Prognosis Of Coronary Heart Disease Research Articles

The Epidemiology of Coronary Heart Disease

Understanding the societal impact and trends of coronary heart disease through basic epidemiological measures is essential to evaluate treatment effectiveness and organize resource distribution. In the following narrative review, data are presented on the prevalence, incidence, and prognosis of coronary heart disease in general and of acute coronary syndrome in particular.

Long-term prognostic impact of cystatin c on acute coronary syndrome octogenarians with diabetes mellitus

ObjectiveCystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM).MethodsWe enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate.ResultsThere were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16–38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704).ConclusionsCys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.

The Impact of Obesity on Risk Factors and Prevalence and Prognosis of Coronary Heart Disease—The Obesity Paradox

Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.

Low disparity and high attendance rate to out-patient cardiac rehabilitation after systematic referral

Purpose: Outpatient Cardiac Rehabilitation (CR) improves prognosis in coronary heart disease (CHD) but remains underutilized, especially among women, ethnic minorities, and the elderly. We hypothesized that automatized early referral will increase attendance and reduce disparities. Methods: All consecutive patients discharged from our hospital with acute coronary syndrome (ACS) or stable CHD in a 24-months period from February 2011 were monitored for referral to and participation in CR after introduction of automatized early referral. Results: 817 patients were included in the study. Index event was STEMI (22%), NSTEMI (26%), unstable angina (18%) and stable CHD (34%). Mean age was 65 (inter quartile range 57-74), 246 (30%) were women and 138 (17%) belonged to an ethnic minority. Overall, 297 (36%) did not participate in CR: 248 (84%) were not referred and 49 declined to participate. Main reasons for non-referral were severe co-morbidity, living in a nursing home or recent participation in CR. The non-referred were older (mean age 69, p for difference compared to referred <0.001), 37% were women (p=0.002), and 16% belonged to an ethnic minority (p=0.81). In a logistic regression younger age (P<0.001) and STEMI versus other index events (OR 2.2, p=0.001) but not gender (p=0.12) or ethnicity (p=0.34) predicted referral after mutual adjustment. Of the 569 patients referred for CR, 49 (9%) declined participation. These non-attendees did not differ from attendees with regard to gender, ethnicity, age or index-event. In relation to traditional cardiovascular risk factors, smokers (p<0.001) and patients with diabetes (p=0.003) were less likely to attend whereas hypertension, hypercholesterolemia, family history of CHD, BMI and physical inactivity did not predict attendance. Conclusion: The study indicate that automatized referral results in very high rates of participation in cardiac rehabilitation with no gender or ethnic disparities. In this unselected sample of consecutive patients discharged with CHD, 74% participated in CR. Main reason for non-participation was non-referral: Among patients deemed eligible to CR only 9% declined participation.

Psychosocial risk factors for coronary heart disease

In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD. Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive. Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD. Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study. Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.

Neglecting the subjective relevance of stress on health: a protective strategy for your heart?

This editorial refers to ‘Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study’[†][1], by H. Nabi et al. , on page 2697 The recent study of Nabi et al . introduced a new variable into the set of risk factors that contribute to the development of coronary heart disease (CHD).1 The authors assessed the perception of the impact one's stress has on health. Therefore, this study goes beyond established risk factors for CHD with established behavioural2 and psychological risk factors such as depression.3 On the other hand, resources such as social support might be beneficial in terms of the onset of CHD2,4 (see the ‘Basic model’ in Figure 1 ). Figure 1 Aetiologic models of risk factors and resources of coronary heart disease. Initial health status is associated with CHD incidence and prognosis. Therefore, an adjustment for health status in longitudinal studies is necessary, and has been included in the study of Nabi et al . … [1]: #fn-2

Comment on: Triglyceride-to-HDL cholesterol ratio: Predictive value for CHD severity and new-onset heart failure

