Coronary Heart Disease Outcomes Research Articles

Aspirin and omega-3 fatty acid status interact in the prevention of cardiovascular diseases in Framingham Heart Study

BackgroundThe roles of omega-3 (n3) fatty acids [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] and low-dose aspirin in the primary prevention of ischemic cardiovascular disease (CVD) are controversial. Since omega-3 (n3) fatty acids and aspirin affect cyclooxygenase activity in platelets, there could be a clinically-relevant effect of aspirin combined with a particular n3 fatty acid level present in each individual. MethodsRBC EPA+DHA, arachidonic acid (AA) and docosapentaenoic acid (DPA) were measured in 2500 participants without known CVD in the Framingham Heart Study. We then tested for interactions with reported aspirin use (1004 reported use and 1494 did not) on CVD outcomes. The median follow-up was 7.2 years. ResultsHaving RBC EPA+DHA in the second quintile (4.2–4.9% of total fatty acids) was associated with significantly reduced risk for future CVD events (relative to the first quintile, <4.2%) in those who did not take aspirin (HR 0.54 (0.30, 0.98)), but in those reporting aspirin use, risk was significantly increased (HR 2.16 (1.19, 3.92)) in this quintile. This interaction remained significant when adjusting for confounders. Significant interactions were also present for coronary heart disease and stroke outcomes using the same quintiles. Similar findings were present for EPA and DHA alone but not for DPA and AA. ConclusionsThere is a complex interaction between aspirin use and RBC EPA+DHA levels on CVD outcomes. This suggests that aspirin use may be beneficial in one omega-3 environment but harmful in another, implying that a personalized approach to both aspirin use and omega-3 supplementation may be needed.

Association of Sickle Cell Trait With Incidence of Coronary Heart Disease Among African American Individuals

The incidence of and mortality from coronary heart disease (CHD) are substantially higher among African American individuals compared with non-Hispanic White individuals, even after adjusting for traditional factors associated with CHD. The unexplained excess risk might be due to genetic factors related to African ancestry that are associated with a higher risk of CHD, such as the heterozygous state for the sickle cell variant or sickle cell trait (SCT). To evaluate whether there is an association between SCT and the incidence of myocardial infarction (MI) or composite CHD outcomes in African American individuals. This cohort study included 5 large, prospective, population-based cohorts of African American individuals in the Women's Health Initiative (WHI) study, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the Multi-Ethnic Study of Atherosclerosis (MESA), the Jackson Heart Study (JHS), and the Atherosclerosis Risk in Communities (ARIC) study. The follow-up periods included in this study were 1993 and 1998 to 2014 for the WHI study, 2003 to 2014 for the REGARDS study, 2002 to 2016 for the MESA, 2002 to 2015 for the JHS, and 1987 to 2016 for the ARIC study. Data analysis began in October 2013 and was completed in October 2020. Sickle cell trait status was evaluated by either direct genotyping or high-quality imputation of rs334 (the sickle cell variant). Participants with sickle cell disease and those with a history of CHD were excluded from the analyses. Incident MI, defined as adjudicated nonfatal or fatal MI, and incident CHD, defined as adjudicated nonfatal MI, fatal MI, coronary revascularization procedures, or death due to CHD. Cox proportional hazards regression models were used to estimate the hazard ratio for incident MI or CHD comparing SCT carriers with noncarriers. Models were adjusted for age, sex (except for the WHI study), study site or region of residence, hypertension status or systolic blood pressure, type 1 or 2 diabetes, serum high-density lipoprotein level, total cholesterol level, and global ancestry (estimated from principal components analysis). A total of 23 197 African American men (29.8%) and women (70.2%) were included in the combined sample, of whom 1781 had SCT (7.7% prevalence). Mean (SD) ages at baseline were 61.2 (6.9) years in the WHI study (n = 5904), 64.0 (9.3) years in the REGARDS study (n = 10 714), 62.0 (10.0) years in the MESA (n = 1556), 50.3 (12.0) years in the JHS (n = 2175), and 53.2 (5.8) years in the ARIC study (n = 2848). There were no significant differences in the distribution of traditional factors associated with cardiovascular disease by SCT status within cohorts. A combined total of 1034 participants (76 with SCT) had incident MI, and 1714 (137 with SCT) had the composite CHD outcome. The meta-analyzed crude incidence rate of MI did not differ by SCT status and was 3.8 per 1000 person-years (95% CI, 3.3-4.5 per 1000 person-years) among those with SCT and 3.6 per 1000 person-years (95% CI, 2.7-5.1 per 1000 person-years) among those without SCT. For the composite CHD outcome, these rates were 7.3 per 1000 person-years (95% CI, 5.5-9.7 per 1000 person-years) among those with SCT and 6.0 per 1000 person-years (95% CI, 4.9-7.4 per 1000 person-years) among those without SCT. Meta-analysis of the 5 study results showed that SCT status was not significantly associated with MI (hazard ratio, 1.03; 95% CI, 0.81-1.32) or the composite CHD outcome (hazard ratio, 1.16; 95% CI, 0.92-1.47). In this cohort study, there was not an association between SCT and increased risk of MI or CHD in African American individuals. These disorders may not be associated with sickle cell trait-related sudden death in this population.

