascular disease mortality in dialysis patients. This review discusses antioxidant activity of the commonly prescribed antihypertensive agents and the effects of antioxidant interventions on cardiovascular disease mortality in patients with end-stage renal disease. Several lines of evidence confirm antioxidant activity of the renin-angiotensin-aldosterone antagonists, some of the calcium channel blockers, carvedilol, and hydralazine. This appears to be independent of their antihypertensive activity. Clinical evidence of their superiority in improving cardiovascular disease endpoints in end-stage renal disease, however, is lacking. There are no randomized trials that have examined the effect of correcting oxidative stress on clinical endpoints. One randomized study in patients on hemodialysis reported a reduction in oxidative stress and the plasma methylarginines with valsartan and amlodipine but no clinical endpoints were examined. The effects of the antihypertensive agents with antioxidant activity on cardiovascular disease mortality in end-stage renal disease have not been examined in randomized clinical trials. These agents may offer specific clinical advantage in addition to lowering the blood pressure, but this remains to be proven. Two studies show a reduction in cardiovascular disease events with vitamin E and N-acetylcysteine in patients on hemodialysis without an effect on overall mortality.

H 021 QUALITY OF LIFE OF HYPERTENSIVE PATIENTS TREATED AT AN OUTPATIENT CLINIC

The significance of the metabolic syndrome (MetS) resides either in its ability to identify individuals at high risk of future disease and disability or in its ability to identify individuals in need of a specific treatment. We have previously shown that in the general population the ability of the MetS to identify individuals at increased risk of diabetes or cardiovascular disease (CVD) is inferior to the ability of established predicting models for these conditions. Although it may someday become routine to recommend treatment with insulin-sensitising agents for non-diabetic individuals with the MetS, most of whom are insulin resistant, there are no clinical trial data to support such a recommendation at the present time. Currently, the treatment of the MetS is based on treatment of its component parts.In the present paper, we examine the role of the MetS as defined by the National Cholesterol Education Program (NCEP) criteria in predicting all-cause and CVD mortality in patients with prevalent CVD from the San Antonio Heart Study (SAHS). This population contains a high proportion of Mexican Americans, who are at high risk of developing type 2 diabetes. After adjusting for age and gender, the MetS is moderately predictive of all-cause and CVD mortality. After further adjustment for diabetes, however, the effect of the MetS becomes non-significant in this population. Moreover, among non-diabetics with prevalent CVD, the MetS was not associated with either all-cause or CVD mortality. Thus, this study indicates that the effect of the MetS on these endpoints is primarily driven by the inclusion in the NCEP definition of diabetes, itself a well-established, potent CVD risk factor. In fact, the prevalence of diabetes in SAHS patients with CVD and the MetS was 42% compared with only 9% in patients with CVD, but without the MetS. This excess prevalence of diabetes appears to account for the enhanced all-cause and CVD mortality in subjects with the MetS. However, these results will need to be confirmed in other populations.

Impact of diabetes/metabolic syndrome in patients with established cardiovascular disease

The significance of the metabolic syndrome (MetS) resides either in its ability to identify individuals at high risk of future disease and disability or in its ability to identify individuals in need of a specific treatment. We have previously shown that in the general population the ability of the MetS to identify individuals at increased risk of diabetes or cardiovascular disease (CVD) is inferior to the ability of established predicting models for these conditions. Although it may someday become routine to recommend treatment with insulin-sensitising agents for non-diabetic individuals with the MetS, most of whom are insulin resistant, there are no clinical trial data to support such a recommendation at the present time. Currently, the treatment of the MetS is based on treatment of its component parts. In the present paper, we examine the role of the MetS as defined by the National Cholesterol Education Program (NCEP) criteria in predicting all-cause and CVD mortality in patients with prevalent CVD from the San Antonio Heart Study (SAHS). This population contains a high proportion of Mexican Americans, who are at high risk of developing type 2 diabetes. After adjusting for age and gender, the MetS is moderately predictive of all-cause and CVD mortality. After further adjustment for diabetes, however, the effect of the MetS becomes non-significant in this population. Moreover, among non-diabetics with prevalent CVD, the MetS was not associated with either all-cause or CVD mortality. Thus, this study indicates that the effect of the MetS on these endpoints is primarily driven by the inclusion in the NCEP definition of diabetes, itself a well-established, potent CVD risk factor. In fact, the prevalence of diabetes in SAHS patients with CVD and the MetS was 42% compared with only 9% in patients with CVD, but without the MetS. This excess prevalence of diabetes appears to account for the enhanced all-cause and CVD mortality in subjects with the MetS. However, these results will need to be confirmed in other populations.

Pravastatin reduced all-cause mortality, CHD mortality, and cardiovascular disease mortality in patients with existing CHD

Pravastatin reduced all-cause mortality, CHD mortality, and cardiovascular disease mortality in patients with existing CHD