High Risk Of Heart Attack Research Articles

A proposed tree-based explainable artificial intelligence approach for the prediction of angina pectoris

Cardiovascular diseases (CVDs) are a serious public health issue that affects and is responsible for numerous fatalities and impairments. Ischemic heart disease (IHD) is one of the most prevalent and deadliest types of CVDs and is responsible for 45% of all CVD-related fatalities. IHD occurs when the blood supply to the heart is reduced due to narrowed or blocked arteries, which causes angina pectoris (AP) chest pain. AP is a common symptom of IHD and can indicate a higher risk of heart attack or sudden cardiac death. Therefore, it is important to diagnose and treat AP promptly and effectively. To forecast AP in women, we constructed a novel artificial intelligence (AI) method employing the tree-based algorithm known as an Explainable Boosting Machine (EBM). EBM is a machine learning (ML) technique that combines the interpretability of linear models with the flexibility and accuracy of gradient boosting. We applied EBM to a dataset of 200 female patients, 100 with AP and 100 without AP, and extracted the most relevant features for AP prediction. We then evaluated the performance of EBM against other AI methods, such as Logistic Regression (LR), Categorical Boosting (CatBoost), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), and Light Gradient Boosting Machine (LightGBM). We found that EBM was the most accurate and well-balanced technique for forecasting AP, with accuracy (0.925) and Youden's index (0.960). We also looked at the global and local explanations provided by EBM to better understand how each feature affected the prediction and how each patient was classified. Our research showed that EBM is a useful AI method for predicting AP in women and identifying the risk factors related to it. This can help clinicians to provide personalized and evidence-based care for female patients with AP.

Metabolic syndrome in patients with type 2 diabetes mellitus at Adama Hospital Medical College, Ethiopia: a hospital-based cross-sectional study.

Metabolic syndrome is one of the most serious global public health problems. It is associated with a higher risk of heart attack and other cardiovascular diseases. However, the magnitude of metabolic syndrome among patients with type 2 diabetes mellitus is not well understood, especially in developing countries such as Ethiopia. To determine the magnitude of metabolic syndrome and associated factors among type 2 diabetes mellitus patients at Adama Hospital Medical College, Ethiopia, in 2022. A facility-based cross-sectional study was conducted from September 1 to October 30, 2022. The data was collected through a self-administered questionnaire. A systematic random sampling method was used to select the participants. Data were entered using Epi Info version 7.2 and analyzed by SPSS version 23. Multivariable logistic regression was used to model this study. Statistical significance was set at p-values of < 0.05. A total of 237 participants were included in this study, with a response rate of 95.1%. Overall, the magnitude of metabolic syndrome was 53.2% (95% CI: 46.8 - 59.6), 41.3% (95% CI: 35.0 - 47.5), and 41.8% (95% CI: 35.5 - 48.1) based on 2009 harmonized criteria of MetS, Revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), and International Diabetes Federation (IDF) criteria, respectively. In multivariable logistic analysis, urban residence (AOR=3.07, 95% CI: 1.46-6.42), earning a high income (AOR=5.87 95% CI: 1.8-19.1), history of cardiac illness (AOR=3.33, 95% CI: 1.41-7.84), history of hypertension (AOR=2.65, 95% CI: 1.22-5.78), dyslipidemia (AOR=4.47, 95% CI: 1.96-10.19), current cigarette smoker (AOR=6.2, 95% CI: 1.7-22.93), sedentary activity (AOR=3.62, 95% CI: 1.68-7.82), use of palm oil (AOR=4.87, 95% CI: 2.06-11.51), and BMI ≥25 kg/m2 (AOR=3.36, 95% CI: 1.57-7.16) were significantly associated with metabolic syndrome. The findings of this study suggested that the magnitude of metabolic syndrome among T2DM patients was high. We found consistent results using the NCEP-ATP III and IDF criteria. Similarly, urban residence, high income, history of cardiac, history of hypertension, dyslipidemia, current cigarette smoker, sedentary activity, palm oil, and BMI ≥25 kg/m2 were significantly associated with metabolic syndrome.

Association of increased risk of cardiovascular diseases with higher levels of perfluoroalkylated substances in the serum of adults.

