Term Cardiovascular Mortality Research Articles

Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality in a Cohort of Middle-Aged Men Followed-Up until Extinction

Objectives: To report the relationships of major dietary fatty acids with major cardiovascular disease mortality groups in a cohort of middle-aged men followed up with until extinction. Material and Methods: In the early 1960s, a cohort of men aged 40 to 59 years was enrolled and examined within the Italian Rural Areas section of the Seven Countries Study including dietary history that allowed for the estimation of major fatty acid (FA) intake (saturated FAs: SAFAs; mono-unsaturated FAs: MUFAs; and poly-unsaturated FAs: PUFAs), their ratios, and the production of a dietary score derived from 18 food groups, the high levels of which corresponded to a Mediterranean diet profile. Results: During a follow-up of 61 years, the intake of SAFAs was directly while that of MUFAs was inversely and significantly associated with coronary heart disease (CHD) mortality (the hazard ratio for one standard deviation was 1.28 and 0.84, respectively) but not with other cases of Heart Disease of Uncertain Etiology (HDUE) and stroke mortality. The hazard ratio for SAFAs remained significant after factoring into the multivariate models the dietary score and other classical cardiovascular risk factors (age, smoking habits, cholesterol levels, and systolic blood pressure). The role of the dietary score was inverse and significant (hazard ratio of 0.73). Again, this was true for CHD but not for HDUE and stroke mortality. Conclusions: Both SAFAs and MUFAs predict long-term CHD mortality, together with a dietary score, but not HDUE and stroke, which represent different diseases also in relation to dietary habits.

Serum Albumin was Associated with a Long Term Cardiovascular Mortality among Elderly Patients with Stable Coronary Artery Disease.

Serum albumin (SA), a multifunction protein, contributes to maintaining a variety of physiological functions. Studies have linked SA to atherosclerosis with possible mechanisms including a response to inflammation. The contribution of albumin to cardiovascular (CV) mortality in elderly patients with stable coronary artery disease (CAD) remains unclear. We investigated 321 elderly patients with stable CAD undergoing coronary angiography between 2003 and 2006. CV mortality data were obtained from the National Registry of Deaths in Taiwan. CV mortality included deaths attributable to ischemic heart disease, congestive heart disease, and stroke. The association between baseline SA and CV mortality was assessed using a Cox model and Fine-Gray model when non-CV mortality was considered a competing event. During a median follow-up of 97 months, 39 (12.1%) participants died from CV disease and 76 (23.7%) died from non-CV diseases. After adjusting for covariates, patients in the SA ≥ 3.75 g/dL group had a lower frequency of CV mortality compared with those in the SA < 3.75 g/dL group [hazard ratio (HR): 0.20; 95% confidence interval (CI): 0.08-0.49; p < 0.001]. Similarly, compared to the participants with non-CV mortality, the SA ≥ 3.75 g/dL group had a lower frequency of CV mortality compared with the SA < 3.75 g/dL group (subdistribution HR: 0.27; 95% CI: 0.11-0.65; p < 0.001) in adjusted competing risk models. A SA level ≥ 3.75 g/dL at admission was associated with decreased long-term CV mortality and may be useful for risk prediction in elderly patients with stable CAD.

Exhaled Breath Analysis Using Selected Ion Flow Tube Mass Spectrometry and Disease Severity in Heart Failure.

Exhaled breath volatile organic compounds (VOCs) are elevated in heart failure (HF). The ability of VOCs to predict long term cardiovascular mortality and morbidity has not been independently verified. In 55 patients admitted with acute decompensated heart failure (ADHF), we measured exhaled breath acetone and pentane levels upon admission and after 48 h of diuresis. In a separate cohort of 51 cardiac patients undergoing cardiopulmonary exercise testing (CPET), we measured exhaled breath acetone and pentane levels before and at peak exercise. In the ADHF cohort, admission acetone levels correlated with lower left ventricular ejection fraction (LVEF, r = -0.297, p = 0.035). Greater weight loss with diuretic therapy correlated with a greater reduction in both acetone levels (r = -0.398, p = 0.003) and pentane levels (r = -0.309, p = 0.021). In patients with above-median weight loss (≥4.5 kg), patients demonstrated significantly greater percentage reduction in acetone (59% reduction vs. 7% increase, p < 0.001) and pentane (23% reduction vs. 2% reduction, p = 0.008). In the CPET cohort, admission acetone and pentane levels correlated with higher VE/VCO2 (r = 0.39, p = 0.005), (r = 0.035, p = 0.014). However, there were no significant correlations between baseline or peak exercise acetone and pentane levels and peak VO2. In longitudinal follow-up with a median duration of 33 months, patients with elevated exhaled acetone and pentane levels experienced higher composite adverse events of death, ventricular assist device implantation, or orthotopic heart transplantation. In patients admitted with ADHF, higher exhaled breath acetone levels are associated with lower LVEF and poorer outcomes, and greater reductions in exhaled breath acetone and pentane tracked with greater weight loss. Exhaled acetone and pentane may be novel biomarkers in heart failure worthy of future investigation.

