Incidence Of Coronary Events Research Articles

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

Background: Patients with arteriosclerosis obliterans (ASO) often have co-existing atherosclerotic diseases. The purpose of this study was to examine the clinical features of patients with ASO, including the overlap of atherosclerotic risk factors, characteristics of car-diovascular events, and clinical prognosis. Method: We enrolled 205 consecutive patients who had ankle brachial index (ABI) of ?0.9 between January 2008 and December 2009. Fontaine (F) classification and clinical background were evaluated and clinical events including mortality and major adverse cardiocerebro-vascular events (MACCEs) were determined. Results: There was a high prevalence of each risk factor. Sixty- five percent of subjects had three or more of the four overlapping risk factors, including hypertension, dia- betes, dyslipidemia, and smoking. After a maximum follow-up of 800 days, the incidence of MACCEs and mortality was 46% and 10%, respectively. We divided the patients into two groups according to the presence of ASO symptoms (F1 and F2-4) and compared the incidence of events. The incidence of MACCEs and mortality in the F2-4 group was significantly higher than that in the F1 group (P = 0.048, P = 0.044, respectively). After excluding lower extremity revascularization, coronary artery disease was a common cause of MACCEs, and the mortality rates after MACCEs increased in a stepwise manner according to F classification severity (P = 0.028). Conclusion: Patients with ASO had overlapping coronary risk factors and a high incidence rate of cardiovascular events. The incidence of coronary events was common, especially in symptomatic patients, and the mortality rates after MACCEs were high in accordance with F classification severity.

Association of High-Density Lipoprotein Cholesterol With Incident Cardiovascular Events in Women, by Low-Density Lipoprotein Cholesterol and Apolipoprotein B100 Levels

Prior studies have found inverse associations between high-density lipoprotein cholesterol (HDL-C) or apolipoprotein A-I levels and cardiovascular disease (CVD). Whether this observation is consistent across low-density lipoprotein cholesterol (LDL-C) levels or total atherogenic particle burden (apolipoprotein B100) is less well-studied, particularly in women. To determine the association between HDL-C or apolipoprotein A-I level and CVD across a range of LDL-C and apolipoprotein B100 values. Prospective cohort study. The Women's Health Study, a cohort of U.S. female health professionals. 26,861 initially healthy women, aged 45 years or older at study entry (1992-1995), who were followed for a mean of approximately 11 years. Baseline lipids were measured directly, and apolipoproteins were measured with immunoassays. Outcomes were incident total CVD (n = 929), coronary events (n = 602), and stroke (n = 319). In multivariable analyses, HDL-C and apolipoprotein A-I levels were inversely associated with CVD and coronary events but not stroke. Adjusted coronary hazard ratios for decreasing quintiles of HDL-C were 1.00 (reference), 1.23 (95% CI, 0.85 to 1.78), 1.42 (CI, 0.98 to 2.06), 1.90 (CI, 1.33 to 2.71), and 2.19 (CI, 1.51 to 3.19) (P for linear trend < 0.001); corresponding hazard ratios for apolipoprotein A-I were 1.00 (reference), 0.98 (CI, 0.71 to 1.35), 1.02 (CI, 0.72 to 1.44), 1.37 (CI, 0.98 to 1.90), and 1.58 (CI, 1.14 to 2.20) (P for linear trend = 0.005). Consistent inverse associations were found for HDL-C with coronary events across a range of LDL-C values, including among women with low LDL-C levels. No associations were noted for HDL-C or apolipoprotein A-I among women with low apolipoprotein B100 values (<0.90 g/L). Participants were at low risk for CVD, the number of events in the lowest apolipoprotein B100 stratum was small, only a single baseline measurement was obtained, and residual confounding may have occurred. Consistent inverse associations were found for HDL-C with incident coronary events among women with a range of LDL-C values. Among women with low total atherogenic particle burden (apolipoprotein B100 level <0.90 g/L), few events occurred and no associations were seen. Merck & Co. and the National Heart, Lung, and Blood Institute and National Cancer Institute, National Institutes of Health.

