scholarly journals Large-scale phenome-wide association study of PCSK9 loss-of-function variants demonstrates protection against ischemic stroke

2017 ◽  
Author(s):  
Abhiram S. Rao ◽  
Daniel Lindholm ◽  
Manuel A. Rivas ◽  
Joshua W. Knowles ◽  
Stephen B. Montgomery ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Protective Effect ◽  
Large Scale ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Genetic Associations ◽  
Loss Of Function

AbstractPCSK9 inhibitors are a potent new therapy for hypercholesterolemia and have been shown to decrease risk of coronary heart disease. Although short-term clinical trial results have not demonstrated major adverse effects, long-term data will not be available for some time. Genetic studies in large well-phenotyped biobanks offer a unique opportunity to predict drug effects and provide context for the evaluation of future clinical trial outcomes. We tested association of the PCSK9 loss-of-function variant rsll591147 (R46L) in a hypothesis-driven 11 phenotype set and a hypothesis-generating 278 phenotype set in 337,536 individuals of British ancestry in the United Kingdom Biobank (UKB), with independent discovery (n = 225K) and replication (n = 112K). In addition to the known association with lipid levels (OR 0.63) and coronary heart disease (OR 0.73), the T allele of rs11591147 showed a protective effect on ischemic stroke (OR 0.61, p = 0.002) but not hemorrhagic stroke in the hypothesis-driven screen. We did not observe an association with type 2 diabetes, cataracts, heart failure, atrial fibrillation, and cognitive dysfunction. In the phenome-wide screen, the variant was associated with a reduction in metabolic disorders, ischemic heart disease, coronary artery bypass graft operations, percutaneous coronary interventions and history of angina. A single variant analysis of UKB data using TreeWAS, a Bayesian analysis framework to study genetic associations leveraging phenotype correlations, also showed evidence of association with cerebral infarction and vascular occlusion. This result represents the first genetic evidence in a large cohort for the protective effect of PCSK9 inhibition on ischemic stroke, and corroborates exploratory evidence from clinical trials. PCSK9 inhibition was not associated with variables other than those related to low density lipoprotein cholesterol and atherosclerosis, suggesting that other effects are either small or absent.

Medical Technology Assessment

1985 ◽  
Vol 1 (1) ◽  
pp. 125-146 ◽  
Author(s):  
William H. Yeaton ◽  
Paul M. Wortman
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Medical Technology ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Surgical Innovation ◽  
Widespread Acceptance ◽  
Considerable Controversy

Coronary artery bypass graft surgery (CABGS) has become an important procedure for the treatment of coronary heart disease. Over 100,000 of these surgical procedures are performed each year (1) at an aggregate cost of about $2 billion (2). Despite its current widespread acceptance, this major surgical innovation has generated considerable controversy concerning its effectiveness (3), and there still remains substantial confusion in assessing its overall impact (4).

scholarly journals Lipid Peroxidation Product and Glutathione Levels in Patients with Coronary Heart Disease Before and After Surgery

2015 ◽  
Vol 4 (2) ◽  
pp. 78-82
Author(s):  
Rahman Khansha ◽  
Behnoosh Miladpour ◽  
Zohreh Mostafavi-Pour ◽  
Fatemeh Zal
Keyword(s):  
Oxidative Stress ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Lipid Peroxidation Product ◽  
Cabg Surgery ◽  
Significant Difference ◽  
Before And After

Background: It has been reported that ischemia-reperfusion is associated with augmentation of oxidative stress and its specific and sensitive markers. Oxidative stress may cause atrial fibrillation (AF) which is a common consequence after cardiac surgery. Dietary supplementation with antioxidants might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. Materials and Methods: Fifty patients with coronary heart disease (CHD) referred to Namazi and Faghihi Hospitals in Shiraz, undergone elective CABG, were enrolled in this study. For evaluation of oxidative stress, whole blood was taken before and 24 hours after surgery and malondialdehyde (MDA) as an oxidative marker and glutathione (GSH) as an antioxidant marker were measured. Results: Results showed a significant difference between the mean concentration of GSH before and after CABG surgery (P <0.05); however, the difference in plasma MDA levels before and after CABG was insignificant. Conclusion: CABG surgery results in oxidative stress and reduces GSH 24h after surgery and administration of antioxidants may attenuate post-operative oxidative stress. [GMJ.2015;4(2):78-82]

Contribution of Nursing to Risk Factor Management as Perceived by Patients with Established Coronary Heart Disease

2002 ◽  
Vol 1 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Wilma J.M. Scholte op Reimer ◽  
Chris H. Jansen ◽  
Esther A.M. de Swart ◽  
Eric Boersma ◽  
Maarten L. Simoons ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Patient Education ◽  
Hospital Admission ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Risk Factor Management

Background: Guidelines stress the importance of risk factor management in patients with coronary heart disease (CHD). Aims: To evaluate whether guidelines on patient education in risk factor management are followed in clinical practice and to assess the contribution of nursing to risk factor management as perceived by patients with established CHD. Methods: Within three Dutch hospitals consecutive patients were identified after a first coronary–artery bypass graft, a first percutaneous transluminal coronary angioplasty or hospital admission for acute myocardial infarction or ischaemia ( n=357). Data were collected through patient interviews at least 6 months after hospital admission. Results: Among smokers, overweight patients, patients with hypertension, high cholesterol, and sedentary lifestyle, respectively 75, 36, 67, 61 and 49% reported that information on presence or management of these risk factors was provided. The proportion of patients informed by nurses ranged from 14% (lowering cholesterol) to 23% (increasing physical activity), while 55% (lowering cholesterol) to 71% (stop smoking) were informed by physicians. Conclusion: Many patients with established CHD and cardiovascular risk factors do not remember ever having received information about management of their risk factors. Clearly, there is a substantial potential to improve professionals’ compliance to guidelines on risk factor management, including those on patient education. The perceived contribution of nurses to risk factor management is small compared to that of physicians and other caregivers. If risk factor management is felt to be a main responsibility of nurses, current nursing activities in this area should be reconsidered within an improved organisational structure.