Evidence showing the association of perfluoroalkylated substance (PFAS) exposure with CVD risk is scarce. The objective of this study was to explore the relationships of CVD risk with mixed or individual serum PFAS levels among general adults. We analyzed combined data of 7904 adults who participated in the National Health and Nutrition Examination Survey 2003-2012 with a Bayesian kernel machine regression (BKMR) to examine the relationships of individual or mixed PFAS exposure with total CVD risk. A logistic regression model and restricted cubic spline (RCS) regression with multivariate adjustment were conducted to assess the relationships between individual serum PFAS levels and the risk of total CVD or its subtypes. A mediation model was applied to investigate how C-reactive protein (CRP) levels mediate the strength of the association. The BKMR results indicated a positive relationship between mixed PFAS exposure and total CVD risk; among the PFASs, perfluorooctane sulfonic acid (PFOS) had the highest posterior inclusion probability. As determined by logistic regression, a log-unit change in PFOS levels was positively related to a higher risk of heart attack and stroke in males (both P < 0.05). A nonlinear relationship was found between PFOS levels and stroke risk (P for nonlinearity = 0.04), as illustrated in the RCS plot. The mediation analysis showed that CRP levels mediated 8% and 1.2% of the relationship between serum PFOS and PFNA levels, respectively, and the prevalence of stroke. A significant relationship between higher serum PFAS concentrations and an increased risk of CVD was observed, mainly in males.

Reducing levels of C-Reactive Protein: An eight-week, open-label clinical trial of three oral supplements

C-reactive protein (CRP) is a protein in the blood that increases with inflammation, and high CRP levels measured with high-sensitivity CRP (hs-CRP) tests can indicate higher risk of heart attack or stroke. Several over-the-counter oral supplements reduce CRP levels. This eight-week, open-label clinical trial investigated whether Vitamin C, ginger, or curcumin were most effective at reducing hs-CRP levels in healthy individuals with low baseline hs-CRP levels. Thirty healthy male and female participants were enrolled in one of three trial treatment arms: Vitamin C (1000 mg/day), ginger (2000 mg/day), and curcumin (1000 mg/day). hs-CRP levels were collected at baseline and after eight weeks of oral supplements. Paired t-tests were used to analyze data by age, body mass index (BMI), and baseline hs-CRP level. The primary outcome measure was mean difference between time points and 95% confidence intervals. Twenty-six people completed the study. Baseline hs-CRP levels were very low for all three intervention groups. Based on estimated mean difference, all three supplements reduced hs-CRP levels, but change at eight weeks was not statistically significant. Within the groups, ginger most consistently reduced hs-CRP levels even though the ginger group had the lowest mean baseline hs-CRP levels. Curcumin was least likely to reduce hs-CRP levels. Overall, all three interventions reduced hs-CRP levels in this group of healthy participants with low baseline levels, suggesting that these agents, which are available over-the-counter, may provide an alternative for reducing inflammation. Larger clinical trials to assess the utility of these agents are warranted.

1529-P: State-Level Prevalence of ABC Control among Adults with Self-Reported Diabetes in 2013-2016

Individuals with diabetes (DM) are at high risk of heart attack and other diabetes complications. Control of Hemoglobin A1c, Blood Pressure, and Cholesterol (ABC) can be effective in preventing these complications. However, studies that assess the state-level prevalence of ABC control within the DM population are lacking. This study aims to estimate the state-level proportions of adults with self-reported diagnosed DM meeting the goals of ABC control in the 50 U.S. states and the District of Columbia. We applied weighting adjustments to data from 2013-2016 National Health and Nutrition Examination Survey (NHANES), 2016 American Community Survey (ACS), and 2016 Behavioral Risk Factor Surveillance System (BRFSS) to create state-level estimates. To adjust NHANES national weights to reflect the demographic characteristics of states, we used raking to adjust BRFSS weights to the ACS on age, sex, race, health insurance status, education and income, and then used the propensity score method to adjust NHANES to the ACS-adjusted BRFSS on these variables plus self-reported overall health status. We defined ABC control as A1C &amp;lt; 9%, blood pressure (BP) &amp;lt; 140/90 mmHg, and non-HDL cholesterol (non-HDL-C) &amp;lt; 130 mg/dL. Among adults with DM, 38% (95% CI 30.8%-45.2%) of patients met the goal of ABC control, with the highest rate of 43.7% (36.1%-51.3%) in South Dakota and the lowest rate of 32.9% (27.3%-38.5%) in the District of Columbia. Control rates of A1C were highest in each state, followed by BP and non-HDL-C. Overall, 86.6% (82.3%-90.9%) of patients had controlled A1C, 72.6% (67.0%-78.2%) had controlled BP, and 58.7% (52.9%-64.5%) had controlled non-HDL-C. Control rates for each individual goal varied by state. ABC control is suboptimal among adults with DM and varies by state. Our estimates provide data that public health departments could use in their planning efforts to improve ABC control and thus reduce DM-related complications at the state level. Disclosure Y. Chen: None. D.B. Rolka: None. H. Xie: None. S. Saydah: None.

