Frequency Of Cardiovascular Comorbidities Research Articles

Dyslipidaemias and their treatment in high complexity centres in Colombia

Background and objectiveData is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). Materials and methodsCross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. ResultsMean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. ConclusionsMixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR.

Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia

Background and objectiveData is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). Materials and methodsCross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. ResultsMean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. ConclusionsMixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR.

Long-Term Outcomes After Open Repair for Ruptured Abdominal Aortic Aneurysm

BackgroundEarly mortality in ruptured abdominal aneurysm (rAAA) is high, but data on long-term outcome are scarce. The aim of this study was to investigate the long-term outcome in survivors after open surgery for rAAA in well-defined population.MethodsThis is a population-based, observational long-term follow-up (beyond 30-day mortality) study of patients surgically treated for rAAA from 2000 through 2014. Long-term survival was analysed using Kaplan–Meier estimates and compared to the general population by analyses of relative survival.ResultsOut of 178 patients operated for rAAA, 95 patients (55%) either died in the perioperative period, were referred from other hospitals or were lost to follow-up (two patients). Altogether 83 patients were eligible for long-term outcomes: 72 men and 11 women. Estimated median crude survival time was 6.5 years [95% confidence interval (CI) 4.8–8.2]. Men had a median survival of 7.3 years (95% CI 5.1–9.4) versus 5.4 years in females (95% CI 3.5–7.3) (P = 0.082). Reinterventions during follow-up occurred in 31 (37%). Relative survival demonstrated a slightly higher risk of death in the rAAA population compared to the general age- and gender-matched population. Age, but not comorbidities, had a significant influence on long-term survival.ConclusionFor survivors beyond 30 days after surgery for rAAA, long-term survival compares well to that of an age- and sex-matched population. A high frequency of cardiovascular comorbidities did not seem to affect long-term survival.

Análisis de sobrevida en pacientes de edad avanzada que inician hemodiálisis crónica en Servicio de Salud Chileno

The proportion of older people with end stage renal disease is increasing. Their prognosis is characterized by a high mortality and poor quality of life. To analyze the survival of patients starting chronic hemodialysis (CHD) according to their age. Patients admitted to CHD in the East Metropolitan Health Service of Santiago in a 2-year period were analyzed. Four age groups were created, separating patients older than 70 years in a special group. During the study period, 459 patients were admitted to CHD and were followed for an average of 27 months. The frequency of cardiovascular comorbidity, cancer, and chronic renal disease of unknown cause (attributed to nephrosclerosis) increased along with age. Mortality was higher at older ages. There was a significant association between starting CHD with a catheter, Charlson comorbidity index and increasing age with mortality. For those aged over 80 years, mortality at three months and one year was 25 and 43% respectively. Age, Charlson index and vascular access are predictors of mortality in older adults entering hemodialysis. This study suggests the importance of considering comorbidities, assessment by specialists and creating an arteriovenous fistula in this age group.

Abstract 18164: Obesity Paradox in the Extremely Obese: Evaluaion of In-Hospital and Long Term Clinical Outcomes After Percutaneous Coronary Interventions

Introduction: Data regarding "obesity paradox" in patients with extreme obesity undergoing percutaneous coronary interventions (PCI) is limited and conflicting. We assessed clinical outcomes in patients with extreme obesity (Ex-Ob) compared to lean patients. Methods: From a single center prospective observational registry data, we assessed 1366 patients who underwent PCI from 01'-12'. We compared in-hospital and long term clinical outcomes between lean (body mass index (BMI ≤ 25kg/m2 , N=923) and Ex-Ob (BMI ≥40 kg/m2, N=443) patients. Results: The mean follow up duration was 3.6±2 yrs. Baseline characteristics are shown in table 1. Ex-Ob patients were younger, included fewer males and had higher frequency of cardiovascular co-morbidities (diabetes, hypertension, hyperlipidemia). There was no significant difference between the two groups with regards to in-hospital outcomes (death, major adverse cardiovascular events (MACE) or bleeding events). After multivariate adjustment for baseline differences, Ex-Ob patients had better long term overall (adj OR-0.63, 95%CI=0.41-0.95, p=0.029) and MACE free survival (adj OR-0.62, 95%CI=0.44 - 0.87, p=0.006) as compared to lean patients (Table 2 & Fig 1). Conclusion: Although there was no difference in short term outcomes, obesity paradox was observed in patients with extreme obesity with regards to long term clinical outcomes after PCI.

Prevalence of cardiovascular comorbidities and utilization of evidence-based treatment strategies among statin users in a Medicare and commercial health plan

ABSTRACTBackground: Although statins are widely used for the prevention and management of cardiovascular disease in patients with dyslipidemia, the prevalence of cardiovascular comorbidities among statin users has not been well studied.Objective: To assess the prevalence of cardiovascular comorbidities, use of concomitant medications, interventions for managing the comorbidities, and hospitalization rates among statin users in Medicare and commercial health plan populations in the United States.Research design and methods: This retrospective study assessed pharmacy and medical claims of Medicare and commercial health plan members between 4/1/2005 and 3/31/2006. Patients with at least one claim for a statin were included in the analyses. Comorbidities and procedures were identified based on the presence of at least one diagnosis or procedure code.Results: Of the continuously eligible 238 900 Medicare and 3 258 266 commercial health plan members, 51 818 (21.7%) and 285 820 (8.8%) were statin users. Among the Medicare and commercial statin users, 62.4% and 41.8% were classified with either coronary heart disease (CHD), angina, diabetes mellitus, stroke, transient ischemic attack, or chronic kidney disease. Only 9.2% of Medicare and 29.2% of commercial statin users were not classified with hypertension or any of the comorbidities listed above. Of those with diabetes mellitus, 28.1% of Medicare and 15.9% of commercial statin users appeared to have received no pharmacotherapy for this condition. During the study period, 20.3% of Medicare and 10.3% of commercial statin users were reported to be hospitalized; 24.1% and 30.0% were admitted due to CHD/angina.Limitations: The study design was descriptive in nature and did not allow for demonstration of cause and effect between diagnoses, treatments, and outcomes.Conclusions: This study highlights that statin users have a high frequency of cardiovascular comorbidities and are at high risk for cardiovascular events. Comorbidity-related hospitalizations are common, yet interventions for managing many of these comorbidities may be underutilized.