Combined Coronary Heart Disease Research Articles

DETERMINING THE EFFECTIVENESS OF THE TREATMENT OF CORONARY HEART DISEASE

The frequency of the combination of coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD) is highlighted in the work, and it is concluded that there is a fairly significant stratum of patients, namely 25,9%, with combined pathology of the respiratory system and cardiovascular. On the basis of the therapeutic department of the Poltava central regional clinical hospital, 97 patients (84 men and 13 women) with a combination of COPD and CHD were examined: stable angina pectoris, grade II, which were hospitalized due to exacerbation of respiratory pathology. They were divided into 2 groups. Group 1 patients (51 people) received only basic therapy (β2-agonists, anticholinergics, methylxanthines, inhaled glucocorticosteroids, phosphodiesterase-4 inhibitors). In addition to basic therapy, patients of the 2nd group (46 people) were additionally prescribed L-arginine («Tivomax») in the form of a 4,2% solution of 100 ml intravenously once a day for 10 days. As a result of the treatment, a positive dynamics of the regression of clinical manifestations of acute exacerbation of COPD was revealed in both study groups. However, in the second group of subjects who receive L-arginine on the basis of basic therapy, clinical indicators, indicators of the function of external respiration and exercise tolerance, indicators of cardiohemodynamics significantly (p<0,05) improved compared with the control group. It was concluded that the inclusion of L-arginine in the complex treatment of patients with exacerbation of COPD and concomitant CHD increases the effectiveness of the treatment of respiratory pathology and improves cardiodynamics. The addition of L-arginine to complex therapy for patients with COPD in combination with CHD leads to a statistically significant improvement in clinical and instrumental parameters, which is due to the antihypoxic, antiplatelet, cytoprotective and vasodilatory effects, detoxification activity of L-arginine (“Tivomax”), which is safe improves the effectiveness of treatment.

Research on the effects of CPAP for OSA combined CHD long-term prognosis

Objective:To investigate the effects of CPAP for obstructive sleep apnea（OSA） combined CHD（coronary heart disease） long-term prognosis. Method:One hundred and twenty cases of OSA combind CHD in gansu province people's hospital sleep center were randomly divided into two groups according to apnea hypopnea index（AHI）, group A（light, medium OSA and CHD） 60 cases, group B（severe OSA and CHD） 60 cases. Contrast analysis and comparison between two groups PSG（Polysomnography） parameters, and the differences between the degree of coronary artery lesions and CPAP therapy effect on coronary long-term prognosis. Result:Compared group B with A, AHI, BMI, LSaO2, Epworth sleepiness scale（ESS） score, the amino acid homocysteine, the prevalence of hypertension, type 2 diabetes, the prevalence of acute myocardial infarction（ami） and vascular lesions and SYNTAX score increased significantly（P<0.05）. The ejection fraction decreased significantly（P<0.05）. The BNP（Brain natriuretic peptide） and cTNT（cardiac troponin, cTn） concentration there was no significant difference between the two groups（P>0.05）. CPAP treatment（30.0±4.2） months later, Group B: CAPA + conventional treatment group, compared with the simple routine LSaO2, ejection fraction increased significantly（P<0.05）, AHI, cardiovascular adverse events, vascular lesions, SYNTAX score, the BNP and TNT concentration significantly reduced（P<0.05）; Group A: AHI, decreased significantly（P<0.05）, LSaO2increased significantly（P<0.05）, ejection fraction, cardiovascular adverse events, vascular lesions, SYNTAX score, there was no significant difference between the BNP and TNT concentration; Survival analysis showed that: Group A CPAP+conventional treatment group cumulative survival rate higher than the conventional treatment group, but there was no statistically significant difference（P=0.260）. Group B: CPAP+conventional treatment group total survival rate was significantly higher than that of the conventional treatment group（P<0.001）; Conclusion:With the increase of the severity of OSA, OSA merge CHD coronary artery pathological changes degree aggravating, CPAP therapeutic benefit the long-term prognosis of CHD.

Gastroesophageal Reflux Disease and Coronary Heart Disease: Is There a “Mutual Burden” Syndrome?

