Control Of Classical Risk Factors Research Articles

Study of serum calcium and phosphorus levels in chronic kidney disease patients with acute coronary syndrome

BackgroundCardiovascular (CVS) conditions remain the main etiology of death in individuals with chronic kidney disease (CKD) even after control of classic risk factors of cardiovascular disease (CVD).AimThis study is to detect the sequalae of serum phosphorus and calcium level abnormalities in individuals with CKD and their relation to occurrence of acute coronary syndrome (ACS) in those cases.MethodsA cross-sectional work involved 100 individuals with CKD managed with or without dialysis. They were admitted to Internal Medicine Department, Coronary Care Unit of Sohag University Hospital. Each participant had been subjected to full history taking, clinical assessment, and investigations including serum calcium, phosphorus, creatinine, blood urea, parathyroid hormone level, lipid profile, troponin, CK-MB, electrocardiogram, and echocardiography.ResultsA substantial elevation in serum calcium and phosphorus levels was existed in individuals with CKD with ACS group compared to patients with CKD without ACS group (p = 0.026 and 0.001 respectively). The mean calcium/phosphorus ratio was 3.04 ± 2.14 in patients with CKD with ACS group, while it was 2.31 ± 1.17 in patients with CKD without ACS group. A substantial raise in calcium/phosphorus ratio was existed in CKD with ACS group as compared to patients with CKD without ACS group (p = 0.047). ROC curve analysis shows that calcium/phosphorus ratio can predict acute coronary syndrome at cutoff 1.94 with area under the curve 0.652 with sensitivity and specificity that were 77.8% and 52.1% correspondingly (p = 0.007).ConclusionA substantial raise in calcium and phosphorus levels was existed in individuals with CKD with ACS group contrasted to individuals with CKD without ACS group. Calcium/phosphorus ratio can predict acute coronary syndrome at cutoff 1.94.Clinical trial registration numberNCT05134220.

A multiple risk factor programis associated with decreased risk of cardiovascular disease in 70-year-olds: A cohort study from Sweden.

In individuals below 65 years of age, primary prevention programs have not been successful in reducing the risk of cardiovascular disease (CVD) and death. However, no large study to our knowledge has previously evaluated the effects of prevention programs in individuals aged 65 years or older. The present cohort study evaluated the risk of CVD in a primary prevention program for community-dwelling 70-year-olds. In 2012-2017, we included 3,613 community-dwelling 70-year-olds living in Umeå, in the north of Sweden, in a health survey and multidimensional prevention program (the Healthy Ageing Initiative [HAI]). Classic risk factors for CVD were evaluated, such as blood pressure, lipid levels, obesity, and physical inactivity. In the current analysis, each HAI participant was propensity-score-matched to 4 controls (n = 14,452) from the general Swedish population using national databases. The matching variables included age, sex, diagnoses, medication use, and socioeconomic factors. The primary outcome was the composite of myocardial infarction, angina pectoris, and stroke. The 18,065 participants and controls were followed for a mean of 2.5 (range 0-6) years. The primary outcome occurred in 128 (3.5%) HAI participants and 636 (4.4%) controls (hazard ratio [HR] 0.80, 95% CI 0.66-0.97, p = 0.026). In HAI participants, high baseline levels of blood pressure and lipids were associated with subsequent initiation of antihypertensive and lipid-lowering therapy, respectively, as well as with decreases in blood pressure and lipids during follow-up. In an intention-to-treat approach, the risk of the primary outcome was lower when comparing all 70-year-olds in Umeå, regardless of participation in HAI, to 70-year-olds in the rest of Sweden for the first 6 years of the HAI project (HR 0.87, 95% CI 0.77-0.97, p = 0.014). In contrast, the risk was similar in the 6-year period before the project started (HR 1.04, 95% CI 0.93-1.17, p = 0.03 for interaction). Limitations of the study include the observational design and that changes in blood pressure and lipid levels likely were influenced by regression towards the mean. In this study, a primary prevention program was associated with a lower risk of CVD in community-dwelling 70-year-olds. With the limitation of this being an observational study, the associations may partly be explained by improved control of classic risk factors for CVD with the program.

