High Risk Of Cardiovascular Complications Research Articles

Cardiovascular Disease in Acromegaly.

In patients with acromegaly, chronic excess of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) leads to the development of acromegalic cardiomyopathy. Its main features are biventricular hypertrophy, diastolic dysfunction, and in later stages, systolic dysfunction and congestive heart failure. Surgical and/or pharmacological treatment of acromegaly and control of cardiovascular risk factors help reverse some of these pathophysiologic changes and decrease the high risk of cardiovascular complications.

The fate of patients with intermittent claudication in the 21st century revisited \u2013 results from the CAVASIC Study

Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

Reduced up-regulation of the nitric oxide pathway and impaired endothelial and smooth muscle functions in the female type 2 diabetic goto-kakizaki rat heart

BackgroundType 2 diabetes is associated with greater relative risk of cardiovascular diseases in women than in men, which is not well understood. Consequently, we have investigated if male and female displayed differences in cardiac function, energy metabolism, and endothelial function which could contribute to increased cardiovascular complications in type 2 diabetic female.MethodsMale and female Control and type 2 diabetic Goto-Kakizaki (GK) isolated rat hearts were perfused during 28 min with a physiological buffer before freeze-clamping for biochemical assays. High energy phosphate compounds and intracellular pH were followed using 31P magnetic resonance spectroscopy with simultaneous measurement of contractile function. Nitric oxide (NO) pathway and endothelium-dependent and independent vasodilatations were measured as indexes of endothelial function. Results were analyzed via two-way ANOVA, p < 0.05 was considered as statistically significant.ResultsMyocardial function was impaired in male and female diabetic versus Control groups (p < 0.05) without modification of energy metabolism. Coronary flow was decreased in both diabetic versus Control groups but to a higher extent in female GK versus male GK rat hearts (p < 0.05). NO production was up-regulated in diabetic groups but to a less extent in female GK rat hearts (p < 0.05). Endothelium-dependent and independent vasodilatations were impaired in female GK rat compared with male GK (p < 0.05) and female Control (p < 0.05) rat hearts.ConclusionsWe reported here an endothelial damage characterized by a reduced up-regulation of the NO pathway and impaired endothelial and smooth muscle functions, and coronary flow rates in the female GK rat hearts while energy metabolism was normal. Whether these results are related to the higher risk of cardiovascular complications among type 2 diabetic female needs to be further elicited in the future.

Influence of vitamin D levels on the treatment of premature ventricular complexes in patients with chronic kidney disease

IntroductionRecent studies have shown that in chronic kidney disease (CKD) 25(OH)D deficiency or insufficiency is a significant risk factor for cardiovascular diseases (CVDs), sudden cardiac death (SCD) and mortality. Premature ventricular complexes (PVCs) are very common in patients with CKD, hypertension, obesity, sleep apnea, and structural heart disease. Often PVCs in the structurally normal heart are considered benign, although they seem to be associated with a more than two-fold higher risk of cardiovascular complications, including stroke disease and death. AimIn the present study we aimed to evaluate the influence of different 25(OH)D levels on the changes of the numbers of PVCs in all patients, assessed by 24-hour-Holter monitoring 3months after β-blocker onset. Methods and resultsWe conducted a prospective, longitudinal study of 824 patients with PVCs and CKD (estimated glomerular filtration rate measured by MDRD equation, between 16 and 59mL/min/1.73m2). All patients were treated with a β-blocker (bisoprolol 10mg daily). We observed that the 3 groups presented a significant decrease in the number of PVCs from baseline 26,091±3327 (25(OH)D deficiency group), 25,902±3501 (25(OH)D insufficiency group), and 25,554±3637 (25(OH)D sufficiency group) to 20,554±3782, 19,885±3945 and 15,433±4059, respectively, after 3months of β-blocker therapy (P<0.0001 for the comparisons between time points in the same group). However at the 3rd month after bisoprolol onset, comparisons between 25(OH)D deficiency vs. 25(OH)D sufficiency groups showed a mean difference of 5121 PVCs (P<0.0001), and comparisons between 25(OH)D insufficiency vs. 25(OH)D sufficiency groups showed a mean difference of 4452 PVCs (P<0.0001). No difference was observed between 25(OH)D deficiency vs. 25(OH)D insufficiency groups (P=0.3181). ConclusionsWe suggest that the effectiveness of β-blocker treatment for PVCs in CKD patients was observed in all 25(OH)D levels. However, the responsiveness was higher in patients with a normal range of 25(OH)D in comparison to patients with deficiency or insufficiency in 25(OH)D levels. Whether vitamin D supplementation increases the efficacy of beta-blocker mediated suppression of PVCs requires further evaluation.

