Significant Predictor Of Cardiovascular Events Research Articles

Role of Renal Function and Cardiac Biomarkers (NT-proBNP and Troponin) in Determining Mortality and Cardiac Outcome in Atheromatous Renovascular Disease

Background and Aims: Patients with atheromatous renovascular disease (ARVD) have high cardiovascular morbidity and mortality. The cardiac markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin (cTnT) are easily measured, yet not widely used in renal patients as they are thought to be inaccurate in renal disease. We aimed to see if these markers could be used as prognostic indicators of cardiovascular events (CVEs) and death in ARVD. Methods: Subjects with ARVD treated in 1 renal center in 2003 were prospectively followed up. NT-proBNP and cTnT at baseline were correlated with CVEs and death, echocardiographic findings and degree of renal artery stenosis. Cutoff levels of 0.03 ng/ml (cTnT) and 43 pmol/l (NT-proBNP) were used. Results: Eighty-two patients (mean ± SD age 69 ± 8 years, mean follow-up 40.2 ± 16.6 months) were suitable for analysis. Twenty-nine percent of patients suffered new CVEs, and 37.8% died. Renal function was a significant predictor of CVEs and death. Patients with a raised NT-proBNP were more likely to die than those in the same chronic kidney disease (CKD) category with normal levels (p < 0.0001) even after adjusting for multivariate factors (hazard ratio 8.3 for high proBNP vs. 3.6 for low proBNP in CKD stage 4–5). Conclusion: No study to our knowledge has looked at both NT-proBNP and cTnT as outcome markers in ARVD. Our study shows that renal function is more important as a marker of suffering a CVE. However, raised NT-proBNP is associated with a greater likelihood of death when subdivided by CKD stage. Early risk stratification by simple measurement of these biomarkers may aid in intensifying management in high-risk patients, although further studies to assess the value of this approach are warranted.

Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case?control study

Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk. Metabolic syndrome is a significant predictor of cardiovascular events. To investigate the prevalence of metabolic syndrome in patients with psoriasis. We performed a hospital-based case-control study on 338 adult patients with chronic plaque psoriasis and 334 patients with skin diseases other than psoriasis. Metabolic syndrome was significantly more common in psoriatic patients than in controls (30.1% vs. 20.6%, odds ratio 1.65, 95% confidence interval 1.16-2.35; P = 0.005) after the age of 40 years. Psoriatic patients also had a higher prevalence of hypertriglyceridaemia and abdominal obesity, whereas hyperglycaemia, arterial hypertension and high-density lipoprotein cholesterol plasma levels were similar. Although psoriasis patients were more frequently smokers, the association of psoriasis with metabolic syndrome was independent from smoking. There was no correlation between severity of psoriasis and prevalence of metabolic syndrome. Psoriatic patients with metabolic syndrome were older and had a longer disease duration compared with psoriatic patients without metabolic syndrome. Psoriatic patients have a higher prevalence of metabolic syndrome, which can favour cardiovascular events. We suggest psoriatic patients should be encouraged to correct aggressively their modifiable cardiovascular risk factors.

Brachial Flow-Mediated Dilation Predicts Incident Cardiovascular Events in Older Adults

The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults. FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7% white, 58.6% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3% versus 73.6%, log-rank P=0.006). FMD remained a significant predictor of cardiovascular events after adjustment for age, gender, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, baseline cardiovascular disease status, and total cholesterol (hazard ratio, 0.91 [95% CI, 0.83 to 0.99], P=0.02 per unit SD of FMD) but added only approximately 1% to the prognostic accuracy of the best Cox model. Brachial artery diameter was also predictive of CV events in the adjusted Cox proportional hazard model (hazard ratio, 1.12 [95% CI, 1.02 to 1.28], P=0.025) and also added approximately 1% to the accuracy of our best Cox model. FMD is a predictor of future cardiovascular events but adds very little to the prognostic accuracy of traditional cardiovascular risk scores/factors in older adults. FMD and brachial artery diameter may have similar predictive values for cardiovascular events in older adults.