This study aimed to explore the association between the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and the severity of coronary heart disease (CHD). It also evaluated the clinical role of the TG/HDL-C ratio in predicting in-hospital CHD events and the long-term prognosis of CHD patients.According to the results of coronary angiography examinations, 317 patients were enrolled in the study and classified into a CHD group (n=233) and a control group (n=84). The TG/HDL-C ratio was calculated at baseline. The CHD group was then further classified into cases of single-branch stenosis (n=79), double-branch stenosis (n=73), and multi-branch stenosis (n=81). The Gensini score was calculated for each group to analyze the relationship between the TG/HDL-C ratio and the severity of CHD.The TG/HDL-C ratio in the CHD group was significantly higher than in the normal group (P < 0.001). The TG/HDL-C ratio was positively correlated with the Gensini score. The ratio was significantly higher in patients with new-onset heart failure than in those without heart failure events (P < 0.05). An average 3-year follow-up showed that the serum TG/HDL-C ratios of patients with adverse events were significantly higher than other patients (P < 0.01).The TG/HDL-C ratio is predictive of the severity of CHD. It could also help predict in-hospital new-onset heart failure incidents of CHD patients.

Psychosocial interventions in cardiovascular disease – what are they?

There is growing interest in psychosocial factors in the etiology and prognosis of coronary heart disease. There is also recent interest in psychosocial interventions as a means to improve outcome in this patient group, including those with chronic heart failure or referred for cardiac rehabilitation, and for their support givers. However, there is a lack of consistency in the way psychosocial interventions are defined, delivered and tested, thus complicating or rendering meaningless any evaluation of efficacy. For instance, in trials and meta-analyses the term psychosocial interventions has often not been defined at all or defined in detail, such as ‘a structured nonpharmacologic intervention conducted by health professionals that is focused on improving the psychologic and/or social aspects of a patient’s health’. Typically, the term psychosocial intervention is used when a more apt description would be behavioral, educational, psychological or social intervention. Indeed, some recent reviews of behavioral or nonpharmacological interventions have included studies that are deemed psychosocial interventions or have elements of them. In fact, the terms psychosocial and behavioral interventions are often used synonymously and many supposed psychosocial interventions tend to be a mixture of some or all of these components, e.g. psycho-educational. We suggest, however, that the term should be reserved only for interventions that combine psychological (e.g. cognitive behavioral therapy) and social (e.g. social support) components, whilst acknowledging that psychological and social benefits may accrue, for example, from the education and exercise provided in a cardiac rehabilitation program. An example of a true psychosocial intervention is the ENRICHD (Enhancing Recovery in Coronary Heart Disease) study which addressed depression and social support. To improve transparency of psychosocial interventions and enable their reproducibility, comparison and evaluation, a proposed taxonomy that cuts across four dimensions is helpful. This taxonomy examines along a continuum:

DEVELOPING A REGISTER OF OUTCOMES OF CHRONIC CORONARY HEART DISEASE: CHD PROGNOSIS STUDY

Aim. Using the data from the CHD PROGNOSIS register, to assess the long-term survival of patients with stable coronary heart disease (CHD) confirmed by a diagnostic coronary angiography (CAG). Material and methods. The study design (retro- and prospective observational cohort study) agreed with the register principles. The study included all consecutive patients (Moscow Region residents) who were hospitalised to the State Research Centre for Preventive Medicine with a preliminary diagnosis of CHD, for a diagnostic CAG and therapeutic strategy selection (01.01.2004–31.12.2007). The total number of participants was 641 (500 men and 141 women). Vital status was ascertained in 551 patients (86%). Mean follow-up time was 3,8 years (range 0,76–6,52 years). Results. The register participants had a high prevalence of conventional risk factors and adverse clinical and anamnestic characteristics. CAG???confirmed coronary artery (CA) stenosis ≥50% was registered in 563 patients. In 24 out of 78 individuals with “intact” CA, coronary syndrome X or vasospastic angina was diagnosed; in the other 54, CHD diagnosis could not be confirmed. During the hospitalisation, balloon angioplasty was performed in 38% of the patients with known vital status. Before hospitalisation, the main drug classes with proven prognostic benefits were administered insufficiently often. During the follow-up period (mean follow-up 3,9 years), 50 patients died. All-cause mortality was 11,38±1,61 per 1000 person-years. The leading cause of death was chronic CHD (84%), which confirms high levels of cardiovascular risk in these patients. In total, fatal and non-fatal complications, including revascularisation episodes, were registered in 36%. Conclusion. The established register of stable CHD includes a typical cohort of chronic CHD patients who are referred for invasive diagnostics and treatment. Therefore, the register is expected to provide valid information on the factors determining prognosis and effectiveness of medical intervention, such as pharmacological therapy and percutaneous revascularisation.

