Coronary Artery Disease in Women : Lessons Learned from Single-Center SPECT Registry and Future Directions for INOCA Patients

Background and objectives: Myocardial perfusion imaging with cardiac single-photon emission tomography (SPECT) is widely available for the detection of coronary artery disease (CAD) with high diagnostic and prognostic accuracy for women. A large proportion of symptomatic women with true myocardial perfusion defects in SPECT referred to coronary angiography have an absence of CAD—a condition named INOCA (ischemia with nonobstructive CAD). Additionally, the INOCA endotypes are rarely correctly diagnosed, and therefore, no tailored therapy is prescribed. Materials and methods: The cardiac SPECT for women was performed from 2018 to 2021. Patients with perfusion defect were analyzed according to further prescribed diagnostic tests used to diagnose CAD. According to the diagnostic criteria, patients with INOCA were selected as candidates for invasive microvascular physiology measurements. The correlation was calculated between SPECT results and clinical characteristics, symptoms, and risk factors. Results: A total of 726 women with suspected CAD were analyzed. True myocardial perfusion defects were detected in 125 patients (17.2%). During coronary angiography in 70 (56.0%) women, atherosclerosis in epicardial arteries was not observed. In 17 (20.9%) patients, obstructive CAD was present. Correlation was found between perfusion defect in SPECT and cardiovascular risk factors, including overweight, obesity, arterial hypertension, and dyslipidemia. Women with typical angina were more likely to have INOCA, but with “noncardiac” symptoms—CAD. In total, 68 female patients met three inclusion criteria for INOCA and were selected as candidates for invasive diagnostic testing. Conclusions: The created registry proves the important role of cardiac SPECT and great need for the development of invasively detected physiological measurements. The combination of both interventions could significantly change the future directions for INOCA patients, improving treatment strategies and clinical outcomes, especially knowing the number of risk factors and varying clinical presentation. The study will be continued by performing invasive testing of coronary microvascular function to expand the competence about what is known about INOCA patients.publishersversionPeer reviewe

Differences in long- and short-term memory performance and brain matter integrity in seniors with different physical activity experience

Due to increasing changes in demographics, maintaining cognitive functioning later in life has become both economic and social concerns, and thus finding a cost-effective solution is one of the priorities in research. Factors like physical and intellectual activities have been associated with better cognitive performance in later life. While several studies have considered the impact of short-term physical activity interventions on cognitive functioning, retrospective research focusing on life-time physical activity experience has been sparse. The aim of the study was to determine the relationship between memory performance and whole brain matter integrity in seniors with different regular life-long physical activity experience. Fifty-three Latvian seniors aged 65-85 (M = 72.25, SD = 5.03, 83% female) with no self-reported chronic disease participated in the study. Measures of memory, physical activity and whole brain matter integrity were obtained and analysed. The obtained results indicated no significant relationship between physical activity experience and short and long-term memory and whole brain matter integrity; however, brain matter integrity was significantly correlated with demographic factors like age and education. These results might be related to inadequate physical activity measures, as well as unequal physical activity experience in participants. In the future, more detailed assessment of physical activity experience should be considered

Heart rate and other risk factors in outpatients with stable coronary artery disease in Latvia

Funding Information: This survey was supported by Servier Latvia.The aim of the study was to characterise coronary artery disease (CAD) outpatients in Latvia by risk factors (RF) including heart rate (HR), physical examination data, clinical data and treatment. Twelve practitioners had each examined and questioned 6 to 12 patients with established CAD (n = 120). The most frequent cardiovascular (CV) RF and co-morbidity were dyslipidemia (94.2%) and hypertension (78.3%), respectively. Prevalence of increased resting HR (≥70 bpm) was 35.9% and 33.6%, when measured by pulse palpation and electrocardiography, respectively. Regarding other RFs, prevalence of treated but insufficiently controlled blood pressure 140/90 mmHg, total cholesterol 1 > 5 mmol/l and triglycerides > 1.7 mmol/l was 25.8%, 30.1% and 33.3%, respectively. Aspirin, statins and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers were used in 96.7%, 94.2% and 85.0% of cases, respectively. Beta blockers were used in 81.7% of cases. Average daily doses of most frequently used β blockers (metoprolol and bisoprolol) were 32% and 53% from target doses, respectively. In three cases β blockers were combined with ivabradin. Our results suggest that practitioners follow guidelines and consider CV prevention by treating CAD patients. Our data identified, however, unused potential for better control of increased HR by higher doses and combinations of HR-reducing agents.publishersversionPeer reviewe