Radiotherapy Does Not Increase Long Term Cardiovascular Mortality in Colorectal Cancer Patients.

Radiotherapy Does Not Increase Long Term Cardiovascular Mortality in Colorectal Cancer Patients.

Long Term Effects of Acute Kidney Injury Following Endovascular Intervention: Insights from a Multicentre Trial

Introduction: Endovascular techniques have emerged as an alternative to open surgery for the management of peripheral arterial disease (PAD) owing to their minimally invasive nature, lower periprocedural risk, shorter recovery time, and length of hospital stay. Acute kidney injury (AKI) is a well recognised complication of all endovascular therapies in patients with PAD; up to 20% of patients develop periprocedural AKI. This study looked at the association between AKI in patients with PAD, its severity and duration, and long term cardiovascular mortality, and examined whether AKI is a reflection of overall frailty or the cause of increased long term cardiovascular risk.

Antiarrhythmic effect of 9-week hybrid cardiac telerehabilitation - subanalysis of the TELEREHabilitation in Heart Failure patients - TELEREH-HF randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The National Centre for Research and Development, Warsaw, Poland. Background. Cardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized. Purpose. We analyzed the antiarrhythmic effect of a 9-week hybrid cardiac telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from the TELEREH-HF trial. Methods. We evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes ≥10 beats/hour (PVCs ≥10) with 24-hour ECG monitoring at the baseline and after 9-week HCTR or usual care (UC) of 773 HF patients (NYHA I-III, LVEF ≤ 40%). Results. Among 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p = 0.481). There was no significant difference in the decrease in PVC ≥10 over 9 weeks between randomization arms (14.9% vs. 17.8%, respectively p = 0.410). Functional response for HCTR (Δ peak oxygen consumption [pVO2] in cardiopulmonary exercise test &amp;gt;2.0 ml/kg/min) did not affect occurrence of arrhythmias. The multivariable analysis of the entire population did not identify HCTR as an independent factor determining improvement in terms of nsVT or PVCs &amp;gt;10. However, only in the HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2 years follow-up (Logrank p = 0.0009) (Figure). Conclusions. Significant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs ≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients. Abstract Figure

