Presence Of Atherosclerotic Vascular Disease Research Articles

Clinical implication of homocysteine in premature acute coronary syndrome female patients: Its distribution and association with clinical characteristics and major adverse cardiovascular events risk.

Homocysteine (Hcy) is a risk factor for the presence of atherosclerotic vascular disease and hypercoagulability states, which is associated with increased risk of cardiovascular events in cardiovascular disease patients. Whereas the role of Hcy in premature acute coronary syndrome (ACS) female patients is still obscure. Hence, we aimed to explore the relationship of Hcy with clinical features, and more importantly, to probe its predictive value for major adverse cardiovascular events (MACE) risk in premature ACS female patients.By retrospectively reviewing the medical charts of 1441 premature ACS female patients, we collected patients’ Hcy level (at diagnosis) and other clinical data. According to the follow-up records, the accumulating MACE occurrence was calculated.Hcy presented with a skewed distribution with median value 11.3 μmol/L (range: 4.4–64.0 μmol/L, inter quartile: 9.2–14.1 μmol/L). Hcy was associated with older age, heavy body mass index, dysregulated liver/renal/cardiac indexes, hypertension history, and old myocardial infarction history. The 1-year, 3-year, 5-year MACE incidence was 2.9%, 10.7%, and 12.6%, respectively. Interestingly, Hcy was increased in 1-year MACE patients compared with 1-year non-MACE patients, in 3-year MACE patients compared with 3-year non-MACE patients, in 5-year MACE patients compared with 5-year non-MACE patients, and it had a good value for predicting 1-year/3-year/5-year MACE risk. Furthermore, Hcy was also correlated with increased accumulating MACE occurrence.Hcy associates with increased age and body mass index, dysregulated liver, renal, and cardiac indexes; more interestingly, it predicts increased MACE risk in premature ACS female patients.

Atherosclerotic vascular disease is more prevalent among black ESKD patients on long-term\xa0CAPD in South Africa

BackgroundOccurrence of cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) can be described as a “cruel alliance”, with CVD responsible for about half of all deaths among CKD patients. Chronic kidney disease patients are more likely to die from CVD than progress to end stage kidney disease (ESKD). Dyslipidaemia, a known traditional risk factor for CVD, is highly prevalent among CKD patients and with an even higher frequency among ESKD patients on dialytic therapies. Prolonged exposure of continuous ambulatory peritoneal dialysis (CAPD) patients to high glucose concentrations in CAPD fluid have been associated with increased risk of cardiovascular events. In this study, we investigated the relationship of atherosclerotic vascular disease (AsVD) to clinical and echocardiographic parameters among black South Africans with CKD (stage 3) and ESKD on CAPD and haemodialysis (HD).MethodsThis was a cross-sectional study of 40 adult (18–65 years) non-diabetic CKD patients (kidney disease outcome quality initiative [KDOQI] stage 3), 40 ESKD patients on CAPD, 40 ESKD patients on HD and 41 age and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants’ sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Serum blood samples were analysed for creatinine, albumin and lipid profile; lipoprotein ratios, Framingham’s risk score and the 10-year risk of developing coronary heart disease (CHD) were calculated. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was measured in both right and left carotid arteries at 1 cm proximal to the carotid bulb. Spearman’s rank correlation and binary logistic regression were conducted to determine the relationship of AsVD to clinical and echocardiographic parameters.ResultsAtherosclerotic vascular disease was most prevalent among ESKD patients on CAPD (70%, n = 28/40). Chronic kidney disease and HD patients exhibited a similar prevalence (47.5%, n = 19/40), while the prevalence in controls was 17.1% (n = 7/41). Presence of AsVD was associated with significantly older age, higher waist hip ratio (WHR), left ventricular mass index (LVMI) and Framingham’s 10-year risk of developing CHD. Significant differences in clinical and echocardiographic parameters were observed when the study groups were compared. Age and LVH independently predicted AsVD.ConclusionAtherosclerotic vascular disease was more prevalent among CAPD patients compared to pre-dialysis CKD and HD patients. Among all lipoprotein ratios assessed, non-HDL-C showed the most consistent significant difference between the groups. Age (> 40 years) and presence of LVH were independent predictors of AsVD.

