1,360 research outputs found

    Continued efforts to translate diabetes cardiovascular outcome trials into clinical practice

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    Diabetic patients suffer from a high rate of cardiovascular events and such risk increases with HbA1c. However, lowering HbA1c does not appear to yield the same benefit on macrovascular endpoints, as observed for microvascular endpoints. As the number of glucose-lowering medications increases, clinicians have to consider several open questions in the management of type 2 diabetes, one of which is the cardiovascular risk profile of each regimen. Recent placebo-controlled cardiovascular outcome trials (CVOTs) have responded to some of these questions, but careful interpretation is needed. After general disappointment around CVOTs assessing safety of DPP-4 inhibitors (SAVOR, TECOS, EXAMINE) and the GLP-1 receptor agonist lixisenatide (ELIXA), the EMPA-REG Outcome trial and the LEADER trial have shown superiority of the SGLT2-I empagliflozin and the GLP-1RA liraglutide, respectively, on the 3-point MACE outcome (cardiovascular death, non-fatal myocardial infarction or stroke) and cardiovascular, as well as all-cause mortality. While available mechanistic studies largely support a cardioprotective effect of GLP-1, the ability of SGLT2 inhibitor(s) to prevent cardiovascular death was unexpected and deserves future investigation. We herein review the results of completed CVOTs of glucose-lowering medications and suggest a possible treatment algorithm based on cardiac and renal co-morbidities to translate CVOT findings into clinical practice

    A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (Part I - Protection via specific pathways).

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    Neurocognitive deficits are a major source of morbidity in survivors of cardiac arrest. Treatment options that could be implemented either during cardiopulmonary resuscitation or after return of spontaneous circulation to improve these neurological deficits are limited. We conducted a literature review of treatment protocols designed to evaluate neurologic outcome and survival following cardiac arrest with associated global cerebral ischemia. The search was limited to investigational therapies that were utilized to treat global cerebral ischemia associated with cardiac arrest. In this review we discuss potential mechanisms of neurologic protection following cardiac arrest including actions of several medical gases such as xenon, argon, and nitric oxide. The 3 included mechanisms are: 1. Modulation of neuronal cell death; 2. Alteration of oxygen free radicals; and 3. Improving cerebral hemodynamics. Only a few approaches have been evaluated in limited fashion in cardiac arrest patients and results show inconclusive neuroprotective effects. Future research focusing on combined neuroprotective strategies that target multiple pathways are compelling in the setting of global brain ischemia resulting from cardiac arrest

    ELECTROCARDIOGRAPHIC CHARACTERISTICS OF ATHLETES OF MOUNT CAMEROON ASCENT: PREVENTION OF SUDDEN DEATH

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    Mountain ultra-marathons participants are exposed to multiple internal and external stressors, from exercise and environment that can affect the cardiovascular response such as electrocardiographic profile (ECG). The aim of this study was to determine the electrocardiographic profile of athletes participating on the mount Cameroon race. Fifty-nine athletes and 50 non-athletes (31±7 vs 24±3 years) participated to the study during the 17th edition of Mount Cameroon ascent on February 18, 2012. ECG of 12-leads rest was measured in athletes and non-athletes. Resting heart rate (54±3 vs 71±9 bats/min) was lower (P<0.001) in athletes than non-athletes. P wave duration (108.5±1.8 vs 100.7±1.7 ms), PR interval (170.4±27.2 vs 155.8±22.3 ms), and RR interval (1072.3±188.2 vs 875.6±128.4 ms) were significantly higher (P<0.001) in athletes compared to non-athletes. However, on Rhythm and morphology abnormalities, athletes developed a sinus bradycardia (88.1 vs 8%), sinus arythmia (76.3 vs 22%) and left ventricular hypertrophy (54.2 vs 6%) higher than those of non-athletes (P<0.001). For the abnormalities of ECG conduction, atrioventricular block I (11.9 vs 6%), incomplete Right Bundle Branch Block (5.1 vs 2 %), incomplete Left Branch Block (1.7 vs 0%), Left anterior fascicular block (1.7 vs 0%), T-wave inversion (V1-V6) (10.2 vs 8%), Short PR (3.4 vs 2%), Sus ST Segment shift (5.1 vs 4%) were similar in both groups. But, early repolarization (40.7 vs 16%) was significantly higher (P<0.001) in athletes than non-athletes. Mountain race athletes develop some cardiac ECG electric morpho-functional abnormalities.  Article visualizations

    Acute Myocardial Infarction in a 25-Years-Old Male: Understanding the Risk and Comprehensive Management