ANGINA AND ATRIAL FIBRILLATION IN MELOXICAM USE

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Atrial fibrillation is the most common arrhythmia that affects patients worldwide. Risk factors that contribute to the development of atrial fibrillation include advanced age > 65, hypertension, thyroid disorders, and alcoholic heart disease. We present a case of a male patient who developed atrial fibrillation and angina from meloxicam use. CASE PRESENTATION: A 55-year-old male with history of arthritis, morbid obesity and recent diagnosis of obstructive sleep apnea and hypertension, presented to the ED with intermittent episodes of 5/10 non-radiating retrosternal chest pain. 10-point review of systems was significant for shortness of breath and palpitations. Patient has history of small hand joint arthritis and body pain for which he was taking meloxicam for 3 weeks. Family history was significant for coronary artery disease in father and brother. He consumed 6 beers daily but denied other substance use. Vitals showed blood pressure was 157/104 mm Hg and heart rate in 109 bpm, with a SpO2 96% on room air. EKG showed atrial fibrillation with rapid ventricular response without acute ST-T changes. Troponin was <0.03. Patient was initially managed with loading dose aspirin and heparin drip. Rate control was achieved with two doses of metoprolol 5 mg IV push. The patient was subsequently started on metoprolol 25 mg PO BID and converted to sinus rhythm in 24 hours. Laboratory results showed unremarkable complete blood count, electrolytes, TSH, and lipid panel. Transthoracic echocardiogram demonstrated left ventricular ejection fraction of 55-60% with no signs of left atrial dilation. Nuclear stress test showed likely physiologic fixed apical thinning without any signs of ischemia. Thus, coronary causes of chest pain were ruled out. Patient was subsequently discharged home with metoprolol 25 mg PO BID for rate control and full dose aspirin for CHADS2-VASc of 1. DISCUSSION: Significant risk factors for atrial fibrillation include age > 65, prolonged history of hypertension, and ischemic heart disease. Additional risk factors for atrial fibrillation such as thyroid disorders, pulmonary hypertension, and alcoholic heart disease were ruled out. While APPROVE, APC, and VIGOR trials reported increased cardiovascular risks associated with selective COX-2 inhibitors such as celecoxib, rofecoxib, vedolicoxib, data is limited on adverse cardiovascular effects of meloxicam use (1,2). Our case report elicits the need for heightened awareness of adverse cardiovascular effects of meloxicam. CONCLUSIONS: Given the negative work up and resolution following discontinuation of the agent, the patient’s angina and atrial fibrillation were likely associated with meloxicam use. Further prospective studies should be performed to assess association of non selective COX inhibitors in development of acute cardiac events and long term cardiovascular mortality. Reference #1: Psaty, B. M., & Furberg, C. D. (2005). COX-2 inhibitors--lessons in drug safety. New England journal of medicine, 352(11), 1133-1134. Reference #2: Schmidt, M., Christiansen, C. F., Mehnert, F., Rothman, K. J., & Sørensen, H. T. (2011). Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study. Bmj, 343, d3450. DISCLOSURES: No relevant relationships by Mohammad Al-Akchar, source=Web Response No relevant relationships by Abhishek Kalidas Kulkarni, source=Web Response No relevant relationships by Ruby Maini, source=Web Response No relevant relationships by Zurain Niaz, source=Web Response No relevant relationships by Tharani Sundararajan, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Assessment of long term prognostic value of admission vitamin D level in patients with acute STEMI undergoing primary percutaneous coronary intervention

Objective:&#x0D; Vitamin-D status is very important for optimal function of human body&#x0D; especially cardiovascular system. The aim of this study was to investigate the&#x0D; long term prognostic value of admission vitamin D level in acute ST-segment&#x0D; elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary&#x0D; intervention (PPCI). &#x0D; &#x0D; Methods:&#x0D; One hundred fifty seven consecutive patients, who were admitted to a training&#x0D; and research hospital with a diagnosis of STEMI and underwent PPCI, were&#x0D; recruited in this prospective study. The study patients were divided into 2&#x0D; groups according to their vitamin-D levels as follows: High vitamin-D group&#x0D; (n=80) and Low vitamin-D group (n=77). The severity of coronary artery disease&#x0D; (CAD) was assessed with calculation of the SYNTAX score. &#x0D; &#x0D; Results:&#x0D; There were significant negative correlations between Vitamin-D level and SYNTAX&#x0D; score, serum glucose, and gender, but a positive correlation with hemoglobin&#x0D; level. Cardiovascular mortality was found to be significantly higher in the low&#x0D; vitamin-D group as compared to the high group (p&amp;lt;0.001). In multivariate&#x0D; analysis, low vitamin-D level was found as a significant independent predictor&#x0D; of long term cardiovascular mortality after adjusting for other risk factors. &#x0D; &#x0D; Conclusion:&#x0D; We demonstrated that low admission vitamin-D is related to severity of CAD.&#x0D; Vitamin-D deficiency is an independent predictor for long term cardiovascular&#x0D; mortality in acute STEMI undergoing PPCI.

Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Stenosis: A Systematic Review and Meta-Analysis.

PCI of ULMS is frequently performed through TFA because of technical complexity and safety concern. Studies have shown comparable efficacy and safety of TRA versus TFA, however, these studies are few in number. We intended to compare the clinical outcomes between transradial access (TRA) and transfemoral access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery stenosis (ULMS) by performing a meta-analysis. A systematic search of database, including, PubMed, Web of Science, Google scholar and Cochrane Database were performed by two independent reviewers. Studies were included comparing "TRA" versus "TFA" in patients undergoing PCI in ULMS. The primary outcome was a procedural success rate. Secondary outcomes were major bleeding, access site complications, in-hospital and long term: major adverse cardiac events (MACE), myocardial infarction (MI) and cardiovascular mortality. Eight studies were included in the analysis. The procedural success rate was 97.3% and there was no statistically significant difference between TRA and TFA groups (OR, 1.41 [CI 0.64, 3.12], I2 = 26%). The rates of access site complications (OR, 0.17 [CI 0.07, 0.41], I2 = 16%), major bleeding (OR, 0.39 [CI 0.17, 0.86], I2 = 0%) and all-cause mortality (OR, 0.28 [CI 0.12, 0.64], I2 = 0%) were lower in the TRA group. There were no significant differences in in-hospital and long term cardiovascular mortality, MI and MACE between the two groups. In contrast to TFA, TRA is associated with reduced bleeding and access site complications, with similar procedural success rate in patients undergoing PCI of ULMS.