The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2.

A new type of pneumonia caused by a novel coronavirus SARS-CoV-2 outbreaks recently in China and spreads into many other countries. This disease, named as COVID-19, is similar to patients infected by SARS-CoV and MERS-CoV, and nearly 20% of patients developed severe condition. Cardiac injury is a prevalent complication of severe patients, exacerbating the disease severity in coronavirus disease 2019 (COVID-19) patients. Angiotensin-converting enzyme 2 (ACE2), the key host cellular receptor of SARS-CoV-2, has been identified in multiple organs, but its cellular distribution in human heart is not illuminated clearly. This study performed the first state-of-art single cell atlas of adult human heart, and revealed that pericytes with high expression of ACE2 might act as the target cardiac cell of SARS-CoV-2. The pericytes injury due to virus infection may result in capillary endothelial cells dysfunction, inducing microvascular dysfunction. And patients with basic heart failure disease showed increased ACE2 expression at both mRNA and protein levels, meaning that if infected by the virus these patients may have higher risk of heart attack and critically ill condition. The finding of this study explains the high rate of severe cases among COVID-19 patients with basic cardiovascular disease; and these results also perhaps provide important reference to clinical treatment of cardiac injury among severe patients infected by SARS-CoV-2.

754 The Heart Matters Partnership: A Stepped-Wedge, Cluster-Randomised Trial Targeting Victorian Regions at High-Risk of Heart Attacks With Heart Health Education

The National Heart Foundation’s (NHF) Victorian Heart Maps allow for the identification of Local Government Areas (LGAs) at highest-risk of heart attacks. These regions also have higher rates of risk factors, lower cardiovascular knowledge and lower ambulance use for acute coronary syndrome (ACS) events. The Heart Matters Partnership (between Monash University, NHF, Ambulance Victoria and the Victorian Government) aims to improve public awareness of the personal risk of ACS, ACS symptoms, and the importance of calling an ambulance. To do this we will implement local campaigns in 8 high-risk LGAs, including embedding education coordinators to organise and provide tailored community education. Primary outcomes are: 1) the proportion of ACS presentations by ambulance (main outcome); 2) prehospital delay times: 3) ACS knowledge; 4) rates of Heart Health Checks. Secondary outcomes include: cardiac arrest survival and incidence; ambulance calls and ED presentations for chest pain; and infarct size. The trial is due to commence in October 2020 and will run for 16-months. Eight LGAs were selected based on achieving an adequate sample of ACS patients (n=2240) to detect a change in the proportion arriving by ambulance from 61% to 72% using a stepped-wedge cluster-randomised design –in which LGAs move from control to intervention at 2-month periods. This study will determine whether providing community education to communities at highest-risk can change ACS recognition and response and improve ACS outcomes. Such evidence is also important to practice and policy makers across Australia and internationally.

Cardiovascular risk prediction for primary prevention

Risk prediction tools such as QRISK identify those at higher risk of heart attack and stroke, based on traditional and emerging cardiovascular risk factors, with a view to primary prevention, eg with statins. This article considers how this important aspect of public health management can be optimised.

Metabolic and Biochemical Stressors in Diabetic Cardiomyopathy.

Diabetic cardiomyopathy (DCM) or diabetes-induced cardiac dysfunction is a direct consequence of uncontrolled metabolic syndrome and is widespread in US population and worldwide. Despite of the heterogeneous and distinct features of DCM, the clinical relevance of DCM is now becoming established. DCM progresses to pathological cardiac remodeling with the higher risk of heart attack and subsequent heart failure in diabetic patients. In this review, we emphasize lipid substrate quality and the phenotypic, metabolic, and biochemical stressors of DCM in the rodent and human pathophysiology. We discuss lipoxygenase signaling in the inflammatory pathway with multiple contributing and confounding factors leading to DCM. Additionally, emerging biochemical pathways are emphasized to make progress toward therapeutic advancement to treat DCM.

