Risk Of Myocardial Infarction Research Articles

Incident heart failure and recurrent coronary events following acute myocardial infarction.

Recurrent myocardial infarction (MI) and incident heart failure (HF) are major post-MI complications. Herein, contemporary post-MI risks for recurrent MI and HF are described. A total of 6804 patients with a primary discharge diagnosis of MI at 28 Baylor Scott & White Health hospitals (January 2015 to December 2021) were studied. Patient characteristics, treatment, and outcomes, including incident HF, recurrent MI, all-cause death, and all-cause and cardiovascular rehospitalizations, were assessed. Landmark approach anchored at 3 months post-discharge was used to assess 1-year outcomes. Median age was 69 years, 59.7% were male, and 76.7% had non-ST-elevation MI. Comorbidities included hypertension (89%), dyslipidaemia (87%), Type 2 diabetes (48%), and chronic kidney disease (34%); 17% had a history of MI and 23% of HF; 63% underwent percutaneous/surgical revascularization. In landmark-anchored 1-year outcomes (N = 6210), 413 (6.7%) patients died, 1730 (27.9%) had all-cause and 735 (11.8%) cardiovascular hospitalizations, 234 (3.8%) had recurrent MI. Of patients without history of HF, 1160 (23.8%) developed incident HF [42.2%, 26.7%, and 31.1% with ejection fraction (EF) < 40%, 41-49%, and >50%, respectively) within 3 months of discharge. Patients who developed HF had higher risk of death and hospitalizations (all P < .001), irrespective of EF. Of 2179 patients with EF > 50% without prevalent HF or HF during index hospitalization, 257 (11.8%) developed HF and 77 (3.5%) recurrent MI within 1 year. In a contemporary post-MI cohort, the risk for incident HF was greater than recurrent MI, even among those with normal EF and no HF at discharge.

Sequential Epidemiological Analyses of Real-World Data: A Tool for Prospective Drug Safety Surveillance from the Rofecoxib Example.

Large administrative healthcare databases can be used for near real-time sequential safety surveillance of drugs as an alternative approach to traditional reporting-based pharmacovigilance. The study aims to build and empirically test a prospective drug safety monitoring setup and perform a sequential safety monitoring of rofecoxib use and risk of cardiovascular outcomes. We used Danish population-based health registers and performed sequential analysis of rofecoxib use and cardiovascular outcomes using case-time-control and cohort study designs from January 2000 to September 2004. Each monitoring period added 6 months of data until the end ofthe study period. In the case-time-control study, incident cases of myocardial infarction (MI) and ischemic stroke were identified and matched with up to five time controls on age, sex, and calendar time. Exposure status on the date of diagnosis was assessed using a 60-day focal window, with reference windows 120, 180, and 240 days prior to the diagnoses. In the cohort study, incident users of rofecoxib were matched up to 1:4 with ibuprofen users (active comparators) using high-dimensional disease risk scores and were followed for 60 days. The earliest association between rofecoxib use and therisk of MI was seen in study period 2 for case-time-control design (OR 1.42, 95% CI 1.04-1.93) and instudy period 7 for the cohort study design (RR 1.22; 95% CI 1.02-1.47). Our prospective drug safety monitoring setup showed that the risk of MI could have been detected 3.5 years before theultimate market withdrawal of rofecoxib. However, further research is needed to validate this approach.

Navigating the Double- Edged Sword of Diclofenac: Pain Relief and Associated Cardiovascular Safety

Diclofenac sodium (DFS) is a widely prescribed nonsteroidal anti-inflammatory drug (NSAID) effective in managing pain and inflammation in patients with arthritis and musculoskeletal conditions. While DFS is known for its rapid analgesic effects and broad therapeutic indications, it also poses significant cardiovascular (CV) safety concerns. Research highlights that prolonged or high-dose use of diclofenac increases the risk of myocardial infarction, stroke, and thrombotic events. Despite clinical guidelines discouraging its use in patients with heart conditions, a large percentage of individuals continue its use after hospital discharge. This review explores the dual nature of diclofenac’s benefits for pain relief and its associated cardiovascular risks, discussing pharmacokinetics, therapeutic indications, adverse effects, and regulatory recommendations. Key words: Diclofenac, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Cardiovascular Risk, Pain Relief, COX-1 and COX-2 Inhibition, Myocardial Infarction, Prostaglandins, Thrombosis, Atherosclerosis

