Inflammation-Associated Co-morbidity Between Depression and Cardiovascular Disease

2016 ◽  
pp. 45-70 ◽  
Author(s):  
Angelos Halaris
Keyword(s):  
Cardiovascular Disease ◽  
Co Morbidity

scholarly journals Characteristics and outcomes of clusters of multimorbid patients in UK general practice

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Y Zhu ◽  
D Edwards ◽  
S Kiddle ◽  
R Payne
Keyword(s):  
Cardiovascular Disease ◽  
General Practice ◽  
Health Services ◽  
Mortality Risk ◽  
Service Use ◽  
Service Utilisation ◽  
Validation Data ◽  
Long Term Conditions ◽  
Co Morbidity

Abstract Background Current clinical specialities, guidelines and quality of care metrics are organised around single diseases and treatments of multiple conditions are rarely coordinated, resulting in insufficient or even conflicting care. This study uses large scale English general practice (GP) records to identify and characterise clusters of patients based on their multimorbidity to allow better design of health services and highlight groups that require additional interventions. Methods This is a retrospective cohort study that includes multimorbid adult patients (N = 113,211), from a random sample of 391,669 English patients with valid GP records in 2012 where 38 long-term conditions were defined. Latent class analysis, stratified by age groups, was used to identify multimorbidity clusters. Class solutions are validated and associations between multimorbidity clusters, patient characteristics, public health service utilisation and mortality are assessed. Results Poor socioeconomic status is associated with clusters with higher service use and mortality risk. Physical-mental health co-morbidity is a major component of multimorbidity across all age strata. The clusters with highest age-stratified mortality risk in under 65 year olds were linked to alcohol and substance misuse, whereas in over 65 year olds they were linked to cardiovascular disease. The largest cluster in the 85+ years strata (58%) has the lowest number of morbidities, a low degree of service use and mortality. Consistency was seen across identification and validation data. Conclusions We find a clear distinction between morbidity clusters, both in the prevalence of long term conditions within them, and in their associations with outcomes (service use and mortality). Specific health services and interventions might be more effective when targeted on the distinct types of multimorbidity we have identified, with a particular focus on the morbidity clusters associated with the worst patient outcomes. Key messages The first study to derive age stratified multimorbidity clusters from a large GP record system, whose patients are representative of the English population. Knowledge about particularly dangerous clusters of multimorbidity, such as those involving alcohol and drug use in 18–64 years old, and cardiovascular disease in those 65 years or older.

scholarly journals 2212. Burden of Community-Acquired Pneumonia Attributable to Co-morbid Conditions in Adults

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S754-S754
Author(s):  
Melissa A Rolfes ◽  
Seema Jain ◽  
Anna Bramley ◽  
Wesley Self ◽  
Richard G Wunderink ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Adult Population ◽  
Age Groups ◽  
Population Attributable Fraction ◽  
Community Acquired Pneumonia ◽  
Behavioral Risk ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
Co Morbidity ◽  
Combining Data

Abstract Background Few studies have quantified the risk of community-acquired pneumonia (CAP) among adults with co-morbidities. Combining data from the population-based, prospective Etiology of Pneumonia in the Community study (EPIC) and the nationwide health-related Behavioral Risk Factor Surveillance System (BRFSS) telephone-survey, we estimated the annual risk of hospitalization for CAP among adults with co-morbidities. Methods We identified adults hospitalized with radiographic and clinical CAP at hospitals in Chicago, IL and Nashville, TN from July 2010 to June 2012. Using 2011 BRFSS data, we estimated the prevalence of the population with selected co-morbidities (chronic lung disease [CLD], cardiovascular disease [CVD], chronic kidney disease [CKD], or diabetes) in the EPIC study catchment counties, as well as the population without co-morbidities. We estimated the incidence of hospitalized CAP, age-adjusted relative risk (RR) using Poisson regression, and population attributable fraction for each co-morbidity. Results Among 2,061 adult patients enrolled in EPIC, 1,428 (69%) had at least one selected co-morbidity, most commonly CLD (42%) and CVD (35%). Among the adult population in the EPIC catchment area, 17% had ≥1 selected co-morbidity. The overall incidence of hospitalized CAP was 24.8/10,000, 118.7/10,000 among adults with ≥1 co-morbidity, and 11.2/10,000 among adults without a co-morbidity. Compared with patients without co-morbidities, the incidence of hospitalization for CAP was higher among patients with CLD (aRR: 20.7 [95% confidence interval [CI]: 20.0–21.5]), CKD (aRR: 14.5 [CI: 13.8–15.1]), CVD (aRR: 14.0 [CI: 13.5–14.6]), and diabetes (aRR: 6.2 [CI: 5.9–6.4]). While CLD and CVD accounted for high proportions of the incidence of CAP hospitalizations in the study population, the contribution of the selected co-morbidities varied by age groups (figure). Conclusion There is an increased risk of hospitalization for CAP among adults with co-morbidities, particularly chronic lung and cardiovascular disease. As a large portion of CAP is attributable to these co-morbidities, targeted public health interventions, such as vaccination and risk communication, need to be reinforced among these high-risk groups. Disclosures All authors: No reported disclosures.