A review of the affects of worry and generalized anxiety disorder upon cardiovascular health and coronary heart disease

Objective: The aims of this review article are to present psychophysiological and behavioral pathways for the involvement of worry and generalized anxiety disorder (GAD) upon cardiovascular function. The review will focus on persons with and without coronary heart disease (CHD), and encompass etiological and prognostic studies. Methods: Articles (1975–2011) reporting on GAD or worry affecting CHD prognosis or cardiovascular function were found using MEDLINE, EMBASE, SCOPUS and PsychINFO database searches, and extracted to form a narrative review. Results: Available evidence in experimental and observational studies in CHD free samples consistently showed that worry was associated with diminished heart rate variability (HRV) and elevated heart rate. Worry and GAD were commonly associated with blood pressure and diagnosed hypertension or medication use in both disease-free and established CHD populations. No evidence was found to support worry being beneficial to cardiovascular function or conducive to health promoting behaviors. The literature indicated that measures of worry were associated with fatal and nonfatal CHD in seven etiological studies of initially disease-free individuals; however, females were underrepresented. Three studies reported that GAD was associated with poorer prognosis in establish CHD, independent of depression. The median GAD prevalence was 10.4% in 3266 patients across 15 studies, suggesting that GAD is marginally less common in CHD samples than is depression. Conclusions: A growing literature highlights the association between worry and development of CHD. The association between worry, GAD and CHD risk factors (e.g. blood pressure), and HRV are leading mechanisms of cardiopathogenesis that may affect cardiovascular function. Findings regarding worry and GAD in established CHD are less clear.

Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: A meta-analysis

Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.

Combination of coronary heart disease, chronic heart failure, and anaemic syndrome: clinical features and prognostic impact of anaemia treatment

Practitioners are often faced with a combination of coronary heart disease (CHD), chronic heart failure (CHF), and anaemic syndrome. These patients are typically characterised by a worse prognosis of acute and chronic CHD, as well as by a rapid progression of CHF and chronic renal failure (CKF). This review is focussed on the epidemiology of anaemia in CHD and CHF patients; the aetiology and pathogenesis of anaemia in CHD and CHF; and the changes of cardiovascular parameters in patients with anaemic syndrome. Despite the abundance of studies on CHD and CHF clinical course and prognosis in anaemic syndrome, very little is known about the effects of anaemia treatment on the clinical course and prognosis of CHD. The review presents the external evidence and original results on the prognosis of acute and chronic CHD in anaemic patients. A modern view on anaemia treatment in various CHD forms is also presented.

Low HDL-C predicts risk and PCI outcomes in the Han Chinese population

BackgroundHigh-density lipoprotein cholesterol (HDL-C) can predict the occurrence and prognosis of coronary heart disease (CHD) in the Western population; however, the role of HDL-C in Chinese populations is unclear. Thus, we investigated the predictive value of HDL-C on the risk and clinical outcomes of CHD in the Han Chinese population. MethodsIn a case–control study, plasma HDL-C levels of CHD patients and controls were evaluated to analyse the diagnostic value of HDL-C on CHD. In a prospective cohort study, the predictive value of HDL-C on the development of major adverse cardiovascular events (MACE) was determined in CHD patients who underwent a percutaneous coronary intervention (PCI). ResultsIn the case–control study, HDL-C levels were significantly lower in patients with CHD (n = 375) compared to the controls (n = 328, P < 0.05). There were more male patients in the CHD group than in the control group. Logistic regression analysis showed that, relative to other lipid parameters, the relationship between HDL-C levels and CHD showed the strongest association. A stratified analysis showed that gender did not affect the relationship between HDL-C levels and CHD. The prospective cohort study found that in the low HDL-C subgroup of CHD patients (n = 249) who underwent PCI, 62 (24.9%) patients experienced a MACE during the 120-week follow-up period. However, only 15 (6.8%) patients experienced a MACE in the high HDL-C subgroup (n = 219; P < 0.05). Kaplan–Meier analysis revealed that the MACE rate and death rate were significantly higher in the low HDL-C subgroup than in their counterparts with high HDL-C levels (P < 0.05). The Cox regression analysis showed that HDL-C was an independent predictor of a MACE during the follow-up period (hazard ratio = 0.395, P = 0.005). ConclusionsLow HDL-C was the most powerful lipid parameter for predicting the risk and the clinical outcome of CHD in the Han Chinese population.