Patterns among factors associated with myocardial infarction: chi-squared automatic interaction detection tree and binary logit model

BackgroundAlthough mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye.MethodsMicrodata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI.ResultsThe analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI.ConclusionTo prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Revascularization of Chronic Total Occlusions vs. Planned Complex Percutaneous Coronary Intervention: Long-Term Outcomes and Mortality

Introduction: The number of chronic total occlusion (CTO) revascularization procedures has continuously increased, obtaining better results in recent years. However, there are few data regarding long-term outcomes and no comparisons to planned complex non-CTO percutaneous coronary intervention (PCI). Methods: We included all patients undergoing planned complex PCI. Our main objective was to compare a combined endpoint of all-cause death, myocardial infarction, and target vessel revascularization at the long-term follow-up of CTO PCI versus planned complex non-CTO PCI. We compared the groups using multivariable Cox regression and performed a propensity score matching analysis to control the baseline characteristics. We repeated the analysis for the separate components of the primary endpoint. Results: From January 2018 to June 2023, 1394 complex coronary PCIs were performed at our center. After excluding 393 non-planned cases, 201 CTO PCIs and 800 non-CTO PCIs were included. The mean follow-up was 2.5 ± 1.5 years. The composite endpoint occurred in 23 (11.6%) CTO PCIs and 219 (28.2%) planned non-CTO PCIs. The multivariable Cox regression using the CTO group as the reference showed a lower risk for the primary outcome (HR: 0.59; 95% CI 0.37–0.95; p = 0.031). After matching, a total of 195 adequately balanced pairs were obtained. The CTO group presented a lower risk for the primary combined outcome (HR: 0.46; 95% CI 0.27–0.76; p = 0.003). Conclusions: In patients undergoing planned complex PCI, those in the CTO group presented a reduced risk of all-cause death, myocardial infarction, and target vessel revascularization at the end of the follow-up.

Update on the Efficacy and Safety of Sodium–Glucose Co-Transporter 2 Inhibitors in Patients with Chronic Diseases: A Systematic Review and Meta-Analysis

Background: Sodium–glucose co-transporter-2 (SGLT2) inhibitors have emerged as vital medications for the management of type 2 diabetes mellitus (T2DM). Numerous studies have highlighted the cardioprotective and renal protective benefits of SGLT2 inhibitors. Consequently, it is essential to assess their efficacy and safety in patients with chronic diseases. Method: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of SGLT2 inhibitors on major cardiovascular and safety outcomes in patients with T2DM, heart failure (HF), and chronic kidney disease (CKD). We searched the PubMed, Cochrane, and Embase databases for trials published between 30 September 2021 and 17 May 2023. The primary outcomes of interest included nonfatal myocardial infarction (MI), hospitalization for heart failure (HHF), cardiovascular death, and nonfatal stroke. The safety outcomes assessed were hypoglycemia, urinary tract infections (UTIs), and acute kidney injury (AKI). Result: We identified 13 RCTs involving 90,413 participants. In patients with T2DM, SGLT2 inhibitors significantly reduced the risk of nonfatal MI by 12% (hazard ratio [HR] = 0.88, 95% confidence interval [CI]: 0.78–0.98), HHF by 33% (HR = 0.67, 95% CI: 0.62–0.74), and cardiac death by 15% (HR = 0.95, 95% CI: 0.80–1.13). However, they did not significantly reduce the risk of nonfatal stroke (HR = 0.85, 95% CI: 0.75–0.95). In patients with HF, SGLT2 inhibitors reduced the risk of HHF by 28% (HR = 0.72, 95% CI: 0.66–0.77) and cardiac death by 12% (HR = 0.88, 95% CI: 0.80–0.96). For patients with CKD, SGLT2 inhibitors reduced the risk of HHF by 35% (HR = 0.65, 95% CI: 0.55–0.76) and cardiac death by 16% (HR = 0.84, 95% CI: 0.73–0.96). Regarding safety outcomes, SGLT2 inhibitors did not significantly increase the risk of hypoglycemia in patients with T2DM, HF, or CKD, nor did they increase the risk of urinary tract infections (UTIs) in patients with HF or CKD, or the risk of acute kidney injury (AKI) in patients with HF. However, they did increase the risk of UTIs by 8% (risk ratio [RR] = 1.08, 95% CI: 1.01–1.16) in patients with T2DM and reduced the risk of AKI by 22% (RR = 0.78, 95% CI: 0.67–0.89) and 19% (RR = 0.81, 95% CI: 0.69–0.97) in patients with T2DM and CKD, respectively. Conclusions: SGLT2 inhibitors have demonstrated a significant improvement in cardiovascular outcomes for patients with T2DM, HF, and CKD while also maintaining a favorable safety profile. These findings advocate for the broader application of SGLT2 inhibitors in the management of chronic diseases, particularly in reducing the incidence of nonfatal MI, HHF, and cardiac death. Further research is essential to optimize their use across diverse patient populations and stages of disease.