Interleukin-8 as an independent predictor of long-term clinical outcome in patients with coronary artery disease

Background Accumulating evidence suggests that inflammation plays an essential role in the pathogenesis of atherosclerosis and that circulating inflammatory markers predict future cardiovascular events. However, previous studies evaluated the predictive value of only a single cytokine at a time. Aims This study was designed to simultaneously measure plasma levels of multiple cytokines in patients with coronary artery disease and to evaluate their ability to predict long-term prognosis. Methods The study enrolled 158 consecutive patients with angiographically identified stable coronary artery disease. Using the Luminex micro-beads array system, we simultaneously measured plasma levels of the following 10 cytokines: interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α, granulocyte-macrophage colony stimulating factor (GM-CSF) and γ-interferon (IFN-γ). Results None of the 10 cytokine levels as well as high-sensitive C reactive protein (hs-CRP) was correlated with the severity of coronary artery disease. During a 7-year follow-up period, cardiovascular events occurred in 56 patients (35%). Multi-vessel disease, diabetes, and high levels of all of the 10 measured cytokines and hs-CRP were significant predictors of cardiovascular events in univariate analysis. However, multivariate analysis using multi-vessel disease, diabetes and the levels of all of 10 cytokines and hs-CRP showed that the only independent predictor was IL-8 (RR, 2.98; 95%CI, 1.64–7.24; P = 0.0001). Conclusion IL-8 was the only cytokine that predicted cardiovascular events independent of the other 9 cytokines and hs-CRP. Since IL-8 is a neutrophil chemokine, these results suggest that neutrophil activation may be related to the occurrence of cardiovascular events.

Homocysteine and vascular disease in diabetes: a double hit?

Cardiovascular disease is a major problem in diabetes, and risk factors presumably unrelated to diabetes, such as hyperhomocysteinaemia, may be related to the development of cardiovascular complications in diabetic individuals. Plasma homocysteine levels are usually normal in diabetes, although both lower and higher levels have been reported. Homocysteine levels in diabetes are modulated by hyperfiltration and renal dysfunction, as well as low folate status. Insulin resistance does not appear to be a major determinant of plasma homocysteine level. Hyperhomocysteinaemia has been associated with microalbuminuria and retinopathy in type 1 and type 2 diabetes. In patients with type 2 diabetes, plasma homocysteine concentration is a significant predictor of cardiovascular events and death. This relation seems to be stronger in subjects with diabetes than without. The underlying pathophysiological mechanism of this increased vascular risk remains unexplained, but may be related to worsening of endothelial dysfunction and/or structural vessel properties induced by oxidative stress. Because homocysteine and diabetes have apparent synergistic detrimental vascular effects, patients with diabetes are candidates for screening and treatment with folic acid until the results of ongoing clinical trials are available.

Determination of vessel size: a putative framework to assess clinical outcome

Background Unknown is the predictive value of the coronary artery diameter without the administration of vasomotor stimuli. A small reference diameter of the target vessel has been demonstrated to be an adverse prognostic factor in patients undergoing revascularisation. The present study investigated the prognostic value of the proximal non-stenotic left anterior descending coronary artery (LAD) diameter in patients referred for a first diagnostic angiogram without a previous revascularisation. Methods A total of 277 patients (mean age 57 year, 61% male) were eligible for analysis. The proximal non-stenotic diameter of the LAD was measured by quantitative coronary angiography without prior nitrate infusion. We defined a small LAD as a diameter ≤2.5 mm. Cardiovascular events were defined as cardiac death, myocardial infarction, and hospitalizations for unstable angina. Results During a median follow-up of 47 months, 24 major cardiac events occurred. The cumulative survival for patients with a small LAD was significantly lower, than for patients with a large LAD (hazard ratio 2.51; 95% confidence interval 1.11–5.66, p=0.03). In the multivariate analysis, a LAD diameter ≤2.5 mm remained a significant predictor of cardiovascular events after adjustment for age, gender, and the presence of significant coronary artery disease (hazard ratio 2.32; 95% confidence interval 1.01–5.34, p=0.048). Conclusion In patients referred for a first diagnostic angiogram without a previous revascularisation, the diameter of the proximal non-stenotic LAD is an independent predictor of cardiovascular events.