Long-term cardiovascular mortality after radiotherapy for breast cancer: A systematic review and meta-analysis.

Radiotherapy (RT) is frequently associated with late cardiovascular (CV) complications. The mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, data is limited on the long-term risks of RT on CV mortality. RT for breast cancer is associated with long term CV mortality and left sided RT carries a greater mortality than right sided RT. We searched PubMed, Cochrane Central, Embase, EBSCO, Web of Science, and CINAHL databases from inception through December 2015. Studies reporting CV mortality with RT for left- vs right-sided breast cancers were included. The principal outcome of interest was CV mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random-effects model. The analysis included 289 109 patients from 13 observational studies. Women who had received RT for left-sided breast cancer had a higher risk of CV death than those who received RT for a right-sided breast cancer (RR: 1.12, 95% CI: 1.07-1.18, P < 0.001; number needed to harm: 353). Difference in CV mortality between left- vs right-sided breast RT was more apparent after 15 years of follow-up (RR: 1.23, 95% CI: 1.08-1.41, P < 0.001; number needed to harm: 95). CV mortality from left-sided RT was significantly higher compared with right-sided RT for breast cancer and was more apparent after ≥15 years of follow-up.

Coronary artery calcifications predict long term cardiovascular events in non diabetic Caucasian hemodialysis patients.

Vascular calcifications are frequent in chronic renal disease and are associated to significant cardiovascular morbidity and mortality. The long term predictive value of coronary artery calcifications detected by multi‐layer spiral computed tomography for major cardiovascular events was evaluated in non‐diabetic Caucasian patients on maintenance hemodialysis free of clinical cardiovascular disease. Two‐hundred and five patients on maintenance hemodialysis were enrolled into this observational, prospective cohort study. Patients underwent a single cardiac multi‐layer spiral computed tomography. Calcium load was quantified and patients grouped according to the Agatston score: group 1 (Agatston score: 0), group 2 (Agatston score 1‐400), group 3 (Agatston score 401‐1000) and group 4 (Agatston score >1000). Follow‐up was longer than seven years. Primary endpoint was death from a major cardiovascular event. Actuarial survival was calculated separately in the four groups with Kaplan‐Meier method. Patients who died from causes other than cardiovascular disease and transplanted patients were censored. The “log rank” test was employed to compare survival curves. One‐hundred two patients (49.7%) died for a major cardiovascular event during the follow‐up period. Seven‐year actuarial survival was more than 90% for groups 1 and 2, but failed to about 50% for group 3 and to <10% for group 4. Hence, Agatston score >400 predicts a significantly higher cardiovascular mortality compared with Agatston score <400 (p<0.0001); furthermore, serum Parathyroid hormone levels > 300 pg/l were associated to a lower survival (p < 0.05). Extended coronary artery calcifications detected by cardiac multi‐layer spiral computed tomography, strongly predicted long term cardiovascular mortality in nondiabetic Caucasian patients on maintenance hemodialysis. Moreover, it was not related to conventional indices of atherosclerosis, but to other non‐traditional risk factors, as serum Parathyroid hormone levels. A full cost‐benefit analysis is however necessary to justify a widespread use of cardiac multi‐layer spiral computed tomography in clinical practice.