NLRP3 inflammasome blockade reduces liver inflammation and fibrosis in experimental NASH in mice

NOD-like receptor protein 3 (NLRP3) inflammasome activation occurs in Non-alcoholic fatty liver disease (NAFLD). We used the first small molecule NLRP3 inhibitor, MCC950, to test whether inflammasome blockade alters inflammatory recruitment and liver fibrosis in two murine models of steatohepatitis. We fed foz/foz and wild-type mice an atherogenic diet for 16weeks, gavaged MCC950 or vehicle until 24weeks, then determined NAFLD phenotype. In mice fed an methionine/choline deficient (MCD) diet, we gavaged MCC950 or vehicle for 6weeks and determined the effects on liver fibrosis. In vehicle-treated foz/foz mice, hepatic expression of NLRP3, pro-IL-1β, active caspase-1 and IL-1β increased at 24weeks, in association with cholesterol crystal formation and NASH pathology; plasma IL-1β, IL-6, MCP-1, ALT/AST all increased. MCC950 treatment normalized hepatic caspase 1 and IL-1β expression, plasma IL-1β, MCP-1 and IL-6, lowered ALT/AST, and reduced the severity of liver inflammation including designation as NASH pathology, and liver fibrosis. In vitro, cholesterol crystals activated Kupffer cells and macrophages to release IL-1β; MCC950 abolished this, and the associated neutrophil migration. MCD diet-fed mice developed fibrotic steatohepatitis; MCC950 suppressed the increase in hepatic caspase 1 and IL-1β, lowered numbers of macrophages and neutrophils in the liver, and improved liver fibrosis. MCC950, an NLRP3 selective inhibitor, improved NAFLD pathology and fibrosis in obese diabetic mice. This is potentially attributable to the blockade of cholesterol crystal-mediated NLRP3 activation in myeloid cells. MCC950 reduced liver fibrosis in MCD-fed mice. Targeting NLRP3 is a logical direction in pharmacotherapy of NASH. Fatty liver disease caused by being overweight with diabetes and a high risk of heart attack, termed non-alcoholic steatohepatitis (NASH), is the most common serious liver disease with no current treatment. There could be several causes of inflammation in NASH, but activation of a protein scaffold within cells termed the inflammasome (NLRP3) has been suggested to play a role. Here we show that cholesterol crystals could be one pathway to activate the inflammasome in NASH. We used a drug called MCC950, which has already been shown to block NLRP3 activation, in an attempt to reduce liver injury in NASH. This drug partly reversed liver inflammation, particularly in obese diabetic mice that most closely resembles the human context of NASH. In addition, such dampening of liver inflammation in NASH achieved with MCC950 partly reversed liver scarring, the process that links NASH to the development of cirrhosis.

Design and Analysis of Automatic Insulin Delivery System Using Pic Microcontroller

In our country millions of peoples are affected by diabetes. In future, this range will get increased as said by the World Health Organization (WHO). Diabetes is a chronic disease and has the high risk of heart attack, stroke and in later stages cause blindness, kidney failure. This is mainly associated with insulin production and its action. Hence to recover the diabetic patients from these risks, insulin must be given periodically to the persons. Nowadays insulin is given to the diabetic patients by injector, inhaler or by syringes. This is not a precise method to sustain our blood glucose level. So to manage the problems related with this complex disease, automatic insulin pump provides the better blood glucose level maintained by injecting the insulin at regular intervals. This insulin pump supply distinctly limited dosage of insulin to diabetic persons who require multiple injections daily to maintain their glucose level in blood. This system automatically provides insulin at predefined times regularly, so that they keep control of blood glucose level.