EMOTIONAL CHANGES IN PATIENTS RECEIVING PERCUTANEOUS CORONARY INTERVENTION

ObjectivesThe purpose of this study is to investigate the psychological problems of the patients receiving percutaneous coronary intervention and emotional changes before and after operation.MethodsTo conduct a psychological evaluation to...

Depression and coronary heart disease. Clinical characteristics, pathogenetic links and treatment issues

SummaryIt is widely accepted that depression increases the risk of coronary heart disease (CHD) in healthy people while, in individuals with an existing heart disease, depression is a predictor of recurrent cardiac events and death. It seems that new-onset depression after an acute coronary syndrome (ACS) and not recurrent depression may worsen the cardiovascular outcome, and it has been suggested, although not conclusively proved, that depressive somatic symptoms, could be more cardiotoxic than depressive cognitive symptoms. Both psychosocial (low social support, less adherence to treatment recommendations, physical inactivity) and biological mechanisms (autonomic nervous system dysregulation, platelet and endothelial dysfunctions, inflammation, and neuroendocrine abnormalities) have been hypothesized to explain the link between depression and the increased risk of CHD or adverse cardiovascular prognosis. Randomized controlled clinical trials seem to suggest that depression in CHD patients is poor responsive to both pharmacological and psychotherapeutic treatments. Nevertheless, these trials provide also a robust evidence that CHD depressed patients non responder to antidepressant treatments are at greater risk of adverse cardiac event than patients with successfully treated depression. Therefore, it is advisable that psychiatrists, cardiologists and general practitioners coordinate their efforts in managing depression in CHD patients.

Understanding the Mechanisms That Link Alcohol and Lower Risk of Coronary Heart Disease

For more than 75 years, pathologists have recognized that alcohol consumption has a surprising link to atherosclerosis (1). In those early studies, postmortem examinations of deceased heavy drinkers identified less atherosclerosis than was expected from age and sex, suggesting that alcohol consumption is atheroprotective. In the ensuing 8 decades, investigators have made substantial strides in understanding this relationship, including confirmation of the strength and shape of the association of alcohol consumption with lower risk of coronary heart disease (CHD),2 its consistency across beverage types and in different populations, and its associations with various forms of cardiovascular disease. One of the most important aspects of the alcohol–CHD relationship that continues to draw interest is its underlying mechanism. There are a number of reasons for this interest. First, because no long-term randomized trial of alcohol consumption on CHD incidence or prognosis is likely anytime in the near future, the evidence base will continue to be largely observational, with all of the attendant limitations therein. Consequently, the presence of a plausible mechanism provides reassurance that the observed association is not the result of confounding by such factors as baseline health or socioeconomic status. Second, given the many difficulties with recommending alcohol intake, even in moderation, a better understanding of the mechanisms involved could lead to safer therapies that harness these same pathways to prevent CHD. Finally, because the relationships of alcohol consumption with candidate pathways can be readily tested in randomized trials, even when its relationship with CHD cannot, identification of key pathways helps to direct trialists to the best biomarkers and intermediate outcomes to test in short-term feeding studies. For all of these reasons, studies attempting to draw the full links between alcohol consumption, CHD, and the pathways that connect them remain important. Epidemiologists have taken 2 approaches to this challenge. …

Type D personality and persistence of depressive symptoms in a German cohort of cardiac patients

Depression is associated with a negative prognosis in coronary heart disease and heart failure patients. Type D personality has been shown to predict the persistence of depressive symptoms over 12 months. Data on longer follow-up periods and on the effectiveness of Type D as a screening tool compared to established measures of depressive symptoms are missing. Type D personality and depressive mood were assessed with the DS14 and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) in 679 consecutive cardiac patients (22.2% female, mean age 62.4±10.2 years) over a period of 6 years. Latent class and growth mixture models with Type D, comorbidity, age, and sex as covariates were used to model individual depression trajectory classes and to predict trajectories and class membership. Estimates of specificity and sensitivity were calculated for Type D and the HADS-D baseline cut-off point. In a model with four latent classes (mild symptoms, moderate and increasing symptoms, significant but decreasing symptoms, and significant and increasing symptoms), Type D predicted the membership in the class with significant and increasing symptoms (OR=10.94, 4.93, and 3.15). Sensitivity and specificity were 59% and 78% for Type D and 47% and 80% for the HADS-D. Some possible confounders might be missing. With just two measurement points only linear trajectories could be modeled. Type D personality is a stronger predictor for persistent depressive symptoms than the baseline HADS-D score, but the predictive power seems low for clinical practice.

