New Cases Of Myocardial Infarction Research Articles

Effets médiateurs de la symptomatologie de stress post-traumatique et des symptômes de dissociation somatoforme sur la relation entre l’attachement et la qualité de vie liée à la santé après un infarctus du myocarde

Myocardial infarction (MI) is a particularly frequent coronary disease: the number of new cases of MI recorded each year amounts to nearly 90,000 in France and nearly 790,000 in the United States. Over the past 15 years, the number of people who can survive this major cardiac event has substantially increased, as a result of advances in medical treatment and a reduction in delay to intervention. However, patients often report a decrease in their health-related quality of life following myocardial infarction. In other words, some patients perceive that the disease negatively affects various aspects of their daily lives, including physical functioning, emotional state, social relationships, and overall well-being. Furthermore, studies have shown that health-related quality of life is a prognostic indicator of the evolution of patients’ health status: the more health-related quality of life is reduced, the greater the risk of all-cause mortality, recurrence of cardiovascular events, and re-hospitalization for heart disease. In view of these elements, the identification of potentially modifiable factors, and in particular psychological factors, having an impact on health-related quality of life is particularly relevant. More specifically, insecure attachment, post-traumatic stress symptomatology and somatoform dissociation symptoms could have an impact on the health related-quality of life of people who have experienced a major cardiac event. ObjectivesThe objective of this study was to investigate the mediating role of posttraumatic stress symptoms and somatoform dissociative symptomatology in the relationship between insecure attachment and health related-quality of life after a myocardial infarction. Materials and methodsA total of 73 participants, having suffered a myocardial infarction and participating in a cardiovascular rehabilitation program, completed questionnaires to assess the degree of insecurity of their attachment (Experiences in Close Relationship Scale-12; ECR-12), the severity of post-traumatic stress symptoms (Post-Traumatic Stress Disorder Checklist Scale; PCL-5) and somatoform dissociation symptoms (Somatoform Dissociation Questionnaire; SDQ-20), and their health related-quality of life (MacNew Heart Disease-Health Related Quality of Life; MacNew). Mediation analyses were conducted according to the recommendations formulated by Baron and Kenny. ResultsOur results showed that only anxious attachment was positively and significantly associated with the severity of posttraumatic stress symptomatology, whereas such a link was not observed for avoidant attachment. The importance of posttraumatic symptomatology fully explained why individuals with high levels of fear of abandonment also have the poorest emotional, physical, and social quality of life after myocardial infarction. The importance of dissociative somatoform symptomatology partially explained why individuals with an insecure attachment style characterized by a high level of abandonmen were also those with the poorest health-related quality of life following myocardial infarction. ConclusionsThe results of this study tend to demonstrate the importance of taking into account the specificities of attachment, posttraumatic stress symptoms and somatoform dissociation phenomena in the context of interventions aimed at improving the health related-quality of life of people after a myocardial infarction. Insofar as secure attachment appears to be a protective factor against the risk of developing posttraumatic stress disorder, a psychotherapeutic approach aimed at promoting this form of attachment seems to be well justified. Specifically, it may be helpful to provide patients with a psychotherapeutic framework that takes into account their attachment experiences to allow them to change their beliefs about themselves and others, while helping them develop coping strategies appropriate to the stress. Psychotherapeutic interventions aimed jointly at increasing of the degree of attachment security and reducing the symptoms of posttraumatic stress and somatoform dissociation could be relevant to improve the health-related quality of life after a myocardial infarction.

Association Between Premature Menopause and Cardiovascular Diseases and All-Cause Mortality in Korean Women.