Random Survival Forest Machine Learning for the Prediction of Cardiovascular Events Among Patients With a Measured Lipoprotein(a) Level: A Model Development Study.

Established risk models may not be applicable to patients at higher cardiovascular risk with a measured Lp(a) (lipoprotein[a]) level, a causal risk factor for atherosclerotic cardiovascular disease. This was a model development study. The data source was the Nashville Biosciences Lp(a) data set, which includes clinical data from the Vanderbilt University Health System. We included patients with an Lp(a) measured between 1989 and 2022 and who had at least 1 year of electronic health record data before measurement of an Lp(a) level. The end point of interest was time to first myocardial infarction, stroke/TIA, or coronary revascularization. A random survival forest model was derived and compared with a Cox proportional hazards model derived from traditional cardiovascular risk factors (ie, the variables used to estimate the Pooled Cohort Equations for the primary prevention population and the variables used to estimate the Second Manifestations of Arterial Disease and Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention scores for the secondary prevention population). Model discrimination was evaluated using Harrell C-index. A total of 4369 patients were included in the study (49.5% were female, mean age was 51 [SD, 18] years, and mean Lp(a) level was 33.6 [38.6] mg/dL, of whom 23.7% had a prior cardiovascular event). The random survival forest model outperformed the traditional risk factor models in the test set (c-index, 0.82 [random forest] versus 0.69 [primary prevention] versus 0.80 [secondary prevention]). These results were similar when restricted to a primary prevention population and under various strategies to handle competing risk. A Cox proportional hazard model based on the top 25 variables from the random forest model had a c-index of 0.80. A random survival forest model outperformed a model using traditional risk factors for predicting cardiovascular events in patients with a measured Lp(a) level.

Temperature and myocardial infarction among migrants in Kuwait

BackgroundKuwait, one of the world’s hottest countries, faces increasing temperatures due to climate change. With a large migrant population predominantly employed in physically demanding jobs, the exact effects and burdens...

Regression of carotid atherosclerosis in high-risk individuals with proprotein convertase subtilisin/kexin type 9 inhibitors.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent a novel approach for reducing cholesterol and, accordingly, the burden of atherosclerosis. However, limited data are available regarding the possible effects of PCSK9 inhibitors on atherosclerotic plaque. To evaluate the efficacy of PCSK9 inhibitors in reducing carotid plaque progression in individuals with high-risk carotid atherosclerotic disease. We used carotid total plaque area (TPA) to assess the burden of atherosclerosis. Ultrasound imaging of the carotid was acquired before and after the initiation of PCSK9 inhibitor therapy. We selected high-risk cases with atherosclerosis with a minimum of three ultrasound examinations, 1 year before, one at the time of initiation of a PCSK9 inhibitor, and 1 year after initiating a PCSK9 inhibitor. Statistical analysis was conducted using the mixed-effects model with Restricted Maximum Likelihood (REML). We reviewed data from 131 patients with a mean follow-up of 6 (±4) years. Patients were high-risk, with the majority having diabetes or hypertension. There was a decrease in TPA, particularly during the first 3 years after initiating PCSK9 inhibitor therapy (p < 0.05). Furthermore, we observed that individuals with higher baseline serum low-density lipoprotein cholesterol (LDL-C) levels experienced a greater decline in TPA (p < 0.05). PCSK9 inhibitors are effective in achieving plaque regression in high-risk patients with atherosclerosis. This is important, as plaque regression is associated with a lower risk of stroke, myocardial infarction, or vascular death.