RANTES/CCL5 and Risk for Coronary Events: Results from the MONICA/KORA Augsburg Case-Cohort, Athero-Express and CARDIoGRAM Studies

BackgroundThe chemokine RANTES (regulated on activation, normal T-cell expressed and secreted)/CCL5 is involved in the pathogenesis of cardiovascular disease in mice, whereas less is known in humans. We hypothesised that its relevance for atherosclerosis should be reflected by associations between CCL5 gene variants, RANTES serum concentrations and protein levels in atherosclerotic plaques and risk for coronary events.Methods and FindingsWe conducted a case-cohort study within the population-based MONICA/KORA Augsburg studies. Baseline RANTES serum levels were measured in 363 individuals with incident coronary events and 1,908 non-cases (mean follow-up: 10.2±4.8 years). Cox proportional hazard models adjusting for age, sex, body mass index, metabolic factors and lifestyle factors revealed no significant association between RANTES and incident coronary events (HR [95% CI] for increasing RANTES tertiles 1.0, 1.03 [0.75–1.42] and 1.11 [0.81–1.54]). None of six CCL5 single nucleotide polymorphisms and no common haplotype showed significant associations with coronary events. Also in the CARDIoGRAM study (>22,000 cases, >60,000 controls), none of these CCL5 SNPs was significantly associated with coronary artery disease. In the prospective Athero-Express biobank study, RANTES plaque levels were measured in 606 atherosclerotic lesions from patients who underwent carotid endarterectomy. RANTES content in atherosclerotic plaques was positively associated with macrophage infiltration and inversely associated with plaque calcification. However, there was no significant association between RANTES content in plaques and risk for coronary events (mean follow-up 2.8±0.8 years).ConclusionsHigh RANTES plaque levels were associated with an unstable plaque phenotype. However, the absence of associations between (i) RANTES serum levels, (ii) CCL5 genotypes and (iii) RANTES content in carotid plaques and either coronary artery disease or incident coronary events in our cohorts suggests that RANTES may not be a novel coronary risk biomarker. However, the potential relevance of RANTES levels in platelet-poor plasma needs to be investigated in further studies.

Association of Genetic Variants and Incident Coronary Heart Disease in Multiethnic Cohorts

Background— Genome-wide association studies identified several single nucleotide polymorphisms (SNP) associated with prevalent coronary heart disease (CHD), but less is known of associations with incident CHD. The association of 13 published CHD SNPs was examined in 5 ancestry groups of 4 large US prospective cohorts. Methods and Results— The analyses included incident coronary events over an average 9.1 to 15.7 follow-up person-years in up to 26 617 white individuals (6626 events), 8018 black individuals (914 events), 1903 Hispanic individuals (113 events), 3669 American Indian individuals (595 events), and 885 Asian/Pacific Islander individuals (66 events). We used Cox proportional hazards models (with additive mode of inheritance) adjusted for age, sex, and ancestry (as needed). Nine loci were statistically associated with incident CHD events in white participants: 9p21 (rs10757278; P =4.7×10 −41 ), 16q23.1 (rs2549513; P =0.0004), 6p24.1 (rs499818; P =0.0002), 2q36.3 (rs2943634; P =6.7×10 −6 ), MTHFD1L (rs6922269, P =5.1×10 −10 ), APOE (rs429358; P =2.7×10 −18 ), ZNF627 (rs4804611; P =5.0×10 −8 ), CXCL12 (rs501120; P =1.4×10 −6 ) and LPL (rs268; P =2.7×10 −17 ). The 9p21 region showed significant between-study heterogeneity, with larger effects in individuals age 55 years or younger and in women. Inclusion of coronary revascularization procedures among the incident CHD events introduced heterogeneity. The SNPs were not associated with CHD in black participants, and associations varied in other US minorities. Conclusions— Prospective analyses of white participants replicated several reported cross-sectional CHD-SNP associations.