Background Mortality from cardiovascular diseases in Asian populations is considerable. Menopause is a risk-enhancing factor for cardiovascular disease, but it is unclear whether menopause is an independent risk factor for cardiovascular disease and mortality in Asian women. Methods and Results A total of 1 159 405 postmenopausal women, who had participated in the health examinations of the Korean National Health Insurance Service in 2009, were analyzed, and their reproductive histories were taken. A multivariable Cox proportional hazard model assessed the hazard ratios (HRs) of myocardial infarction (MI), ischemic stroke, and all-cause mortality, according to the history of premature menopause and age at menopause. After an average 10-year follow-up, there were 31 606, 45 052, and 77 680 new cases of MI, ischemic stroke, and all-cause mortality, respectively. The women with premature menopause exhibited increased risks of MI (HR, 1.40 [95% CI, 1.31-1.50]), ischemic stroke (HR, 1.24 [95% CI, 1.17-1.31]), and all-cause mortality (HR, 1.19 [95% CI, 1.14-1.24]) when compared with women with menopause aged ≥50 years. The highest risk was evident with menopause between the ages of 30 and 34 years (HR for MI, 1.52 [95% CI, 1.30-1.78]; HR for ischemic stroke, 1.29 [95% CI, 1.12-1.48]; HR for all-cause mortality, 1.33 [95% CI, 1.20-1.47]) when compared with women with menopause aged ≥50 years. Conclusions Earlier age at menopause was associated with increased risks for MI, ischemic stroke, and all-cause mortality. Future guidelines and risk assessment tools should consider menopause as an independent risk factor of cardiovascular disease in Korean women.

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

EFFECT OF HYPOTHYROIDISM ON MYOCARDIAL INFARCTION AND REVASCULARIZATION IN PATIENTS WITH RHEUMATOID ARTHRITIS

CARDIOVASCULAR DISEASE RISK PREDICTION IN EASTERN EUROPE ACCORDING TO 5-YEARS PROSPECTIVE STUDY

Objective: The aim of the study was to identify the most significant risk factors for cardiovascular diseases in Eastern European. Design and method: We conducted 5-years prospective andomised study of 3,500 individuals of the Belarusian population living in a district of Vitebsk in 2007/2008 (coverage of the survey was 97.9%), 2010/2011 (coverage of the survey was 77.8%) and 2012/2013 (coverage of the survey was 84.3%). The survey included standard questionnaires for detection of cardiovascular risk factors, measurements of blood pressure, electrocardiography, blood chemistry (serum CRP, uric acid and cholesterol data). In 5 years we registered new cases of hypertension, myocardial infarction, stroke and death from cardiovascular diseases in the studied population. Results: According to multifactorial regression analysis the risk factors for hypertension development included in the final model (df = 10; 2 Walda = 422,98; p < 0,001) were traditional risk factors, such as age (p < 0,001), sex (p < 0,23), high systolic blood pressure (>120 mmHg) (p < 0,001), high body mass index (>25,7 kg/m2) (p < 0,001), alcohol abuse (p < 0,01), heart rate (>70 beats/min) (p < 0,01), hereditary burden of stroke (p < 0,05) and new risk factors - high uric acid level (>338 mol/l) (p < 0,001), and high level of amount of ECG peaks SV1+RV5–V6 (>25 mm) (p < 0,001). The risk factors for the development of new cases of myocardial infarction, stroke and death from cardiovascular diseases included in the final model (df = 1; 2Walda = 32,2; p < 0,001) were age (p < 0,001), sex (p < 0,001), heart failure (p < 0,01), hypertension (p < 0,05), edema (p < 0,05) as well as low HDL (<1,08 mmol/l) (p < 0,01) and comorbidity, especially COPD (p < 0,01). The special role of COPD can be explained by the high prevalence of smoking in the Belarusian population (men - 60.6%, women - 13.8% (p < 0,001)). Conclusions: In the Belarusian population as well as traditional risk factors for cardiovascular diseases and cardiovascular death new risk factors, such as high uric acid level, high level of amount of ECG peaks SV1+RV5–V6, low HDL cholesterol and COPD, were established.

