Risk Of Ischemic Heart Disease Research Articles

Racial disparities in new-onset diabetes mellitus in prostate cancer patients on androgen deprivation therapy: a retrospective analysis of TriNetX data.

Prostate cancer (PCa) is the most common cancer in men in the US and androgen deprivation therapy (ADT) is the most frequently used systemic therapy for PCa. Data suggest that ADT is associated with an increased risk of new-onset diabetes mellitus (NODM) and cardiovascular complications. As the incidence and mortality of PCa are highest among the African American (AA) population, it is important to evaluate the difference in the incidence of NODM and ischemic heart disease (IHD) between AA men compared to Caucasian men. This is a retrospective cohort study utilizing the TriNetX database to assess NODM and IHD risk, risk difference, and risk ratio (RR) after recent ADT initiation in an AA cohort and a Caucasian cohort of patients with PCa. Propensity score matching (PSM) was performed by age, BMI, and confounding comorbidities. After matching, the cohort included 1159 AA patients and 843 Caucasian patients with NODM after ADT initiation. The IHD cohort included 1269 AA patients and 1248 Caucasian patients. The risk of incidence of NODM is higher among AA men at 11.6% risk compared to Caucasian men at 7.4%. The risk difference is 4.1% (95% CI = 3.4, 4.9) p = 0.000. The RR is 1.56 (95% CI = 1.43, 1.70). In contrast, risk difference and risk ratio of IHD was not significant between AA and Caucasian groups. ADT exposure increases the risk of NODM in men with PCa, especially among AA men compared with Caucasian men. Men receiving ADT should be monitored routinely for signs and symptoms of metabolic syndrome and diabetes. Targeted close monitoring of AA men on ADT would be critical to prevent and treat metabolic complications with potential of reducing disparities in PCa morbidity.

Influence of Salt Intake on Segmental Lesions of Patients with Ischaemic Heart Disease in Sri Lanka: A Cross-sectional Study

Background: Sodium assists in maintaining body fluid balance. Excess sodium intake increases the risk of ischaemic heart disease (IHD) adding to global and local mortality due to non-communicable diseases. Aim: To determine the salt intake levels of patients having coronary artery bypass grafting (CABG) and to explain the relationship between salt consumption and atheroma development. This study used an adapted cross-sectional design with 233 patients admitted to Sri Jayewardenepura General Hospital with acute heart diseases. Method: Demographic and lifestyle-related data, medical history and food intake data were collected. Salt intake was calculated based on the consumption of salt used per month at household level, salt added to food – including in restaurants. Salt content was determined using web-based applications and food tables. Multivariate logistic regression was used to identify variables significantly associated with IHD. Results: In this study, the daily intake of sodium per person was 6,176 mg. This was much higher than WHO’s recommended level of 2,000 mg/day, demonstrating a significant relationship between segmental lesions and sodium intake (p<0.01). The multivariate binary logistic model demonstrated that high salt intake (OR 8.54; 95% CI [4.545–16.734]) and the presence of diabetes (OR 2.23; 95% CI [1.206–4.238]), contributed to the high number of segmental lesions (p<0.01). Conclusion: A high daily intake of sodium increases the risk of atheroma formation in more coronary segments, regardless of age, sex, several known disease conditions and risk factors.

Elevated Uric Acid Levels with Early Chronic Kidney Disease as an Indicator of New-Onset Ischemic Heart Disease: A Cohort of Koreans without Diabetes.