Coronavirus-nephropathy; renal involvement in COVID-19

Renal disturbances by coronavirus disease 2019 (COVID-19), consisted of acute kidney injury, due to acute tubular necrosis induced by sepsis, hydration, cytokine storm syndrome, rhabdomyolysis and hypoxia. As the direct cytopathic effect of virus on various renal cells has been detected in previous studies, direct virus invasion to the renal tubular cells and interstitium or glomeruli is possible. Previous studies showed that coronavirus enters into the cells by angiotensin-converting enzyme II receptors that are extensively presented in the renal cells. Further, acute kidney injury in COVID-19 is strongly associated with higher mortality and morbidity and is an indicator for survival with Coronavirus infection. In the overall approach to patients with COVID-19 infection, special attention should be paid to control of classical risk factors of kidney injury.

Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors

Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors

Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors

Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors

Pregnancy and Long-Term Maternal Cardiovascular Health: Progress Through Harmonization of Research Cohorts and Biobanks.

In 2011, the American Heart Association added preeclampsia, gestational diabetes mellitus (GDM), and delivery of a growth-restricted child as pregnancy-related risk factors for cardiovascular disease (CVD).1 This move was applauded by the obstetric research community, which for some years had emphasized the importance of pregnancy as a stress test for detecting women at excessive risk for premature CVD.2–4 CVD is the leading cause of death for men and women in high-income and most low-to-middle–income countries.5 Globally, coronary artery disease kills more women than men,6 although women develop CVD 10 to 15 years later than men. Women frequently present with unrecognized CVD symptoms and are twice as likely as men to die of a first acute myocardial infarction if <50 years old.7 The preclinical stages of CVD are evident from a young age and are modifiable through control of classic risk factors (insulin resistance/diabetes mellitus, obesity, lack of exercise, tobacco smoking, hypertension, and hyperlipidemia).8,9 In this regard, pregnancy is a window of opportunity for identifying those women with perinatal complications who may benefit from early risk detection and early CVD prevention. In this article, we summarize the associations between pregnancy, placenta-related pregnancy complications, and future maternal CVD. We present established as well as more novel hypotheses, which may explain these epidemiological associations. The interventions that potentially could reduce risks of future CVD are enumerated. To facilitate progress, we suggest methods of harmonizing study designs, long-term follow-ups of pregnancy cohorts and biobanks, and pooling of the world’s data in ways that can enhance the power of current and future research. ### Preeclampsia and Fetal Growth Restriction and Future CVD Risk Preeclampsia is a pregnancy-specific multisystem disorder defined by new-onset hypertension and proteinuria after gestational week 20, or new onset preeclampsia-associated signs in the absence of proteinuria.8 Preeclampsia requires the presence of …

Significance of the nitrosative-oxidative stress disequilibrium on endothelial dysfunction during cardiac development

Endothelial dysfunction as a consequence of a variety of common cardiovascular disease risk factors is thought to be associated with increased reactive oxygen species (ROS) and the subsequent decrease in vascular bioavailability of nitric oxide (NO). In this article we give a detailed discussion of evidence of the impact of oxidative-nitrosative stress during maternal pregnancy on fetal development in animal models and also the association with the onset of cardiovascular conditions in adult humans. We highlighted specifically the presence of ROS in circulating blood as the key intermediary related to vascular injury and organ dysfunction, the evidence that red blood cells regulate the arteriolar microcirculation, coupling oxygen delivery with blood flow, and highlighting their role in NO bioavailability. The unique nature of relationship between cell-signalling, transcriptional mechanisms and oxidative-nitrosative stress in the progression of coronary heart disease has also been discussed in greater detail. We have also discussed the emerging concepts that pharmacological prevention of cardiovascular events in the future might consists of the control of classical risk factors with specific interventions targeting oxidative stress while simultaneously improving NO production.

Prevention and treatment of coronary artery vasculopathy

Cardiac allograft vasculopathy (CAV) is still one of the major causes of death following heart transplantation. Here, we review the recent advances in its prevention and treatment. Preventive measures comprise control of classical risk factors, prophylaxis against cytomegalovirus, avoidance of graft endothelial damage during heart transplantation, and prevention of acute rejection. These measures can be effective if begun early. The treatment options for established CAV are limited, percutaneous revascularization and coronary artery bypass graft only being viable for a minority of patients because of the diffuse nature of CAV. Retransplantation is the only definitive therapy for CAV and may be considered for suitable patients with advanced CAV and allograft dysfunction. One of the most promising developments in the recent years is the use of mTOR inhibitors, which can now be regarded as effective in preventing CAV in de novo patients; their role in the treatment of established CAV is still uncertain despite some encouraging recent findings. The implementation of measures and lifestyles that help prevent CAV should be a priority of postheart transplantation management. Research should urgently evaluate mTOR inhibitors for the treatment of established CAV.