scholarly journals Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines

2009 ◽  
Vol 3 (2) ◽  
pp. 71-95 ◽  
Author(s):  
Niklas Ekerstad ◽  
Annika Edberg ◽  
Per Carlsson
Keyword(s):  
Cardiovascular Disease ◽  
Elderly Patients ◽  
Priority Setting ◽  
Hospital Care ◽  
Inpatient Care ◽  
Evidence Base ◽  
Evidence Based ◽  
Complex Needs ◽  
Co Morbidity ◽  
Evidence Based Guidelines

In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i) to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii) to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity), and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a) a literature review, (b) a register study, based on a unique population-based register of inpatient care in Sweden, and (c) a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty

scholarly journals The problem of accelerated atherosclerosis in systemic lupus erythematosus: Insights into a complex co-morbidity

2011 ◽  
Vol 106 (11) ◽  
pp. 849-857 ◽  
Author(s):  
Nekeithia Wade ◽  
Amy Major
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
Autoimmune Diseases ◽  
Lupus Erythematosus ◽  
Inflammatory Responses ◽  
Systemic Lupus ◽  
Accelerated Atherosclerosis ◽  
Increased Risk ◽  
Co Morbidity

SummaryRheumatic autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE), are associated with antibodies to “self” antigens. Persons with autoimmune diseases, most notably SLE, are at increased risk for developing accelerated cardiovascular disease. The link between immune and inflammatory responses in the pathogenesis of cardiovascular disease has been firmly established; yet, despite our increasing knowledge, accelerated atherosclerosis continues to be a significant co-morbidity and cause of mortality in SLE. Recent animal models have been generated in order to identify mechanism(s) behind SLE-accelerated atherosclerosis. In addition, clinical studies have been designed to examine potential treatments options. This review will highlight data from recent studies of immunity in SLE and atherosclerosis and discuss the potential implications of these investigations.

scholarly journals Coronary artery disease secondary to familial hypercholesterolaemia: An infrequent cause of increasingly common pregnancy co-morbidity

2015 ◽  
Vol 8 (3) ◽  
pp. 152-154
Author(s):  
Nicla A Varnier ◽  
Franzisca Pettit ◽  
David Rees ◽  
Steven Thou ◽  
Mark Brown ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Familial Hypercholesterolaemia ◽  
Physiological Stress ◽  
Management Options ◽  
Coronary Syndrome ◽  
Risk Pregnancy ◽  
Co Morbidity ◽  
Artery Disease

Background Cardiovascular disease affects 0.2–4% of pregnancies. Coupled with the physiological stress of pregnancy, cardiovascular disease may present significant management challenges including appropriate risk:benefit analysis of medical and surgical management options. Case A 33-year-old gravida 4 para 1 miscarriage 2 presented at 18 weeks’ gestation to the high-risk pregnancy service with a history of coronary artery disease and homozygous familial hypercholesterolaemia. Pre-pregnancy echocardiogram showed probable aortic xanthoma and preserved cardiac function. Prior to planned interventional cardiology assessment for her coronary artery disease she became pregnant, taking aspirin and multivitamins only. She had exertional angina responsive to metoprolol, agreed to recommencing statin therapy when serum cholesterol worsened, but declined angiography during pregnancy. At 36 weeks’ gestation, she had further angina symptoms but no acute coronary syndrome. Induction in the High Dependency Unit with elective assisted vaginal delivery of a healthy female infant (birthweight 2460 g) occurred at 37 weeks. She underwent triple-vessel coronary artery bypass postpartum, recovering well. Conclusion Whilst this specific condition is rare, the increase in cardiovascular disease and cardiovascular risks in the obstetric population emphasises the need for clear, multidisciplinary management from the outset of pregnancy for these women.

scholarly journals High risk of cardiovascular side effects after treatment of Hodgkin’s lymphoma – is there a need for intervention in long-term survivors?