Several studies have showed that hyperuricemia is related to the development of ischemic heart disease (IHD). There is also growing evidence indicating that hyperuricemia may contribute to the progression of IHD as a pathogenic factor. Ironically, uric acid can be an antioxidant agent, as shown in experimental studies. The aim of our study is to analyse the association between uric acid and IHD with early-stage chronic kidney disease (CKD). Data were assessed from 17,492 participants without cardiovascular disease from the Korean Genome and Epidemiology Study (KoGES) and Korea Health Insurance Review and Assessment (HIRA) data. The subjects were categorized as four groups according to CKD and uric acid levels. We retrospectively evaluated hazard ratios (HRs) with 95% confidence intervals (CIs) for IHD by using multivariate Cox regression analysis over a 4-year period from the baseline survey. During the follow-up, 335 individuals (3.4%; 236 men and 99 women) developed IHD. Compared to the participants without elevated uric acid and early CKD HRs for incident IHD according to uric acid levels and early CKD, the uric acid level was 1.13 (95% CI, 0.86-1.48) in participants with elevated uric acid and without early CKD, 0.99 (95% CI, 0.55-1.77) in participants without elevated uric acid and with early CKD, and 1.65 (95% CI, 1.03-2.66) in participants with elevated uric acid and early CKD after adjusting for confounding metabolic factors. Early CKD and high uric acid levels increased the risk of new-onset IHD (HR, 1.65; 95% CI, 1.03-2.66). Elevated uric acid levels were related to an increased risk of incident IHD in early-stage CKD patients. It is expected that uric acid can be a reliable predictor for IHD, even in early-stage CKD patients; thus, in those with CKD, proactively managing uric acid levels can play a significant role in reducing the risk of cardiovascular disease.

Long-Term Non-Congenital Cardiac and Renal Complications in Down Syndrome: A Study of 32,936 Patients.

Individuals with Down syndrome are at a higher risk of cardiac, renal, and other health issues due to a complex disease physiology. However, few data exist on long-term disease risks to guide prevention and care. We aimed to determine the 10-year incidence of cardiac, renal, and urinary tract complications in Down syndrome versus matched controls. This retrospective cohort study utilized a large collaborative database. We identified 32,444 patients with Down syndrome and matched controls, excluding those with pre-follow-up target events. Covariates included demographics, lifestyle factors, and comorbidities. Outcomes were ischemic heart disease, hypertension, hypothyroidism, epilepsy, urinary tract infections and chronic kidney disease. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox regression and plotted Kaplan-Meier survival curves. Over 10 years, Down syndrome patients showed a 3.7-fold higher ischemic heart disease risk (95% CI: 3.0-4.6) and a 1.6-fold higher hypertension risk (95% CI: 1.4-1.8) versus controls. Hypothyroidism (HR = 2.0; 95% CI: 1.7-2.4), epilepsy (HR = 4.5; 95% CI: 3.5-5.8), and urinary tract infection (HR = 3.9; 95% CI: 3.4-4.6) risks were also higher. Chronic kidney disease risk was 2.7-fold greater (95% CI: 2.1-3.5). Survival analysis confirmed a significantly higher incidence of all outcomes in Down syndrome (p < 0.0001). This large study found major health challenges in Down syndrome, with risks 3- to 5-fold higher for chronic conditions versus matched controls over 10 years. Though survival remains high with proper care, focusing resources on the prevention and management of complications in this high-risk group can optimize well-being across the lifespan. Future research accounting for limitations here would provide definitive estimates of disease risk in Down syndrome to guide targeted health strategies.

Frailty Predicts Incident Atrial Fibrillation in Women but Not in Men: The Kuopio Ischaemic Heart Disease Risk Factor Study