Impaired functionality of HDL in diabetes

Patients with type 2 diabetes mellitus (T2DM) remain at higher risk of cardiovascular diseases than nondiabetic subjects even when they have achieved the recommended targets of serum lipids, blood glucose and blood pressure. A growing body of recent investigations suggests that the characteristics of plasma lipoproteins may be altered in such conditions. It is now accepted that a low concentration of highdensity lipoprotein cholesterol (HDL-C) is the most common lipoprotein abnormality in patients with coronary heart disease (CHD), and the level of HDL-C serves as the strongest prediction of CHD risk [1]: for every 1 mg/dl increase in HDL-C, the predicted incidence of coronary events decreases by 2% in men and 3% in women. Besides, low HDL-C is also associated with unfavorable prognosis in patients with CHD. Even with the most aggressive lowdensity lipoprotein-cholesterol (LDL-C) intervention, two thirds of all cardiovascular events are not prevented. Combination therapy involving the addition of aggressive HDL-based interventions may potentially improve this number. Conventional treatment to raise HDL-C includes lifestyle modifications, exercise, smoking cessation, weight control, moderate alcohol intake, a diet rich in n-3 polyunsaturated fatty acids with limited carbohydrates, niacin, fibrates and statins. HDL forms a structurally and functionally heterogeneous class of lipoproteins. Most of them contain apolipoprotein (apo) A-I as the most abundant protein constituent of the water-soluble surface. The bulk of HDL is formed by spherical particles containing a core of water-insoluble cholesteryl ester. Apo A-I and apo A-II also have biological actions such as receptor binding and the modulation of several enzymes. In addition to these major apolipoproteins, certain HDL subclasses have enzymes such as lecithincholesterol acyltransferase (LCAT), cholesteryl-estertransfer protein (CETP), phospholipid transfer protein (PLTP), anti-oxidative enzymes or bioactive lipids on the surface.

Incidence of Coronary Events and Case Fatality Rate in Relation to Blood Lymphocyte and Neutrophil Counts

Elevated levels of blood leukocytes have been associated with acute coronary events (CEs), but data on leukocyte subclasses are limited. This study aimed to explore whether blood lymphocyte and neutrophil counts are associated with incidence of CEs and with fatal outcome in subjects who subsequently experienced a first CE. Neutrophil and lymphocyte counts were measured in 27 419 subjects from the general population without a history of CEs, heart failure, or atrial fibrillation. Incidence of CEs was studied in relation to leukocyte counts during a mean follow-up of 13.6 years. Neutrophil but not lymphocyte counts were significantly associated with incidence of CEs. After adjustments for confounding factors, the hazard ratios (95% confidence interval) were 1.00 (reference), 1.07 (0.94-1.23), 1.09 (0.95-1.25), and 1.39 (1.22-1.59) for subjects with neutrophils in the first, second, third, and fourth (highest) sex-specific quartiles, respectively (P for trend <0.001). Of the 1965 subject who had a CE, 471 subjects died on the first day of the CE, in- or outside hospital. The proportions of subjects who died the first day were 19%, 21%, 25%, and 28%, respectively in the first, second, third, and fourth quartiles (P for trend <0.001). Increased neutrophil counts are associated with incidence of CEs and increased case-fatality rate after a CE.

Effect of vitamin B6 and antihelicobacter pylori on prognosis and serum levels of inflammation mediators in patients with acute coronary syndrome

AimTo study the effect of administration of vitamin B6 and antihelicobacterial agents on coronary events and the serum levels of inflammatory mediators in patients with acute coronary syndrome.MethodsOne hundred and...

TGF‐β1 content in atherosclerotic plaques, TGF‐β1 serum concentrations and incident coronary events