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Anne Andersson ◽  
Beatrice Melin ◽  
Gunilla Enblad ◽  
Martin Erlanson ◽  
Ann-Sofie Johansson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Hodgkin Lymphoma ◽  
Clinical Symptoms ◽  
Medical Community ◽  
Adequate Treatment ◽  
Cardiac Symptoms ◽  
Cardiovascular Side Effects ◽  
Co Morbidity

Background: Hodgkin lymphoma (HL) patients have a good prognosis after adequate treatment. Previous treatment with mantle field irradiation has been accompanied by an increased long-term risk of cardiovascular disease (CVD). This study identified co-morbidity factors for the development of cardiovascular side effects and initiated an intervention study aimed to decrease morbidity and mortality of CVD in HL survivors. Design: Hodgkin lymphoma patients aged ≤45 years diagnosed between 1965 and 1995 were invited to participate. In total, 453 patients completed a questionnaire that addressed co-morbidity factors and clinical symptoms. Of these, 319 accepted to participate in a structured clinical visit. The statistical analyses compared individuals with CVD with those with no CVD. Results: Cardiovascular disease was reported by 27.9%. Radiotherapy (odds ratio [OR]: 3.27), hypertension and hypercholesterolemia were shown to be independent risk factors for the development of CVD. The OR for CVD and valve disease in patients who received radiotherapy towards mediastinum was 4.48 and 6.07, respectively. At clinical visits, 42% of the patients were referred for further investigation and 24% of these had a cardiac ultrasound performed due to previously unknown heart murmurs. Conclusion: Radiotherapy towards mediastinum was an independent risk factor for CVD as well as hypercholesterolemia and hypertension. A reasonable approach as intervention for this cohort of patients is regular monitoring of hypertension and hypercholesterolemia and referral to adequate investigation when cardiac symptoms appear. Broad knowledge about the side effects from radiotherapy in the medical community and well-structured information regarding late side effects to the patients are all reasonable approaches as late effects can occur even 40 years after cancer treatment.

scholarly journals HIV INFECTION, ANTIRETROVIRAL THERAPY AND CARDIOVASCULAR RISK

2010 ◽  
Vol 2 (3) ◽  
pp. e2010034 ◽  
Author(s):  
Katleen De Gaetano Donati ◽  
Roberto Cauda ◽  
Licia Iacoviello
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Antiretroviral Therapy ◽  
General Population ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Co Morbidity

In the last 15 years, highly active antiretroviral therapy (HAART) has determined a dramatic reduction of both morbidity and mortality in human immunodeficiency virus (HIV)-infected subjects, transforming this infection in a chronic and manageable disease. Patients surviving with HIV in the developed world, in larger number men,  are becoming aged. As it would be expected for a population of comparable age, many HIV-infected individuals report a family history of cardiovascular disease, a small proportion have already experienced a cardiovascular event and an increasing proportion has diabetes mellitus. Smoking rate is very high while an increasing proportion of HIV-infected individuals have dyslipidaemia. Studies suggest that these traditional risk factors could play an important  role in the development of cardiovascular disease in these patients as they do in the general population. Thus, whilst the predicted 10-year cardiovascular disease risk remains relatively low at present, it will likely increase in relation to the progressive aging of  this patient population. Thus, the long-term follow-up of HIV infected patients has to include co-morbidity management such as cardiovascular disease prevention and treatment. Two intriguing aspects related to the cardiovascular risk in patients with HIV infection are the matter of current investigation: 1) while these subjects share many cardiovascular risk factors with the general population, HIV infection itself increases cardiovascular risk; 2) some HAART regimens too influence atherosclerotic profile, partly due to lipid changes. Although the mechanisms involved in the development of cardiovascular complications in HIV-infected patients remain to be fully elucidated, treatment guidelines recommending interventions to prevent cardiovascular disease in these individuals are already available; however, their application is still limited.

Physical health monitoring of patients on antipsychotic medication in community - findings of an audit

2011 ◽  
Vol 26 (S2) ◽  
pp. 1272-1272
Author(s):  
M. Paul ◽  
D. Philip ◽  
J. Garcia
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
Blood Glucose ◽  
Physical Health ◽  
Lipid Profile ◽  
Antipsychotic Medication ◽  
Fasting Blood Glucose ◽  
Medication Effects ◽  
Increased Risk ◽  
Co Morbidity

IntroductionPatients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.Aim/objectivesThe aim of this audit is to ascertain the regularity of blood tests (u&e's, fasting blood glucose, lipid profile)among patients on Antipsychotic medication under North Durham Psychosis team.MethodAccording to audit standards (based on NICE guidelines-Schizophrenia and Maudsley guidelines), All patients on antipsychotic medication should have Urea & Electorates, Fasting blood glucose and Fasting Lipid profile done at least once a year. All 67 patients in North Durham Psychosis Team were included. We searched for these readings between 1st September 2008 to 30th August 2009 in patient records. Of the 67 patients, notes were retrieved for 50. Of the 50, 46 were on antipsychotic medications.ResultsOf 46 patients, 58% had urea & electorates, 58% had Fasting blood glucose and 46%had fasting lipid profile recorded.ConclusionBecause of lifestyle, co-morbidity and medication effects, patients with severe mental illness are at increased risk of cardiovascular disease. Our audit identified a need for systemic assessment of physical health with appropriate blood investigations and follow up with appropriate management plan (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences. This results may also reflect a lack of communication between primary care and secondary care as the physical health for these clients are primarily managed by General Practitioners. It may be that these investigations are conducted but not communicated to secondary care.

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