Risk assessment in atrial fibrillation: not all factors are created equal

This editorial refers to ‘Comparison of CHADS2 and CHA2DS2-VASC anticoagulation recommendations: evaluation in a cohort of atrial fibrillation ablation patients’ by R.A.Winkle et al ., on page 195. Oral anticoagulation (OAC) reduces the risk of stroke and improves survival in patients with atrial fibrillation (AF). Despite these benefits, the risks of long-term OAC are not trivial and include intracranial haemorrhage. Therefore, the decision to use OAC to prevent stroke in patients with AF is heavily dependent upon the underlying risk and potential benefit for each individual patient. Following its derivation in the National Registry of Atrial Fibrillation, the CHADS2 score has become the most familiar and widely used risk stratification tool for patients with AF.1 The score assigns 1 point each for congestive heart failure, hypertension, age ≥75, and diabetes, and 2 points for a history of prior stroke or transient ischaemic attack (TIA). Rates of stroke range from 1.2 events per 100 patient-years for patients with a score of 0, to >6 events per 100 patient-years in patients with scores of ≥3. However, the upper confidence limit of the stroke rate for patients with a CHADS2 score of 1 is nearly four events per 100 patient-years—significantly higher than a comparable non-AF population. Thus, while CHADS2 can identify patients at high risk of stroke, it is less accurate in resolving risk at the lower end of the spectrum. The CHA2DS2-VASc algorithm was developed to discriminate in a better manner patients at low risk.2 The score subdivides age (65–74 receives 1 point, ≥75 receives 2), and adds female sex (1 point) and the presence of atherosclerotic vascular disease (1 point). As a result, the CHA2DS2-VASc score can provide better risk discrimination in patients with CHADS2 scores of 0–1. …

Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery

Elastic properties of large arteries have been shown to deteriorate with age and in the presence of atherosclerotic vascular disease. In this study, the performance of ultrasonographic strain measurements was compared with conventional measures of vascular stiffness in the detection of age-dependent differences in the elastic properties of the common carotid artery (CCA). In 10 younger (25-28 years, four women) and 10 older (50-59 years, four women) healthy individuals, global and regional circumferential, and radial strain variables were measured in the short-axis view of the right CCA using ultrasonographic two-dimensional (2D) strain imaging with recently introduced speckle tracking technique. Conventional elasticity variables, elastic modulus (E(p)), and beta stiffness index, were calculated using M-mode sonography and non-invasive blood pressure measurements. Global and regional circumferential systolic strain and strain rate values were significantly higher (P < 0.01 for regional late systolic strain rate, P < 0.001 otherwise) in the younger individuals, whereas the values of conventional stiffness variables in the same group were lower (P < 0.05). Among all strain and conventional stiffness variables, principal component analysis and its regression extension identified only circumferential systolic strain variables as contributing significantly to the observed discrimination between the younger and older age groups. Ultrasonographic 2D-strain imaging is a sensitive method for the assessment of elastic properties in the CCA, being in this respect superior to the conventional measures of vascular stiffness. The method has potential to become a valuable non-invasive tool in the detection of early atherosclerotic vascular changes.

Liver transplantation: Do you have the heart for it?

Liver transplantation: Do you have the heart for it?

C-reactive protein as a cardiovascular risk factor and its therapeutic implications in end-stage renal disease patients.

We observed the association between a persistent elevation of C-reactive protein (CRP) level and the presence of ischemic heart disease in 73 peritoneal dialysis (PD) patients. Twenty-six patients showed an elevation of CRP for more than 6 months. Seventeen (65%) of the 26 patients had positive thallium single photon computed tomography (SPECT). Three of 9 patients who had a persistent elevation of CRP and negative thallium SPECT had a history of cerebral infarction or peripheral vascular disease. Therefore, 77% (20/26) of an elevated CRP level that lasted longer than 6 months can be explained by the presence of atherosclerotic vascular disease. There are as yet no valid recommendations on how chronic inflammation should be handled. We found that aspirin 200 mg daily for 8 weeks induce no significant changes of the CRP levels in PD patients (0.22 vs. 0.18 mg/dL, p > 0.05). However, 62 HD patients were randomly assigned to treatment group (simvastatin 20 mg/day) and control group. After 8 weeks medication, hs-CRP levels significantly reduced from a median of 0.23 mg/dL to 0.12 mg/dL.