Aim. This review aims to generalize data on the mutual aggravating effect on the course of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).General findings. The combination of CHD and GERD is a common clinical situation. In recent years, more and more information has appeared indicating a non-accidental character of the comorbidity of both diseases. In addition to common risk factors, a number of pathophysiological mechanisms have been established that determine a pathogenetic relationship between CHD and GERD. Reflux disease contributes adversely to chronic coronary heart disease, e.g. by increasing the risk of developing myocardial infarction (MI). The co-occurrence of myocardial ischemia episodes (registered by ECG) with those of heartburn has been identified. A correlation between pathological reflux and ST segment depression has been found. A trigger role of reflux in relation to angina attacks and heart rhythm disturbances has been determined. The pro-arrhythmic effects of GERD on the myocardium are explained by an imbalance of the autonomic nervous system with a predominance of the parasympathetic tone. In turn, both stable angina and myocardial infarction contribute to a more aggressive and refractory course of reflux esophagitis (RE), thus triggering reflux symptoms.Conclusion. The comorbid course of coronary heart disease and GERD is based on complex associations; this clinical situation is characterized by a mutual burden syndrome. Given the high prevalence of a combination of both diseases, it seems relevant to develop pathogenetically substantiated approaches to the management of this category of patients.

Особливості змін вуглеводного та ліпідного обмінів при різних варіантах несприятливого перебігу серцевої недостатності у хворих на іхс поєднано з цукровим діабетом 2 типу

Особливості змін вуглеводного та ліпідного обмінів при різних варіантах несприятливого перебігу серцевої недостатності у хворих на іхс поєднано з цукровим діабетом 2 типу

PECULIARITIES OF SYSTEMIС INFLAMMATION OF LOW INTENSITY IN PATIENTS WITH STABLE CORONARY HEART DISEASE CONCURRENT WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Nowadays, coronary heart disease and non-alchoholic fatty liver disease are significant problems in Ukraine and world. Functional liver disorders potentiate the development and progression of CHD. The initiation process of atherosclerosis is a chronic systemic inflammation of low intensity. This view on atherosclerosis development has been forming during the past two decades. The aim of the research was to study the features/characteristics of systemic inflammation of low intensity in patients with coronary heart disease in combination with non-alcoholic fatty liver disease. The research involved 135 people with CHD: stable angina, I-II functional class, 0-I heart failure in combination with non-alcoholic fatty liver disease and 30 healthy individuals. We examined patients in terms of blood levels of cytokines -TNFα and IL-10, the content of the acute phase reactant and the coagulation factor, the marker of endothelial dysfunction is the amount of circulating endothelial microparticles (CEM) CD32+ CD40+ and the expression level of IkBα gene NF-kB in mononuclear peripheral blood. We studied the level of expression of the mRNA gene of IkBα in mononuclear cells, which reflects the level of transcriptional activity of NF-kB in patients with stable coronary artery disease and CHD in combination with NAFLD showed a significant increase in the expression of the mRNA gene of IkBα by 88.5% compared to patients with stable stable coronary heart disease. The analysis of the functional state of the endothelium with help of CEM CD32+ CD40+ has shown the presence of endothelial dysfunction in the groups of patients with CHD and CHD in combination with of NAFLD. Comparison of the indicators of systemic inflammation of low intensity and marker of endothelial dysfunction in patients with CHD in combination with NAFLD revealed a significant increase of TNFα, acute phase reactant and coagulation fibrinogen factor and expression of the mRNA IkBα gene in patients with comorbidity, indicating an increase the level of systemic inflammation of low intensity in patients with CHD in combination with NAFLD as compared with the group of patients with CHD.

Chronic heart failure with an&#x0D; intermediate ejection fraction of the left ventricle in patients hospitalized in the cardiology hospital.

