Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease

© 2019 S. Karger AG, Basel. Background: While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. Objective: We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). Methods: A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. Results: Young to middle-aged patients compared to older ones were more likely to be male (p \u3c 0.01), smokers (21 vs. 9%, p \u3c 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p \u3c 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p \u3c 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. Conclusion: Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population

Falls following discharge after an in-hospital fall

Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. METHODS: We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks). Time spent rehospitalized or institutionalized was censored in rate calculations. RESULTS: Of 95 hospitalized patients who fell during recruitment, 65 (68%) met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days). Seventy-five percent were African-American and 43% were women. Sixteen patients (25%) had multiple falls during hospitalization and 23 patients (35%) suffered a fall-related injury during hospitalization. Nineteen patients (29%) experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4). Twenty-three patients (35%) were readmitted and 3(5%) died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008). CONCLUSION: Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population

CARDIOVASCULAR RISK FACTORS PROFILE OF YOUNG PATIENTS WITH CORONARY ARTERY DISEASE: THE YOUNG HEART STUDY

Therapeutic Area: ASCVD/CVD Risk Factors Background: The increasing trends in acute myocardial infarction among the young suggest potential increases in specific cardiovascular risk profiles. As traditional risk calculators underperform in the younger groups, early identification of specific risk factors and therapeutic management are critical. We sought to evaluate traditional and non-traditional risk factors in this population, rates of guideline-directed therapy and the impact of a risk reduction program on residual risk. We report the baseline characteristics of this population. Methods: We enrolled 60 patients, ≤59 years old, with angiographically proven coronary artery plaque and at least two uncontrolled risk factors: BMI>25 kg/m2, A1C >7% in diabetic patients and >5.6 in those without, systolic blood pressure >130 mmHg, LDL>70 mg/dL, smoking. These cross-sectional, baseline data were collected through structured questionnaires on socio-demographic and lifestyle factors, blood samples, and angiographic data. Continuous variables were analyzed using median and quartiles (Q1-Q3) and the Wilcoxon rank-sum test. Categorical variables were analyzed using frequency (percentage) and the Chi-Square or Fisher's Exact test. Results: The median age (Q1-Q3) was 51 (45-55), 70% were male, 46.7% were white. 76.7% had hypertension, 91.7% had hyperlipidemia, 36.7% had diabetes, 28.3% had prediabetes, 88.3% had obstructive CAD and 38.3% had a history of myocardial infarction. The median (IQR) BMI was 28.8 (26.8-33.8), SBP 129 mmHg (121-138), LDL 69 mg/dL (53-96), Lp (a) 57.8 nmol/L (19.8-129.6), HbA1c 6.1% (5.5-7.5), hsCRP 1.25 mg/L (0.60-4.45), TMAO 2.95 µmol/L (1.9-5.2).Uncontrolled risk factors were prevalent: gender-specific waist circumference goals were unmet in 54.6%, metabolic syndrome in 60%, 47.5% had an LDL >=70, 42.4% had Lp(a) >=75nmol/L, 41.7% had hsCRP >=2, 28.3% had suboptimal TMAO, 68.2% of diabetics had an HbA1c >=7% and 26.7% were either current smokers or had quit smoking within the last year. Only 83% of the patients were on antiplatelet therapy, and 70% were on a guideline dose of statin. Conclusion: These data from the Young Heart study suggest a high prevalence of cardiometabolic disease related to obesity/overweight and abnormal glucometabolic state. However, entry criteria may also dictate these findings. Interestingly, elevated CRP, elevated TMAO and Lp(a) were high and may warrant future investigation

A novel electrocardiographic index for the diagnosis of diastolic dysfunction

Contains fulltext : 128595.pdf (publisher's version ) (Open Access)BACKGROUND: Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD. METHODS AND RESULTS: ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422+/-24ms and 434+/-32ms vs. 409+/-25ms, p<0.0005) and shorter Tend-P and Tend-Q intervals, reflecting the electrical and mechanical diastole (240+/-78ms and 276+/-108ms vs. 373+/-110ms, p<0.0001; 409+/-85ms and 447+/-115ms vs. 526+/-119ms, p<0.0001). The PQ-interval was significantly longer in the patient group (169+/-28ms and 171+/-38ms vs. 153+/-22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend-P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%). CONCLUSIONS: A novel electrocardiographic index Tend-P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI

Drug-gene interactions and the search for missing heritability: a cross-sectional pharmacogenomics study of the QT interval

Variability in response to drug use is common and heritable, suggesting that genome-wide pharmacogenomics studies may help explain the 'missing heritability' of complex traits. Here, we describe four independent analyses in 33 781 participants of European ancestry from 10 cohorts that were designed to identify genetic variants modifying the effects of drugs on QT interval duration (QT). Each analysis cross-sectionally examined four therapeutic classes: thiazide diuretics (prevalence of use=13.0%), tri/tetracyclic antidepressants (2.6%), sulfonylurea hypoglycemic agents (2.9%) and QT-prolonging drugs as classified by the University of Arizona Center for Education and Research on Therapeutics (4.4%). Drug-gene interactions were estimated using covariable-adjusted linear regression and results were combined with fixed-effects meta-analysis. Although drug-single-nucleotide polymorphism (SNP) interactions were biologically plausible and variables were well-measured, findings from the four cross-sectional meta-analyses were null (Pinteraction>5.0 × 10-8). Simulations suggested that additional efforts, including longitudinal modeling to increase statistical power, are likely needed to identify potentially important pharmacogenomic effects.The Pharmacogenomics Journal advance online publication, 5 March 2013; doi:10.1038/tpj.2013.4