Extent and severity of atherosclerotic vascular disease in patients undergoing coronary angiography--the Kuwait Vascular Study.

Only a few angiographic studies have correlated the presence and severity of coronary artery disease with atherosclerosis in other arteries. The presence of disease in more than 1 area clearly has important implications on management. One hundred and seventy eight patients had angiographic evaluation of their peripheral arteries and abdominal aorta after routine diagnostic coronary angiography. The extent and severity of vascular disease was correlated with those of coronary artery disease. Of the 178 patients, 73.6% were men (mean age +/- sd was 52.93 +/- 10.12 years). Hypercholesterolemia (59%), systemic hypertension (56.7%) and diabetes mellitus (50.6%) were the major risk factors. Triple-vessel coronary artery disease was present in 48.9%, and 13.5% had normal coronaries. A new atherosclerotic vascular disease score, which reflects the presence and severity of atherosclerotic vascular disease elsewhere, was seen to correlate significantly with the extent of coronary artery disease. Of particular interest was the involvement of the first part of the vertebral artery in 41.6% of patients. The combined involvement of the abdominal aorta, renal artery, and iliac artery segments (together referred to as the lower body segment) was seen almost exclusively in those with 2- or 3-vessel coronary artery disease. Also there was a direct correlation between the extent of coronary artery disease and the score in the lower body segment as opposed to the upper body segment (subclavian, vertebral, and internal mammary arteries). The presence of atherosclerotic vascular disease correlated with the severity of coronary artery disease, particularly in respect to disease in the lower body segment. Thus early detection of such disease in the iliac or femoral arteries has a potential for early diagnosis of significant coronary artery disease.

Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study.

Calcification complications are frequent among long-term dialysis patients. However, the prognostic implication of cardiac valve calcification in this population is not known. This study aimed to determine if cardiac valve calcification predicts mortality in long-term dialysis patients. Baseline echocardiography was performed in 192 patients (mean +/- SD age, 55 +/- 12 yr) on continuous ambulatory peritoneal dialysis (mean +/- SD duration of dialysis, 39 +/- 31 mo) to screen for calcification of the aortic valve, mitral valve, or both. Valvular calcification was present in 62 patients. During the mean follow-up of 17.9 mo (range, 0.6 to 33.9 mo), 46 deaths (50% of cardiovascular causes) were observed. Overall 1-yr survival was 70% and 93% for patients with and without valvular calcification (P < 0.0001, log-rank test). Cardiovascular mortality was 22% and 3% for patients with and without valvular calcification (P < 0.0001). Multivariable Cox regression analysis showed that cardiac valve calcification was predictive of an increased all-cause mortality (hazard ratio [HR], 2.50; 95% CI, 1.32 to 4.76; P = 0.005) and cardiovascular death (HR 5.39; 95% CI, 2.16 to 13.48; P = 0.0003) independent of age, male gender, dialysis duration, C-reactive protein, diabetes, and atherosclerotic vascular disease. Eighty-nine percent of patients with both valvular calcification and atherosclerotic vascular disease, 23% of patients with valvular calcification only, 21% of patients with atherosclerotic vascular disease only, and 13% of patients with neither complication died at 1-yr (P < 0.0005). The cardiovascular death rate was 85% for patients with both complications, 13% for patients with valvular calcification only, 14% for patients with atherosclerotic vascular disease only, and 5% for those with neither complication (P < 0.0005). The number of calcified valves was associated with all-cause mortality (P < 0.0005) and cardiovascular death (P < 0.0005). One-year all-cause mortality was 57% for patients with both aortic and mitral valves calcified, 40% for those with either valve calcified, and 15% for those with neither valve calcified. In conclusion, cardiac valve calcification is a powerful predictor for mortality and cardiovascular deaths in long-term dialysis patients. Valvular calcification by itself has similar prognostic importance as the presence of atherosclerotic vascular disease. Its coexistence with other atherosclerotic complications indicates more severe disease and has the worst outcome.

