Low Cardiovascular Risk Group Research Articles

Exercise treadmill tests in patients with low cardiovascular risk: are we wasting our time?

INTRODUCTION The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered?

Untraditional endothelial dysfunction markers in low CV risk individuals.

Objectives: The relationship between impaired endothelial function and the frequency of cardiovascular (CV) events are well-known, but the relation of endothelial dysfunction with classical CV risk factors in low CV risk individuals is controversial. In our study, we assessed this issue in Turkish adults who were in the 'low CV risk group' according to ESC (European Society of Cardiology)-Score Risk Charts.

Association of Inflammatory and Oxidative Stress Biomarkers in Subjects With Cardiovascular Risk

Cardiovascular disease is originated in the vascular endothelium, which controls the homeostasis and the filtration and diffusion of molecules from blood to the tissues. The classical cardiovascular risk factors (CRFs) act directly on the endothelium through an increase in the production of reactive oxygen species, promoting an endothelial activation mediated by the expression of adhesion and proinflammatory molecules, which lead to endothelial dysfunction, the progression of the atherosclerotic plaque, and the onset of cardiovascular disease. The objective of this study was to analyze the association of superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation with fibrinogen, interleukin (IL)-6, tumor necrosis factor-α, and vascular cell adhesion molecule (VCAM)-1 in subjects with cardiovascular risk (CVR) and CRF. This was a cross-sectional study of 114 individuals; oxidative stress (superoxide dismutase, catalase, gluthatione peroxidase, and lipoperoxidation) and inflammatory (fibrinogen, IL-6, tumor necrosis factor-α, and VCAM-1) biomarkers were measured; a CVR score (Framingham) and its CRF were taken into consideration to classify the participants. Twenty-nine subjects out of a total of 114 had high CVR. Smokers and subjects with diabetes (43 subjects) were excluded from the low CVR group. Significant decreases in lipoperoxidation, IL-6, and VCAM-1 and an increase in SOD were found in the high CVR group (P ≤ 0.05). Individual analysis of each CRF in the 114 subjects revealed a different pattern in the biomarkers' statistical differences. Concluding that the biomarkers show statistical differences in each CRF, especially IL-6, VCAM-1, and SOD; therefore, these are highly recommended to be used as biomarkers of the oxidative stress and inflammatory status in CVR.

Carotid intima-media thickness as a screening tool in cardiovascular primary prevention

Increased carotid intima-media thickness (CIMT) is associated with cardiovascular events. The purpose of this study was to identify advanced subclinical atherosclerosis in patients who are at low or intermediate risk. Thousand hundred and eighteen Spanish subjects were prospectively enrolled in an ambulatory screening of cardiovascular risk (CVR). Three hundred and twenty patients aged over 30 years with low-intermediate CVR according to European SCORE function underwent carotid ultrasonography. Carotid IMT and plaque assessment were performed using high-resolution B-mode ultrasonography. Participants with abnormal CIMT were reclassified to high CVR. According to SCORE function, 104 patients (32·5%) were of low CVR and 216 (67·5%) of intermediate CVR. Mean carotid IMT was 0·62 ± 0·13 mm, and carotid plaque was found in 35 (10·9%) patients. Carotid ultrasonography changed the risk stratum in 59 (18·4%) patients, who were reclassified to high CVR. Reclassification was more frequent in the intermediate CVR group than in the low CVR group (22·7% vs. 9·6%, P = 0·005) and was associated to age (P = 0·002), history of arterial hypertension (P < 0·001) and increased systolic blood pressure (P = 0·05). CIMT calculated by high-resolution B-mode ultrasonography could become an important tool in preventive medicine. Measuring CIMT may be useful in identifying asymptomatic individuals with subclinical atherosclerosis not detected by the actual CVR functions.