Pilot project to study the association of troponin I with cardiovascular events in the population of Russian region

Aim. As part of a pilot study, to investigate the potential significance of cardiac troponin I (cTnI) in assessing the risk of cardiovascular diseases (CVD) in general population aged 35-64 years of one of the regions from the ESSE-RF study.Material and methods. The study is based on the ESSE-RF observational prospective study using a sample from one Russian region. The analysis included socio-demographic variables, risk factors, history of CVD. The cTnI level was measured from November to December 2021 in serum samples stored at -70° C using high sensitivity chemiluminescent microparticle immunoassay using Architect Stat High Sensitivity Troponin I (Abbott) reagents on an Architect i2000SR immunoassay analyzer (Abbott, Abbot Park IL USA). The endpoints were hard (cardiovascular death and myocardial infarction) and composite endpoints (cardiovascular death, new cases of myocardial infarction, stroke, coronary artery disease and revascularization). The median follow-up was 5,5 years. In total, the analysis included 1120 people aged 35-64 years.Results. Analysis of the associations between Systematic Coronary Risk Evaluation (SCORE) and cTnI showed a significant difference in risk stratification for these two parameters. In women from cTnI-related high-risk category for cardiovascular events (CVE), there were no endpoints at all. In men of moderate and high risk, the proportion of endpoints increases with increasing cTnI-related risk. The survival curves corresponding to first 3 quintiles of cTnI risk distribution did not diverge, and, therefore, the number of CVEs in these groups did not differ. At the same time, the curves corresponding to 4th and 5th quintiles significantly differed from the first 3 quintiles, which indicates a higher CVE risk in subjects from these groups (p<0,001). Considering that there were only 3 endpoints in cTnI-related high-risk group, a survival analysis was performed for low-risk versus moderate-high risk. The curves obtained diverge significantly (p=0.006). Cox proportional hazards models were analyzed to assess the relationship between the cTnI level and endpoints. It was shown that cTnI itself or its logarithm is significantly associated with hard and composite endpoints. The cTnI cut-off point of 12/10 pg/ml (males/females) was associated with hard endpoint, and 6/4 pg/ml — with composite one. It should be noted that the recommended cut-off point of 6/4 pg/ml is close to the upper quartile of cTnI distribution in the European population. For the Russian population, the upper quartile corresponds to cTnI level of 3,5/2,1 pg/ml, which indicates the need to reduce the critical cTnI values in Russia. To assess risk reclassification, Cox models were analyzed using the Net Reclassification Index (NRI), as well as NRIsurvival for survival analysis. For categorical variables, the NRIcategorial was used. Both methods of including cTnI in the model significantly improve the risk classification of severe endpoints in men.Conclusion. The results obtained confirm the need to lower the threshold values for predicting combined endpoints, in particular, in Russian men. cTnl has an independent effect on CVE risk and its addition to SCORE improves the prediction of CVEs among men. However, the data obtained are preliminary and require clarification sing larger sample. At the same time, it is obvious that the determination of cТnI level can play a significant role in cardiovascular risk assessment and be an unfavorable prognosis marker among Russian population.

Low level of HDL as a predictor of development of new cases of myocardial infarction, stroke and death from cardiovascular diseases in the Belarusian urban population

Background and Aims: The aim of the study was to determine the impact of low HDL level on the development of new cases of myocardial infarction, stroke and death from cardiovascular diseases (CVD) in the Belarusian urban population.

The Efficacy, Safety and Adherence to Treatment when New Anticoagulants Taking in Over 75 Years Old Patients with Atrial Fibrillation