Introduction: Frailty and atrial fibrillation (AF) are common aging problems and increasing globally. The association(s) between frailty and AF has been inconclusive. The purpose of this prospective population-based cohort was to investigate the associations between frailty and incident AF in older men and women. Methods: In total 839 participants, women (n = 458) and men (n = 381), aged 61–74 years from the Kuopio Ischaemic Heart Disease Risk Factor Study were included (March 1, 1998, to December 31, 2001). At the baseline, frailty prevalence was 49.3% (n = 414), and non-frailty 50.7% (n = 425) of the total population. Frailty was ascertained with the presence of 3–5 and prefrailty 1–2 of the following criteria: weight loss (highest 20% over 7 years), self-reported tiredness, weakness (measured by handgrip strength), slow walking speed (walking pace), and low physical activity (lowest 20%). AF events were obtained by record linkages from the national computerized hospitalization registry in Finland up to December 31, 2019. Multivariate Cox proportional hazard regression estimated the hazard ratio (HR) of incident events, adjusted for potential confounders. Results: During the mean follow-up of 14.2 years, 288 AF cases (169 women; 119 men) occurred. After adjustment for possible confounders, the HRs (95% confidence intervals [CIs]) for AF was 1.46 (1.48–1.85) in the frail population, compared to the non-frail group. The association was observed only among older frail women (multivariable-adjusted HR 1.78, 95% CI [1.28–2.48]) (p for interaction = 0.04). No statistically significant associations were observed between frailty and future AF incident among men (multivariable-adjusted HRs 1.12, 95% CI (0.77–1.63)). Conclusions: In this population-based epidemiological cohort, the risk of developing AF was increased in women affected by frailty at baseline but not in men.

Plasma tissue-type plasminogen activator is associated with lipoprotein(a) and clinical outcomes in hospitalized patients with COVID-19

BackgroundPatients with COVID-19 have a higher risk of thrombosis and thromboembolism, but the underlying mechanism(s) remain to be fully elucidated. In patients with COVID-19, high lipoprotein(a) (Lp(a)) is positively associated with the risk of ischemic heart disease. Lp(a), composed of an apoB-containing particle and apolipoprotein(a) (apo(a)), inhibits the key fibrinolytic enzyme, tissue-type plasminogen activator (tPA). However, whether the higher Lp(a) associates with lower tPA activity, the longitudinal changes of these parameters in hospitalized patients with COVID-19, and their correlation with clinical outcomes are unknown. ObjectivesTo assess if Lp(a) associates with lower tPA activity in COVID-19 patients, and how in COVID-19 populations Lp(a) and tPA change post infection. MethodsEndogenous tPA enzymatic activity, tPA or Lp(a) concentration were measured in plasma from hospitalized patients with and without COVID-19. The association between plasma tPA and adverse clinical outcomes was assessed. ResultsIn hospitalized patients with COVID-19, we found lower tPA enzymatic activity and higher plasma Lp(a) than that in non–COVID-19 controls. During hospitalization, Lp(a) increased and tPA activity decreased, which associates with mortality. Among those who survived, Lp(a) decreased and tPA enzymatic activity increased during recovery. In patients with COVID-19, tPA activity is inversely correlated with tPA concentrations, thus, in another larger COVID-19 cohort, we utilized plasma tPA concentration as a surrogate to inversely reflect tPA activity. The tPA concentration was positively associated with death, disease severity, plasma inflammatory, and prothrombotic markers, and with length of hospitalization among those who were discharged. ConclusionHigh Lp(a) concentration provides a possible explanation for low endogenous tPA enzymatic activity, and poor clinical outcomes in patients with COVID-19.

Dosimetric Evaluation of Cardiac Structures on Left Breast Cancer Radiotherapy: Impact of Movement, Dose Calculation Algorithm and Treatment Technique.

Breast cancer is the most frequently diagnosed and leading cause of cancer-related deaths among females. The treatment of breast cancer with radiotherapy, albeit effective, has been shown to be toxic to the heart, resulting in an elevated risk of cardiovascular disease and associated fatalities. In this study, we evaluated the impact of respiratory movement, treatment plans and dose calculation algorithm on the dose delivered to the heart and its substructures during left breast radiotherapy over a cohort of 10 patients. We did this through three image sets, four different treatment plans and the employment of three algorithms on the same treatment plan. The dose parameters were then employed to estimate the impact on the 9-year excess cumulative risk for acute cardiac events by applying the model proposed by Darby. The left ventricle was the structure most irradiated. Due to the lack of four-dimensional computed tomography (4DCT), we used a set of images called phase-average CT that correspond to the average of the images from the respiratory cycle (exhale, exhale 50%, inhale, inhale 50%). When considering these images, nearly 10% of the heart received more than 5 Gy and doses were on average 27% higher when compared to free breathing images. Deep inspiration breath-hold plans reduced cardiac dose for nine out of 10 patients and reduced mean heart dose in about 50% when compared to reference plans. We also found that the implementation of deep inspiration breath-hold would reduce the relative lifetime risk of ischemic heart disease to 10%, in comparison to 21% from the reference plan. Our findings illustrate the importance of a more accurate determination of the dose and its consideration in cardiologists' consultation, a factor often overlooked during clinical examination. They also motivate the evaluation of the dose to the heart substructures to derive new heart dose constraints, and a more mindful and individualized clinical practice depending on the treatment employed.