Aim. Identification of clinical, anamnestic, etiological, echocardiographic features of chronic heartfailure with an intermediate ejection fraction of the left ventricle among patients hospitalized in the cardiology hospital. Material and methods. Analyzed 423 hospitalization. The diagnosis of CHF was present 378patients (89,6%), the median age was 62 [56; 69]. All patients underwent six-minute walk test, followed by determination of the functional class of heart failure, ultrasound of the heart. Results. In the group of patients Cnppv met significantly less complaints of shortness of breath and weakness, in comparison with patients suffering from Snfu and Ssfv (p&lt;0.05). The severity of violations of the functional state ofpatients with CHF was progressively increased by reducing the levels of LVEF less than 40%. The vast majority of the reason for the development of CHF was a combination of coronary heart disease and arterial hypertension found in 82% of cases in the total cohort. In isolation, these diseases were the cause of heart failure in 3% (coronary heart disease) and 3.4% (arterial hypertension) patients. Conclusion. The incidence of heart failure with an intermediate ejection fraction of the left ventricle among patients with CHF, hospitalized in the cardiology hospital, was 12%. Patients Cnppv had removed the clinical symptoms, despite significant pathological changes in echocardiographic parameters. In addition, the development of Snpf in 93% of cases on a background of myocardial infarction significantly aggravates the prognosis of life ofpatients suffering this pathology.

Association between plasma CD36 levels and incident risk of coronary heart disease among Danish men and women

Background and aimsCD36 is a cholesterol receptor involved in the uptake of oxidized low-density lipoprotein cholesterol and development of atherosclerotic plaques. Cross-sectional studies have shown correlations between plasma CD36 and atherosclerosis but no prospective study has examined the association yet. We prospectively examined the association between plasma CD36 levels and risk of incident coronary heart disease (CHD) in a Danish population. MethodsPlasma CD36 levels were measured in a case-cohort study nested within the Danish population-based cohort, the Diet, Cancer and Health Study. A total of 1963 incident CHD events occurred between baseline (1993–1997) and 2008, and a sub-cohort of 1759 participants were randomly selected as reference. Cox proportional hazard regression models were used to compute the hazard ratio (HR) and corresponding 95% confidence interval (CI). ResultsAfter adjusting for CHD risk factors, including history of hypercholesterolemia and diabetes, elevated plasma CD36 levels were not associated with higher CHD risk in the total population, and the HR comparing the highest versus lowest tertile of CD36 levels was 1.02 (95% CI: 0.84–1.23). High CD36 levels were only found to be associated with risk of CHD in combination with prevalent diabetes (HR = 2.83, 95% CI: 1.08–7.45) vs. the joint reference group of lowest CD36 tertile and no diabetes. ConclusionsPlasma CD36 levels were not predictive of CHD risk in the general population.

Effect of omega-3 polyunsaturated fatty acids on blood lipid profile, leptin level and endothelial function in patients with ischemic heart disease in combination with non-alcoholic steatosis of the liver

The objective: to study the effect of omega-3 polyunsaturated essential fatty acids (PUFAs) on leptin level, lipid profile of blood and endothelial function in patients with coronary heart disease (CHD) in combination with non-alcoholic steatosis of the liver.Materials and methods. 44 men were examined. Group А consisted of 24 patients aged 55–72 (median 64 [59,0; 69,0] years) with CHD in combination with non-alcoholic steatosis of the liver, group В – 18 patients aged 53–70 (median 59,7 [56,0, 65,0] years) with CHD without non-alcoholic steatosis. Blood lipid profile, leptin level and functional state of vascular endothelium were defined in all patients.Results. After the treatment with omega-3 PUFAs 2000 mg for 2 months in patients with CHD in combination with steatosis of the liver, a decrease in the level of triglycerides (TG) (by 42%; p=0,02), very low density lipoproteins (VLDL-C) (by 15%; p=0,02), leptin level (by 13%; p=0,002), C-reactive protein (CRP) (by 45%; p=0,02), increase of high-density lipoprotein levels (HDL-C) (by 3%; p=0,02) and improvement in endothelial function (by 26%; p&lt;0,05) were determined.Conclusion. Using of omega-3 PUFAs in the treatment of patients with CHD in combination with liver steatosis as a secondary prevention provides a reduction in the level of TG, VLDL-C, leptin, and increase in HDL-C. The positive dynamics of indicators of endothelial function and CRP level and the tendency to decrease of blood glucose levels were revealed, which indicates the presence of pleiotropic effects of omega-3 PUFAs.