Commentary atherosclerosis, vascular aging and therapeutic strategies

With the arrival of the era of global population aging, we strive for healthy aging and a healthy senior life rather than simple prolongation of the physical age. For the past 50 years, cardiovascular diseases (CVD) have been the most common cause of death among the elderly people globally. In China, there has been an exponential increase in the incidence of heart disease and stroke in the elderly population. Atherosclerosis is the pathological change in the coronary artery disease, stroke, and peripheral vascular disease. Despite the significant benefit demonstrated, control of classic risk factors alone, such as lifestyle change or drug therapy, was shown to have limitations in reducing the incidence of cardiovascular events. Vascular aging has been shown to be an important independent predictor of CVD events. Interventions targeting vascular aging have emerged as a new paradigm in conjunction with control of risk factors for the prevention of CVD. Vascular aging and atherosclerosis are two distinct pathological changes and difficult to distinguish clinically. Recent research with Chinese medicine (CM) has shown encouraging observations, linking the clinical benefit of delaying vascular aging and treating atherosclerosis. These results demonstrate great potential of CM in the prevention and treatment of CVD.

Left atrial thrombus formation early after mitral valve replacement

THE RISK OF STROKE after mitral valve replacement is at its highest within the first postoperative month. 1 Orszulak T.A. Schaff H.V. Pluth J.R. et al. The risk of stroke in the early postoperative period following mitral valve replacement. Eur J Cardiothoracic Surg. 1995; 9: 615-619 Crossref PubMed Scopus (37) Google Scholar , 2 Heras M. Chesebro J.H. Fuster V. et al. High risk of thromboemboli early after bioprosthetic cardiac valve replacement. J Am Coll Cardiol. 1995; 25: 1111-1119 Abstract Full Text PDF PubMed Scopus (251) Google Scholar Although transesophageal echocardiography (TEE) can show the presence of small thrombi or strands in the first 24 hours after mitral valve replacement, 3 Bonnefoy E. Perinetti M. Girard C. et al. Systematic transesophageal echocardiography during the postoperative first 24 hours after mitral valve replacement. Arch Mal Coeur Vaiss. 1995; 88: 315-319 PubMed Google Scholar there are few reports of clinically relevant left atrial thrombus occurring within the first postoperative hours. 4 Take A. Yamaguchi T. Horimi H. et al. Left atrial thrombus in the early postoperative period after mitral valve replacement. Nippon Kyobu Geka Gakkai Zasshi. 1991; 39: 1039-1048 PubMed Google Scholar Moreover, evidence for de novo thrombus formation despite optimal control of classical risk factors is frequently not provided, and postoperative changes in intracardiac hemodynamics associated with thrombus formation are frequently poorly documented. Left atrial thrombus formation within the first 2 postoperative hours after mitral valve replacement is reported below despite surgical and echocardiographic verification of the emptiness of the left atrial appendage and postbypass restoration of sinus rhythm. Serial evaluation by transesophageal echocardiography allowed an extensive description of the postoperative changes in intracardiac hemodynamics associated with early thrombus formation.

Psychosocial distress and impaired quality of life--targets neglected in the secondary prevention in women with ischaemic heart disease.

Secondary prevention in patients with ischaemic heart disease (IHD) focusing on classical risk factors has been less successful in women than in men. Previous studies have suggested that psychosocial factors may be new targets for secondary prevention. In the present study, psychosocial factors have been compared in women with and without IHD. Using a cross-sectional comparison, classical cardiovascular risk factors and self-rated stress behaviour, vital exhaustion, stressful life events and quality of life were assessed in 198 women (age 35-77 years) who had IHD and a population-based sample of 206 women (age 45-74 years) without IHD. Control of classical risk factors was most often adequate in women with IHD. The prevalence of smoking was 9% in women with versus 18% in women without IHD (P<0.001), blood pressure levels were similar, and a very large share of women with IHD were on treatment with anti-thrombotic, anti-hypertensive and/or lipid-lowering drugs (P<0.001 compared with women free of IHD). In contrast, women with IHD scored significantly worse than women without IHD in self-rated stress behaviour (P=0.003 after adjustment for other possible determinants), and in vital exhaustion (P=0.003). In univariate analyses, quality of life was significantly worse in women with IHD. Stressful life events did not differ between the two groups. In this group of women with IHD, control of classical risk factors was good, whereas control of psychosocial risk factors was clearly inadequate. Secondary prevention by psychosocial intervention in women with IHD should be evaluated in randomized controlled trials.