We tested the hypothesis that high TGF-β1 content in atherosclerotic plaques and high TGF-β1 serum levels are associated with lower risk of coronary events in two independent prospective studies. In the prospective Athero-Express biobank study, total TGF-β1 plaque levels were measured in 632 atherosclerotic lesions from patients who underwent carotid endarterectomy. In a population-based case-cohort study within the Monitoring of trends and determinants in cardiovascular disease (MONICA)/Cooperative Health Research in the Region of Augsburg (KORA) Augsburg studies, baseline total TGF-β1 serum levels were measured in 333 individuals with and 1728 without incident coronary events. Patients with TGF-β1 content in their plaques above the study median did not have a lower risk of coronary events than patients with lower TGF-β1 levels [adjusted HR (95% CI) 1·46 (0·83-2·53); P = 0·16; mean follow-up 2·6 ± 0·7 years] in the Athero-Express biobank study. Cox proportional hazard models adjusting for age, sex, body mass index, metabolic factors, lifestyle factors and survey did not reveal a significant association between TGF-β1 serum levels and incident coronary events [HR (95% CI) for increasing TGF-β1 tertiles 1·0, 1·22 (0·88-1·68), 1·13 (0·82-1·57); P = 0·47; mean follow-up: 10·8 ± 4·6 years] in the MONICA/KORA Augsburg studies. Our results indicate that high TGF-β1 content in human atherosclerotic plaques and high serum levels of TGF-β1 are not associated with reduced risk of coronary events.

LONG-TERM EXPOSURE TO AIR POLLUTION WITHIN EUROPEAN CITIES AND CARDIOVASCULAR DISEASE: THE ESCAPE STUDY

Background and Aims. Work package 5 of the European multicenter ESCAPE project aims to delineate the role of long-term exposures to ambient particles in cardiovascular disease development and coronary artery and cerebrovascular disease incidence. Specifically the impact of ambient air pollution on markers of inflammation, and gene-environment interactions (aim1), on blood pressure and prevalence of hypertension (aim2), on the risk for build-up of preclinical atherosclerosis measured by intima-media thickness (IMT) of the carotid artery (aim3), and on incident coronary events (aim4) will be evaluated. Methods. The 14 contributing adult cohort studies originate from Austria, Denmark, Finland, Germany, Italy, Norway, Spain, Sweden, and Switzerland and cover different geographical regions within Europe. All participating cohorts assessed the spatial variability of PM10, PM2.5 and NOx within their communities based on the ESCAPE exposure protocol. City-specific analyses with subsequent pooling of the regression coefficients applying methods for meta-analyses are underway and first results will be shown. Endpoint-specific confounders and effect-modifiers are considered and include e.g. gender, age, BMI, smoking, alcohol intake, social class indicators, dietary variables, and noise. Results. A different set of cohorts will participate in each specific aim. There are 8 cohorts contributing to aim1 with 32,000 participants, 14 cohorts to aim2 with 228,800 participants, and 4 cohorts to aim3 with 9,500 participants. 9 cohorts participate to aim4 with a study population of 120,000. The follow-up time varied between studies ranging from 15 months to 15 years. Conclusions. The project will provide important information for the assessments of the role of ambient air pollution on the development of cardiovascular disease integrating effects of pollution on systemic inflammation, hypertension, atherosclerosis, and incident events. Thereby, ESCAPE will provide important information for estimating the overall public health impact of air pollution and for developing prevention strategies for at risk populations based on air quality measures.

Comparison of different metabolic syndrome definitions and risks of incident cardiovascular events in the elderly

The metabolic syndrome is associated with increased cardiovascular risk, and its prevalence increases with age. Various definitions of the metabolic syndrome exist, but whether some definitions are more predictive of future cardiovascular events in the elderly is unclear. We compared the risk of incident cardiovascular events in elderly individuals at least 65 years old from the Cardiovascular Health Study with and without the metabolic syndrome as defined by the European Group for the Study of Insulin Resistance (EGIR), National Cholesterol Education Program (NCEP)/American Heart Association (AHA), American Association of Clinical Endocrinologists, International Diabetes Federation (IDF), and modified World Health Organization (WHO) criteria (n = 3390). Participants were without baseline diabetes or cardiovascular disease. Except for EGIR, all definitions of the metabolic syndrome were significantly associated with increased risk of incident cardiovascular (coronary or cerebrovascular) events. Adjusted hazard ratios (HRs) for risk of incident cardiovascular events as defined by the modified WHO, NCEP/AHA, American Association of Clinical Endocrinologists, and IDF criteria ranged from 1.153 (P = .045) for NCEP/AHA to 1.314 (P < .001) for IDF, with 95% confidence interval (CI) ranging from 1.003 to 1.503. Adjusted HR for EGIR was 1.087 (95% CI, 0.908-1.301; P = .362). Similarly, all definitions of the metabolic syndrome were significantly associated with incident coronary events except for the EGIR definition. Only the modified WHO definition was associated with increased risk for cerebrovascular events (adjusted HR, 1.301; 95% CI, 1.038-1.631; P = .022). Although all metabolic syndrome definitions except EGIR were associated with total cardiovascular events and coronary events, only the modified WHO definition was also associated with risk of cerebrovascular events.