307: Bilateral internal mammary artery bypass grafting: long-term clinical benefits of a consecutive series of 1000 patients

Bilateral internal mammary arteries (BIMA) remain still widely underutilized in coronary artery bypass grafting (CABG). This historical cohort study evaluated the early and long term outcomes of BIMA grafts in isolated CABG in a single institution. Between 1996 and 2008, we performed elective, isolated, primary, multiple CABG using bilateral internal mammary artery (IMA) grafts and supplemental venous grafts for multivessel coronary disease in 1000 consecutive patients. The mean age of the overall population was 64±15 years. 20% of patients were diabetics with a left ventricular ejection fraction (LVEF) ≤45% in 28% of patients. Comorbidities were represented by chronic renal failure, chronic obstructive pulmonary disease and peripheral artery disease in 11%, 11,5% and 26,9% of cases respectively. Acute coronary syndrome represented the initial clinical presentation in 41% of cases. The 30-day mortality rate was 2.8%. Early postoperative morbidity included myocardial infarction (2,2%), stroke (0,9%), mesenteric ischemia (0,7%), sternitis requiring reintervention (6,7%) and supraventricular arrhythmia (23,1%). The follow-up (between 3 and 14,8 years; mean follow up: 6,4±5 years) revealed 103 deaths. Kaplan-Meier 8-year survival rates for patients <65 and 65 to 74 years of age were 88% and 66% respectively (p<0,01). Multiple regression analysis showed that age ≥ 65 years at baseline (odds ratio (OR): 2,3; 95% confidence interval (CI): 1,3 to 4, p<0,001), acute coronary syndrome (OR: 1,9; 95% CI: 1,1 to 3,4, p=0,02), chronic renal failure (OR: 2,7; 95% CI, 1,4 to 5,2, p<0,001), peripheral artery disease (OR: 3,1; 95% CI, 1,8 to 5,5, p<0,001) and LVEF ≤45% (OR: 2,6; 95% CI, 1,4 to 4,5, p<0,001) were independent predictors of long term cardiovascular mortality. Our longitudinal analysis demonstrates that bilateral IMA grafting has a low operative risk and provides excellent long-term survival.

115: Placental abruption as a marker for long term cardiovascular mortality: a follow up period of more than a decade

HC to express a proportion score (PS) for CPD. The PS was significantly smaller in ID and CS-CPD, in comparison to NVD, in all pelvic levels: inlet (1.08 0.1 and 1.09 0.1 VS 1.15 0.08, p 0.006); mid (0.92 0.09 and 0.97 0.1 VS 1.03 0.08, p 0.0003); and outlet (0.77 0.04 and 0.81 0.07 VS 0.84 0.08 p 0.011). ROC analysis showed that a mid pelvis PS of 1 had a 68% sensitivity, 58% specificity and a positive predictive value of 89% for CS-CPD. CONCLUSION: Low proportion score of maternal pelvic parameters and neonate head circumference, is highly correlated with ID and CSCPD.

Antibodies to malondialdehyde oxidized low-density lipoproteins predict long term cardiovascular mortality in high risk patients

AimsAntibodies to oxidized low-density lipoproteins (oxLDLAbs) are detectable in the serum of patients with and without atherosclerosis, but it is unclear if they play a pathogenic or a protective role in atherogenesis or if they are simply a marker of atherosclerosis. Therefore, in a prospective cohort study we investigated if oxLDLAbs titer predicts cardiovascular (CV) events in high-risk coronary artery disease patients. Methods and resultsThe titer of IgG antibodies to malondialdehyde modified oxidized low-density lipoproteins was measured in 748 randomly selected patients of the GENICA study who underwent coronary angiography and assessment of incident CV events at follow-up. Patients were classified by oxLDLAbs into a low and a high titer group, corresponding to the first three and the last quartile, respectively. Cardiovascular event-free survival was compared between oxLDLAbs groups by Kaplan–Meier and multivariate technique including propensity score matching analysis. During long-term follow-up (median 7.2years) CV deaths were observed in 65 patients (11.6%), more commonly in the high than in the low oxLDLAbs group (patients free from CV death 83.1% vs. 89% respectively, p=0.025). The incidence of CV events was also higher in the former than in latter (event-free survival 69.2% vs. 77.7% respectively, p=0.030). ConclusionsAn oxLDLAbs titer above the 75th percentile is a marker of LDL oxidation which predicts a worse CV prognosis at long term follow-up in high-risk Caucasian patients referred for coronary angiography.