Serum Uric Acid and Diabetes: From Pathophysiology to Cardiovascular Disease.

Hyperuricemia, has been traditionally related to nephrolithiasis and gout. However, it has also been associated with the development of type 2 diabetes mellitus (T2DM) and cardiometabolic and cardiovascular diseases. Pathophysiologically, elevated serum uric acid (SUA) levels may be associated with abnormal lipid and glucose metabolism. In this narrative review, we consider the associations between hyperuricemia, hyperglycemia, atherosclerosis and thrombosis. Furthermore, we comment on the available evidence linking elevated SUA levels with the incidence and outcomes of coronary heart disease, stroke, peripheral artery disease and non-alcoholic fatty liver in subjects with T2DM. The effects of antidiabetic drugs (e.g. metformin, pioglitazone, sulfonylureas, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors and insulin) on SUA concentrations are also reviewed.

Family nursing with the assistance of network improves clinical outcome and life quality in patients underwent coronary artery bypass grafting

Background:Family nursing with the assistance of network (FNAN) improves nurses’ practice and provides family/community-oriented nursing care. This study aimed to explore the effects of FNAN on the clinical outcome and life quality of coronary atherosclerotic heart disease (CHD) patients underwent coronary artery bypass grafting (CABG).Trial Design:This study is a randomized, placebo-controlled and double-blind trial.Methods:One-hundred and twelve patients underwent CABG were randomly divided into control group (CG, routine family nursing care) and experimental group (EG, FNAN) and the allocation ratio was 1:1. The situation of anxiety and depression were analyzed using the Hamilton Anxiety Scale (HAMA) scale and Hamilton Depression Scale (HAMD). Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). Lung function parameters were measured, including minute ventilation (MVV), partial pressure of oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), oxygen saturation measurement by pulse oximetry (SpO2), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Life quality was measured by using Chronic Obstructive Pulmonary Disease Assessment Test (CAT).Results:After a 3-month intervention, 10 and 6 patients were lost in the CG and EG groups, respectively. The scores of HAMA, HAMD, PSQI and CAT were reduced in the EG group when compared with the CG group (P < .05). The values of MVV, PaO2, SpO2, FEV1 and FVC in the EG group was higher than those in the CG group whereas the levels of PaCO2 in the EG group was lower than those in the CG group (P < .05). PSQI score had a strong relationship with the values of MVV, PaO2, PaCO2, SpO2, FEV1, and FVC.Conclusion:FNAN improves the clinical outcome and life quality in the patients underwent CABG.

Effect of Anacetrapib on Cholesterol Efflux Capacity: A Substudy of the DEFINE Trial.

BackgroundAnacetrapib is the only cholesteryl ester transfer protein inhibitor proven to reduce coronary heart disease (CHD). However, its effects on reverse cholesterol transport have not been fully elucidated. Macrophage cholesterol efflux (CEC), the initial step of reverse cholesterol transport, is inversely associated with CHD and may be affected by sex as well as haptoglobin copy number variants among patients with diabetes mellitus. We investigated the effect of anacetrapib on CEC and whether this effect is modified by sex, diabetes mellitus, and haptoglobin polymorphism.Methods and ResultsA total of 574 participants with CHD were included from the DEFINE (Determining the Efficacy and Tolerability of CETP Inhibition With Anacetrapib) trial. CEC was measured at baseline and 24‐week follow‐up using J774 macrophages, boron dipyrromethene difluoride–labeled cholesterol, and apolipoprotein B–depleted plasma. Haptoglobin copy number variant was determined using an ELISA assay. Anacetrapib increased CEC, adjusted for baseline CEC, risk factors, and changes in lipids/apolipoproteins (standard β, 0.23; 95% CI, 0.05–0.41). This CEC‐raising effect was seen only in men (P interaction=0.002); no effect modification was seen by diabetes mellitus status. Among patients with diabetes mellitus, anacetrapib increased CEC in those with the normal 1‐1 haptoglobin genotype (standard β, 0.42; 95% CI, 0.16–0.69) but not the dysfunctional 2‐1/2‐2 genotypes (P interaction=0.02).ConclusionsAmong patients with CHD, anacetrapib at a dose linked to improved CHD outcomes significantly increased CEC independent of changes in high‐density lipoprotein cholesterol or other lipids, with effect modification by sex and a novel pharmacogenomic interaction by haptoglobin genotype, suggesting a putative mechanism for reduced risk requiring validation.