Optimization of treatment of patients with arterial hypertension in combination with coronary heart disease.

Arterial hypertension (AH) is one of the most important risk factors for atherosclerosis, mainly coronary heart disease (CHD) and damage to the brain vessels. Especially often there is a combination of CHD and hypertension. There is a great need in systematizing the approaches to antihypertensive therapy in patients with coronary artery disease, as well as treating coronary artery disease in patients with hypertension. The aim of this work was to study the clinical efficacy and adherence to treatment of patients with hypertension in combination with CHD with a fixed combination of β-adrenoblockators bisoprolola fumarate (5 mg) and calcium channel blockers - amlodipine (5 mg) (alothedine). The use of alotdine in patients with hypertension and coronary artery disease with a high cardiovascular risk provides a significant anti-ischemic effect in combination with a clear antihypertensive effect. Normalization of daily blood pressure monitoring in patients at high risk shows a significant positive result which affects the long-term prognosis of the disease and the development of complications. The fixed combination of bisoprolol and amlodipine provides a high degree of patients’ adherence to treatment.

Inhibitory effects of Danhong Injection and its major constituents on human cytochrome P450 enzymes in vitro.

Danhong Injection (DHI) as a Chinese patent medicine is mainly used to treat ischemic encephalopathy and coronary heart disease in combination with other chemotherapy. However, the information on DHI's potential drug interactions is limited. The goal of this work was to examine the potential P450-mediated metabolism drug interaction arising from DHI and its active components. The results showed that DHI inhibited CYP2C19, CYP2D6, CYP3A4, CYP2E1 and CYP2C9 with IC50 values of 1.26, 1.42, 1.63, 1.10 and 1.67% (v/v), respectively. Danshensu and rosmarinic acid inhibited CYP2E1 and CYP2C9 with IC50 values of 36.63 and 75.76 μm, and 34.42 and 76.89 μm, respectively. Salvianolic acid A and B inhibited CYP2D6, CYP2E1 and CYP2C9 with IC50 values of 33.79, 21.64 and 31.94 μm, and 45.47, 13.52 and 24.15 μm, respectively. The study provides some useful information for safe and effective use of DHI in clinical practice.

Сравнительный анализ данных проспективного исследования биохимических параметров сыворотки крови у больных ишемической болезнью сердца с наличием и отсутствием сахарного диабета 2 типа

Functional activity of the endothelium in groups of patients with ischemic heart disease and coronary heart disease in combination with diabetes under condition of absence of significant lesion of coronary arteries. Determine a set of laboratory parameters that determine the likelihood of developing cardiovascular complications. Materials. According to the data of selective coronary angiography, patients without significant coronary stenosis were identified. Group 1 - patients with IHD (n = 29), 2nd group - CHD with type 2 diabetes mellitus (DM), (n = 39). The study of laboratory parameters of blood serum was performed against the background of standard therapy before and after 12 ± 2.4 months of follow-up. Results. In both groups, the excess of the reference values of the parameters of the lipid profile and the markers of vascular inflammation was revealed. In the 2nd group the levels of total cholesterol, LDL, Apo-B, high-sensitivity C-reactive protein, homocysteine, interleukin 1 beta are significantly higher than in the 1st group. Prospective observation with standard therapy demonstrated the presence of negative dynamics of the lipid spectrum, the preservation of a prolonged response to the activation of the inflammatory reaction, which was indicated by interleukin 1 , homocysteine, matrix metalloproteinase 9 and the persistence of disorganization of the endothelin system in both groups of patients. Conclusion: The results of the study indicate the preservation of a prolonged inflammatory response in the endothelium in both the 1 st and 2 nd group of patients, which can become a provoking factor for the destabilization of the atherosclerotic process. The increased risk of atherothrombosis in both groups of patients requires a strict control of the effectiveness of the therapy in the conditions of real clinical practice.