Aim. To study the efficacy, safety, and adherence to therapy with new oral anticoagulants in patients older than 75 years with atrial fibrillation.Material and methods. Patients (n=431) over 75 years old (82.7±3.4 years) with various types of atrial fibrillation/flutter (AF) were included in a nonrandomized observational study of new oral anticoagulants (NOAC) in real clinical practice. A history of cardiac surgery was in 27.6% of patients. All patients had >3 risk factors for ischemic stroke (CHA2DS2-VASс 4.81±0.4 points) and >1 risk factor for bleeding (HAS-BLED 3.01±0.2 points). The duration of the observation study was from 12 to 42 (26.9±4.9) months. Dabigatran was taken in 38.5% (n=166) of patients, rivaroxaban – in 41.3% (n=178), apixaban – in 20.2% (n=87) of patients.Results. The incidence of new cases of myocardial infarction was 0.8% per year, surgical revascularization – 0.9% per year, cardiovascular death – 0.8% per year. The frequency of ischemic stroke was 1.1% per year, transient ischemic attacks – 0.4% per year, all thromboembolic episodes – 1.77% per year. The incidence of intracranial hemorrhage was 0.2% per year, of minor bleeding – 4.4% per year, of the combined cardiac point (the total frequency of all strokes, major bleeding, myocardial infarction, mortality from cardiovascular causes, revascularization procedures) – 4.2% per year. Significant differences in the frequency of endpoints depending on the drug of NOAC taken by patients were not found. Violations of the regimen and doses were more often observed with twice daily intake (63.9% for dabigatran and 59.8% for apixaban) than with a single dosage regimen per day (45.5% for rivaroxaban). The leading causes of non-adherence to NOAC therapy in patients over 75 years of age included skipping the next scheduled dose (43.6%) and changing the frequency of the drug taking (16.9%). For NOAC with a double dose per day, dabigatran and apixaban, the frequency of administration was violated in 27.7% and 28.7%, respectively, and with a single dose per day, rivaroxaban – in 1.1%.Conclusion. Therapy with NOAC in patients older than 75 years with AF is effective and safe. There were no statistically significant differences in the incidence of thromboembolic or hemorrhagic events during three NOACs treatment in patients with AF older than 75 years. The incidence of non-adherence was less

Obesity phenotypes and the risk of myocardial infarction: a prospective cohort study

Aim . To study the dynamics of obesity phenotypes and risk of myocardial infarction (MI) during 13-year follow-up period. Material and methods . The study was performed based on the material of the international project HAPIEE (population sample of men and women 45-69 years old, n=9360, basic survey 2003-2005). The analysis included persons with a body mass index (BMI) >30 kg/m2: 3197 people; 857 men (26,8%) and 2340 women (73,2%). To analyze the incidence of MI, a sample of 3008 subjects free from baseline history of MI was selected (752 men and 2256 women). New cases of myocardial infarction have been collected according to the data of the WHO “Register of Acute Myocardial Infarction” program, held at the Research Institute of Therapy and Preventive Medicine; the results of two repeated examinations (2006-2008 and 2015-2017) and repeated postal interview of cohort during 13-year follow-up. The analysis was carried out in individuals with a metabolically phenotype of healthy obesity (MHO). The MHO is defined according to various classifications: NCEPATPIII 2001 — in the presence of 2 and/or less components of the metabolic syndrome; IDF 2005 — waist circumference (WC) >94 cm in men and >80 cm in women and one or no risk factor; Russian Society of Cardiology (RSC) — the index of waist circumference/hip circumference (WC/HC) 0,05. Conclusion . MHO is unstable condition accompanied by transition to the MUH among more than half of men and women during 13 years of observation. In studied population cohort the 13-years risk of incident MI in subjects with MUO was higher compared to MHO: OR=1,9 (95% CI: 1,2; 2,9) by NCEPATP III; OR=3,2 (95% CI: 1,7; 6,1) by RSC criteria.

Epidemiology of cardiovascular diseases among patients with diabetes mellitus according to the federal diabetes register of the Russian Federation (2013–2016)