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    Acute coronary syndrome (ACS) in young adults is a rare entity, yet it occurs. We present a case of a man 25 years old with no history of certain diseases, suddenly come up with ST elevation myocardial infarct. Young patients have different risk factors, clinical features and prognosis as compared to elderly patients. The diagnosis of ACS is also often overlooked in this subset of population. Furthermore, it constitutes an important problem because of the devastating effect of this disease on the more active lifestyle of young adults. This case report was an attempt to look for the risk factors most prevalent in young patients and its management prior and during the hospital stay

    Clinical Use of Aspirin in Treatment and Prevention of Cardiovascular Disease

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    Cardiovascular disease (CVD), principally heart disease and stroke, is the leading cause of death for both males and females in developed countries. Aspirin is the most widely used and tested antiplatelet drug in CVD, and it is proven to be the cornerstone of antiplatelet therapy in treatment and prevention of CVD in clinical trials in various populations. In acute coronary syndrome, thrombotic stroke, and Kawasaki's disease, acute use of aspirin can decrease mortality and recurrence of cardiovascular events. As secondary prevention, aspirin is believed to be effective in acute coronary syndrome, stable angina, revascularization, stroke, TIA, and atrial fibrillation. Aspirin may also be used for patients with a high risk of future CVD for primary prevention, but the balance between benefits and the possibility of side effects must be considered

    Age-related differences in the effect of psychological distress on mortality:Type D personality in younger versus older patients with cardiac arrhythmias

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    Background. Mixed findings in biobehavioral research on heart disease may partly be attributed to age-related differences in the prognostic value of psychological distress. This study sought to test the hypothesis that Type D (distressed) personality contributes to an increased mortality risk following implantable cardioverter defibrillator (ICD) treatment in younger patients but not in older patients. Methods. The Type D Scale (DS14) was used to assess general psychological distress in 455 younger (≤70 y,. Cardiac resynchronization therapy (CRT), but not Type D personality, was associated with increased mortality in older patients. Among younger patients, however, Type D personality was associated with an adjusted hazard ratio = 1.91 (95% CI 1.09–3.34) and 2.26 (95% CI 1.16–4.41) for all-cause and cardiac mortality; other predictors were increasing age, CRT, appropriate shocks, ACE-inhibitors, and smoking. Conclusion. Type D personality was independently associated with all-cause and cardiac mortality in younger ICD patients but not in older patients. Cardiovascular research needs to further explore age-related differences in psychosocial risk

    The night effect of anger: relationship with nocturnal blood pressure dipping

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    Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State–Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon

    Coronary slow flow: Benign or ominous?

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    Objective: Coronary slow flow phenomenon has been arbitrarily defined as delayed coronary blood flow in the absence of obstructive coronary artery disease. The present study sought to investigate the clinical features, natural history, and outcomes of affected patients. Methods: In this prospective cross-sectional study, 217 consecutive patients who had undergone coronary angiography and showed features of coronary slow flow phenomenon were evaluated for demographic and coronary risk factor profile, as well as clinical outcomes, at baseline and following treatment. Results: The study population consisted of 165 (76) males and 52 (24) females. The mean age of patients was 52.6±10 years. Mean ejection fraction was 48.2±5.4, 39.3 had diabetes, 43.3 had hypertension, 49.8 was a cigarette smoker, 41.9 had dyslipidemia, and 15 had a familial history of cardiac disease. Forty-nine percent was detected to have abnormal hsCRP levels. The most prevalent presenting complaint was atypical chest pain. Fifty-four percent of patients had slow blood flow in all three vessels. Thirty-six people had undergone repeat coronary angiography in a follow-up period of 5-7 years due to persisting or worsening clinical symptoms, of whom 6 (16.6) showed significant coronary artery stenosis. Eight (22.2) had mild CAD, and the rest still showed coronary slow flow without significant stenosis. The most common complaint during follow-up and after initiation of medical therapy was nonanginal chest pain. Conclusion: Patients with coronary slow flow phenomenon are predisposed to atherosclerosis and obstructive coronary artery disease. Therefore, this pathology should not be considered as a totally benign condition. Primary and secondary cardiovasculature preventive measures should be constituted and seem worthwhile in this patient population. © Copyright 2015 by Turkish Society of Cardiology

    The association of depressive symptoms in patients with acute myocardial infarction in a regional hospital in Durban, South Africa

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    Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI).Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01).Conclusion: Depressive symptoms are a common finding in a South African population presenting with MI. They are linked to higher rates of MACE, a previous history and/or family history of depression, greater stress levels and major life events. Females with MI are significantly more likely to present with depressive symptoms. These findings suggest that patients with MI should be screened for depressive symptoms and psychosocial factors as this may serve as an important arena for research and therapeutic intervention
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