A population-based cross-sectional study of cardiovascular risk factor in Latvia

Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background and Objective: To date, the epidemiological studies of noncommunicable diseases in Latvia were more episodic and covered only selected areas. The first national crosssectional population-based survey of cardiovascular risk factors after regaining independence was carried out to provide reliable information on the cardiovascular risk factor profile in adults. Material and Methods: Computerized random sampling from the Registry of Latvian population was carried out. A total of 6000 enrolled subjects aged 25-74 years were divided into 10 age subgroups. The data of 3807 respondents (63.5% of all) were included into the final analysis. Results: The mean number of cardiovascular risk factors was 2.99±0.026 per subject: 3.45±0.043 and 2.72±0.030 for men and women, respectively. Of all the respondents, 75.2% had an increased total cholesterol level. Hypercholesterolemia was found in almost 56% of men and 41% of women in the age group of 25-34 years. Hyperglycemia was documented in 34.1% of the respondents (41.6% of men and 29.8% of women). More than two-thirds (67.8%) of the persons were overweight, while obesity was found in 25.6% of men and 32.6% of women. Arterial hypertension was identified in 44.8% of the respondents; its prevalence was higher in men than women (52.9% vs. 40.2%). There were more current smokers among men than women (30.5% vs. 11.4%). Conclusions: The levels of cardiovascular risk factors in Latvia were found to be relatively high. The data can be utilized as baseline characteristics that can be compared down the road including the monitoring of health prevention activities.publishersversionPeer reviewe

Effects of metabolic syndrome on arterial function in different age groups: the Advanced Approach to Arterial Stiffness study

Objective: The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied. Methods: This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health & Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study. Results: Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P < 0.001). Age-adjusted and sex-adjusted values of CF-PWV and CAVI were weakly intercorrelated (r 2 = 0.06, P < 0.001). Age-adjusted and sex-adjusted values for CF-PWV but not CAVI were higher in presence of MetS (CF-PWV: 9.57 ± 0.06 vs. 8.65 ± 0.10, P < 0.001; CAVI: 8.34 ± 0.03 vs. 8.29 ± 0.04, P = 0.40; mean ± SEM; MetS vs. no MetS). The absence of an overall effect of MetS on CAVI was related to the heterogeneous effects of the components of MetS on this parameter: CAVI was positively associated with the high glycaemia and high blood pressure components, whereas lacked significant associations with the HDL and triglycerides components while exhibiting a negative association with the overweight component. In contrast, all five MetS components showed positive associations with CF-PWV. Conclusion: This large European multicentre study reveals a differential impact of MetS and age on CAVI and CF-PWV and suggests that age may have a more pronounced effect on CAVI, whereas MetS increases CF-PWV but not CAVI. This important finding may be due to heterogeneous effects of MetS components on CAVI. The clinical significance of these original results will be assessed during the longitudinal phase of the study

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Comparative Analysis of the Most Important Cardiovascular Risk Factors Based on Cross-Sectional Studies in the Population of Latvia

Background and Objectives: The aim of the study was to analyze the prevalence of cardiovascular risk factors (RFs) in Latvia from the population-based cross-sectional study performed in 2019–2020 and to compare the results with a similar study done in 2009–2010. Materials and Methods: The target sample of 6000 individuals representing a cross-section of Latvia’s inhabitants (aged 25–74) was formed using stratified two-stage cluster sampling. The survey had two components: (1) an interview using a pre-specified questionnaire and (2) physical examination (height, weight, arterial pressure) and collection of venous blood samples to measure levels of fasting glucose (Glu), total cholesterol (TC), high and low-density lipoprotein cholesterol (HDL-C/LDL-C), and triglycerides (Tg). In total, 4070 individuals were interviewed (32% non-response), from which 2218 (55%) individuals underwent physical examination and collection of blood samples. Results: The most frequently observed RFs were high LDL-C (62.0%), smoking (45.3%), and arterial hypertension (36.8%), while the prevalence of self-reported high cholesterol and hypertension was 19.3 and 18.6%, respectively. A decrease in the prevalence of hypertension, high LDL-C, and Glu was noted. Smoking decreased in younger men. The mean number of five most important cardiovascular RFs was 2.0 (95% confidence interval (CI) 2.0, 2.1); 2.3 (95% CI 2.2, 2.4) for men and 1.8 (95% CI 1.7, 19) for women. The average number of RFs has decreased by 0.3 in 10 years, t(5883) = −7.2, p Conclusions: Although the prevalence of cardiovascular RFs remains noteworthy, an improvement in the risk profile of the Latvian population has been observed over the past decade. The study shows subjective self-underestimation of cardiovascular risk

Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System

Funding Information: The authors acknowledge the National Research Program BIOMEDICINE (2014–2017) for funding this study. Ministry of Education and Sciences, Republic of Latvia. Publisher Copyright: Copyright © 2018 Ivanovs, Kivite, Ziedonis, Mintale, Vrublevska and Rancans.Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥ 10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥ 10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥ 10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.publishersversionPeer reviewe