BACKGROUND: Cardiovascular diseases (CVD) are the main cause of death for patients with diabetes mellitus (DM).
 AIMS: To evaluate the CVD epidemiology: coronary heart disease (CHD), myocardial infarction (MI) and cerebrovascular diseases in adult patients with type 1 (T1DM) and type 2 (T2DM) diabetes, compare dynamics with data of implementation of the Federal Program Diabetes mellitus in 20072012 and over the online period 20132016.
 MATERIALS AND METHODS: The database of the Federal Diabetes register (81 regions at 12.2017). We estimated prevalence and incidence rates/10 thousand (th) adult DM patients over 18 years.
 RESULTS: The prevalence of CVD for the period 2007 2016 significant decreased in CHD for T1DM from 14,9% to 3,5%, for T2DM from 20,1% to 11,7%; MI for T1DM from 5,7% to 1,3%, for T2DM from 7,6% to 3,5%; cerebrovascular diseases for T1DM from 4,9% to 1,7%, for T2DM from 7,6% to 4,3%, respectively. In 20132016 positive trends continued: MI for T1DM 8,25,9/10th patients, for T2DM 19,214,7/10th patients, respectively; CVD for T1DM 11,310,5, for T2DM 29,425,4/10th patients, respectively. There was a large heterogeneity of the prevalence of CVD in the regions. MI varied in patients for T1DM from 319/10 th patients to absence, for T2DM from 800 to 7/10 th patients; the development of cerebrovascular diseases for T2DM from 900 to less than 100/10 th patients, which is largely due to differences in their registration. A small number of cases may be due to insufficient filling of the database, the facts of a huge number require further analysis. The average age of development of MI had increased: for T1DM 51,253 years, for T2DM 63,565 years, cerebrovascular diseases for T1DM 52,352.5 years, for T2DM 65,266,5, respectively.
 CONCLUSIONS: The prevalence of CVD significantly decreased in the Russian Federation compared to 20072012, as well as for the period 20132016: the prevalence of CHD and cerebrovascular diseases declined, the number of new cases of MI decreased, the average age and duration of DM before the development of CVD significantly increased. These data reflect the results of the program for improvement medical care and prevention measures for patients with diabetes.

Obesity in the development of coronary artery disease (according to population studies)

Studies of large groups of people within the framework of the big data approach show the key features of the multifactorial mechanisms for the development of comorbid pathology. Limit values, the sequence of shifts of these indicators during the implementation of risk factors and predictors should be determined at the preclinical stage in the population conditions. Clinical and epidemiological methods were used to examine organized contingents — 4,012 subjects (1,866 men and 2,146 women) aged 20—59 years, unorganized contingent — 7,629 men aged 40—59 years. The population prevalence of obesity and coronary artery disease has been established together with the levels of these indicators. During the five-year prospective study the authors determined an integral indicator of the percentage increase in new cases of myocardial infarction (MI) per 1000 people/year of observation, depending on the presence of obesity and other risk factors that were found on the primary screening. The percentage increase of MI cases per 1000 people/year of observation in the presence of obesity, mainly among women in the 50—59 age group, has been demonstrated. The applied mathematical model allowed the monitoring and correction of risk factors at the preclinical stage, depending on the presence or absence of risk factors, predictors of the disease. Based on the multifactorial nature of the genesis of chronic pathology and the resulting difficulties of early detection of their precursors, the conduction of trials using clinical and epidemiological methods within the framework of evidence-based medicine seems to be most expedient.

MON-196 Gender-Affirming Hormonal Therapy and Incidence of Metabolic Syndrome and Cardiovascular Events in Patients with Gender Dysphoria