Intensity of Guideline-Directed Medical Therapy for Coronary Heart Disease and Ischemic Heart Failure Outcomes

PurposeThe impact of guideline-directed medical therapy for coronary heart disease in those hospitalized with acute heart failure is unknown. MethodsWe studied guideline-directed medical therapies for coronary disease: angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta-adrenoreceptor antagonists, antiplatelet agents or anticoagulants, and statins. Using inverse probability of treatment weighting the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation, or prior myocardial infarction. ResultsAt discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%) patients, respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.28-0.84, P = 0.009) or all 4 drug classes (HR 0.56, 95% CI 0.33-0.96, P = 0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43, 95% CI 0.18-1.02, P = 0.054) and was significantly reduced with 4 drugs (HR 0.32, 95%CI 0.12-0.84, P = 0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 days when discharged on 2-3 (HR 0.30 for 181-365 days, 95%CI 0.14-0.64, P = 0.002) or all 4 drug classes (HR 0.43, 95%CI 0.19-0.95, P = 0.038). ConclusionsIncreasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions.

Do socioeconomic status and ethnicity predict CR outcomes in coronary heart disease patients in Denmark?

Abstract Background Cardiac patients with low socioeconomic status and other ethnic background have worse prognosis and outcomes. Cardiac rehabilitation (CR) has the potential to diminish this socioeconomic and ethnical disparity, but evidence is lacking. Purpose To describe if socioeconomic status and ethnicity predicts CR outcomes in coronary heart disease (CHD) patients in Denmark. Methods The study is based “The Danish Cardiac rehabilitation database” (DHRD) which monitors quality of CR in Denmark. The study population are all patients with CHD (myocardial infarction or stable coronary artery disease with revascularization or medical treatment) participating in CR reported to the database from Aug 2015 to Mar 2018. The quality indicators (QI) were &amp;gt;80% participation in exercise sessions, &amp;gt;10% increase in VO2peak, smoking cessation, LDL &amp;lt;1.8mmol/L (or 50% reduction of baseline LDL), blood pressure &amp;lt;140/90, dietary consulting, screening for diabetes, screening for depression and medical treatment with acetylsalicylic acid, statins and beta-blockers at completion of CR. Educational level as a marker for socioeconomic status was divided into no-, basic-, medium- and high education, and ethnicity into Danish, Western and non-western origin. We compared QI across educational level and ethnicity using descriptive statistics. Results Analyses are based on 9000 patients. Age and gender differed significantly in the groups (all p&amp;lt;0.001). Medical treatment and achievement of LDL- and blood pressure control was overall good with no difference across socioeconomic strata or ethnicity. Despite similar participation rate, higher education was associated with greater improvements in VO2peak. Patients of non-western ethnicity were less often screened for depression and less often received dietary consulting. Conclusion In this nationwide quality database for CR, medical treatment and achievement of traditional risk factor goals was good across socioeconomic and ethnic strata. However, outcome in VO2peak and implementation of screening for depression and diabetes showed disparity across socioeconomic and ethnic groups. The effect on long-term outcomes remains to be addressed. Funding Acknowledgement Type of funding source: None