Long-term outcomes of second-generation drug-eluting stents versus coronary artery bypass graft: a systematic review and meta-analysis of randomized trials and multivariable adjusted data.

Long-term data are limited comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) vs coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). We aimed to conduct a systematic review and meta-analysis comparing these interventions in patients with left main or multivessel CAD. We systematically reviewed PubMed, Embase, and Cochrane for studies that compared PCI with S-DES and CABG in patients with left main or multivessel CAD with a minimum mean follow-up period of 3 years. Outcomes of interest were all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). We extracted data from observational studies as multivariable-adjusted or propensity score-matched hazard ratio to minimize confounding and pooled hazard ratios with 95% confidence intervals (CIs) using a random effects model in Review Manager 5.4.1. We included 10 studies, 3 of which were randomized controlled trials, comprising a total of 26964 patients, of whom 14928 underwent PCI. As compared with CABG, S-DES had a significantly higher risk of all-cause mortality (hazard ratio 1.35; 95% CI 1.22-1.49; P < 0.001; I2 = 0%), MACE (hazard ratio 1.27; 95% CI 1.08-1.50; P = 0.005; I2 = 67%), and MI (hazard ratio 2.43; 95% CI 1.80-3.28; P < 0.01; I2 = 0%). There was no significant difference between groups in incidence of stroke. In this meta-analysis of patients with complex CAD, PCI with S-DES was associated with an increased risk of mortality, MI, and MACE compared with CABG.

Skeletal muscle adiposity, coronary microvascular dysfunction, and adverse cardiovascular outcomes.

Skeletal muscle (SM) fat infiltration, or intermuscular adipose tissue (IMAT), reflects muscle quality and is associated with inflammation, a key determinant in cardiometabolic disease. Coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD), is independently associated with body mass index (BMI), inflammation and risk of heart failure, myocardial infarction, and death. The relationship between SM quality, CMD, and cardiovascular outcomes is not known. Consecutive patients (n = 669) undergoing evaluation for coronary artery disease with cardiac stress positron emission tomography demonstrating normal perfusion and preserved left ventricular ejection fraction were followed over a median of 6 years for major adverse cardiovascular events (MACEs), including death and hospitalization for myocardial infarction or heart failure. Coronary flow reserve was calculated as stress/rest myocardial blood flow. Subcutaneous adipose tissue (SAT), SM, and IMAT areas (cm2) were obtained from simultaneous positron emission tomography attenuation correction computed tomography using semi-automated segmentation at the 12th thoracic vertebra level. Median age was 63 years, 70% were female, and 46% were nonwhite. Nearly half of patients were obese (46%, BMI 30-61 kg/m2), and BMI correlated highly with SAT and IMAT (r = .84 and r = .71, respectively, P < .001) and moderately with SM (r = .52, P < .001). Decreased SM and increased IMAT, but not BMI or SAT, remained independently associated with decreased CFR (adjusted P = .03 and P = .04, respectively). In adjusted analyses, both lower CFR and higher IMAT were associated with increased MACE [hazard ratio 1.78 (95% confidence interval 1.23-2.58) per -1 U CFR and 1.53 (1.30-1.80) per +10 cm2 IMAT, adjusted P = .002 and P < .0001, respectively], while higher SM and SAT were protective [hazard ratio .89 (.81-.97) per +10 cm2 SM and .94 (.91-.98) per +10 cm2 SAT, adjusted P = .01 and .003, respectively]. Every 1% increase in fatty muscle fraction [IMAT/(SM + IMAT)] conferred an independent 2% increased odds of CMD [CFR <2, odds ratio 1.02 (1.01-1.04), adjusted P = .04] and a 7% increased risk of MACE [hazard ratio 1.07 (1.04-1.09), adjusted P < .001]. There was a significant interaction between CFR and IMAT, not BMI, such that patients with both CMD and fatty muscle demonstrated highest MACE risk (adjusted P = .02). Increased intermuscular fat is associated with CMD and adverse cardiovascular outcomes independently of BMI and conventional risk factors. The presence of CMD and SM fat infiltration identified a novel at-risk cardiometabolic phenotype.