Background: Long-term effects of gender-affirming hormonal therapy (GAHT) on cardiovascular risk factors and metabolic syndrome (MS) is currently unclear. Particularly, the effect of GAHT on cardiovascular outcomes in older individuals (>60 years) with gender dysphoria (GD) is unknown. The aim of this study was to examine the effect of GAHT on cardiovascular risk factors, MS and the incidence of T2DM in subjects with GD. Methods: We reviewed the records of 75 subjects with GD, 54 transwomen (age 49 ± 2 years) and 21 transmen (age 37 ± 2 years), who had a detailed clinical, biochemical and hormonal profile (lipid profile, HbA1C, FPG, testosterone, estradiol) of which 55 were followed for at least 1 year. MS was defined based on ATP III criteria. As a control group, we reviewed the records of 30 subjects without GD who attended the endocrinology clinic for other hormone-related disorders. Results: The median (IR) follow-up was 22 (11-39) months for transwomen and 15 (11-21) months for transmen. In transwomen plasma testosterone levels decreased (379 ± 31 vs 71 ± 18 ng/dL), estradiol increased (40 ± 7 vs 124 ± 34 pg/mL) while the plasma testosterone levels increased in transmen (57 ± 14 vs 411 ± 79 ng/dL). At baseline, 24% of transwomen had MS and after 1 year, 16% of subjects had MS. In transmen, the prevalence of MS was similar before and 1 year after treatment (25 % vs. 24%). In transwomen, GAHT was associated with mild weight gain, BMI increased (29 ± 1 vs. 30 ± 1 kg/m2, p=0.04). There was no difference in HDL, total cholesterol and triglyceride levels before and after hormone therapy, though LDL cholesterol tended to decrease (101 ± 6 vs. 90 ± 6 mg/dL, p=0.06). There was no change in HbA1C, FPG or SBP in transwomen, though DBP decreased (77 ± 1 vs. 74 ± 1 mmHg, p=0.05). In transmen, no changes were observed in BMI, HDL, total cholesterol, triglycerides, LDL, HbA1C, FPG and blood pressure. There were no new cases of T2DM, however 1 transman developed MS, 1 transman had CABG and 1 transwoman died from laryngeal cancer. There were no new cases of myocardial infarction or stroke in subjects with and without GD. For subjects above 60 years (n=16, 13 transwomen and 3 transmen), BMI in transwomen increased (27 ± 1 vs. 29 ± 2 kg/m2, p=0.03), there was no change in HDL, LDL and total cholesterol, triglycerides, HbA1C, FPG or blood pressure. In 3 transmen older than 60 years old, only the LDL decreased (194 ± 59 vs. 141 ± 55 mg/dL, p=0.006). In the entire group as well as older individuals with GD the incidence of CV events were not different from the control group. Conclusion: GAHT for 1.5 years was not associated with worsening cardiovascular risk factors, metabolic syndrome or incidence of T2DM in both transmen and transwomen regardless of their age. Long-term studies are required to assess the definite effects of GAHT on cardiovascular outcomes.

Combined Coronary Artery Bypass Graft (CABG) Surgery and Lung Resection for Lung Cancer in Patients More than 50 Years-of-Age.

BackgroundThe co-existence of coronary heart disease (CHD) and lung cancer is increasing in an increasingly aging population. The aim of this study was to evaluate patient outcome from combined off-pump coronary artery bypass graft (CABG) surgery and lung resection in patients more than 50 years-of-age.Material/MethodsA retrospective clinical study of 23 patients with a mean age of 70.2±8.4 years (range, 51–86 years) included 18 men and five women with CHD and lung cancer who underwent a single operation with combined off-pump CABG surgery and lung resection, for non-small cell lung cancer (NSCLC) (n=22) and small cell lung cancer (n=1). Surgical approaches included: median sternotomy in six patients; left lateral thoracotomy in nine patients; a median sternotomy in three patients; median sternotomy combined with thoracoscopic lobectomy in five patients.ResultsIn the retrospective study of 23 patients, there were no deaths and no new cases of myocardial infarction (MI) in the immediate perioperative period. During the follow-up period, six patients died from lung cancer metastasis or recurrence; one patient died of acute renal failure; and one patient died from the effects of chemotherapy. The remaining 15 patients underwent postoperative follow-up for between 3–79 months with no deaths and no new cases of MI.ConclusionsFor patients who are more than 50 years-of-age and who have CHD and lung cancer, a single combined operation that includes off-pump CABG and lung resection can be safe and effective.

Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012.

Population-based data on myocardial infarction rates in the Islamic Republic of Iran have not been reported on a national or provincial scale. In a cross-sectional study, data were collected on 20 750 new cases of myocardial infarction (ICD10 codes I21-22) admitted to hospitals and registered by the Iranian Myocardial Infarction Registry in 2012. The crude and age-adjusted incidence for the 31 provinces and the whole country were directly calculated per 100 000 people using the WHO standard population. Overall, males comprised 72.4% of cases and had a significantly lower mean age at incidence than women [59.6 (SD 13.3) years versus 65.4 (SD 12.6) years]. The male:female incidence ratio was 2.63. The age-standardized myocardial infarction incidence rate was 73.3 per 100 000 in the whole country (95% CI: 72.3%-74.3%) and varied significantly from 24.5 to 152.5 per 100 000 across the 31 provinces. The study provides baseline data for monitoring and managing cardiovascular diseases in the country.