Влияние комбинированной терапии на состояние сосудистой стенки у больных высокого сердечно-сосудистого риска

Introduction. The evaluation of therapy effectiveness in patients at high risk of cardiovascular complications includes the evaluation of target organs condition. A complex approach means follow-up control of laboratory and instrumental data. Materials and methods. The study included 113 patients with hypertension and nonstenotic atherosclerosis of brachiocephalic arteries. All the patients received antihypertensive therapy and some received hypolipidemic drugs. Cholesterol and low density lipoproteins (LDL) levels, brachial and central blood pressure (BP), brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively), augmentation index (AI) of fibrosis markers (C-terminal telopeptide from collagen I (CITP) and C-terminal terminal propeptide of pro-collagen I (PINP) were assessed at baseline, after 6 months and 12 months of treatment with fixed combination of amlodipine, lisinopril and rosuvastatin. Results. The conducted therapy was followed by lowering the LDL levels from 3.9 (3.1; 4.6) to 2 (1.8; 2.3) mmol/L (p<0.01), brachial systolic and diastolic BP levels from 127 (116; 139) to 123 (115; 131) mm Hg (p<0.01) and from 79 (72; 89) to 75 (70; 83) mm Hg (p<0.01) respectively, central systolic and diastolic BP levels from 126 (112; 137) to 120 (110; 124) mm Hg (p<0.01) and from 80 (75; 87) to 76 (70; 81) mm Hg (p<0.01) respectively; by decreasing arterial stiffness: baPWV from 13.6 (12.5; 15.9) to 12.9 (11.8; 14.3) m/s (p<0.01) and cfPWV from 11 (9; 12.2) to 9.4 (8.4; 10.2) m/s (p<0.01), AI decreased from 31 (25; 35) to 26 (21; 32); p<0.05. The arterial stiffness index calculated without BP levels (cardio-ankle vascular index) decreased from 7.2 (6.6; 8.3) to 7.0 (6.6; 7.9) m/s (p<0.05). Treatment with Ekvamer® resulted in PINP levels decreasing from 49.8 (33; 67) to 35 (21; 52) mg/dL (p<0.05) and CITP - from 0.44 (0.24-0.6) to 0.3 (0.18-0.46) mg/dL (p<0.05). No difference between initial and final PINP/CITP levels was observed. The dynamics of PINP levels was associated with aortal stiffness dynamics, cfPWV (r=0.5; p<0.05). Conclusion. Treatment with fixed combination of amlodipine, lisinopril and rosuvastatin resulted in reaching target levels of LDL, brachial and central BP, and arterial stiffness decrease in patients at high risk of cardiovascular complications. The cfPWV dynamics was inter-related with collagen synthesis marker PINP levels.