Long-term exposure to low-concentration PM2.5 and heart disease in older men in Perth, Australia: The Health in Men Study.

PM2.5 exposure was estimated for 11,249 older adult males who resided in Perth, Western Australia and were recruited from 1996 to 1999. Participants were followed until 2018 for the HF and AF outcomes, and until 2017 for IHD. Cox-proportional hazards models, using age as the analysis time, and adjusting for demographic and lifestyle factors were used. PM2.5 was entered as a restricted cubic spline to model nonlinearity. We observed a mean PM2.5 concentration of 4.95 μg/m3 (SD 1.68 μg/m3) in the first year of recruitment. After excluding participants with preexisting disease and adjusting for demographic and lifestyle factors, PM2.5 exposure was associated with a trend toward increased incidence of IHD, HF, and AF, but none were statistically significant. At a PM2.5 concentration of 7 μg/m3 the hazard ratio for incident IHD was 1.04 (95% confidence interval [CI] = 0.86, 1.25) compared with the reference category of 1 μg/m3. We did not observe a significant association between long-term exposure to low-concentration PM2.5 air pollution and IHD, HF, or AF.

Genetic variation in solute carrier family 5 member 2 mimicking sodium-glucose co-transporter 2-inhibition and risk of cardiovascular disease and all-cause mortality: reduced risk not explained by lower plasma glucose.

Treatment with sodium-glucose co-transporter 2 (SGLT2)-inhibitors reduces the risk of cardiovascular disease and mortality, but the mechanism is unclear. We hypothesized that a functional genetic variant in solute carrier family 5 member 2 (SLC5A2), known to be associated with familial renal glucosuria, would mimic pharmacological SGLT2-inhibition, and thus provide an opportunity to examine potential mediators of the effects on lower risk of cardiovascular disease and mortality. We examined 112 712 individuals from the Copenhagen City Heart Study and Copenhagen General Population Study (CCHS + CGPS), 488 687 from the UK Biobank, and 342 499 from FinnGen, genotyped for SLC5A2 rs61742739, c.1961A > G; p.(Asn654Ser). The 2.0% heterozygotes and 0.01% homozygotes were pooled as carriers and compared with the 98% non-carriers. First, we examined the risk of cardiovascular disease and mortality; second, whether carrying the variant was associated with potential mediators of the effect; and third, whether identified potential mediators could explain the observed reduced risk of cardiovascular disease and mortality. In the CCHS + CGPS, carriers vs. non-carries had a 31% lower risk of heart failure, 21% lower risk of myocardial infarction, 16% lower risk of ischaemic heart disease, and 22% lower risk of all-cause mortality. Corresponding values in meta-analyses of the three studies combined were lower risk by 10%, 6%, 6%, and 10%, respectively. The SLC5A2 rs61742739 variant was not associated with a risk of ischaemic stroke or cardiovascular mortality. Of the lower risks observed in CCHS + CGPS, lower plasma glucose mediated 2.0%(P = 0.004) on heart failure, 3.1%(P = 0.09) on myocardial infarction, 4.1%(P = 0.02) on ischaemic heart disease, and 6.0%(P = 0.39) on all-cause mortality; corresponding values in the UK Biobank were 2.9%(P = 0.70), 1.5%(P = 0.77), 4.1%(P = 0.23), and 3.1%(P = 0.21), respectively. A functional genetic variant in SLC5A2, mimicking SGLT2-inhibition, was associated with a lower risk of heart failure, myocardial infarction, ischaemic heart disease, and all-cause mortality. These effects were at most minimally mediated through lower plasma glucose.