A comparison of bilevel and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary edema

BackgroundWhether bilevel positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary edema (ACPO) remains uncertain. The aim of the meta-analysis was to assess potential beneficial and adverse effects of CPAP compared with BiPAP in patients with ACPO. MethodsRandomized controlled trials comparing the treatment effects of BiPAP with CPAP were identified from electronic databases and reference lists from January 1966 to December 2012. Two reviewers independently assessed study quality. In trials that fulfilled inclusion criteria, we critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality, endotracheal intubation, myocardial infarction, and the length of hospital stay. Data were combined using Review Manager 4.3 (The Cochrane Collaboration, Oxford, UK). Both pooled effects and 95% confidence intervals (CIs) were calculated. ResultsTwelve randomized controlled trials with a total of 1433 patients with ACPO were included. The hospital mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.14; P = .46; I2 = 0%) and need for requiring invasive ventilation (RR, 0.89; 95% CI, 0.57-1.38; P = .64; I2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. The occurrence of new cases of myocardial infarction (RR, 0.95; 95% CI, 0.77-1.17; P = .53, I2 = 0%) and length of hospital stay (RR, 1.01; 95% CI, −0.40 to 2.41; P = .98; I2 = 0%) were also not significantly different between the 2 groups. ConclusionsThere are no significant differences in clinical outcomes when comparing CPAP vs BiPAP. Based on the limited data available, our results suggest that there are no significant differences in clinical outcomes when comparing CPAP with BiPAP.

GW24-e1268 A comparison of bi-level and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary oedema; a systematic review

ObjectivesWhether bi-level positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary oedema (ACPO) remains uncertain. The aim of the meta-analysis was to...

Community-based incidence rate of cardiovascular disease and mortality in 50–75-year-old adults

Abstract Backgrounds and objectives Updated information on the incidence of the principal cardiovascular diseases (CVDs) and cardiovascular mortality is not available in Spain. We have studied the density of the incidence of new cases of myocardial infarction, heart failure, stroke and cardiovascular mortality in adults from a population in Sanlucar de Barrameda (Spain). Materials and methods A community-based prospective follow-up study was conducted. The study enrolled 858 participants aged 50–75 years who were randomly selected from the population and followed-up for 5 years. Age and gender-adjusted incidence rates of cardiovascular disease and cardiovascular mortality were calculated, obtaining complete information for 855 participants. Prognostic risk factors of new cases of cardiovascular disease were obtained using Cox proportional hazard modeling. Results The community-based incidence rate of heart failure was 455/100,000 persons-year. The incidence of myocardial infarction, stroke and cardiovascular mortality (506, 216 and 225/100,000 persons-year, respectively) was also very elevated. Male gender, family history of early cardiovascular disease, diabetes, hypertension and sedentary life style were independent risk factors of cardiovascular disease. Conclusions The incidence of myocardial infarction in Sanlucar de Barrameda (Spain) is very high. It is the first study reported in Spain. The incidence of myocardial infarction is among the highest in Spain.

Incidencia poblacional de enfermedad cardiovascular y mortalidad en los adultos de 50-75 años

Backgrounds and objectivesUpdated information on the incidence of the principal cardiovascular diseases (CVD) and cardiovascular mortality is not available in Spain. We have studied the incidence rate of new cases of myocardial infarction, heart failure, stroke and cardiovascular mortality in the adult population in Sanlúcar de Barrameda (Spain). Material and methodsA community-based prospective follow-up study was conducted. The study enrolled 858 participants aged 50-75 years who were randomly selected from the population and followed-up for 5 years. Age and gender-adjusted incidence rates of cardiovascular disease and cardiovascular mortality were calculated, obtaining complete information for 855 participants. Prognostic risk factors of new cases of cardiovascular disease were obtained using Cox proportional hazard modeling. ResultsThe community-based incidence rate of heart failure was 455/100.000 persons-year. The incidence of myocardial infarction, stroke and cardiovascular mortality (506, 216 and 225/100.000 persons-year, respectively) was also very elevated. Male gender, family history of early cardiovascular disease, diabetes, hypertension and sedentary life style were independent risk factors of cardiovascular disease. ConclusionsThe community-based incidence rate of heart failure in Sanlúcar de Barrameda (Spain) is very high, and it is the first to be reported in Spain. The incidence of myocardial infarction is among the highest in Spain.