Alfredo Morabia. Enigmas of health and disease

Alfredo Morabia’s Enigmas of Health and Disease, which is aimed at members of the lay public who have an interest in epidemiology, is an exceptionally informative and engaging book that covers landmark events in the history of epidemiology while at the same time discussing the discipline’s concepts and strategies. Its leitmotifs are the importance of group comparisons for causal inference (in contrast with the focus on individuals) and the interface of epidemiology with public health and medicine. Faithful to the paraphrase attributed to Einstein— ‘‘Things have to be made as simple as possible, but not simpler’’—Morabia uses a simple and elegant language without sacrificing depth. He states that ‘‘epidemiology is infamously arcane, even though, as this book shows, there is no intrinsic complexity to it. On the contrary, the principles of comparing groups of people involve no more than simple logic’’ (page 184). Although some may disagree with the statement—for example, to the extent that it ignores the complexity of inferring causality based on epidemiologic findings—epidemiology’s concepts and methods are conveyed with such clarity that it is hard to believe that any lay person would find it difficult to follow most of the author’s explanations. Throughout the book, Morabia emphasizes the importance of differentiating between belief and knowledge while cautioning the reader against making unwarranted inferences from knowledge. Take, for example, his statement in the Prologue: ‘‘I used the term knowledge as opposed to beliefs. Don’t read it as a synonym of truth, but rather of evidence’’ (page XIV). Even though many epidemiologic concepts and methods are not explicitly named, Morabia manages to describe them using many interesting examples. On page 200, for instance, he explains that, ‘‘intuitively, it may seem that treating fewer people but focusing in those with a high risk of heart attack...would decrease the NNT (sic, number needed to treat)...this is not necessarily so: twice as many cases of lung cancer occur among smokers of a pack or less per day than among those who smoke more than a pack per day. Why? ... The risk among light and moderate smokers is smaller than that of heavy smokers, but they are more numerous. A small risk applied to a large number of people can generate more excess cases than a large risk that is applied to a small fraction of the population.’’ This is an exquisite description of the population attributable risk! Other key concepts in epidemiology covered in this book include differences between observational and experimental epidemiology (randomized trials), designs in observational epidemiology (including quasi-experimental studies, as exemplified by Snow’s study of water supplying companies; page 53), efficacy, number of individuals who need to be treated to prevent one case of the disease or one death, bias (including inferential bias; see Chapter 16), external validity, and issues of comparability in observational studies (confounding effects). The book also emphasizes the difficulties in applying population (group) findings to individuals, which probably explain why

Special Operations Soldier With Cardiac Family History: Use of CCTA and Protein Biomarker Testing to Detect Risk of Heart Attack From Noncalcified Plaque

We sought to characterize the risk of a heart attack in a 48-year-old asymptomatic US Special Operations Command (SOCOM) Soldier without known coronary artery disease (CAD).CAD continues to be a leading cause of morbidity and mortality among most age groups in the United States. Much research is dedicated to establishing new techniques to predict myocardial infarction (MI).Coronary computed tomography (CT) angiography, also known as CCTA, along with 7-protein serum biomarker risk assessment was performed for risk evaluation.A 48-year-old SOCOM Soldier with a family history of heart disease had skeletal chest pain from war injuries and a 5-fold higher risk of heart attack over the next 5 years on the basis of protein markers. A nonobstructive left anterior descending coronary artery (LAD) plaque with a lipid-rich core and a thin fibrous cap (i.e., vulnerable plaque) was detected by CCTA. The patient was warned about his risk and prescribed four cardiac medications and scheduled for angioplasty even though he fell outside the guidelines by not having a severe obstructive blockage. Four days later, unfortunately, he had a heart attack before starting his medications and before angioplasty.CCTA with biomarker testing may have an important role in predicating acute coronary syndrome (ACS) in Special Operations Forces (SOF) Soldiers with at least one risk factor. Conventional stress testing and nuclear scanning would not detect non-flow-limiting vulnerable plaques in vulnerable patients. In order to collect more data, the PROTECT Registry has been started to evaluate asymptomatic Soldiers with at least one risk factor referred to the clinic by military physicians.

Statins and Risk of New-Onset Diabetes Mellitus

For any prescription drug, the potential benefits to health must be balanced against potential risks. Understanding these potential risks can help physicians and patients make informed decisions on whether to use a medication. Recently, statins, a class of medications prescribed to treat high cholesterol levels, have been found to modestly increase the risk of developing diabetes mellitus. It is clear that statins can prevent future major cardiovascular events, such as heart attack, stroke, and deaths from cardiovascular causes, in patients who have had a previous heart attack or those with multiple cardiovascular risk factors. However, the associations between diabetes mellitus and statin use have raised concerns over the widespread use of statin medications in patients at lower risk for cardiovascular disease. In this Patient Page, we describe the indications for statin therapy, the most common adverse effects, and recent concerns about new-onset diabetes mellitus to help patients and providers make more informed decisions about the use of this important class of medications in at-risk individuals. Cardiovascular disease is a major cause of illness and death worldwide. Elevated blood cholesterol levels (specifically the low-density lipoprotein [LDL] cholesterol) are associated with a higher risk of heart attack, stroke, and heart failure. It has become clear that elevated LDL cholesterol levels predict future events, and modern risk scores such as the Framingham Risk Score use LDL cholesterol level as an important predictor of future cardiac events.1 In addition, as new large trials shed light on the important role of LDL in cardiac disease, the optimal LDL cholesterol level has been progressively lowered in national guidelines. Statins are a class of medications called 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. These drugs block a critical …