Lipid and C-Reactive Protein Levels, Cardiovascular Disease Risk Factors and Simvastatin Treatment in Brazilian Individuals

The Framingham Risk Score (FRS) is widely recommended to estimate global risk for cardiovascular (CV) disease; however, it does not recognize all individuals with a high risk for coronary artery disease, because it does not take into account the various novel markers, such as the C-reactive protein levels (CRP). The present study aims to describe the profile of the simvastatin users and non-users in relation to FRS and high-sensitivity CRP (hs-CRP) levels. In this cross-sectional study, 277 European descent individuals were divided in two groups: 177 using simvastatin 20 mg per day (T+) and 100 not using simvastatin (T-). TC, HDL-C, TG, glucose and hs-CRP levels were determined by standard methods and the FRS was calculated. The individuals in T+ sample were more prevalent in high risk group (according FRS score) than individuals in T- sample (p < 0.0001; adjusted residual = 4.21). All the individuals, users and non-users, were simultaneously classified by FRS and hs-CRP levels and no significant differences were found, even though 21.6% of those individuals in T- showed high hs-CRP levels they were in the low CV risk group, as well as 9.9% of the simvastatin users. Considering that some works have shown CRP as an independent risk factor of CV and that statins could reduce CRP levels and prevent CV events, our findings show that some people that might benefit from the pleiotropic effect of statin remain without treatment if the decision is based only in those classical risk factors present in FRS.

An IVUS study of May-Thurner syndrome in patients with cryptogenic stroke and patent foramen ovale

Background: We have previously documented the incidence of MayThurner Syndrome (MTS) in patients with cryptogenic stroke and patent foramen ovale (PFO). We prospectively performed intravascular ultrasound (IVUS) in a cohort of 16 patients undergoing PFO closure in the context of a cryptogenic stroke. Methods: IVUS was performed of the left common iliac vein (CIV) in all patients with documented MTS by magnetic resonance venography using an 8F, 40-MHz transducer (Boston Scientific Corporation, Natick, MA, USA). The transducer was positioned distally in the inferior vena cava and systematically pulled back through the left CIV into the sheath. Studies were recorded and analyzed offline. Results: The patients were predominantly female (88%) with a mean age of 40±12 years. The group represented a low cardiovascular risk group with hypertension (12%), hypercholesterolemia (11%), smokers (27%), and diabetes (17%). All PFOs demonstrated right-to-left shunting on transesophageal echocardiography. Atrial septal aneurysms were present in 16% and hypermobile atrial septae in 17% of patients. IVUS demonstrated N75% lumen area stenosis from the adjacent right common iliac artery in all studied vessels. Intimal venous spurs were observed in two patients, venous stasis with rouleaux formation was observed in 10 patients but no evidence of deep venous thromboses was evident in these vessels. Conclusion: IVUS is a safe and reliable invasive tool for the study of MTS in the context of PFO and cryptogenic stroke. This study further highlights the importance of the association of MTS and PFO in the context of cryptogenic stroke.

Endovascular intervention in aortoiliac disease is associated with sustained long-term benefit independent of the lesion complexity based upon Transatlantic Inter-Society Consensus (TASC) classification

Background: We have previously documented the incidence of MayThurner Syndrome (MTS) in patients with cryptogenic stroke and patent foramen ovale (PFO). We prospectively performed intravascular ultrasound (IVUS) in a cohort of 16 patients undergoing PFO closure in the context of a cryptogenic stroke. Methods: IVUS was performed of the left common iliac vein (CIV) in all patients with documented MTS by magnetic resonance venography using an 8F, 40-MHz transducer (Boston Scientific Corporation, Natick, MA, USA). The transducer was positioned distally in the inferior vena cava and systematically pulled back through the left CIV into the sheath. Studies were recorded and analyzed offline. Results: The patients were predominantly female (88%) with a mean age of 40±12 years. The group represented a low cardiovascular risk group with hypertension (12%), hypercholesterolemia (11%), smokers (27%), and diabetes (17%). All PFOs demonstrated right-to-left shunting on transesophageal echocardiography. Atrial septal aneurysms were present in 16% and hypermobile atrial septae in 17% of patients. IVUS demonstrated N75% lumen area stenosis from the adjacent right common iliac artery in all studied vessels. Intimal venous spurs were observed in two patients, venous stasis with rouleaux formation was observed in 10 patients but no evidence of deep venous thromboses was evident in these vessels. Conclusion: IVUS is a safe and reliable invasive tool for the study of MTS in the context of PFO and cryptogenic stroke. This study further highlights the importance of the association of MTS and PFO in the context of cryptogenic stroke.