South Asian ethnicity as a risk factor for coronary heart disease

Background and aimsSouth Asian ethnicity has been associated with increased cardiovascular risk, in the context of a greater burden of traditional cardiovascular disease risk factors. We aimed to identify the 10-year incidence of coronary heart disease (CHD) in South Asians, as compared to other racial-ethnic groups, in a retrospective cohort study, using the Kaiser Permanente Northern California integrated health care system, and to understand whether traditional risk factors could explain differences in outcomes. Methods and resultsA study cohort established in 2006, with 10-year follow-up, identified a total n = 341,309 patients, including 5149 South Asians, aged 30–70 years who underwent a screening lipid panel and had no prior history of CHD. There were a total of 460 (8.93%) patients with at least one cardiovascular event, including cardiovascular death, coronary artery revascularization, and myocardial infarction, in South Asians, as compared to 5.66% patients in the total population (p < 0.0001). In a multivariable logistic regression analysis, South Asian ethnicity, compared to White race, was associated with an adjusted odds ratio (aOR) = 2.04 (95%CI: 1.83, 2.28) in predicting the cardiovascular outcomes. ConclusionsSouth Asian ethnicity, even after adjustment for traditional risk factors, is associated with an increased risk of coronary heart disease outcomes. This risk was greater than other studied racial-ethnic groups and second only to diabetes in CHD risk prediction.

Associations Between Education Level and In-hospital Treatment and Outcomes Among Acute Coronary Syndrome in China

BackgroundPrevious studies have shown an inverse relationship between education and clinical outcomes in coronary heart disease. Whether a similar association exists in patients presenting with suspected acute coronary syndromes (ACS) in China is unknown. MethodsClinical Pathways for Acute Coronary Syndromes – Phase 2 (CPACS-2) was a study to evaluate a quality improvement for ACS management in China which implemented in 75 hospitals between October 2007 and August 2010. All patients was divided into 6 groups by education level. We evaluated clinical managements and outcomes according to level of education. ResultsA total of 14350 patients were enrolled in current analysis. Patients with less education were older, had greater female representation and had a higher Killip class at admission. Compared to patients with lower education levels, more educated patients had a longer length of hospitalization (p for trend <0.001), greater likelihood of receiving appropriate coronary angiography (p for trend <0.001) and appropriate reperfusion therapy for ST-segment elevated myocardial infarction (STEMI) (p for trend <0.001) even after adjustment for differences in patient characteristics and comorbidities at presentation. Patients with less education were at higher risk of death, cardiac death and major adverse cardiovascular events but none of these differences remained statistically significant after adjustment for baseline characteristics. ConclusionIn China, less educated patients with ACS were less likely to receive appropriate coronary angiography and reperfusion therapy. Less educated patients were at higher risk for adverse clinical events; however this was explained by differences in baseline characteristics.

Comparative Analysis of Some Structural Equation Model Estimation Methods with Application to Coronary Heart Disease Risk

This study compared a ridge maximum likelihood estimator to Yuan and Chan (2008) ridge maximum likelihood, maximum likelihood, unweighted least squares, generalized least squares, and asymptotic distribution-free estimators in fitting six models that show relationships in some noncommunicable diseases. Uncontrolled hypertension has been shown to be a leading cause of coronary heart disease, kidney dysfunction, and other negative health outcomes. It poses equal danger when asymptomatic and undetected. Research has also shown that it tends to coexist with diabetes mellitus (DM), with the presence of DM doubling the risk of hypertension. The study assessed the effect of obesity, type II diabetes, and hypertension on coronary risk and also the existence of converse relationship with structural equation modelling (SEM). The results showed that the two ridge estimators did better than other estimators. Nonconvergence occurred for most of the models for asymptotic distribution-free estimator and unweighted least squares estimator whilst generalized least squares estimator had one nonconvergence of results. Other estimators provided competing outputs, but unweighted least squares estimator reported unreliable parameter estimates such as large chi-square test statistic and root mean square error of approximation for Model 3. The maximum likelihood family of estimators did better than others like asymptotic distribution-free estimator in terms of overall model fit and parameter estimation. Also, the study found that increase in obesity could result in a significant increase in both hypertension and coronary risk. Diastolic blood pressure and diabetes have significant converse effects on each other. This implies those who are hypertensive can develop diabetes and vice versa.