Epidemiología del síndrome coronario agudo y la insuficiencia cardiaca en Latinoamérica

Cardiovascular disease is the principle cause of death in Latin America. Data from the World Health Organization indicate that the region is currently experiencing a large-scale epidemic of cardiovascular disease. This could be attributable to demographic and lifestyle changes inherent in the epidemiologic transition: one consequence of increased life-expectancy is longer exposure to cardiovascular risk factors, which results in a higher probability of adverse events. Latin America is one of the regions of the world with the highest burden of cardiovascular risk factors, particularly overweight, dyslipidemia and diabetes mellitus. These factors will have a significant impact on the incidence of coronary events and heart failure in the near future. In addition, infectious conditions, especially Chagas disease and rheumatic fever, affect large sections of the population in the region. Unless preventive measures are introduced in the next three to four decades, the number of deaths due to cardiovascular disease in the region will increase by more than 200%. Data currently available indicate that mortality in patients with acute coronary syndrome is greater in Latin America than in developed countries. Among the possible factors that could explain this finding are the underuse of therapies that have been shown to be effective and the more conservative and later use of surgical and percutaneous interventions. In Latin America, heart failure occurs in younger subjects than in the rest of the world and is most frequently related to ischemic heart disease. However, Chagas disease is close to hypertension as the second most common cause. There is an urgent need for well-designed epidemiologic studies to guide the implementation of preventive measures and appropriate treatment.

Immunological and Cardiometabolic Risk Factors in the Prediction of Type 2 Diabetes and Coronary Events: MONICA/KORA Augsburg Case-Cohort Study

BackgroundThis study compares inflammation-related biomarkers with established cardiometabolic risk factors in the prediction of incident type 2 diabetes and incident coronary events in a prospective case-cohort study within the population-based MONICA/KORA Augsburg cohort.Methods and FindingsAnalyses for type 2 diabetes are based on 436 individuals with and 1410 individuals without incident diabetes. Analyses for coronary events are based on 314 individuals with and 1659 individuals without incident coronary events. Mean follow-up times were almost 11 years. Areas under the receiver-operating characteristic curve (AUC), changes in Akaike's information criterion (ΔAIC), integrated discrimination improvement (IDI) and net reclassification index (NRI) were calculated for different models. A basic model consisting of age, sex and survey predicted type 2 diabetes with an AUC of 0.690. Addition of 13 inflammation-related biomarkers (CRP, IL-6, IL-18, MIF, MCP-1/CCL2, IL-8/CXCL8, IP-10/CXCL10, adiponectin, leptin, RANTES/CCL5, TGF-β1, sE-selectin, sICAM-1; all measured in nonfasting serum) increased the AUC to 0.801, whereas addition of cardiometabolic risk factors (BMI, systolic blood pressure, ratio total/HDL-cholesterol, smoking, alcohol, physical activity, parental diabetes) increased the AUC to 0.803 (ΔAUC [95% CI] 0.111 [0.092–0.149] and 0.113 [0.093–0.149], respectively, compared to the basic model). The combination of all inflammation-related biomarkers and cardiometabolic risk factors yielded a further increase in AUC to 0.847 (ΔAUC [95% CI] 0.044 [0.028–0.066] compared to the cardiometabolic risk model). Corresponding AUCs for incident coronary events were 0.807, 0.825 (ΔAUC [95% CI] 0.018 [0.013–0.038] compared to the basic model), 0.845 (ΔAUC [95% CI] 0.038 [0.028–0.059] compared to the basic model) and 0.851 (ΔAUC [95% CI] 0.006 [0.003–0.021] compared to the cardiometabolic risk model), respectively.ConclusionsInclusion of multiple inflammation-related biomarkers into a basic model and into a model including cardiometabolic risk factors significantly improved the prediction of type 2 diabetes and coronary events, although the improvement was less pronounced for the latter endpoint.