FEATURES OF THE RELATIONSHIP BETWEEN THE INDICATORS OF SYSTEMIC INFLAMMATION, LIPID PROFILE, STRUCTURAL AND FUNCTIONAL STATE OF HEART AND THYROID GLAND IN STABLE CORONARY HEART DISEASE IN COMBINATION WITH AUTOIMMUNE THYROIDITIS

Objective: to examine the relationship between indicators of systemic inflammation, blood lipid spectrum, structural and functional condition of heart and thyroid gland in patients with stable coronary heart disease (CHD) in combination with autoimmune thyroiditis (AIT). Material and Methods. The open one-stage clinical study involved 30 patients with coronary artery disease: stable CHD, II FC, CH 0-I, and concomitant AIT, euthyroid stage. The patients underwent laboratory studies to determine the lipid spectrum of the blood, chronic systemic inflammation, inflammatory activation of endothelium, function of the thyroid gland, and instrumental studies (US and Holter ECG) to determine myocardial ischemia, disorders of the central hemodynamics and thyroid blood flow. Results. The study of correlations between parameters and results of regression analysis of patients with stable CHD in combination with AIT demonstrated the close relationship of chronic systemic inflammation, dyslipidemia and thyroid function decline, the negative impact of these factors on systolic and diastolic left ventricular function and development of myocardial ischemia. The interrelations between the chronic systemic inflammation, autoaggression to thyroid peroxidase and the decline of thyroid function with increasing of velocities of blood flow in the thyroid arteries were found. Conclusions. The results define chronic systemic inflammation as a leading factor in the development and progression of CHD in combination with AIT and an important target to develop pathogenically reasonable approaches to the treatment under conditions of comorbidity.

Results of the Ultrasound Study of Intracardial Hemodynamics in Patients with Ischemic Heart Disease in Combination with Arterial Hypertension and Complicated by Chronic Heart Failure 2A and 2B

Objective. To conduct a comprehensive study of patients with ischemic heart disease (IHD) in combination with arterial hypertension (AH) complicated by chronic heart failure (HF) 2A and 2B, by studying parameters of intracardiac hemodynamics considering the pressure in the pulmonary artery.Research results. We examined 120 patients with coronary heart disease in combination with hypertension aged 44 to 90 years old (mean age 72.29 ± 1.66), the majority were men (86.7%). All patients were divided into two groups according to the degree of heart failure: HF 2A - 54 persons, with HF 2B - 66 people. The groups were compared in age, gender, functional class of IHD, severity of AH and HF.Analysis of heart ultrasound showed the following. In IHD in combination with hypertension, complicated by HF 2A, the pressure in the pulmonary artery rises in an average to 46.46 ± 3.64 mm Hg and it increases in HF 2B to 57.00 ± 5.19 mm Hg., that corresponding to the average level of pulmonary hypertension (p&lt;0.01); at the same time, the fraction of ejection of left ventricle in the first patients decreases moderately up to 45.96 ± 2.01%, in others - to 39.93 ± 1.99% (p ˂0.01).In patients with IHD in combination with hypertension complicated by chronic heart failure the structural and functional changes are formed on the side of the left heart, accompanied by an increase in their size due to hypertrophy, formation of stagnant phenomena, regurgitation, functional state disorders by the restrictive type, progressive systolic and diastolic dysfunction, increased pressure in the pulmonary artery.Conclusions. Consideration of pulmonary hypertension, along with other parameters of intracardiac hemodynamics, is an important component in determining the degree and nature of heart failure, which requires the selection of adequate and timely therapeutic tactics.