ANTIHYPERTENSIVE AND VASOPROTECTIVE EFFECTS OF FOSINOPRILE IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: evaluate antihypertensive and vasoprotective effects of fosinopril in patients with arterial hypertension with a high and very high risk of cardiovascular complications. Material and methods. The open study included 26 Grade 2 hypertensive patients with high and very high cardiovascular risk. Among them were 13 (50%) women, 13 (50%) men, the average age of which was 58.1 ± 10.3 years. Initially, all patients received hydrochlorothiazide diuretic therapy at a dose of 12.5 mg per day and various ACE inhibitors, but target blood pressure levels were not achieved. Fosinopril, an angiotensin converting enzyme (ACE) inhibitor (Monopril, VALEANT LLC, Russia), was administered to correct blood pressure for all patients instead of ACE inhibitors which they received earlier. The patients underwent a complete clinical and instrumental examination. The emphasis was placed on the study of the endothelial function by instrumental and laboratory methods. A test with endothelium-dependent vasodilatation (EDVD) was performed using method D. Celermajer; the total concentration of nitrate- and nitrite ions (NO2, NO3) in the blood serum was determined by the colorimetric method. The results of the examination were compared before administration of the drug and after 4 weeks of treatment. Results. 22 patients (85%) could achieve the target level of blood pressure (less than 140/90 mm Hg) after 8 weeks of fosinopril treatment. Daily monitoring of blood pressure showed a significant decrease in the variability of both systolic (SBP) and diastolic blood pressure (DBP). Initially, the dilatation reaction of the brachial artery was reduced in all patients and averaged to 6.8 ± 1.9%. The level of NO2 was 18.1 ± 0.9 μmol/l, NO3 – 28.8 ± 0.3 μmol/l. After 4 weeks of treatment, the EDVD increased to 7.5 ± 2.9%. The level of NO2 was 19.3 ± 0.4 μmol/l, NO3 – 38.75 ± 0.54 μmol/l. Conclusion. Fosinopril, an ACE inhibitor, had a pronounced antihypertensive effect, and improved endothelial function in patients with hypertension with a high and very high risk of cardiovascular complications after 4 weeks of treatment.

Moxibustion (Artemisia Plant at Acupuncture Point) as Alternative Therapy in Hypertension: A Promising Approach.

Hypertension is a pathological condition in which the blood pressure is higher than under normal physiological conditions, i.e., 140/90 mmHg or higher. Blood pressure is measured as the force exerted by the blood pumped by the heart against the walls of arteries (aorta) and distributed throughout the body. Use of complementary and alternative medicine as a cure for hypertension is a common phenomenon because of the high risk of cardiovascular complications and kidney diseases caused by conventional Western medicine. It is reported that high blood pressure causes ~49% of myocardial infarction and 62% of strokes. Effective treatment of hypertension is restricted by adverse effects and cost of the medication. Moxibustion is the application of heat by burning a small bundle of tightly bound moxa, to targeted acupoint, and sometimes it is used along with acupuncture. Encouraging results have been reported on randomized trials indicating the efficacy of moxibustion. But more controlled clinical trials are required to further establish the potential efficacy of moxibustion approach in hypertension.

Factors associated with levels of interleukins -18, -8, and -6 in hypertensive patients at high and very high cardiovascular risk

To identify the most significant factor influencing blood levels of cytokines in patients at high and very high cardiovascular risk. A patient base from the "Management of chronic patients with multiple diseases" project was analyzed. 523 patients (mean age, 87±17.8) were included. Plasma samples were analyzed for concentrations of sodium, creatinine, IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, and NT-proBNP. GFR was calculated using the CKD-EPI formula. Time-related CHF progression was assessed in one year; the time-related progression was considered an increase in CHF stage. Salt consumption was determined using the Charlton: SaltScreener questionnaire at the baseline visit and at one year. Low-salt diet containing 5 g of salt per day was recommended to all patients; 3.5 g of salt per day was recommended to patients with a documented diagnosis of CHF. Statistical analysis was performed using the Statistica 10.0 software. 52.2 % of included patients consumed 6-10 g of salt per day; 43.4 % of patients consumed 10 g of salt or more per day; and only 4.4 % of patients consumed 5 g of salt or less per day. 21 % of included patients were at high risk of cardiovascular complications whereas for the vast majority of patients (79 %), the risk was stratified as very high. Two clusters of patients were formed based on the grade of hypertension, one-year CHF progression, and plasma levels of IL-6, -8, and -18. The one-year progression of CHF most significantly influenced the levels of IL-18, -8, and -6. The IL-6 level was correlated with the NT-proBNP level; an approximately similar degree of correlation was found for NT-proBNP and BP. Therefore, the performed statistical analysis determined correlations between the following factors: IL-6 level, NTproBNP level, and one-year CHF progression.