Cardiac Myosin Binding Protein-C: A Potential Early-Stage, Cardiac-Specific Biomarker of Ischemia-Reperfusion Injury

Cardiac myosin binding protein-C (cMyBP-C) regulates sarcomeric structure, as well as myocardial contractility, and its phosphorylation is known to confer cardioprotection. We recently showed that cMyBP-C is an easily releasable and soluble myofilament; dephosphorylation of cMyBP-C results in its degradation and release into the blood post-myocardial infarction (MI); and plasma cMyBP-C levels are significantly increased in animal models and patients with MI. Strikingly, the level of plasma cMyBP-C is significantly (twofold) higher than the gold-standard plasma cardiac troponin-I (cTnI). This editorial provides an opportunity to discuss cMyBP-C as a potential new biomarker signaling ischemia-reperfusion injury. It is, however, clear that defining cMyBP-C as a bona fide selective and cardiac-specific biomarker of ischemia-reperfusion injury, as well as validating precise plasma cMyBP-C levels, will require further studies using systematic and advanced proteomics methods. Acute coronary syndrome (ACS) encompasses all conditions that are caused by a sudden inadequate perfusion of the heart. This can occur through a decrease of blood flow or increased demand to the heart. ACS includes ST-segment elevation MI (STEMI), non-STEMI (NSTEMI) and unstable angina [1]. Symptoms can vary from classic crushing chest pain that radiates down the left arm to non-descript jaw or back sensations. Every 25 s, approximately one American will experience ACS with an estimated 34% chance of dying within 1 year subsequent to the ACS event [1]. An ECG provides immediate diagnosis of STEMI, activating a fast 90-min treatment pathway from first medical contact to opening the blocked coronary artery (i.e., ‘door to balloon time’) [2]. However, ST-elevation could be due to other causes such as pericarditis, early repolarization and ventricular hypertrophy. More importantly, life-threatening NSTEMI/unstable angina can still be missed due to a nondiagnostic ECG. Furthermore, the incidence of NSTEMI has increased (from 126 to 132 per 100,000), while the incidence of STEMI has decreased (from 121 to 77 per 100,000) between 1997 and 2005 [3]. Moreover, NSTEMI shows greater 1-year mortality (18.7–27.6%) than STEMI (8.3–15.4%) [3]. When a patient presents with ACS, but without ST-segment elevation, a clinician has to decide on either an early invasive or conservative approach based on assessment of the patient’s risk [4,5]. Currently, this decision process can be difficult. The Timing of Intervention in Patients with Acute Coronary Syndromes (TIMACS) trial has shown that early invasive therapy decreases the possibility of death, MI and stroke in higher risk NSTEMI/unstable angina patients compared with standard care, with longer time to invasive therapy [6]. The American Heart Association (AHA) guidelines [4,5], the Global Registry of Acute Coronary Events (GRACE) score [4] and the Thrombolysis in Myocardial Infarction (TIMI) risk score [4] all require a positive circulatory biomarker as an indicator of high risk of heart attack. Consequently, biomarkers play a crucial role in risk-stratifying a NSTEMI ACS patient for proper care [4,5]. In this time-critical context, cMyBP-C has the potential to outperform cardiac troponins at identifying patients needing early invasive therapy and can be used to diagnose recurrent MI, which is not possible with troponins as they cannot diagnose delayed clearance.

