Reply to racial and gender disparities among patients with Takotsubo syndrome

We read with great interest the Letter to the Editor titled “Racial and Gender Disparities among Patients with Takotsubo Syndrome” by Khalid et al regarding our recent publication. Their excellent comments and detailed assessment highlights the low prevalence of diabetes mellitus in patients with Takotsubo syndrome (TTS) compared to general population. This is in contrast with relatively high prevalence of many other cardiovascular risk factors in TTS patients. This so called “diabetes paradox” has been previously explained in TTS patients and is the target of many active investigations. As highlighted in the Letter to the Editor, the prevalence of diabetes mellitus in our patient population is very close to the results of prior meta‐analyses of multiple small studies of patients with TTS

Comparison of outcomes of percutaneous coronary intervention on proximal versus non-proximal left anterior descending coronary artery, proximal left circumflex, and proximal right coronary artery: A cross-sectional study

BACKGROUND: Previous studies have shown that lesions in proximal left anterior descending coronary artery (LAD) may develop more restenosis after balloon angioplasty than lesions in other coronary segments. However, stenting seems to have reduced this gap. In this study, we compared outcomes of percutaneous coronary intervention (PCI) on proximal LAD versus proximal left circumflex (LCX) or right coronary artery (RCA) and proximal versus non-proximal LAD. METHODS: From 1737 patients undergoing PCI between March 2004 and 2005, those with cardiogenic shock, primary PCI, total occlusions, and multivessel or multi-lesion PCI were excluded. Baseline characteristics and in-hospital outcomes were compared in 408 patients with PCI on proximal LAD versus 133 patients with PCI on proximal LCX/RCA (study I) and 244 patients with PCI on non-proximal LAD (study II). From our study populations, 449 patients in study I and 549 patients in study II participated in complete follow-up programs, and long-term PCI outcomes were compared within these groups. The statistical methods included Chi-square or Fisher's exact test, student's t-test, stratification methods, multivariate logistic regression and Cox proportional hazards model. RESULTS: In the proximal LAD vs. proximal LCX/RCA groups, smoking and multivessel disease were less frequent and drug-eluting stents were used more often (p = 0.01, p < 0.001, and p < 0.001, respectively). Patients had longer and smaller-diameter stents (p = 0.009, p < 0.001, respectively). In the proximal vs. non-proximal LAD groups, multivessel disease was less frequent (p = 0.05). Patients had larger reference vessel diameters (p < 0.001) and were more frequently treated with stents, especially direct stenting technique (p < 0.001). Angiographic success rate was higher in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups (p = 0.004 and p = 0.05, respectively). In long-term follow-up, major adverse cardiac events showed no difference. After statistical adjustment for significant demographic, angiographic or procedural characteristics, long-term PCI outcomes were still similar in the proximal LAD versus proximal LCX/RCA and non-proximal LAD groups. CONCLUSION: Despite the known worse prognosis of proximal LAD lesions, in the era of stenting, our long-term outcomes were similar in patients with PCI on proximal LAD versus proximal LCX/RCA and non-proximal LAD. Furthermore, we had better angiographic success rates in patients with PCI on proximal LAD

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Reply to “racial and gender disparities among patients with Takotsubo syndrome”

We read with great interest the Letter to the Editor titled “Racial and Gender Disparities among Patients with Takotsubo Syndrome” by Khalid et al regarding our recent publication. Their excellent comments and detailed assessment highlights the low prevalence of diabetes mellitus in patients with Takotsubo syndrome (TTS) compared to general population. This is in contrast with relatively high prevalence of many other cardiovascular risk factors in TTS patients. This so called “diabetes paradox” has been previously explained in TTS patients and is the target of many active investigations. As highlighted in the Letter to the Editor, the prevalence of diabetes mellitus in our patient population is very close to the results of prior meta‐analyses of multiple small studies of patients with TTS

Comparison of Outcomes of Alcohol Septal Ablation or Septal Myectomy for Hypertrophic Cardiomyopathy in Patients ≤65 Years Versus \u3e65 Years

Alcohol septal ablation (ASA) and septal myectomy (SM) are therapeutic interventions for patients with hypertrophic cardiomyopathy (HC) who remain symptomatic despite medical treatment. Outcomes for both interventions in age groups ≤65 versus \u3e65 years are scarce. We queried the National Readmission Database for adult patients undergoing either SM or ASA between 2010 and 2015 for HC. Patients were divided into 2 age-groups (≤65-years and \u3e65-years). We aimed to compare the in-hospital mortality, complication rates, and resource utilization for each procedure between the 2 age-groups. We identified 4,358 patients with HC who underwent intervention, of which 2,113 were treated with SM and 2,245 with ASA. In-hospital mortality was 6-times higher in patients ≤65 years old who underwent SM compared with ASA (1.5% vs 0.3% odds ratio 6.2; p = 0.04); and 4-times higher in patients \u3e65 years treated with SM compared with ASA (6.7% vs 1.7% odds ratio 4.29; p = 0.04). Blood transfusion rates and stroke were higher in patients undergoing SM, regardless of their age-group. Length of hospital stay was lower in the ASA group (3 days vs 6 days for both age groups, p \u3c0.001) as well as median hospital costs (≤65 years old: $15,474 vs$31.531; and \u3e65 years old: $16,672 vs$36,042, p \u3c0.001). In conclusion, patients with HC treated with ASA had significantly lower in-hospital mortality, complications rates, length of hospital stay, and hospital costs compared with patients undergoing SM at any age