SCHEME FOR COMBINED USE OF STATINS AND URSODEOXYCHOLIC ACID IN PATIENTS WITH A HIGH RISK OF CARDIOVASCULAR EVENTS AND CONCOMITANT NON-ALCOHOLIC FATTY LIVER DISEASE: PROBLEMS OF PRACTICAL APPLICATION

Russian physicians often afraid to use statins in patients with high cardiovascular risk and nonalcoholic fatty liver disease (NAFLD) or other hepatobiliary diseases, especially in cases when elevated levels of serum transaminases are detected. To expand the use of statins in these patients, a scheme of statins and ursodeoxycholic acid (UDCA) co-administration was developed in 2014 and subsequently in 2016 it was included into the Russian clinical guidelines for the diagnosis and treatment of NAFLD. In addition to the scheme, the guidelines contain the results of clinical trials that demonstrated hepatoprotective, lipid-lowering and anti-atherogenic effects of UDCA in patients with NAFLD. This paper presents a critical review of these trials, as well as it discusses the points of the scheme, which may contribute to unduly delayed prescribing and insufficiently intensive use of statins in patients with high risk of cardiovascular complications and associated NAFLD.

Достижение основных целей терапии при применении тройной фиксированной комбинации амлодипина, индапамида и периндоприла (препарат Ко-Дальнева®) у пациентов с артериальной гипертензией

Introduction. Combined antihypertensive therapy is indicated in 94% of patients with hypertension. Fixed combinations are preferable to use as they have a high profile of effectiveness, safety, more convenient to use and significantly increase the adherence. Objective. To evaluate the effectiveness of triple fixed combination of amlodipine/indapamide/perindopril for the control of blood pressure in patients who did not achieve the target blood pressure level in the previous combined therapy. Materials and methods. The study included 44 patients with hypertension of high and very high risk of cardiovascular complications (mean age - 58.59±10.57 years, 17 men, 27 women). Blood pressure levels, quality of life, anxiety and depression levels, adherence, biochemical indices, levels of inflammation markers (CRP, IL-6, IL-10) and endothelial dysfunction (sVCAM-1, VEGF) were assessed in all patients at baseline and after 6 months of amlodipine/indapamide/perindopril therapy. Results. Against the backdrop of the treatment, all patients reached the target level of blood pressure (BP), pulse BP decreased by 30.3 mm Hg. (p<0.001), all quality of life indicators improved: significant changes (p<0.05) in physical functioning (from 58.1±27.7 to 71.3±20.5%), role-physical functioning (from 54.7±41.2 to 85.5±31.5%), role-emotional (from 53.3±46.0 to 77.3±40.1%), vitality (from 53,4±16.9 to 63.2±14.5%). The anxiety levels (from 5.9±2.8 to 3.5±2.6) and depression (from 5.9±2.5 to 3.7±2.1) significantly decreased. Adherence increased to a high level (from 3.4±1.8 to 6.5±1.0 points, p<0.01). There were no reliable dynamics of biochemical parameters and markers of inflammation. The level of sVCAM-1 decreased (from 1063.5±442.4 to 898.67±433.5 ng/ml, p<0.001). There were no cases of orthostatic hypotension. Conclusion. Therapy with a triple fixed combination of perindopril/indapamide/amlodipine (Ko-Dalneva®) achieves the target blood pressure level with a significant reduction in pulse BP, increases adherence and quality of life, reduces anxiety and depression with good tolerability and metabolic neutrality, and improves the vascular endothelial state, significantly lowering sVCAM-1.

Carbamylated Low-Density Lipoprotein (cLDL)-Mediated Induction of Autophagy and Its Role in Endothelial Cell Injury.