THE STUDY OF THE RELATIONSHIP BETWEEN FGB GENE POLYMORPHISM AND PLATELET PARAMETERS IN PATIENTS WITH CORONARY HEART DISEASE, TYPE 2 DIABETES MELLITUS, AND ARTERIAL HYPERTENSION

Genetic factors are an important contributor to the risk of ischemic heart disease (IHD), and great progress has been made in this area over the past decade. The problem of studying the genetic mechanisms of IHD is quite complex and is associated with the development of adequate approaches and methods of analysis, which is noted by many authors. One of the effective approaches to studying the role of genetic mechanisms in the development of IHD is associated with the identification of a group of genes with a potentially greatest contribution to the pathogenesis of the disease. Purpose. Study of FGB gene polymorphisms and its relationship with platelet indexes in Azerbaijani patients with ischemic heart disease, arterial hypertension, and type 2 diabetes mellitus. Material and methods. 100 patient participated in the study. Anthropometric parameters, total blood count, lipid profile, fasting blood sugar and/or HbA1C, fibrinogen gene, and electrocardiographic and echocardiographic examination were performed in each patient. Results. A statistically significant prevalence of the homozygous G/G genotype of the FGB G (-455) A fibrinogen gene was noted in the studied groups. A statistically significant difference in the frequency of the GA polymorphism of the FGB G (-455) A fibrinogen gene was found between all groups. In addition, an increase in thrombocyte indexes was observed in homozygous allele A genotype carriers, which may be an indicator of thrombosis tendency in these genotype carriers.

Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease.

This study aims to investigate the prevalence of undiagnosed cardiovascular risk factors in patients with ischaemic heart disease (IHD). We assessed the prevalence of previously undiagnosed cardiovascular risk factors, including elevated lipoprotein(a) [Lp(a)], among consenting patients with IHD who were admitted to hospital. Clinical information, including dietary history, from patients with newly diagnosed IHD and known IHD were compared. Of the 555 patients, 82.3% were males and 48.5% of Chinese ethnicity. Overall, 13.3% were newly diagnosed with hypertension, 14.8% with hypercholesterolemia, and 5% with type 2 diabetes (T2DM). Patients with newly diagnosed IHD, compared to those with known IHD, had a higher prevalence of new diagnoses of hypercholesterolemia (29.1% vs. 2.0%, p < 0.001), hypertension (24.5% vs. 3.4%, p < 0.001) and T2DM (7.3% vs. 3.1%, p = 0.023). Active smoking was prevalent in 28.3% of patients, and higher in newly diagnosed IHD (34.1% vs. 23.2%, p = 0.005). Elevated Lp(a) of ≥120 nmol/L was detected in 15.6% of all patients, none of whom were previously diagnosed. Dietary habits of >50% of patients in both groups did not meet national recommendations for fruits, vegetables, wholegrain and oily fish intake. However, patients with known IHD had a more regular omega-3 supplement intake (23.4% vs. 10.3%, p = 0.024). Increased detection efforts is necessary to diagnose chronic metabolic diseases (hypertension, hypercholesterolemia, T2DM) especially among patients at high risk for IHD. Cardiovascular risk factors, in particular elevated Lp(a), smoking, and suboptimal dietary intake in patients with IHD deserve further attention.

Associations of oxidative balance score and visceral adiposity index with risk of ischaemic heart disease: a cross-sectional study of NHANES, 2005–2018

ObjectiveEvidence on the association of oxidative balance score (OBS) and visceral adiposity index (VAI) with risk of ischaemic heart disease (IHD) is limited. We aimed to explore the association of...