Risk factors for ischemic optic neuropathy after cardiopulmonary bypass: a matched case/control study.

Visual loss (acuity or field) secondary to ischemic optic neuropathy (ION) is a rare but devastating complication of cardiac surgery involving cardiopulmonary bypass (CPB). We determined clinical features and risk factors for ION by a retrospective time-matched, case-control study. ION was identified in 17 (0.06%) patients out of 27,915 patients who underwent CPB between January 1, 1976, and December 31, 1994. For each ION patient, two patients who underwent CPB exactly 2 wk before the ION patient were selected as controls. Data were analyzed by using conditional logistic regression with the 1:2 matched-set feature of 17 cases and 34 controls. Two-tailed P values < or =0.05 were considered significant. From bivariate analysis, smaller minimum postoperative hemoglobin concentration (odds ratio [OR] = 1.9, P = 0.047) and the presence of atherosclerotic vascular disease (OR = 7.0, P = 0.026) were found to be independently associated with ION after CPB, as were smaller minimum postoperative hemoglobin concentration (OR = 2.2, P = 0.027) and preoperative angiogram within 48 h of surgery (OR = 7.2, P = 0.042). In ION patients, 13 (76.5%) of 17 experienced a minimum postoperative hemoglobin value of < 8.5 g/dL, whereas only 14 (41.2%) of 34 control patients experienced values < 8.5 g/dL. Patients with clinically significant vascular disease history or preoperative angiogram may be at increased risk for ischemic optic neuropathy after cardiac surgery, especially if the hemoglobin remains low in the postoperative period.

Pregnancy complicating diabetes

Following the introduction of insulin by F. G. Banting and C. H. Best in the early 1920’s, diabetes mellitus gradually became a relatively common complication of pregnancy. During the 1930’s and 1940’s, however, the reported mortality rate in the fetuses and neonates of women with this complication varied from almost nil to 70 per cent or more. To a great extent this variation resulted from differences in the severity of the disease and the degree of associated complications in those cases reported. White, of Boston’s Joslin Clinic, first brought some semblance of order into the reports of results with her clinical classification of diabetes based on the age at onset of the disease, its duration, and the presence of atherosclerotic vascular disease and renal complications. In addition, this classification allowed a partial prediction of the course of an individual diabetic patient during pregnancy and the chances for survival of the newborn infant. In 1952, White reported on the outcome of pregnancy in 278 diabetic women. Although 100 per cent of the infants of Class A patients were live-born, the survival rates of patients with clinically overt disease were as follows: Class B, 67 per cent; Class C, 48 per cent; Class D, 32 per cent; Class E, 13 per cent. (Joslin, E. P., Root, H. F., White, P., and Marble, A., editors: The Treatment of Diabetes Mellitus, ed. 9, Philadelphia, 1952, Lea 8c Febiger, Publishers, p. 676). In 1965, she added to the classification those patients with proliferating retinopathy (Class R) (Pregnancy and diabetes, medical aspects, Med. Clin. North Am. 49: 1015, 1965). Recently, the classification was modified further (Diabetes mellitus in pregnancy, Clin. Perinatol. 1: 33 1, 1974). White also contributed to knowledge of the newborn infant of the diabetic mother and of juvenile diabetes by presenting the classic description of the natural course of insulin dependency and neuropathic and vascular complications (Childhood diabetes, its course, and influence on the second and third generations. The Banting Memorial Lecture, Diabetes 9: 345,196O). Because of her leadership in the early diagnosis and rigorous management of prenatal care of women with this disease, White must be credited, to a great degree, with the decrease in the perinatal mortality rate from about 50 per cent three or four decades ago to 3 or 4 per cent at present.