Mortality Risk Among Middle-aged Women With First Atrial Fibrillation

IN THIS ISSUE OF JAMA, THE REPORT BY CONEN AND COLleagues provides further evidence to confirm an increased mortality risk among middle-aged women with new-onset atrial fibrillation (AF). The study cohort consisted of 34 722 health care professionals in the Women’s Health Study (WHS) who agreed to prospective follow-up after the end of the randomized treatment trial. These women were aged 49 to 59 years and free of cardiovascular disease at baseline. During a median follow-up of 15.4 years, 1011 women (2.9%) developed new-onset AF, and 63 deaths occurred among these women. In multivariable models, incident AF was associated with an increased adjusted risk of all-cause mortality, as well as cardiovascular and noncardiovascular death. Analyses of mortality outcomes in the Framingham Heart Study demonstrated that the development of AF was associated with attenuation of the female survival advantage. Other studies that have examined mortality have also observed an association between AF and death after adjusting for potential confounders, with the exception of studies of lone AF. The study by Conen et al adds to the existing literature that AF is not a benign condition but in fact is associated with premature death. Newly identified AF in seemingly healthy women should be taken seriously and treated aggressively, recognizing that anticoagulation, which is an integral part of AF management, reduces stroke and mortality risk. In the WHS cohort, nearly half of the women who subsequently developed AF had hypertension, a third had hypercholesterolemia, and 9% were current smokers at baseline. Compared with women who remained free of AF, those who developed AF had higher prevalence of hypertension, diabetes, hypercholesterolemia, smoking, and body mass index higher than 25 at baseline, representing a higher-risk subgroup. Therefore, while the cohort was event-free at baseline, whether these women can be considered “healthy” is questionable. Why was the mortality risk greater once AF was identified? Conen et al suggest that the increased risk was at least partly mediated through nonfatal cardiovascular events such as congestive heart failure and stroke, as has been reported by others. Conen et al also observed an association between incident AF and myocardial infarction, which was thought to also contribute to an increased mortality risk among these women. This observation is consistent with results of the Olmsted County AF study, in which a strong relationship between incident AF and subsequent coronary events was observed, and extends the evidence of this relationship to younger women. In the Olmsted County study, incident AF was associated with substantially higher risk of coronary events in women than that predicted by the Framingham risk score, with the excess mortality risk significantly greater among women than men. While standardized echocardiographic studies were not performed in all women with incident AF in the WHS cohort, structural abnormalities were common in the subgroup for whom echocardiographic data were available. Using linear left atrial dimension, a relatively crude way to measure left atrial size and with a cutoff of 40 mm for enlargement, 41% of women who developed AF had an enlarged left atrium at the time of diagnosis. Furthermore, 32% had left ventricular hypertrophy. These data suggest that women who developed AF had preexisting structural substrates for this arrhythmia. Left atrial enlargement and left ventricular hypertrophy are typical features of hypertensive heart disease. In a study of lone AF, patients with normal-sized atria were found to have a benign clinical course throughout a 30-year follow-up. In contrast, patients with increased left atrial volume at diagnosis or during follow-up experienced adverse events. Although left atrial enlargement is not the direct cause of AF, stroke, heart failure, or death, it has consistently been shown to be the common denominator for the pathophysiologic cascade that leads to AF, stroke independent of AF, heart failure, and death. While it is

Vanin-1 T26I polymorphism, hypertension and cardiovascular events in two large urban-based prospective studies in Swedes