Role of polyunsaturated fatty acids in Japanese patients with coronary spastic angina

Backgroundn-3 polyunsaturated fatty acids (PUFAs) reduce the risk of ischemic heart disease. However, there are few reports of a relationship between n-3 PUFAs and coronary spastic angina (CSA). This study aimed to assess the age-dependent role of serum levels of fatty acid in patients with CSA. Methods and resultsWe enrolled 406 patients who underwent ergonovine tolerance test (ETT) during coronary angiography for evaluation of CSA. All ETT-positive subjects were diagnosed as having CSA. We categorized the patients by age and results of ETT as follows: (1) young (age ≤ 65 years) CSA-positive (n = 32), (2) young CSA-negative (n = 134), (3) elderly (age > 66 years) CSA-positive (n = 36), and (4) elderly CSA-negative (n = 204) groups. We evaluated the serum levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid, and dihomo-gamma-linolenic acid. In the young groups, the serum levels of EPA (64.3 ± 37.7 μg/mL vs. 49.4 ± 28.8 μg/mL, p = 0.015) and DHA (135.7 ± 47.6 μg/mL vs. 117.4 ± 37.6 μg/mL, p = 0.020) were significantly higher in the CSA-positive group than in the CSA-negative group, respectively. However, this was not the case with elderly groups. In the multivariate analysis in young groups, the serum levels of EPA (p = 0.028) and DHA (p = 0.049) were independently associated with the presence of CSA, respectively. ConclusionOur results suggested that the higher serum levels of EPA and/or DHA might be involved in the pathophysiology of CSA in the young population but not in the elderly population.

Occupational physical activity predicts baseline and 8-year progression of carotid atherosclerosis among women.

Recent reviews link higher levels of occupational physical activity (OPA) to cardiovascular disease (CVD). However, the evidence for women is inconsistent and studies of activity-limiting symptomatic CVD are prone to healthy worker survivor effect. To address these limitations, this study investigated OPA effects on asymptomatic carotid artery intima-media thickness (IMT) among women. Participants include 905 women from the population-based Kuopio Ischemic Heart Disease Risk Factor Study with baseline (1998-2001) data on self-reported OPA and sonographic measurement of IMT. Linear mixed models with adjustment for 15 potential confounders estimated and compared mean baseline IMT and 8-year IMT progression for five levels of self-reported OPA. Analyses stratified by cardiovascular health and retirement status were planned because strong interactions between preexisting CVD and OPA intensity have previously been reported. Light standing work, moderately heavy active work, and heavy or very heavy physical work were all consistently associated with greater baseline IMT and 8-year IMT progression than light sitting work. The greatest baseline IMT was observed for heavy or very heavy physical work (1.21 mm), and the greatest 8-year IMT progression for light standing work and moderately heavy active work (both 0.13 mm), 30% above sitting work (0.10 mm). Stratified analyses showed that these differences were driven by much stronger OPA effects among women with baseline carotid artery stenosis. Retired women experienced slower IMT progression than those working at baseline. Higher levels of OPA predict higher baseline IMT and 8-year IMT progression, especially among women with baseline stenosis.

Risk assessment of dietary factors in global pattern of ischemic heart disease mortality and disability-adjusted life years over 30 years.

The aim of this study was to investigate differences in the burden of ischemic heart disease (IHD)-related mortality and disability-adjusted life years (DALYs) caused by dietary factors, as well as the influencing factors with age, period, and cohort effects, in regions with different social-demographic status from 1990 to 2019. We extracted data on IHD mortality, DALYs, and age-standardized rates (ASRs) related to dietary risks from 1990 to 2019 as IHD burden measures. Hierarchical age-period-cohort analysis was used to analyze age- and time-related trends and the interaction between different dietary factors on the risk of IHD mortality and DALYs. Globally, there were 9.2 million IHD deaths and 182 million DALYs in 2019. Both the ASRs of death and DALYs declined from 1990 to 2019 (percentage change: -30.8% and -28.6%, respectively), particularly in high and high-middle socio-demographic index (SDI) areas. Low-whole-grain, low-legume, and high-sodium diets were the three main dietary factors that increased the risk of IHD burden. Advanced age [RR (95%CI): 1.33 (1.27, 1.39)] and being male [1.11 (1.06, 1.16)] were independent risk factors for IHD mortality worldwide and in all SDI regions. After controlling for age effects, IHD risk showed a negative period effect overall. Poor diets were positively associated with increased risk of death but were not yet statistically significant. Interactions between dietary factors and advanced age were observed in all regions after adjusting for related variables. In people aged 55 and above, low intake of whole grains was associated with an increased risk of IHD death [1.28 (1.20, 1.36)]. DALY risks showed a similar but more obvious trend. IHD burden remains high, with significant regional variations. The high IHD burden could be attributed to advanced age, sex (male), and dietary risk factors. Dietary habits in different SDI regions may have varying effects on the global burden of IHD. In areas with lower SDI, it is recommended to pay more attention to dietary problems, particularly in the elderly, and to consider how to improve dietary patterns in order to reduce modifiable risk factors.