Prolonged bedrest reduces plasma high-density lipoprotein levels linked to markedly suppressed cholesterol efflux capacity

Recent observations strongly connect high-density lipoproteins (HDL) function and levels with coronary heart disease outcomes and risk for infections and sepsis. To date, our knowledge of factors determining this connection is still very limited. The immobility associated with prolonged bedrest is detrimental to health, affecting several systems, including the cardiovascular, pulmonary, gastrointestinal, musculoskeletal and urinary. Effects of prolonged bedrest on the composition and functional properties of HDL remain elusive. We evaluated metrics of HDL composition and function in healthy male volunteers participating in a randomized, crossover head-down bedrest study. We observed that HDL cholesterol efflux capacity was profoundly decreased during bedrest, mediated by a bedrest associated reduction in plasma levels of HDL-cholesterol and major apolipoproteins (apo) apoA-I and apoA-II. Paraoxonase activity, plasma anti-oxidative capacity and the activities of lecithin-cholesterol acyltransferase and cholesteryl ester transfer protein were not affected. No change was observed in the content of HDL-associated serum amyloid A, a sensitive marker of inflammation. Resistive vibration exercise countermeasure during bedrest did not correct impaired cholesterol efflux capacity and only tended to increase arylesterase activity of HDL-associated paraoxonase. In conclusion, prolonged bedrest reduces plasma HDL levels linked to markedly suppressed HDL cholesterol efflux capacity. Resistive vibration exercise during bedrest did not correct HDL levels and impaired cholesterol efflux capacity.

Periodontal disease classifications and incident coronary heart disease in the Atherosclerosis Risk in Communities study.

Periodontal disease has been linked to coronary heart disease (CHD), but studies have been inconclusive. This study investigates the link between periodontal disease and incident CHD. Baseline periodontal data from a full-mouth periodontal exam (N=6,300) and CHD outcomes through 2017 were obtained from the Atherosclerosis Risk in Communities Study. Periodontitis was defined by the Periodontal Profile Class System adapted to Stages (PPC stages) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) index. Competing risk models were used to determine hazard ratios (HR) for incident CHD, congestive heart failure (CHF), and other causes of death. Secondary analysis included myocardial infarction (MI) and fatal CHD. Females comprised 56% of participants and males 44% with a combined mean age of 62.3 years (range: 52 to 74). Participants were followed for an average of 16.7 (SD: 5.5) years. In a fully adjusted model, PPC stage VII (Severe Tooth Loss) was moderately significantly related to incident CHD, (HR 1.51 [1.11 to 2.09]). PPC stage V (Mild Tooth Loss/High Gingival Inflammation) was significant for fatal CHD (HR, 5.27 [1.80 to 15.4]) and PPC stage VII was significant for incident MI (HR, 1.59 [1.13 to 2.23]). The CDC/AAP definition was not significantly associated with incident CHD. Incident CHD was moderately significantly associated with a specific stage of periodontal disease characterized by severe tooth loss, while none of the categories of the CDC/AAP were significantly associated. Thus, while periodontal therapy may improve oral health, it may be effective at impacting CHD incidence in only certain groups of people.

Prospective Study of Eating Habits as a Predictor of Incident Coronary Heart Disease Hospitalization and Mortality: The 2004 Canadian Community Health Survey

Abstract Objectives Eating habits such as skipping breakfast and snacking are increasingly common practices among North American adults; however, their long-term effects on incident coronary heart disease (CHD) outcomes remain unknown. Previous studies of breakfast skipping and/or eating frequency and cardiometabolic risk have suggested plausible biological pathways for either a protective or harmful relationship to exist, especially when other cardiometabolic risk factors such as diabetes, hypertension, and obesity are present. The objectives of this study were to assess whether long-term associations exist between eating habits (skipping breakfast and eating frequency) and incident CHD (hospitalization and mortality risk), and whether these are intensified by the presence of cardiometabolic risk factors. Methods Skipping breakfast (yes/no) and eating frequency (times per day) were assessed via a 24-hour dietary recall in a nationally representative sample of 13,587 adults (aged ≥18 years) in the 2004 Canadian Community Health Survey (CCHS), who were free of CHD and cancer. Data from the CCHS 2.2 were linked to the population-based Discharge Abstract Database and Canadian Mortality Database to determine the incidence of CHD hospitalization and mortality in the subsequent 9 years. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results During follow-up, 762 cases of CHD hospitalization and mortality were documented. Skipping breakfast was not associated with risk of CHD hospitalization and mortality in all participants together (multivariable-adjusted HR = 1.02, 95% CI: 0.74–1.39) or within baseline risk factor subgroups (hypertension: n = 2472; 0.95, 0.55–1.64; diabetes: n = 826; 1.38, 0.65–2.93; BMI ≥ 30 kg/m2: n = 2942; 1.43, 0.84–2.43). Similarly, no associations were observed between eating frequency and risk of CHD hospitalization and mortality. Conclusions Skipping breakfast and eating frequency were not associated with either increased or decreased risk of CHD hospitalization and mortality in this cohort of Canadian adults. Funding Sources Nova Scotia Health Research Foundation Development and Innovative Grant and a Nova Scotia Health Authority Research Foundation New Investigator Grant to LEC.