Recurrent miscarriage associated with higher risk of heart attack

Recurrent miscarriage associated with higher risk of heart attack

Dual Peroxisome Proliferator-Activated Receptor-??/?? Agonists

The metabolic syndrome consists of a combination of cardiovascular risk factors that include hyperglycemia with or without type 2 diabetes mellitus, visceral obesity, elevated blood pressure, and atherogenic dyslipidemia. These interrelated disorders and their associated lipotoxicity, oxidative stress, and inflammatory state predispose to a constellation of cardiovascular conditions leading to high risk of heart attack, stroke, renal failure, blindness, and lower extremity amputation. Visceral obesity, a prime risk factor for type 2 diabetes and a major component of the metabolic syndrome, potentiates atherogenesis, atherosclerosis, organ lipotoxicity, and oxidative tissue damage.Peroxisome proliferator-activated receptors (PPARs) are relatively recently discovered nuclear transcription factors that are modulated by dietary fatty acids, including the essential polyunsaturated fatty acids, arachidonic acid and its metabolites, and are essential to the control of energy metabolism. Of the three PPAR isoforms (alpha, gamma, and delta), synthetic pharmaceutical ligands that activate PPARalpha (the antidyslipidemic fibric acid derivatives ['fibrates']) and PPARgamma (the antidiabetic thiazolidinediones) have been studied extensively. Recently developed dual PPARalpha/gamma agonists may combine the therapeutic effects of these drugs, creating the expectation of greater efficacy, and perhaps other advantages in the treatment of type 2 diabetes and the metabolic syndrome. However, thiazolidinediones are hampered by adverse effects related to increased weight gain and fluid overload. It remains to be seen whether the dual PPARalpha/gamma agonists currently under development have similar limitations. Nevertheless, existing clinical data imply that the combined effects of thiazolidinediones and fibrates are likely to be emulated by dual PPARalpha/gamma agonists, providing superior efficacy to these classes for the treatment of type 2 diabetes, the metabolic syndrome, and their cardiovascular and other end-organ complications.

From the Feds: Research, programs, and products

From the Feds: Research, programs, and products

Cyclic and circadian variations in cardiovascular events

The incidence of many biologic phenomena displays a reproducible and cyclic variation. Cardiovascular disease, the most common cause of death in the United States and other developed countries, also has an intrinsic variation in events. These events are more common in winter, at the beginning of each month, on Mondays (in working people), and during the early morning hours of each day. Recent meta-analyses have quantitated the excess risk of cardiovascular events in the hours around and just after awakening. Between 6 am and noon, there is a 40% higher risk of heart attack, a 29% increased risk of cardiac death, and a 49% increased risk of stroke (compared with what would be expected if these events happened at random and were evenly distributed throughout the day). These observations have major consequences for emergency medical personnel and medical transport systems. The reasons for these observations are less clear. The circadian pattern of blood pressure (BP) and heart rate may be a major contributor, and long-term “hard endpoint” studies designed to test specific pharmacologic interventions targeting the early morning rise in BP and heart rate are underway. Individuals who work night shifts and those whose BP has a different circadian pattern have a higher risk of cardiovascular events, but may be less likely to have an increased risk of cardiovascular events in the morning.

Worldwide prevention of cancer and other chronic diseases based on knowledge of mechanisms

International research, particularly as part of US/Japan programs, has led to major advances in knowledge of causes of heart disease, stroke, many types of cancer and diabetes, showing that individual lifestyle is associated with these diseases. In Japan, a major health problem is high blood pressure and stroke, and cancer of the stomach, from excessive use of salt and salted, pickled foods, and the relative low intake of protective fruits and vegetables. We identified a likely gastric carcinogen, 2-chloro-4-methylthiobutanoate, in salted, pickled fish. In the Western world, heart disease and cancer of the breast, colon, rectum, prostate, pancreas, ovary and endometrium relate to a nutritional tradition too high in total fat and fried or broiled meats, and too low in fiber, vegetables and fruits. The cooked meats contain genotoxic chemicals, heterocyclic amines, causative elements in heart disease and the nutritionally linked cancers. Decreasing total fat intake, from 40 to 20% of calories and a greater use of starches such as rice, pasta, potatoes and whole grain bread, as well as daily intake of five to nine vegetables and fruits would be beneficial. Adults should consume 2.5 1 of fluids per day. Green or black tea and fruit juices have health promoting properties. Regular exercise contributes to good health, and to the avoidance of obesity, a major problem in the USA and of increasing importance in Japan. Avoidance of a risky lifestyle would likely prevent diseases important not only for the individual and his family, but with major impact in lowering medical care costs. Tobacco and cigarette use, particularly on a Western diet, involve a high risk of heart attacks, and cancers of the lung, pancreas, kidney, urinary bladder, and cervix, accounting for 35% of medical care expenditures.