Contaminant Metals as Cardiovascular Risk Factors: A Scientific Statement From the American Heart Association.

Exposure to environmental pollutants is linked to increased risk of cardiovascular disease. Beyond the extensive evidence for particulate air pollution, accumulating evidence supports that exposure to nonessential metals such as lead, cadmium, and arsenic is a significant contributor to cardiovascular disease worldwide. Humans are exposed to metals through air, water, soil, and food and extensive industrial and public use. Contaminant metals interfere with critical intracellular reactions and functions leading to oxidative stress and chronic inflammation that result in endothelial dysfunction, hypertension, epigenetic dysregulation, dyslipidemia, and changes in myocardial excitation and contractile function. Lead, cadmium, and arsenic have been linked to subclinical atherosclerosis, coronary artery stenosis, and calcification as well as to increased risk of ischemic heart disease and stroke, left ventricular hypertrophy and heart failure, and peripheral artery disease. Epidemiological studies show that exposure to lead, cadmium, or arsenic is associated with cardiovascular death mostly attributable to ischemic heart disease. Public health measures reducing metal exposure are associated with reductions in cardiovascular disease death. Populations of color and low socioeconomic means are more commonly exposed to metals and therefore at greater risk of metal-induced cardiovascular disease. Together with strengthening public health measures to prevent metal exposures, development of more sensitive and selective measurement modalities, clinical monitoring of metal exposures, and the development of metal chelation therapies could further diminish the burden of cardiovascular disease attributable to metal exposure.

Prediction of risk of ischemic heart disease in first-diagnosed systemic lupus erythematosus patients in taiwan: is air pollution exposure a risk factor?

BackgroundAir pollution is a key public health factor with the capacity to induce diseases. The risk of ischemia heart disease (IHD) in those suffering from systemic lupus erythematosus (SLE) from air pollution exposure is ambiguous. This study aimed to: (1) determine the hazard ratio (HR) of IHD after the first-diagnosed SLE and (2) examine the effects of air pollution exposure on IHD in SLE for 12 years.MethodsThis is a retrospective cohort study. Taiwan’s National Health Insurance Research Database and Taiwan Air Quality Monitoring data were used in the study. Cases first diagnosed with SLE in 2006 cases without IHD were recruited as the SLE group. We randomly selected an additional sex-matched non-SLE cohort, four times the size of the SLE cohort, as the control group. Air pollution indices by residence city per period were calculated as the exposure. Life tables and Cox proportional risk models of time-dependent covariance were used in the research.ResultsThis study identified patients for the SLE group (n = 4,842) and the control group (n = 19,368) in 2006. By the end of 2018, the risk of IHD was significantly higher in the SLE group than in the control group, and risks peaked between the 6th and 9th year. The HR of incidence IHD in the SLE group was 2.42 times that of the control group. Significant correlations with risk of developing IHD were noted for sex, age, CO, NO2, PM10, and PM2.5, of which PM10 exposure had the highest risk of IHD incidence.ConclusionsSubjects with SLE were at a higher risk of IHD, especially those in the 6th to 9th year after SLE diagnosis. The advanced cardiac health examinations and health education plan should be recommended for SLE patients before the 6th year after SLE diagnosed.