Background and aimsVanin-1 (gene name VNN1) is an enzyme with pantetheinase activity generating the amino-thiol cysteamine which is implicated in the regulation of red-ox status through its effect on glutathione. We tested the hypothesis that the rs2294757 VNN1 T26I polymorphism could affect blood pressure (BP) levels, hypertension prevalence, and risk of incident cardiovascular events. Methods and resultsThe VNN1 T26I polymorphism was genotyped in 5664 participants of the cardiovascular cohort of the "Malmö Diet and Cancer" (MDC-CVA) study and successively in 17874 participants of the “Malmö Preventive project”(MPP). The incidence of cardiovascular events was monitored for an average of nearly 12 years of follow-up in the MDC-CVA and for 25 years in the MPP. Both before and after adjustment for sex, age and BMI in the MDC-CVA the polymorphism had a mild lowering effect on diastolic BP and hypertension, especially in females. However in MPP no effect on BP phenotypes was detectable. Before and after adjustment for major cardiovascular risk factors, the hazard ratio for incident ischemic stroke and coronary events in the MDC-CVA was not significantly different in carriers of different genotypes. ConclusionsOur data do not support a major role for the VNN1 T26I variant in determining BP level and incident ischemic events.

Statins for Cardiovascular Disease Prevention

HMG-CoA reductase inhibitors, better known as statins, are used in the primary prevention of cardiovascular disease (CVD) in patients with elevated cholesterol. Statins also reduce the incidence of coronary events and stroke and improve survival rates in CVD.

The health impacts of poor housing conditions and thermal discomfort

On summer and winter months, cardiovascular morbidity and mortality rates vary throughout Europe. For example, areas with mild winters seem to be the ones with higher number of seasonal mortality. In fact, Portugal is one of the southern countries together with Ireland that have higher mortality in winter. However, the number of studies relating cold weather with morbidity/mortality is still very rare. These occurrences are suspected to be associated with housing quality especially thermal insulation. In order to assess the relation between the incidence of coronary events and housing conditions in Portugal, a survey on inpatients with any form of acute coronary syndromes was undertaken during winter months, in order to get some data about houseability and residents behavior attitudes against cold exposure. It remained clear that poor housing conditions and/or lack of protective measures against cold exposure are common in Portugal. A better knowledge about the impact of weather and climate on health may be applied to built up a set of regulations for housing design (for new but also for old dwellings restoration); but also it is essential for the establishment of adaptation and mitigation policies and strategies, as well as on health planning and on the development of early warning systems.

Reduced Health Care Expenditures After Enrollment in a Collaborative Cardiac Care Service

To assess the impact of a collaborative cardiovascular risk reduction service (Collaborative Cardiac Care Service [CCCS]) on total health care expenditures after an incident acute coronary event. Matched, retrospective cohort study. Kaiser Permanente Colorado (KPCO) databases. Patients who had an incident coronary event between January 1999 and June 2004 and were either enrolled (CCCS group) or never enrolled in the CCCS (No CCCS group). Patients in the CCCS group (628 patients) were matched in a 1:1 ratio to patients in the No CCCS group (628 patients) by Chronic Disease Score (CDS) and total health care expenditures in the 180 days before the index coronary event (baseline). Drug purchases and medical utilization encounters were extracted from the KPCO administrative and claims databases after the incident coronary event until death, KPCO plan termination, 3 years later, or December 31, 2005, whichever came first (follow-up). Expenditure estimates from the plan's decision support system (in 2007 U.S. dollars) were applied to each utilization encounter. A $1/follow-up day cost was applied to all patients in the CCCS group. Expenditures/follow-up day were modeled with adjustment for matching variables, patient characteristics, baseline expenditures, and intracorrelations of matched patients. Patients in the No CCCS group were slightly older and were more likely to be female and have had a myocardial infarction as their incident event compared with those in the CCCS group. During follow-up, there were 12 and 98 cardiac-related deaths and 16 and 188 all-cause deaths for the CCCS and No CCCS groups, respectively; mean and median total health care expenditures/day were $39 and $20, respectively, for the CCCS group, and $108 and $45, respectively, for the No CCCS group (all p<0.001). After adjustment, total health care expenditures for patients in the CCCS group were approximately $60/day ($21,900/yr) lower than those for patients in the No CCCS group (p<0.001; adjusted R(2)=0.29 with log-transformed expenditures). The comprehensive and aggressive implementation of secondary cardiac prevention strategies and close monitoring and follow-up of patients with coronary artery disease provided by the CCCS were associated with reduced health care expenditures.