Occupational exposure to diesel engine exhaust and first-time acute myocardial infarction - a nationwide register-based cohort study 1976- 2018.

Exposure to air pollution including diesel engine exhaust (DEE) is associated with increased risk of acute myocardial infarction (AMI). Few studies have investigated the risk of AMI according to occupational exposure to DEE. The aim of this study was to evaluate the association between occupational exposure to DEE and the risk of first-time AMI. The study was a register-based cohort study of the Danish working population and included 903,415 individuals aged 35-50 years in 1995. Exposure estimates of DEE were assigned by linking a quantitative DEE job exposure matrix with the individual job history (1976-2017). National registers provided data on AMI throughout the follow-up period (1996-2018). The incidence rate ratios (IRR) for AMI were computed using Poisson regression while adjusting for demographics, comorbidities, socio-economic factors, ambient air pollution and occupational exposure to noise, physically demanding work, and job strain. 35,511 cases of AMI occurred during the follow-up period of 19,357,326 person-years. IRRs for cumulative exposure to DEE in the fully adjusted model were 1.04 (95%CI: 1.00-1.08) for exposure levels between the 50th and 75thpercentiles and 1.08 (95%CI: 1.04-1.12) for exposure levels ≥75thpercentile. Recent exposure to DEE was associated with an increased IRR in the highest exposed quartile (IRR=1.15 (95%CI: 1.05-1.27)), but only when compared within exposed workers. Increasing exposure to DEE was associated with increasing IRR for first-time AMI across different exposure measures. The results indicate that AMI should be included in risk assessment of DEE when establishing occupational exposure limits.

Risk of myocardial infarction and heart failure in gout patients: a systematic review and meta-analysis

BackgroundGout is a metabolic disease caused by decreased blood uric acid excretion and purine metabolism disorders. Long-term and persistent metabolic dysfunction gradually affects other organ functions and is the main factor inducing Myocardial Infarction (MI) and Heart Failure (HF), seriously affecting the health of patients. This study adopts a meta-analysis to analyze the risk of MI and HF in gout patients.MethodsClinical research literature related to gout complicated with MI or HF was searched in databases such as PubMed, Embase, Web of Science, Cochrane Library, etc. through computer retrieval before March 2023. Literature content was carefully read and retrieved, and screening was conducted based on inclusion and exclusion criteria. Relevant data were extracted from the final screened literature, and a forest map was drawn using RevMan 5.3 software for meta-analysis.ResultsAfter searching in various databases, 2519 articles were obtained. After screening, 8 articles were finally included for meta-analysis. Among the 22 included literature, 9 analyzed the risk of gout and MI, and heterogeneity tests showed P = 0.20 and I2 = 28%. Fixing effects analysis showed RR = 4.60, 95%CI = 4.39–4.82, and P < 0.001. Nine articles analyzed the risk of gout and HF, and heterogeneity tests showed that P = 0.13 and I2 = 37%. Fixing effects analysis showed RR = 2.71, 95%CI = 2.61–2.82, and P < 0.001. Eight studies compared the incidence of MI or HF between male gout and non-gout patients. Heterogeneity tests showed P = 0.21 and I2 = 28%, while fixing effects analysis showed RR = 1.98 and 95%CI = 1.89–2.01, with P < 0.001. Four articles statistically compared the incidence of MI or HF between female gout and non-gout patients. Heterogeneity tests showed P = 0.15 and I2 = 43%. Fixing effects analysis showed RR = 1.70, 95%CI = 1.57–1.83, and P < 0.001. Thirteen studies compared the incidence of MI or HF in gout patients of different genders. Heterogeneity tests showed P = 0.37 and I2 = 7%. Fixing effects analysis showed RR = 0.03, 95%CI = 0.03–0.03, and P < 0.001.ConclusionCompared to non-gout patients, gout patients are more prone to MI or HF and are not affected by gender. However, among gout patients, women have a higher risk of MI or HF than men.