LDL-cholesterol Predicts a First CHD Event in Senior Citizens, Especially So in Those With Elevated Lipoprotein(a): Dubbo Study of the Elderly

The analysis was designed to explore the combined effects of LDL-cholesterol and lipoprotein(a) (Lp(a)) in predicting incident coronary heart disease (CHD) in senior citizens without prior CHD. This is a prospective cohort study in Dubbo NSW which has followed 2805 men and women 60 years and older for 16 years since 1988-1989. Subjects with prior CHD (n=607) were excluded from this analysis. Incident CHD events were identified by hospital record linkage. The contributions of LDL and Lp(a) to CHD events and their combined effects were evaluated in proportional hazards regression models. There were 689 CHD events over 16 years in a cohort of 2198 men and women without prior CHD. LDL-cholesterol (corrected for cholesterol content of Lp(a)) and Lp(a) modelled in quartile categories each independently predicted CHD, but exclusively in Quartile 4 (Q4) for each parameter. Using the combination of LDL Q1 and Lp(a) Q1 as a reference group, LDL Q4 (>4.90mmol/L) most clearly predicted CHD in combination with Lp(a) Q4 (>276mg/L), hazard ratio 1.95 (95%CI 1.31-2.90). The present findings may have important practical implications in clinical management. If Lp(a) is assessed in senior citizens without prior CHD and found to be genuinely low, elevated LDL-cholesterol may not require active intervention.

THE INCIDENCE OF PAROXYSMAL ATRIAL FIBRILLATION DEPENDING ON WEATHER CONDITIONS

Objective: to analyze the influence of different meteorological conditions: relative air humidity, atmospheric pressure, precipitation on the incidence of development of AF paroxysms. Material and methods. The study involved 259 patients with AF paroxysms who were admitted into the Cardiology ward of Gomel City Clinical Hospital of Emergency Medical Care during the period from November 2015 to January 2016. Results. We have determined the incidence of development of AF paroxysms depending on such weather conditions as atmospheric pressure, relative air humidity, cloudiness, and precipitation. Conclusion. Meteorological conditions have a direct effect on the occurrence of AF paroxysms. The determined risk factors in this case are: high relative humidity, fall of temperature and harsh precipitation and changes in atmospheric pressure. Also, the aggravating factor in the development of AF paroxysms was age of patients over 56 and a combination of coronary heart disease and hypertension.

Assessment of leptin gene (Arg223Gln) genotypes polymorphism in patients with coronary heart disease and obesity

Aim of study – to estimate leptin gene (Arg223Gln) genotypes polymorphism in patients with coronary heart disease and obesity. Materials and Methods. 222 patients with the coronary heart disease (CHD) and obesity have been comprehensively examined. All patients were on treatment in cardiologic unit of KUZ of the Kharkiv city hospital № 27, which is the basic clinic of Department of Internal Medicine № 2 and Clinical Immunology and Allergology of the Kharkiv National Medical University of MH of Ukraine. The comparison group consisted of 115 ischemic heart disease patients with normal body weight. 35 practically healthy persons formed the control group. Groups were comparable in age and sex. The study didn't include the patients with the serious accompanying pathology of respiratory organs, digestion, kidneys and persons with oncological diseases. Results. In the control group there was the following distribution of leptin gene (Arg223Gln) alleles and genotypes polymorphism frequency: 15 people were allele A that made 42.86 %, allele G – 20 people (57.14 %); genotypes G/G, A/A and G/G had 15 (42.86 %), 7 (20 %) and 13 (37.14 %) persons respectively. 42 patients with CHD were allele A, which made 36.52 %, allele G – 73 patients (63.48 %). Genotypes G/G, A/A and G/G had 47 (40.87 %), 20 (17.39 %) and 48 (41.74%) patients with CHD respectively. In group of patients with combination of CHD and obesity 71 patients (31.98 %) were allele A, allele G – 151 people (68.02 %); genotypes G/G, A/A and G/G – 81 (36.49 %), 33 (14.87 %) and 108 (48.64 %) respectively. Comparison of leptin gene (Arg223Gln) alleles and genotypes polymorphism frequency of detection between groups showed the reliable differences of alleles A, G and a genotype G/G. In patients with CHD and obesity allele G was 10.88 % more and genotype G/G was 11.5 % more, than in the control group. Allele A was 10.88 % more in the control group, than in patients with CHD and obesity (p < 0.05). Reliable differences between group of CHD patients and the control group in distribution of detected alleles and genotypes frequency of leptin gene (Arg223Gln) polymorphism were not found (p < 0.05). Conclusions. By results of the study allele G and a genotype G/G of leptin gene (Arg223Gln) polymorphism in patients with CHD has been associated with obesity.