Risk Assessment for Sudden Cardiac Death in Dialysis Patients

Patients with end-stage renal disease (ESRD) on long-term dialysis therapy have very high mortality due to predominantly cardiovascular causes1 (Figure 1). Sudden cardiac death (SCD) is the single most common form of death in dialysis patients, accounting for 20% to 30% of all deaths in this cohort.2,3 These patients indeed have a very high burden of coronary artery disease (CAD), and a proportion of SCD events could be due to obstructive CAD.1,2 However, epidemiological and observational studies have reported that the overall incidence of SCD in this population is much greater than the incidence of coronary events,4,5 and the risk of SCD persists even after coronary revascularization.6 These findings suggest a possibility of a primary increase in the risk of fatal ventricular arrhythmias, which is the most common cause of SCD. Dialysis patients with ESRD have several factors that could predispose them to a high risk of ventricular arrhythmias (Table 1). A large number of dialysis patients have diabetes, and thus, autonomic neuropathy as a consequence of both chronic uremia and coexisting diabetes is very common,7 resulting in alterations in autonomic control with a sustained increase in the sympathetic tone reported to be proarrhythmic. Similarly, hypertension is very common, and uremia leads to secondary hyperparathyroidism, both of which lead to considerable left ventricular hypertrophy (LVH).8 In addition, chronic uremia leads to endothelial dysfunction, and the combination of endothelial dysfunction and LVH compromises perfusion reserve and makes the individual susceptible to arrhythmias precipitated by ischemia. Long-standing uremia leads to uremic cardiomyopathy, with typical changes of diffuse myocardial fibrosis,9 which could lead to slowing of conduction and increased dispersion of repolarization, both of which have been shown to be proarrhythmic.10 Significant sudden shifts in electrolytes and fluid …

E0448 A study of relation between tissue factor pathway and acute coronary syndrome

ObjectiveTo investigate the changes of plasma quantity of Tissue Factor (TF) and Tissue Factor Pathway Inhibitor (TFPI) in different type of Acute coronary syndrome (ACS) patients and the association between...

Serum albumin concentration and heart failure risk: The Health, Aging, and Body Composition Study

How serum albumin levels are associated with risk for heart failure (HF) in the elderly is unclear.We evaluated 2,907 participants without HF (age 73.6 +/- 2.9 years, 48.0% male, 58.7% white) from the community-based Health ABC Study. The association between baseline albumin and incident HF was assessed with standard and competing risks proportional hazards models controlling for HF predictors, inflammatory markers, and incident coronary events.During a median follow-up of 9.4 years, 342 (11.8%) participants developed HF. Albumin was a time-dependent predictor of HF, with significance retained for up to 6 years (baseline hazard ratio [HR] per -1 g/L 1.14, 95% CI 1.06-1.22, P < .001; annual rate of HR decline 2.1%, 95% CI 0.8%-3.3%, P = .001). This association persisted in models controlling for HF predictors, inflammatory markers, and incident coronary events (baseline HR per -1 g/L 1.13, 95% CI 1.05-1.22, P = .001; annual rate of HR decline 1.8%, 95% CI 0.5%-3.0%, P = .008) and when mortality was accounted for in adjusted competing risks models (baseline HR per -1 g/L 1.13, 95% CI 1.05-1.21, P = .001; annual rate of HR decline 1.9%, 95% CI 0.7%-3.1%, P = .002). The association of albumin with HF risk was similar in men (HR per -1 g/L 1.13, 95% CI 1.05-1.23, P = .002) and women (HR per -1 g/L 1.12, 95% CI 1.04-1.22, P = .005) and in whites and blacks (HR per -1 g/L 1.13, 95% CI 1.04-1.22, P< .01 for both races) in adjusted models.Low serum albumin levels are associated with increased risk for HF in the elderly in a time-dependent manner independent of inflammation and incident coronary events.