The association between physical activity with incident obesity, coronary heart disease, diabetes and hypertension in adults: a systematic review of longitudinal studies published after 2012

BackgroundA growing body of studies that investigated the longitudinal association between physical activity (PA) and the outcome of incident obesity, coronary heart disease (CHD), diabetes and hypertension has become available in recent years. Thus, the purpose of this systematic review was to provide an update on the association between PA and onset of obesity, CHD, diabetes and hypertension in individuals aged ≥18 years who were free of the respective conditions at baseline.MethodsWe systematically searched OVID, Pubmed, and Web of Science databases for pertinent literature published between January of 2012 and February of 2019. To ensure that conclusions are based on high quality evidence, we only included longitudinal studies conducted in samples of ≥500 participants and with ≥5 years of follow-up.ResultThe search yielded 8929 records of which 26 were included in this review. Three studies were conducted on the outcome of incident obesity, eight on incident CHD, nine on incident diabetes, four on incident hypertension, one on the outcome of both diabetes and hypertension, and one on the outcome of CHD, diabetes and hypertension. Overall, there was an association between PA and lower risk of incident obesity, CHD and diabetes, but not hypertension. Higher levels or amount of PA were associated with a reduced risk of new onset of the respective diseases in 20 studies (77%). Whereas four studies reported an elevated risk of incidence of diseases with lower PA levels (15%). PA was not associated with incidence of diseases in two studies (8%).ConclusionHigher levels of PA are likely associated with a lower risk of becoming obese, develop CHD or diabetes. These findings replicate and strengthen conclusions from earlier reviews underlining the importance of promoting PA in adults. The associations between PA and incident hypertension were less consistent. More research, particularly using prospective cohort designs in large population-based samples, is needed to further untangle the association between PA and incident hypertension.Trail registrationCRD42019124474 (PROSPERO Protocol registration). Date of registration in PROSPERO 27 February 2019.

Long-Term Effects of High Exposure to Ambient Fine Particulate Matter on Coronary Heart Disease Incidence: A Population-Based Chinese Cohort Study.

Evidence of long-term effects of high exposure to ambient fine particulate matter (PM2.5) on coronary heart disease (CHD) remains limited. We incorporated the high-resolution satellite-based PM2.5 estimates with a large-scale, population-based Chinese cohort comprising 118 229 individuals, to assess the CHD risk of long-term exposure to high PM2.5. During the follow-up of 908 376 person-years, 1586 incident CHD caseswere identified. The long-term average PM2.5 concentration for study population was 64.96 μg/m3, ranging from 31.17 to 96.96 μg/m3. For an increment of 10 μg/m3 in PM2.5, the multivariate-adjusted hazard ratios (HRs) were 1.43 (95% confidence interval [CI]: 1.35-1.51) for total CHD, 1.45 (95% CI: 1.36-1.56) for nonfatal CHD, and 1.38 (95% CI: 1.25-1.53) for fatal CHD, respectively. The effects were different across specific CHD outcomes, with greater effects for unstable angina (HR, 1.71 [95% CI, 1.56-1.88]), and weaker effects for acute myocardial infarction (HR, 1.28 [95% CI, 1.19-1.39]) and other CHD (HR, 1.27 [95% CI, 1.10-1.48]). The exposure-response curve suggested that HRs increased with elevated PM2.5 concentration over the entire exposure range. Elderly and hypertensive individuals were more susceptible to PM2.5-induced CHD. Our findings demonstrate the adverse health effects of severe air pollution and highlight the potential health benefits of air quality improvement.