Adherence to statins and risk of cardiovascular disease in patients with breast cancer.

e24065 Background: Adherence to clinician prescribed cardiovascular disease (CVD) medications is poor in breast cancer (BC) survivors who are at heightened risk of CVD. Information on the effect of nonadherence to lipid-lowering medications on CVD risk in BC survivors is limited. We assessed adherence to statins, common lipid-lowering drugs, and their association with risk of CVD events in BC patients with dyslipidemia in the Kaiser Permanente Northern California (KPNC) integrated health system. Methods: Data were extracted from KPNC electronic health records (EHR). We identified 4,776 stage I-III BC patients diagnosed between 2005-2013 who were alive 6 months post-BC diagnosis (index date), and had a dyslipidemia diagnosis at the time of BC diagnosis along with ≥1 prior outpatient order or dispensing for a statin in the 30 months before index date. Incident heart failure (HF), ischemic heart disease (IHD), and stroke were determined via EHR and validated diagnosis and procedure codes. Statin adherence was assessed using drug dispensing data and updated quarterly starting on the index date to calculate cumulative average adherence (CAA). Working marginal structural models (MSM) fitted with inverse probability weighting were used to evaluate the effect of statin adherence regimens on the hazards for each of the CVD events, while controlling for baseline and time-varying CVD clinical risk factors, BC tumor characteristics, cancer treatments, other lipid-lowering drugs, and socioeconomic status. We considered two MSM parameterizations for two CAA categorizations: poor CAA &lt; 80% vs. good CAA≥80% (ref); and poor CAA &lt; 80% vs. 80%≤good CAA &lt; 100% vs. perfect CAA = 100% (ref). Results: Women were on average 67 years old with BMI of 30 kg/m2 and 65% non-Hispanic white. Over a mean follow-up of 6.5 years, 420 HF, 360 IHD, and 170 stroke events occurred. Overall, poor statin adherence was associated with higher risk of HF, IHD, and stroke combined: CAA &lt; 80% (HR = 2.54; 95% CI: 1.09, 5.94) vs. CAA≥80%. Separately, compared with CAA≥80%, poor statin adherence was associated with a non-statistically significant higher risk of IHD alone, CAA &lt; 80% (HR = 2.69; 95% CI: 0.85, 8.52) and stroke alone, CAA &lt; 80% (HR = 8.13; 95% CI: 2.03, 32.51). Poor adherence was not associated with risk of HF alone, CAA &lt; 80% (HR = 1.03; 95% CI: 0.31, 3.48) vs. CAA≥80%. When examining dose response of adherence, compared with perfect adherence (CAA≥100%), good adherence (80%≤CAA &lt; 100%) was associated with lower risk (HR = 0.35; 95% CI: 0.13, 0.92) while poor adherence (CAA &lt; 80%) was associated with higher risk of any CVD event (HR = 2.45; 95% CI: 1.05, 5.70). Conclusions: Maintaining good adherence (at least 80%) to statins after BC treatment is overall beneficial for cardiovascular health in patients with dyslipidemia. However, unmeasured confounding cannot be ruled out in our study. Future studies should determine factors associated with lower adherence and ways to improve adherence.

Trombosis coronaria en paciente con esclerosis múltiple: a propósito de un caso

La enfermedad coronaria es la principal causa de muerte a nivel mundial. Se han descrito factores de riesgo clásicos para desarrollarla, como la hipertensión y la diabetes mellitus; sin embargo, otras entidades como la esclerosis múltiple (EM) pueden aumentar el riesgo de cardiopatía isquémica en muchos pacientes, con una incidencia 24% mayor que en las personas sin EM, la cual puede ser debida a disfunción del sistema nervioso autónomo o a efectos adversos de medicamentos utilizados en esta patología. Describimos un caso de infarto agudo de miocardio en un paciente con EM y revisamos la asociación de estas dos enfermedades.

The association between population drinking and ischemic heart disease mortality in educational groups.

A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.