Patients with chronic kidney disease (CKD) have high risk of cardiovascular complications. Plasma levels of carbamylated proteins produced by urea-derived isocyanate or thiocyanate are elevated in CKD patients and that they are significant predictors of cardiovascular events and all-cause mortality. Carbamylated LDL (cLDL) has pro-atherogenic properties and is known to affect major biological processes relevant to atherosclerosis including endothelial cell injury. The underlying mechanisms of cLDL-induced endothelial cell injury are not well understood. Although autophagy has been implicated in atherosclerosis, cLDL-mediated induction of autophagy and its role in endothelial cell injury is unknown. Our studies demonstrate that human coronary artery endothelial cells (HCAECs) respond to cLDL by specific induction of key autophagy proteins including LC3-I, beclin-1, Atg5, formation of lipid-conjugated LC3-II protein, and formation of punctate dots of autophagosome-associated LC3-II. We demonstrated that autophagy induction is an immediate response to cLDL and occurred in a dose and time-dependent manner. Inhibition of cLDL-induced autophagy by a specific siRNA to LC3 as well as by an autophagy inhibitor provided protection from cLDL-induced cell death and DNA fragmentation. Our studies demonstrate that autophagy plays an important role in cLDL-mediated endothelial cell injury and may provide one of the underlying mechanisms for the pathogenesis of cLDL-induced atherosclerosis in CKD patients.

The structural and functional changes of blood cells and molecular components in diabetes mellitus.

It is known fact that diabetes mellitus (DM) affects blood cells. Changes in the erythrocyte membrane, disorder in hemoglobin oxygen-binding and modification in mechanical characteristics, are effects of hyperglycemia on red blood cells. Altered susceptibility infection of patients with diabetes has been ascribed to a depression in the function of polymorphonuclear leukocytes. Neutrophil function in patients with diabetes with good glucose control is slightly different than in healthy ones. DM causes significant changes in lymphocytes metabolism and their functions. Patients with diabetes, presenting with acute coronary syndrome, are at higher risk of cardiovascular complications and recurrent ischemic events in comparison to non-diabetic counterparts. Various mechanisms, including endothelial dysfunction, platelet hyperactivity, and abnormalities in coagulation and fibrynolysis have been implicated for this increased atherothrombotic risk. There are many other alterations of blood cells due to DM. In the present review we focused on modifications of blood cells due to DM. Then, as a second point, we explored how the changes affect functions of red blood cells, white blood cells and platelets.

Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome?

It is well known that there is a very high risk of cardiovascular complications among diabetic patients. In spite of all efforts at aggressive control of diabetes and its complications, the incidence of cardiovascular morbidity and mortality remains high, including in patients with no prior symptoms, underscoring a possible advantage for appropriate screening of asymptomatic patients for the presence of obstructive coronary artery disease (CAD). In this article, we sought primarily to review the results of studies designed to evaluate a possible role of coronary computed tomography angiography (CCTA) in the screening of asymptomatic diabetic patients for possible obstructive CAD. Our review of current literature indicates that there is still no method of CAD screening identified that has been shown to reduce the cardiovascular risk of asymptomatic diabetic patients. Therefore, the utility and value of screening for CAD in asymptomatic diabetic patients remains controversial. CCTA screening has shown promise and has been demonstrated to predict future risk, but as yet has not demonstrated improvement in the outcomes of these high-risk patients. At our present state of knowledge, aggressive risk factor reduction appears to be the most important primary prevention strategy for all asymptomatic high-risk diabetic patients. However, there remains a great need for better and more sensitive and specific screening methods, as well as more effective treatments that may allow us to more accurately target diabetic patients who really are at high risk. Further large randomized and well-controlled clinical trials may be necessary to determine whether screening for CAD can reduce cardiovascular event rates in patients with diabetes.

PP.12.21] ENDOTHELIN-1 CONTRIBUTION TO THE ENDOTHELIAL FLAXMOTIONS AND MYOGENIC TONE IN PATIENTS WITH AH AND STROKE.