Cigarette smoking and perceived risk of cardiovascular disease in Iran

IntroductionStudies have consistently demonstrated a strong link between cigarette smoking and an increased risk of cardiovascular diseases (CVD). On the other hand, studies have shown that most smokers do not have a real understanding of the cardiovascular health hazards of smoking. Therefore, the study aimed to determine the perceived risk of Myocardial Infarction (MI), Hypertension (HTN), and Stroke among current smokers in Iran.MethodsThis cross-sectional study was conducted between January and May 2023, and recruited 380 smokers by convenience sampling who smoked at least 100 cigarettes in their lifetime. The data were collected using three questionnaires (1) the questionnaire to assess the risk perception for MI, HTN, and Stroke, (2) the smoking stage of change questionnaire, and (3) the Fagerström Test for nicotine dependence (FTND). The CVD risk perception consisted of two parts, perceived susceptibility and perceived severity. Each part scores between 0 and 10 and finally gets a total score of 0–20. A score of zero indicated the lowest risk perception while a score of 20 indicated the highest risk perception. We examined the relationship between the demographic and smoking-related variables and the smokers’ perceived risk of MI, stroke, and HTN by using multiple linear regression.FindingsThe mean age of participants was 35.57 ± 12.05 years, and 77.1% were male. The perceived risk score of MI was 10.68 ± 4.69 out of 20. The scores related to stroke and HTN were 10.00 ± 4.65 and 10.89 ± 4.73, respectively. Identified variables collectively contributed significantly to predicting the perceived risk of MI (p <.0001, Adj R-squared = 0.05%), stroke ( p <.0001, Adj R-squared = 0.08%), and HTN (p <.0001, Adj R-squared = 0.06%). We found that longer smoking duration [coefficient=-1.96 (95% CI= -3.91, − 0.09)] for 20–29 years and − 4.08 ( 95% CI= -6.70, -1.46 ) for 30 + years), older smoking age onset [coefficient=-2.10 ( 95% CI= -3.24, − 0.96 )] for 20 + years), and dual tobacco users [coefficient= -1. 04 (95% CI= -2.08, − 0.06)] were significantly associated with lower perceived risk for MI. We also found that longer smoking duration [coefficient=-2.23 (95% CI= -4.13, − 0.32)] for 20–29 years and − 5.01 (95% CI= -7.565734, -2.462361 ) for 30 + years), older smoking age onset [coefficient=-1.86 (95% CI= -2.970021, − 0.75 ] for 20 + years), and being male [coefficient= -2. 00, (95% CI= -3.53, − 0.47)] were significantly associated with lower perceived risk for stroke. We found that longer smoking duration (coefficient=-4.40 for 30 + years), older smoking age onset [coefficient=-2.02 (95% CI= -3.14, − 0.87,)] for 20 + years), and being dual users [coefficient=-1.36, 95% CI= -2.40, − 0.3241238)] were significantly associated with lower perceived risk for HTN.ConclusionThe results of this study demonstrated a moderate perceived risk of participants to CVD. Also, the perceived risk decreases as the duration of smoking and the age for the smoking onset increases to 20 years and above. It seems necessary to carry out interventions to inform the public about the harms of smoking, especially for adolescents and young adults, and its risks in causing cardiovascular disease.

An improved stacking model for predicting myocardial infarction risk in imbalanced data.