Concomitant use of clopidogrel and proton pump inhibitors may attenuate the prognosis of coronary heart disease in hemodialysis patients

Introduction and objectivesRecent pharmacodynamic and clinical analyses have suggested that proton pump inhibitors (PPIs) may weaken the antiplatelet effects of clopidogrel by involving CYP (cytochrome P450) 2C19 and 3A4. Although acute coronary syndrome (ACS) is common in hemodialysis patients and percutaneous coronary intervention (PCI) is widely performed, little attention has been paid to this point in hemodialysis patients. Patients and methodsFifty-nine hemodialysis patients (including 28 concomitant users of clopidogrel and PPIs) who had coronary angiography (CAG) were examined in this study. Baseline and follow-up drug use was assessed. Primary outcomes were PCI or coronary artery bypass grafting (CABG) after first CAG. ResultsIn univariate analysis, observation periods and platelet count between concomitant users (CU: patients with clopidogrel and PPIs) and non-concomitant users A (NCUA: patients with only clopidogrel) and gender, mean age and distribution of multivessel coronary disease between CU and non-concomitant users B (NCUB: NCUA and taking ticlopidine) were significantly different (p<0.05). The cumulative incidence of PCI or CABG after first CAG between CU and NCUA was significantly different (p=0.038 log-rank test) while that between CU and NCUB was not significantly different (p=0.112, log-rank test). The relative hazard (HR) associated with concomitant use of clopidogrel and PPIs for PCI or CABG after CAG between CU and NCUA or CU and NCUB was 1.63 and 1.55 (95% confidence interval (CI): 1.12–2.45, 1.07–2.30), respectively. The other significant factors for PCI or CABG after CAG between CU and NCUA, or NCUB were diabetes mellitus as a cause of renal failure (HR: 1.58, 1.56, CI: 1.08–2.34, 1.06–2.33, respectively). ConclusionIn hemodialysis patients with serious coronary heart disease treated with clopidogrel and PPIs, the corresponding point estimate for serious cardiovascular events may increase.

Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox?

To determine the combined effects of body mass index (BMI) and body fat (BF) on prognosis in coronary heart disease (CHD) to better understand the obesity paradox. We studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided into low (<25) and high BMI (≥25), as well as low (≤25% men and ≤35% women) and high BF (>25% in men and >35% in women). Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311). During the 3-year follow-up, mortality was highest in the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, respectively); using the high BF/high BMI group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (confidence interval [CI], 1.76-10.23; P=.001). In multivariate logistic regression for mortality, when entered individually, both high BMI (odds ratio [OR], 0.79; CI, 0.69-0.90) and high BF (OR, 0.89; CI, 0.82-0.95) as continuous variables were independent predictors of better survival, whereas low BMI (OR, 3.60; CI, 1.37-9.47) and low BF (OR, 3.52; CI, 1.34-9.23) as categorical variables were independent predictors of higher mortality. Although both low BF and low BMI are independent predictors of mortality in patients with CHD, only patients with combined low BF/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition in the secondary prevention of CHD.

The Importance of Gender Differences in the Diagnosis and Management of Cardiovascular Disease

For many years, the majority of the observational and epidemiological studies assessing coronary artery disease patients, national and international clinical guidelines, registries and randomized trials have focused almost exclusively on men whereas women were usually excluded in most series. This underrepresentation of women in the medical literature in this field has resulted in few data being available regarding the clinical course of the condition, its management and clinical outcomes in this specific population, despite the relatively high prevalence of ischemic heart disease in women. The situation has changed -at least partially- in the past few years with publications focusing on this issue and reporting the existence of inequalities between genders regarding the diagnosis and treatment of coronary heart disease. This article will briefly review gender differences in the clinical presentation, diagnostic strategies and prognosis of coronary heart disease.