Objective: The aim was to perform a comparative analysis of the parameters of the LDF-gramme and to determine the difference in concentration of endothelin-1 in serum between patients with II-III grades of primary arterial hypertension (AH) and with history of ischemic stroke and in patients with II-III grades of AH only. Design and method: We followed 45 patients, (aged mean 61,8 ± 9,6), with II-III grades of AH and with high risk of cardiovascular complications: 15 patients with history of ischemic stroke (I group) and a sample of 30 patients without one (II group). Both groups had comparable clinical characteristics. All participants of our study were carried out blood sampling to its research on the concentration of endothelin-1 and were examined using laser doppler flowmetry with LAKK-02 analyzer. Total and specific peripheral vascular resistance were studied with the help computer oscillometry. Results of the study were processed with Statistica 8.0 software. Results: The concentration of endothelin-1 in serum was significantly higher in the II group (1.95 [25%th- 0,3; 75%th–5,39), than in the I one (0,31 [25%th-0.16; 75%th-1.42]) (p < 0,05). The level of investment of low endothelial flaxmotion component in the microcirculation also differ significantly between two groups (2,43 [25%th-1,78; 75%th-4,26] vs 1,81 [25%th-1,33; 75%th-2,13] accordingly, p < 0,05). The study of vascular parameters identified that total and specific peripheral vascular resistance were significantly higher in the I group (1388 [25%th-1273; 75%th-1504] dyne · cm- 5), than in the II one (1270 [25%th-1089; 75%th-1364] dyne · cm- 5) (p < 0,05). Bypass ratio also was significantly higher in the first group (1,6 ± 0,75) vs (1,22 ± 0,29), accordingly, p < 0,05) due to increased myogenic tone in comparison with the group of patients without stroke. Conclusions: Elevation of vascular resistance and bypass ratio in the first group because of the increased myogenic tone of the vascular wall. The increased concentrations of endothelin-1 in the serum of patients with AH probably related decline level of investment of endothelial flaxmotion component in the microcirculation.

PP.32.18] PREVALENCE OF DIABETES AND LIPID DISORDERS IN HYPERTENSION PATIENTS REFERRED TO SPECIALIZED CARDIOLOGICAL CENTRE

Objective: Diabetes mellitus (DM) and lipid disorders in hypertensive patients are associated with higher risk of cardiovascular complications and poor outcome and require more aggressive treatment strategies and follow-up. The main objective of this study was to describe trends in prevalence of DM and lipids disorders in adult hypertensive patients referred to specialized cardiology clinic during the period of January 2010 - December 2014. Design and method: Data included 59268 (21153 males and 38115 females) patients, mean age 58.3 ± 13,8 years, referred to specialized clinic due to uncontrolled hypertension. Descriptive statistics were used to estimate the means in gender and age [under 35 years (n = 4079), 35–49 (n = 8566), 50–65 (n = 26381), older than 65 (n = 20242) years] subgroups. Linear regression was employed to determine the yearly trends. Age and gender-specific results were adjusted to Saint-Petersburg general population data for 5-years period and every studied year. Results: The average prevalence of known lipid disorders for the studied period was 3,7% (2160 patients) without any significant 5-years trends. Increased level of total cholesterol in combination with increased low density lipoprotein levels was the most frequent disorder (917 cases; 42,7%). There were no significant changes in prevalence and characteristics of lipids disorders in gender subgroups. Analysis of age groups demonstrated increase in lipid disorders frequency in patients over 65 years (R2 = 0,80; p = 0,04). The average prevalence of known diabetes was 14,5% (8592 patients) and impaired glucose tolerance 0,9% (518 cases) without any significant trends during studied period in overall population and in gender subgroups. While in subgroup of hypertensive patients over 65 years there was an increase in prevalence of diabetes and impaired glucose tolerance during the last 5 years (R2 = 0,78, p = 0,05 and R2 = 0,95 p = 0,005, respectively). Conclusions: During the last 5 years age older than 65 was associated with increase in prevalence of metabolic disorders in difficult to control hypertension. These trends can be important for the total risk reduction in the elderly and explain poor blood pressure control in this subgroup.

The Fate of Patients with Intermittent Claudication in the 21st Century Revisited – Results from the CAVASIC Study

Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

Eye Dose Reduction with Various X-ray Protection Shields during Endovascular Procedures

s 417 Introduction: Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five year total mortality of up to 30% for these patients, the majority dying due to cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. Methods: The CAVASIC Study included 255 male PAD patients with intermittent claudication who were prospectively followed for a median of 7 years. During follow-up overall mortality, vascular morbidity and mortality as well as local PAD outcomes were assessed. Results: During entire follow-up, overall mortality reached 16.1% (n 1⁄4 41). Most patients died from cancer (n 1⁄4 20). Half of patients (n 1⁄4 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) experienced a complication during the first five years. Vascular mortality was as low as 5.1% (n 1⁄4 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms stayed stable or improved in the majority of patients (67%) during follow-up. Patients with PAD treatment at baseline carried a higher risk for reintervention after three years of follow-up. Conclusion: Compared with proposed frequency estimates from TASC the proportion of cardiovascular events did not markedly decrease over the last 2 decades. Vascular mortality, however, was surprisingly low among our study population. The data at hand might indicate that nowadays patients more frequently survive cardiovascular events. A relevant number died from cancer. Disclosure of Interest: None Declared.