Application of propensity score method to analyze the effect of Maixuekang capsule on the treatment outcome of coronary heart disease

Objective To analyze the effect of Maixuekang Capsule on the treatment outcome of coronary heart disease (CHD) by propensity score. Methods Based on the electronic medical record database of 22 large-scale tertiary hospitals nationwide, this study matched the coronary heart disease patients using and not using Maixuekang capsule according to a certain standard (1∶1). After matching, there were 2 464 cases in the patients group (group A) and the patients group (group B). In the database, the recombination of recovery and improvement is defined as effective treatment, and invalid , death and other are combined as ineffective treatment population. The effectiveness of the two groups after the re combination is compared by propensity score. Results The results of χ2 test showed that the difference between the two groups was statistically significant (P 0, and there was statistical significance (P<0.01). Conclusions The therapeutic effect of Maixuekang capsule on coronary heart disease is higher than that of patients without the drug. Key words: Propensity score; Maixuekang capsule; Coronary disease; Electronic health records

Testosterone concentrations and risk of cardiovascular events in androgen-deficient men with atherosclerotic cardiovascular disease

BackgroundWhether androgen deficiency among men increases the risk of cardiovascular (CV) events or is merely a disease marker remains a subject of intense scientific interest. ObjectivesAmong male subjects in the AIM-HIGH Trial with metabolic syndrome and low baseline levels of high-density lipoprotein (HDL)-cholesterol who were randomized to niacin or placebo plus simvastatin, we examined the relationship between low baseline testosterone (T) concentrations and subsequent CV outcomes during a mean 3-year follow-up. MethodsIn this post hoc analysis of men with available baseline plasma T concentrations, we examined the relationship between clinical/demographic characteristics and T concentrations both as a continuous and dichotomous variable (<300 ng/dL [“low T"] vs. ≥300 ng/dL [“normal T"]) on rates of pre-specified CV outcomes, using Cox proportional hazards models. ResultsAmong 2118 male participants in whom T concentrations were measured, 643 (30%) had low T and 1475 had normal T concentrations at baseline. The low T group had higher rates of diabetes mellitus, hypertension, elevated body mass index, metabolic syndrome, higher blood glucose, hemoglobin A1c, and triglyceride levels, but lower levels of both low-density lipoprotein and HDL-cholesterol, and a lower rate of prior myocardial infarction (MI). Men with low T had a higher risk of the primary composite outcome of coronary heart disease (CHD) death, MI, stroke, hospitalization for acute coronary syndrome, or coronary or cerebral revascularization (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07, and a higher risk of the CHD death, MI, and stroke composite endpoint (11.8% vs. 8.2%; final adjusted HR 1.37, P = .04), respectively. ConclusionsIn this post hoc analysis, there was an association between low baseline testosterone concentrations and increased risk of subsequent CV events in androgen-deficient men with established CV disease and metabolic syndrome, particularly for the composite secondary endpoint of CHD death, MI, and stroke. Condensed AbstractIn this AIM-HIGH Trial post hoc analysis of 2118 men with metabolic syndrome and low HDL-cholesterol with available baseline plasma testosterone (T) samples, 643 males (30%) had low T (mean: 229 ng/dL) and 1475 (70%) had normal T (mean: 444 ng/dL) concentrations. The “low T" group had a 24% higher risk of the primary 5-component endpoint (20.1%) compared with the normal T group (15.2%); final adjusted HR 1.23, P = .07). There was also a 31% higher risk of the secondary composite endpoint: coronary heart disease death, myocardial infarction, and stroke (11.8% vs. 8.2%, final adjusted HR 1.37, P = .04) in the low vs. normal T group, respectively.

Rates, predictors and the impact of cannabis misuse on in-hospital outcomes among patients undergoing percutaneous coronary intervention (from the National Inpatient Sample).

Whether cannabis use worsens outcomes in coronary heart disease is unknown and no previous study has evaluated the outcomes for patients who undergo percutaneous coronary intervention (PCI) according to cannabis use. We analysed patients in the National Inpatient Sample between 2004 and 2014 who underwent PCI and evaluated rates, predictors and outcomes of patients according to cannabis misuse defined by cannabis abuse or dependence. A total of 7306012 patients were included and 32765 cannabis misusers (0.4%). Cannabis misusers were younger (49.5 vs 64.6years, P<.001) and were more likely to be male (82.7% vs 66.3%, P<.001). There was also a greater proportion of patients who were of black ethnicity in the cannabis misuse group (27.7% vs 7.9%, P<.001) and fewer elective admissions (7.8% vs 27.6%, P<.001). There was no difference in in-hospital mortality (OR 1.06 95% CI 0.80-1.40, P=.67), bleeding (OR 0.94 95% CI 0.77-1.15, P=.55) and stroke/transient ischaemic attack (OR 1.19 95% CI 0.98-1.45, P=.084) compared with non-cannabis misusers. Cannabis misusers had significantly lower odds of in-hospital vascular complications (OR 0.73 95% CI 0.58-0.90, P=.004). Our results suggest that cannabis misusers are more likely to be male, of black ethnicity and from the lowest quartile of income, but there was no evidence that cannabis misuse is associated with worse periprocedural outcomes following PCI when controlling for key proxies of health status.