Медикаментозная терапия больных ишемической болезнью сердца в сочетании с фибрилляцией предсердий в реальной медицинской практике (результаты регистра РЕКВАЗА ФП-Курск)

The article considers the questions of drug therapy with statins, β-blockers, angiotensin converting enzyme inhibitors / sartans and oral anticoagulants in patients with coronary heart disease (CHD) in combination with atrial fibrillation (AF) at various stages of treatment according to the data of the RECVASA AF-Kursk registry. It is shown that, in comparison with the prehospital stage, the rate of prescribing these groups of drugs on discharging from hospital has increased, but has not significantly changed at the post-hospital stage and is not fully implemented. Moreover at the hospital stage, there was an insufficient achievement of target parameters of the lipid profile, heart rate and INR after treating with statins, β-blockers and warfarin, respectively. That is why, more adequate correction of risk factors and compliance with clinical recommendations in patients with CHD in combination with AF are required.

Treatment-Resistant Hypertension and Outcomes Based on Randomized Treatment Group in ALLHAT

BackgroundAlthough hypertension guidelines define treatment-resistant hypertension as blood pressure uncontrolled by ≥3 antihypertensive medications, including a diuretic, it is unknown whether patient prognosis differs when a diuretic is included. MethodsParticipants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) were randomly assigned to first-step therapy with chlorthalidone, amlodipine, or lisinopril. At a Year 2 follow-up visit, those with average blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic on ≥3 antihypertensive medications, or blood pressure <140/90 mm Hg on ≥4 antihypertensive medications were identified as having apparent treatment-resistant hypertension. The prevalence of treatment-resistant hypertension and its association with ALLHAT primary (combined fatal coronary heart disease or nonfatal myocardial infarction) and secondary (all-cause mortality, stroke, heart failure, combined coronary heart disease, and combined cardiovascular disease) outcomes were identified for each treatment group. ResultsOf participants assigned to chlorthalidone, amlodipine, or lisinopril, 9.6%, 11.4%, and 19.7%, respectively, had treatment-resistant hypertension. During mean follow-up of 2.9 years, primary outcome incidence was similar for those assigned to chlorthalidone compared with amlodipine or lisinopril (amlodipine- vs chlorthalidone-adjusted hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.53-1.39; P = .53; lisinopril- vs chlorthalidone-adjusted HR = 1.06; 95% CI, 0.70-1.60; P = .78). Secondary outcome risks were similar for most comparisons except coronary revascularization, which was higher with amlodipine than with chlorthalidone (HR 1.86; 95% CI, 1.11-3.11; P = .02). An as-treated analysis based on diuretic use produced similar results. ConclusionsIn this study, which titrated medications to a goal, participants assigned to chlorthalidone were less likely to develop treatment-resistant hypertension. However, prognoses in those with treatment-resistant hypertension were similar across treatment groups.

Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis

SummaryBackgroundGuidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment.MethodsIn this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7·5%, and ≥7·5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure.FindingsWe recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1·56–1·98) for the combination of coronary heart disease and stroke and 2·00 (1·77–2·26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0·012 (0·010–0·014) and a net reclassification improvement of 0·027 (0·019–0·036) for the combination of coronary heart disease and stroke and a C-index increase of 0·019 (0·016–0·022) and a net reclassification improvement of 0·028 (0·019–0·038) for the combination of coronary heart disease, stroke, and heart failure.InterpretationIn people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention.FundingBritish Heart Foundation, Austrian Science Fund, UK Medical Research Council, National Institute for Health Research, European Research Council, and European Commission Framework Programme 7.

Endotelial dysfunction, blood lipid spectrum, level of leptin and mass of body in patient with coronary heart disease in combination with hepatic steatosis

Endotelial dysfunction, blood lipid spectrum, level of leptin and mass of body in patient with coronary heart disease in combination with hepatic steatosis