Early diagnosis and treatment of myocardial infarction (MI) can significantly reduce the severity of the disease. Disease data are often imbalanced, which can lead to poor prediction outcomes when using conventional models. Therefore, developing a risk prediction model for MI with imbalanced datasets has become challenging. This paper presents a novel model called 2GDNN-FL-Stacked, which aims to address the issue of predicting the risk of MI in imbalanced data. Our group mitigates the impact of data imbalance on the model by employing random under-sampling and cost-sensitive techniques. We improve the model's identification capabilities by stacking and combining 2GDNN-FL, CatBoost, RandomForest, and LightGBM. Our model's Matthews Correlation Coefficient(MCC), F1-score, and Area Under the ROC Curve(AUC) scores increased by 0.87% 15.70%, 0.55% 9.81%, and 0.75% 8.11% respectively, compared to some baseline models, which represent a significant improvement over the performance of a single model on imbalanced datasets. This paper demonstrates the effectiveness of each component through ablation experiments, showing that removing either component affects model performance and proves the efficacy of all components. The method offers new insights into predicting heart attack risks and has the potential to offer potent assistance in making clinical decisions.

Impact of Uterine Leiomyomas on Cardiovascular Disease Risk in Young Reproductive-Aged Women: A Nationwide Population-Based Cohort Study.

Background/Objectives: Uterine leiomyomas are the most common benign gynecological tumors in women of reproductive age and are often associated with localized symptoms. However, emerging evidence suggests a link between uterine leiomyomas and systemic conditions such as cardiovascular disease (CVD), particularly myocardial infarction (MI) and ischemic stroke (IS). This study aimed to investigate the relationship between uterine leiomyomas and the risk of CVD events in young women aged 20-39 years using a large, nationwide, population-based cohort. Methods: This retrospective cohort study analyzed data from the National Health Insurance Service database of South Korea of 2,581,700 women aged 20-39 years who underwent health screening between 2009 and 2012. Uterine leiomyomas were identified using International Code of Disease, 10th Edition codes. CVD events (MI and IS) were defined according to hospital claims and radiological data. Multivariate hazard ratios (HRs) were calculated to evaluate the association between leiomyomas and CVD after adjusting for confounders (age, lifestyle factors, comorbidities, and body mass index). Results: In all, 58,812 were diagnosed with uterine leiomyomas, and 25,063 underwent surgical treatment. During the follow-up period, MI occurred in 115 women (0.21%) and IS in 82 women (0.15%) in the leiomyoma group, compared with 3107 cases of MI (0.12%) and 2240 cases of IS (0.09%) in the non-leiomyoma group. The leiomyoma group demonstrated a higher incidence rate of CVD (IR: 0.63 vs. 0.39 per 1000 person-years). After adjusting for confounding factors such as age, lifestyle, comorbidities, and body mass index (BMI), the hazard ratio (HR) for MI was 1.32, indicating a statistically significant increase in cardiovascular risk. The risk of CVD was lower in women who underwent surgical treatment; however, when specifically analyzing the occurrence of MI and IS, no statistically significant differences were observed between the two groups. Conclusions: Uterine leiomyomas are associated with an increased risk of MI and IS in young women. Surgical treatment itself may be associated with additional cardiovascular risks. Further research is needed to develop strategies to mitigate these risks and elucidate the underlying mechanisms.

Cannabis use and atherosclerotic cardiovascular disease outcomes: A meta-analysis of multinational cohort data.

While an association between cannabis use and the risk of atherosclerotic cardiovascular diseases (ASCVD) has been reported numerous times, it remains inconclusive as to whether this link is causal in nature. We sought to consolidate data from observational studies to explore the association between ever use of cannabis and ASCVD outcomes, including myocardial infarction, stroke, and a combined measure of any adverse cardiovascular events in comparison to non-users or controls. We performed a systematic literature search on PubMed, Scopus, ScienceDirect, and Cochrane Library for relevant studies from inception until April 2024. Statistical analyses utilized RevMan 5.4 with a random effects model. The study protocol has been registered with PROSPERO (CRD42024530366). Our analysis incorporated data from 17 studies involving a total of 1,902,481 individuals aged between 18 and 74 years, with a mean follow-up duration of 8.5 years. Upon pooled analysis, no statistically significant association was found between cannabis use and the risk of myocardial infarction compared to non-users, with an RR of 1.25 (95% CI: 0.91-1.71, p = 0.17). Similarly, while the risk of stroke showed no significant association with cannabis use (RR: 1.38, 95% CI: 0.88 to 2.16, p = 0.16), a statistically significant association was observed between ever use of cannabis and the composite of any adverse cardiovascular events (RR: 1.48, 95% CI: 1.16-1.90, p = 0.002). The evident statistical correlations between cannabis use and adverse cardiovascular outcomes underscore its potential as a risk factor for cardiovascular disease, suggesting plausibility for a causal relationship between cannabis use and ASCVD. With rising trends in medical cannabis use and cannabis use disorder across age demographics, heightened risk awareness and informed decision-making regarding cannabis consumption are critical priorities in healthcare and public health initiatives.