Association between serum ferritin and acute coronary heart disease: A population-based cohort study

Background and aimsSeveral studies aiming to determine the association between iron stores and coronary heart disease (CHD) have reported conflicting results. None of them has been performed in a Mediterranean region. Our aim is to assess the association between the level of serum ferritin and the incidence of CHD in a Mediterranean region. MethodsWe performed a cohort study using a primary health care population database. Primary outcome was incidence of CHD. Subjects aged between 35 and 74 years with serum ferritin (SF) measurements at baseline (January 1, 2006 to December 31, 2008) were included. Cox regression models were used to compute hazard ratios (HRs) and 95%CIs for the associtation between SF and time until CHD outcome. ResultsWe include 242,084 subjects with SF levels at baseline. Participants were observed for a median of 8.4 years. During follow-up, 1106 incident cases of CHD were identified. Persons with elevated SF did not have an increased CHD risk at follow-up (adjusted hazard ratio = 0.99; 95%CI 0.94–1.05; p = 0.86 in men, and 0.95; 95%CI 0.81–1.13; p = 0.60 in women). ConclusionsOur study, by far the largest, showed that high levels of SF do not confer an increased risk of CHD, and questions its role as a risk factor for this disease.

Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data

SummaryBackgroundEarly menopause is linked to an increased risk of cardiovascular disease mortality; however, the association between early menopause and incidence and timing of cardiovascular disease is unclear. We aimed to assess the associations between age at natural menopause and incidence and timing of cardiovascular disease.MethodsWe harmonised and pooled individual-level data from 15 observational studies done across five countries and regions (Australia, Scandinavia, the USA, Japan, and the UK) between 1946 and 2013. Women who had reported their menopause status, age at natural menopause (if postmenopausal), and cardiovascular disease status (including coronary heart disease and stroke) were included. We excluded women who had hysterectomy or oophorectomy and women who did not report their age at menopause. The primary endpoint of this study was the occurrence of first non-fatal cardiovascular disease, defined as a composite outcome of incident coronary heart disease (including heart attack and angina) or stroke (including ischaemic stroke or haemorrhagic stroke). We used Cox proportional hazards models to estimate multivariate hazard ratios (HRs) and 95% CIs for the associations between age at menopause and incident cardiovascular disease event. We also adjusted the model to account for smoking status, menopausal hormone therapy status, body-mass index, and education levels. Age at natural menopause was categorised as premenopausal or perimenopausal, younger than 40 years (premature menopause), 40–44 years (early menopause), 45–49 years (relatively early), 50–51 years (reference category), 52–54 years (relatively late), and 55 years or older (late menopause).FindingsOverall, 301 438 women were included in our analysis. Of these 301 438 women, 12 962 (4·3%) had a first non-fatal cardiovascular disease event after menopause, of whom 9369 (3·1%) had coronary heart disease and 4338 (1·4%) had strokes. Compared with women who had menopause at age 50–51 years, the risk of cardiovascular disease was higher in women who had premature menopause (age <40 years; HR 1·55, 95% CI 1·38–1·73; p<0·0001), early menopause (age 40–44 years; 1·30, 1·22–1·39; p<0·0001), and relatively early menopause (age 45–49 years; 1·12, 1·07–1·18; p<0·0001), with a significantly reduced risk of cardiovascular disease following menopause after age 51 years (p<0·0001 for trend). The associations persisted in never smokers, and were strongest before age 60 years for women with premature menopause (HR 1·88, 1·62–2·20; p<0·0001) and early menopause (1·40, 1·27–1·54; p<0·0001), but were attenuated at age 60–69 years, with no significant association observed at age 70 years and older.InterpretationCompared with women who had menopause at age 50–51 years, women with premature and early menopause had a substantially increased risk of a non-fatal cardiovascular disease event before the age of 60 years, but not after age 70 years. Women with earlier menopause need close monitoring in clinical practice, and age at menopause might also be considered as an important factor in risk stratification of cardiovascular disease for women.FundingAustralian National Health and Medical Research Council.