Endocarditis infecciosa sobre válvula aórtica bicúspide: características clínicas, complicaciones y pronóstico

IntroductionBicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. It is associated to a higher risk of cardiovascular complications, including infective endocarditis (IE). MethodsRetrospective, observational and single centre study that included all patients with IE diagnosed between 1996 and 2014. An analysis was made of the epidemiological, clinical, microbiological and echocardiographic data, complications during hospital admission, need for surgery, in-hospital mortality, and 1-year follow-up. Cases with endocarditis on prosthetic valves or other locations were excluded, as well as those for which the aortic valve morphology had not been accurately defined. A comparative statistical analysis was performed between BAV and tricuspid (TAV). ResultsOf a total of 328 cases with IE, 118 (35.67%) were on aortic valve, with 18 (16.22%) of them being BAV. The BAV cases were younger than TAV (51±19.06 vs. 60.83±15.73 years, P=.021) and they had less comorbidity (Charlson 0.67±0.77 vs. 1.44±1.64, P=.03).). There was a higher tendency of Staphylococcal origin (38.9 vs. 21.5%, P=.137), and 55.6% showed peri-valvular complications (TAV 16.1%, P=.001), in particular, abscesses (38.9 vs.16.1%, P=.047). BAV was the only predictive factor of peri-valvular complications (OR 7.87, 95% CI; 2.38–26.64, P=.001). Patients with BAV had more surgery during their admission (83.3 vs. 44.1%, P=.004), had less in-hospital mortality, with no statistical significance (5.6 vs. 25.8%, P=.069), and 1-year survival was significantly superior (93.8 vs 69.3%, P=.048). ConclusionsPatients with IE on BAV are young, with low comorbidity. They frequently present with peri-valvular complications and they often require early surgery. Compared to TAV cases, in-hospital mortality is lower and 1-year survival is significantly higher.

Degenerative Aortic Stenosis: Modern View on Development, Course, and Management

Degenerative aortic stenosis is an acquired heart defect manifesting as progressive thickening and calcification of leaflets of originally normal tricuspid or congenital bicuspid aortic valve with development of orifice narrowing, left ventricular hypertrophy, and high risk of cardiovascular complications. In this review we present modern concepts of formation and progression of degenerative aortic stenosis and discuss optimal methods of management of this disease.

Design of DEVOTE (Trial Comparing Cardiovascular Safety of Insulin Degludec vs Insulin Glargine in Patients With Type 2 Diabetes at High Risk of Cardiovascular Events) – DEVOTE 1

DEVOTE was designed to evaluate the cardiovascular safety of insulin degludec (IDeg) vs insulin glargine U100 (IGlar) in patients with T2D at high risk of cardiovascular events. DEVOTE is a phase 3b, multicenter, international, randomized, double-blind, active comparator-controlled trial, designed as an event-driven trial that would continue until 633 positively adjudicated primary events were accrued. The primary end point was the time from randomization to a composite outcome consisting of the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Patients with T2D at high risk of cardiovascular complications were randomized 1:1 to receive either IDeg or IGlar, each added to background therapies. This trial was designed to demonstrate statistical noninferiority of IDeg vs IGlar for the primary end point. DEVOTE enrolled 7,637 patients between October 2013 and November 2014 at 436 sites in 20 countries. Of these, 6,506 patients had prior cardiovascular disease or chronic kidney disease, and the remainder had multiple cardiovascular risk factors. DEVOTE was designed to provide conclusive evidence regarding the cardiovascular safety of IDeg relative to IGlar in a high-risk population of patients with T2D.