Association Between a Family Caregiver's Relationship to Persons With Dementia and Cardiovascular Disease by Race and Ethnicity: A Secondary Analysis of the Behavioral Risk Factor Surveillance System Data.

Caregiver stress is linked to key mechanisms for developing cardiovascular disease and the burden differs by caregiving relationship (eg, spouse). Furthermore, cardiovascular disease risk in family caregivers (FCGs) has been shown to differ by race and ethnicity. However, little is known about whether the association between caregiving relationship and FCGs' cardiovascular health differs by race and ethnicity. This study examined the association between an FCG's relationship to persons with dementia and risk factors for cardiovascular disease and cardiovascular disease conditions and identified how these associations differed by race and ethnicity in FCGs. This was a secondary analysis of the 2015-2020 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System data. Logistic regression models were used to examine the associations between predictors (caregiving relationship, race/ethnicity, and their interaction) and outcomes (cardiovascular disease risk and conditions). A sample of 6042 FCGs of persons with dementia were included. When analyzing race/ethnicity groups as a whole, cardiovascular disease risk and conditions differed significantly by caregiving relationship. Notably, spouse caregivers were at higher risk of diabetes, stroke, angina, and myocardial infarction, while showing lower rates of current smoking, heavy drinking, and obesity, compared to adult children. The associations between caregiving relationship and select cardiovascular disease risk factors (depression, previous smoking) differed significantly between racial and ethnic groups. There is a need to develop culturally appropriate cardiovascular preventive health care strategies that reduce cardiovascular disease risks by considering caregiving relationship. Research is especially needed among minoritized racial and ethnic FCG groups.

Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and CKD.

Chronic kidney disease (CKD) is associated with higher risk of myocardial infarction and anemia. Among patients with anemia and CKD who experience myocardial infarction, it remains uncertain if a liberal red blood cell transfusion threshold strategy (hemoglobin cutoff [Hgb] < 10 g/dL) is superior to a restrictive transfusion threshold (Hgb 7-8 g/dL) strategy. Among the 3,504 patients enrolled in the Myocardial Ischemia and Transfusion (MINT) trial with non-missing creatinine, we compared baseline characteristics and 30-day and 6-month outcomes of patients without CKD (N = 1279), CKD with eGFR 30-60 mL/min/1.73 m2 (N = 999), CKD with eGFR < 30 mL/min/1.73 m2 (N = 802), and CKD requiring dialysis (N = 415) by assigned transfusion strategy. No statistically significant interactions were observed between CKD stage and assigned transfusion strategy. Among non-dialysis dependent patients with an eGFR < 30 mL/min/1.73 m2, a restrictive transfusion strategy was associated with a higher risk of 30-day death or recurrent myocardial infarction (risk difference [RD], 5.8%, 95% CI 0.4% to 11.2%) compared to a liberal transfusion strategy. Among patients with an eGFR 30-60 mL/min/1.73 m2, a restrictive strategy was associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, 3.7%, 95% CI -0.9% to 8.2%) compared to a liberal transfusion strategy. Among patients with CKD requiring dialysis, a restrictive strategy was also associated with a similar risk of 30-day death or recurrent myocardial infarction (RD, -2.6%, 95% CI -10.0% to 4.8%) compared to a liberal transfusion strategy. In patients with CKD included in this MINT subgroup analysis, a liberal transfusion strategy was not worse than a restrictive transfusion strategy and was associated with less harm in subgroups not receiving dialysis.

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial.

Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial. Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. Images of 1769 patients were assessed (56​% male, 58​±​9 years). Diabetes mellitus was present in 196 (11​%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p​<​0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p​<​0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p​=​0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95​% confidence interval 1.09 to 3.17, p​=​0.024). Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.