Are Continuing Medical Education Activities Effective in Improving the Competence and Performance of Clinicians?

An estimated 610,000 new cases of myocardial infarction (MI) and 325,000 recurrent MIs will occur this year in the United States, accounting for 1 MI every 34 seconds. Despite the advances in acute coronary syndrome management, recurrent events and the mortality associated with acute coronary syndromes are also high. There is clear evidence that knowledge, competence, and performance gaps exist among clinicians, contributing to the lack of adherence, premature discontinuation, and the increased risk of cardiovascular events in patients. As primary care clinicians manage these patients during the chronic phase of treatment, educational activities addressing identified gaps were developed and presented nationally. Outcome measurements using pre-, post-, and follow-up surveys showed that knowledge, confidence, competence, and performance significantly improved resulting in better patient outcomes as reported by activity participants. Thus, continuing medical education activities developed with the clear goal of changing clinician behavior can be effective in improving outcomes among patients with coronary artery disease.

An epidemic of coronary heart disease

The major public health concern during the past 50 years has been coronary heart disease (CHD), which has been the leading cause of death in the UK and other nations in the temperate parts of the world, in particular northern Europe and North America. It has run in families and it has brought to a premature end the lives of people in their prime. It has robbed wives of their husbands and husbands of their wives. It has robbed children of their parents and sometimes parents of their children. However, it is now clear that in these countries CHD was an epidemic of the latter half of the 20th century. The onset of the epidemic appears to have been shortly after the First World War, but now, in the early 21st century, the epidemic is almost at an end. The earliest clinico-pathological report of CHD was in 1859, an anecdotal case report of myocardial infarction (MI) presented to the Swedish Medical Society.1 It defined the clinical features of MI and also the pathological features found at autopsy, linking the two aspects. The report was not known outside Sweden and at the time it did not appear to be important. The fact that this was a single case report was emphasized by the Swedish physician B.W. Johansson and pathologist P. Nichol. They drew attention to the 1859 report, contrasting it with 770 new cases of MI occurring in Malmo in 1978 alone.1 At the beginning of the 20th century, CHD was effectively unknown in the UK. It received no mention in the earlier writings of Sir James MacKenzie, who was initially a general medical practitioner in Burnley, Lancashire and later the father of cardiology in the UK.2 MacKenzie first mentioned angina in the third edition of his book …

Reduction of smoking in Dutch adolescents over the past decade and its health gains: a repeated cross-sectional study

Smoking is the main preventable lifestyle-related risk factor threatening human health. In this study, time trends in smoking behaviour between 1996 and 2005 among adolescents enrolled in secondary school were assessed. In 1996, 2001 and 2005, a survey was conducted in the south-eastern region of the Netherlands. All students in second and fourth year of secondary education (1996: n = 20 000; 2001: n = 27 500; 2005: n = 24 000) were asked to complete a questionnaire about their smoking behaviour. A simulation model was used to estimate lifetime health gains related to the observed trends. In 1996, 2001 and 2005, the number of questionnaires analysed were 13 554 (68%), 20 767 (76%) and 17 896 (75%), respectively. The results show a decrease in 'ever smoking' as well as 'current smoking' between 1996 and 2005. Among second year high school students, current smoking prevalence decreased from 22.2% in 1996 to 8.0% in 2005 (P(trend) < 0.001). Among fourth year students, current smoking declined from 37.5% in 1996 to 22.0% in 2005 (P(trend) < 0.001). Time trends were not influenced by gender or educational level. Model projections show that if these students not take up smoking later in life, 11 500 new cases of COPD, 3400 new cases of lung cancer and 1800 new cases of myocardial infarction could be prevented for the Dutch 13-year-olds. This study found that, in the past decade, smoking prevalence among adolescents has declined by almost 50%, potentially resulting in a considerable reduction in new cases of COPD or lung cancer.