Regulation of cardiovascular calcification

Vascular calcification is highly correlated with cardiovascular disease (CVD) and is a significant predictor of cardiovascular events, especially in high risk patients such as the end stage renal disease (ESRD) population. Vascular calcification can lead to serious problems including valve stenosis, decreased vascular compliance, calciphylaxis, and even sudden death. However, the contribution of vascular calcification to progression of atherosclerosis is unknown and needs more study. Biochemical, histological, and genetic studies indicate that vascular calcification is actively regulated and involves both positive and negative modulators. Several nonmutually exclusive theories to account for vascular calcification based on current studies are discussed.

P11-09 Ankle-brachial index measured by an automated oscillometric method as a predictor of cardiovascular events in patients with coronary artery disease

Background: Ankle-brachial index (ABI) measured by conventional Doppler method has been reported to be an independent predictor of adverse cardiovascular events in patients with coronary artery disease (CAD). Recently, a clinical device has been developed to measure ABI by an oscillometric method. It is unclear whether ABI measured by this device can serve as a significant predictor of cardiovascular events in patients with CAD. Materials and Methods: We included 82 patients from our outpatient clinic, who had received coronary angiography examination. ABI was determined in all subjects using the ABI-form (Colin VP1000) device. The lower value of ABI in either of the right or left limbs was used for data analysis. We divided our subjects into two groupswitheitherABI0.9orABI0.9andcomparedbasalcharacteristicsbetweengroups.Wefollowedupthese patients for 20.0 3.6 months (range 10 to 26). We analyzed the relationship between ABI and cardiovascular events. Then, we used univariate analysis to determine the significant predictors of cardiovascular events. Finally, we utilized multiple logistic regression analysis to identify the independent predictors of cardiovascular events. Results: There were 14 patients with ABI 0.9 and 68 patients with ABI 0.9. The patients with ABI 0.9 were olderandhadhigherplasmalevelofuricacid.Theprevalenceofthree-vesselCAD,diabetesmellitus,hypertension, diuretic use, and the risk of cardiovascular death and cardiovascular events were significantly higher in the group of patients with ABI 0.9. In a univariate analysis, cardiovascular events were significantly related to ABI 0.9 (odds ratio: 12.6), three-vessel CAD (odds ratio: 12.5) and DM (odds ratio: 4.7). After a multiple logistic regression analysis, ABI 0.9 and three-vessel CAD were still significant predictors of cardiovascular events. Conclusions: ABI measured by the automated oscillometric method, like three-vessel CAD, can serve as a useful parameter to predict cardiovascular events in patients with CAD.

Prognostic Significance of Left Ventricular Diastolic Dysfunction Assessed by Color M-mode Doppler Echocardiography in Patients With Chronic Left Ventricular Systolic Dysfunction

Background. Color M-mode Doppler echocardiography provides accurate evaluation of LV diastolic function noninvasively and is reportedly preload independent compared with pulsed Doppler transmitral velocity indexes. This study aimed to determine the prognostic significance of left ventricular (LV) diastolic function in patients with different degrees of chronic LV systolic dysfunction using color M-mode Doppler echocardiography.Methods. A total of 98 consecutive subjects (mean age 57 years, 78 males) with LV systolic dysfunction (61 with previous myocardial infarction and 37 with dilated cardiomyopathy) underwent clinical and echocardiographic evaluation to determine functional status. Measurements of LV and left atrial dimensions, LV ejection fraction (EF), the peak of early and late diastolic transmitral velocities (E and A, respectively), the E/A ratio, deceleration time of E velocity and isovolumic relaxation time using conventional echo-Doppler techniques, and LV flow propagation velocity (FPV) and FPV/E using color M-mode Doppler echocardiography were taken.Results. During the mean follow-up period of 37±28 months, 26 patients had cardiovascular events (death in 4, congestive heart failure in 13, ventricular tachycardia in 6, and cerebral infarction in 3). EF was the single independent predictor of cardiovascular events. While, in the subgroup with EF <0.35, the functional class was the single significant predictor of cardiovascular events, FPV/E was the single best predictor of cardiovascular events in the subgroup with EF ≥0.35.Conclusions. The evaluation of LV diastolic function using color M-mode Doppler-derived FPV/E contributes to predicting clinical outcomes of patients with mildly depressed LV systolic function.