PP102. Hypertension in pregnancy and long term cardiovascular mortality outcomes

Hypertensive Disorders of Pregnancy (HDP) remain a leading cause of maternal morbidity and mortality worldwide affecting up to 10% of all pregnancies. Previous works inform that long term morbidity includes cardiovascular disease, including ischaemic heart disease, stroke and hypertension. The extent of long term mortality amongst women distant from the primary pregnancy event is not known. To determine mortality rates and cause of death for women who had hypertension during pregnancy between the years 1980-86. Women who had hypertension during pregnancy were identified via by ICD-9 coding. From record examination, there was an existing cohort of women who participated in clinical trials at Royal Prince Alfred Hospital in the 1980's. These trials included placebo controlled for blood pressure in pregnancy. The deaths among this cohort were identified by the NSW Registry of Birth Deaths and Marriages. The causes of death were verified from the International Classification of Diseases versions depending upon the year of death. There were a total of 332 women identified as participating in the various trials between the years 1980-86. Of these, there were 17 deaths reported by 2011. This gives an overall mortality rate of 5.1%. Five of these deaths were due to CVD. This equates to an RR of 44.6 (CI 95% 17.43-112.56). Women with hypertensive disorders in pregnancy have a higher mortality rate compared to the general female population. Further research is required to determine the relationship between HDP and future hypertension and whether the type of treatment and management women receive with HDP effects their risk of future long term health outcomes.

Abstract 5151: Waveform Reflections and Arterial Stiffness in the Prediction of 15.1-Year All-Cause and Cardiovascular Mortalities: A Community-Based Study

Background- The role of arterial wave reflection, usually assessed by the transit-time dependent augmentation index (AI) and augmented pressure (Pa), in the prediction of cardiovascular events may have been underestimated. We investigated whether the transit-time independent measurements of reflected wave magnitude predict cardiovascular outcomes independently of arterial stiffness indexed by carotid-femoral pulse wave velocity (PWV). Method- A total of 1272 participants (47.0% women) from a community-based survey were studied. Carotid pressure waveforms derived by tonometry were decomposed to generate forward wave amplitude (Pf), backward wave amplitude (Pb), and reflection index (RI, = [Pb/(Pf+Pb)]), in addition to AI, Pa, and reflected wave transit time (RWTT). Results During a median follow-up of 15.1 years, 225 deaths occurred, including 64 cardiovascular origins. In univariate Cox proportional hazards regression analysis, PWV, Pa and Pb predicted all-cause and cardiovascular mortalities in both men and women whereas AI, RWTT and RI were predictive only in men. In multi-variate Cox analysis accounting for age, height, and heart rate, Pb predicted all-cause mortality in women and cardiovascular mortality in both men and women, whereas Pa only predicted cardiovascular mortality in men but not in women. When PWV and Pb were jointly entered into the multivariate model accounting for age, sex, height, heart rate, and brachial mean blood pressure, Pb (hazard ratio 1.066, 95% confidence interval 1.023–1.110) but not PWV (1.086, 0.993–1.189), independently predicted cardiovascular mortality. Conclusion- Pb, a transit-time independent measurement of reflected wave magnitude, predicted long term cardiovascular mortality in men and women independently of PWV.

Análisis crítico de un artículo: Vitaminas antioxidantes no reducen la mortalidad general ni cardiovascular

Introduction: Oxidized LDL is thought to play an important part in the pathogenesis of atherosclerosis. Observational studies have associated alpha tocopherol (vitamin E), beta carotene, or both, with reductions in cardiovascular events, but not clinical trials. We did a meta-analysis to assess the effect of these compounds on long term cardiovascular mortality and morbidity. Methods: We analyzed seven randomized trials of vitamin E treatment and, separately, eight of beta carotene treatment; all trials included 1000 or more patients. The dose range for vitamin E was 50-800 IU, and for beta carotene was 15-50 mg. Follow-up ranged from 1.4 to 12.0 years. Findings: The vitamin E trials involved a total of 81788 patients and the beta carotene trials 138113 in the all cause mortality analyses. Vitamin E did not provide benefit in mortality compared with control treatment (11.3 vs 11.1%, odds ratio 1.02 [95% CI 0.98-1.06] p=0.42) or significantly decrease risk of cardiovascular death (6.0 vs 6.0%, p=0.86) or cerebrovascular accident (3.6 vs 3.5%, p=0.31). Beta carotene led to a small but significant increase in all cause mortality (7.4 vs 7.0%, 1.07 [1.02-1.11] p=0.003) and with a slight increase in cardiovascular death (3.4 vs 3.1%, 1.1 [1.03-1.17] p=0.003). No significant heterogeneity was noted for any analysis. Interpretation: The lack of a salutary effect was seen consistently for various doses of vitamins in diverse populations. Our results, combined with the lack of mechanistic data for efficacy of vitamin E, do not support the routine use of vitamin E