PREGNANCY COMPLICATING DIABETES

Following the introduction of insulin by F. G. Banting and C. H. Best in the early 1920’s, diabetes mellitus gradually became a relatively common complication of pregnancy. During the 1930’s and 1940’s, however, the reported mortality rate in the fetuses and neonates of women with this complication varied from almost nil to 70 per cent or more. To a great extent this variation resulted from differences in the severity of the disease and the degree of associated complications in those cases reported. White, of Boston’s Joslin Clinic, first brought some semblance of order into the reports of results with her clinical classification of diabetes based on the age at onset of the disease, its duration, and the presence of atherosclerotic vascular disease and renal complications. In addition, this classification allowed a partial prediction of the course of an individual diabetic patient during pregnancy and the chances for survival of the newborn infant. In 1952, White reported on the outcome of pregnancy in 278 diabetic women. Although 100 per cent of the infants of Class A patients were live-born, the survival rates of patients with clinically overt disease were as follows: Class B, 67 per cent; Class C, 48 per cent; Class D, 32 per cent; Class E, 13 per cent. (Joslin, E. P., Root, H. F., White, P., and Marble, A., editors: The Treatment of Diabetes Mellitus, ed. 9, Philadelphia, 1952, Lea 8c Febiger, Publishers, p. 676). In 1965, she added to the classification those patients with proliferating retinopathy (Class R) (Pregnancy and diabetes, medical aspects, Med. Clin. North Am. 49: 1015, 1965). Recently, the classification was modified further (Diabetes mellitus in pregnancy, Clin. Perinatol. 1: 33 1, 1974). White also contributed to knowledge of the newborn infant of the diabetic mother and of juvenile diabetes by presenting the classic description of the natural course of insulin dependency and neuropathic and vascular complications (Childhood diabetes, its course, and influence on the second and third generations. The Banting Memorial Lecture, Diabetes 9: 345,196O). Because of her leadership in the early diagnosis and rigorous management of prenatal care of women with this disease, White must be credited, to a great degree, with the decrease in the perinatal mortality rate from about 50 per cent three or four decades ago to 3 or 4 per cent at present.

Pregnancy complicating diabetes

Following the introduction of insulin by F. G. Banting and C. H. Best in the early 1920’s, diabetes mellitus gradually became a relatively common complication of pregnancy. During the 1930’s and 1940’s, however, the reported mortality rate in the fetuses and neonates of women with this complication varied from almost nil to 70 per cent or more. To a great extent this variation resulted from differences in the severity of the disease and the degree of associated complications in those cases reported. White, of Boston’s Joslin Clinic, first brought some semblance of order into the reports of results with her clinical classification of diabetes based on the age at onset of the disease, its duration, and the presence of atherosclerotic vascular disease and renal complications. In addition, this classification allowed a partial prediction of the course of an individual diabetic patient during pregnancy and the chances for survival of the newborn infant. In 1952, White reported on the outcome of pregnancy in 278 diabetic women. Although 100 per cent of the infants of Class A patients were live-born, the survival rates of patients with clinically overt disease were as follows: Class B, 67 per cent; Class C, 48 per cent; Class D, 32 per cent; Class E, 13 per cent. (Joslin, E. P., Root, H. F., White, P., and Marble, A., editors: The Treatment of Diabetes Mellitus, ed. 9, Philadelphia, 1952, Lea 8c Febiger, Publishers, p. 676). In 1965, she added to the classification those patients with proliferating retinopathy (Class R) (Pregnancy and diabetes, medical aspects, Med. Clin. North Am. 49: 1015, 1965). Recently, the classification was modified further (Diabetes mellitus in pregnancy, Clin. Perinatol. 1: 33 1, 1974). White also contributed to knowledge of the newborn infant of the diabetic mother and of juvenile diabetes by presenting the classic description of the natural course of insulin dependency and neuropathic and vascular complications (Childhood diabetes, its course, and influence on the second and third generations. The Banting Memorial Lecture, Diabetes 9: 345,196O). Because of her leadership in the early diagnosis and rigorous management of prenatal care of women with this disease, White must be credited, to a great degree, with the decrease in the perinatal mortality rate from about 50 per cent three or four decades ago to 3 or 4 per cent at present.