scholarly journals Effectiveness of the fixed-dose combination therapy with perindopril and amlodipine in coronary heart disease patients after coronary artery bypass graft surgery

2011 ◽  
Vol 10 (6) ◽  
pp. 47-54
Author(s):  
B. G. Iskenderov ◽  
O. N. Sisina ◽  
O. A. Kameneva
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Combination Therapy ◽  
Coronary Artery Bypass Graft ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Fixed Dose ◽  
Artery Bypass Graft ◽  
Dose Combination

Aim. To study the effectiveness of the fixed-dose combination therapy with perindopril and amlodipine (Prestance 5/5 mg/d) in coronary heart disease (CHD) patients after coronary artery bypass graft (CABG) surgery. Material and methods. The clinical trial included 65 patients (37 men, 28 women aged 45-68 years; mean age 56,3±3,5 years) after CABG. All patients were randomised into two groups: the control group (CG; n=35) and the main group (MG; n=30). Both groups received antiplatelet agents and statins, while the MG patients additionally received Prestance (5/5 mg/d). Prestance therapy started three-four weeks after CABG and lasted for four months. All participants underwent 24-hour monitoring of ECG and blood pressure (BP), Doppler echocardiography, and Doppler ultrasound of brachial and common carotid arteries. Results. Compared to the CG, the MG demonstrated decreased incidence of pain and painless ischemia episodes, reduced maximal ST segment depression and its total duration, and increased rate threshold of myocardial ischemia. In addition, Prestance therapy was associated with improved systolic and diastolic heart function and significantly improved endothelium-dependent vasodilatation. In patients with normal BP, Prestance (5/5 mg/d) did not cause hypotension, but reduced excessive BP variability. In the MG, acute coronary syndrome (ACS) was registered in 1 individual (3,3 %), while in the CG, it was registered in 4 patients (11.4 %), and in 3 cases, coronary artery stenting was performed. Conclusion. In patients with normal BP, Prestance (5/5 mg/d) therapy in the early post-CABG period had a pronounced anti-ischemic, cardio- and vasoprotective effects, and also prevented excessive BP variability.

scholarly journals Dynamics of psychoemotional characteristics in patients with coronary heart disease after coronary artery bypass graft surgery: Russian sampling specifics

2020 ◽  
Vol 17 (2) ◽  
pp. 310-329
Author(s):  
Arseniy A. Velikanov ◽  
Anna A. Stoljarova ◽  
Evgeniy A. Protasov ◽  
Irina A. Zelenskaya ◽  
Ekaterina I. Lubinskaya
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Postoperative Period ◽  
State Anxiety ◽  
Inpatient Treatment ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Coronary artery bypass graft (CABG) is known to be one of the most important surgical methods for treating coronary heart disease (CHD) which significantly reduces mortality and improves the quality of life of patients. In most cases, surgical intervention is a serious lifethreatening event and also a strong stress factor that affects the patients mental state. For this reason, there is an urgent need for psychological support for patients with CHD who are preparing for CABG. Therefore, when developing rehabilitation programmes and optimising psychodiagnostic and psychocorrectional measures, it is very important to study the psychoemotional characteristics of patients with CHD prior to CABG surgery. The objective of the present research was to study the dynamics of psychoemotional characteristics (including manifestations of asthenia, anxiety and psychopathological symptoms) in the patients with CHD during their stay in the cardiology hospital prior to CABG surgery. The study used a clinical-psychological method and an experimentalpsychological method, including the Scale of Asthenic State (SAS), Integrative Anxiety Test (IAT), Symptom Check List-90-Revised (SCL-90-R), and the Big Five Personality Test. A comparative study of the asthenic state in the patients with CHD before and after myocardial revascularisation during inpatient treatment revealed the presence of a more pronounced asthenic component in the postoperative period as compared with the results obtained at the preoperative stage. The patients with CHD prior to CABG during inpatient treatment had a higher level of anxiety as compared with the postoperative stage, especially regarding the general level of state anxiety, including emotional discomfort and social defence reactions. In the postoperative period, a higher rate of the asthenic component was observed in the structure of state anxiety. A comparative study of the severity of psychopathological symptoms in the patients with CHD prior to CABG surgery and during the postoperative period recorded more intense manifestations of anxiety, obsessiveness and compulsiveness as well as paranoid tendencies before the operation. In the structure of personal characteristics of the patients with CHD during their stay in the cardiology hospital prior to CABG surgery, the lowest indicators, on average, were Agreeableness and Conscientiousness. The results obtained are crucial for planning psychological intervention for patients with CHD.

Abstract P367: Trends in Mortality and Recurrent Coronary Heart Disease Events Following an Acute Myocardial Infarction Among Medicare Beneficiaries, 2001 - 2009

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Todd M Brown ◽  
Luqin Deng ◽  
David J Becker ◽  
Vera Bittner ◽  
Emily B Levitan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
White Men ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Age Adjusted Rates

Background: Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality following acute myocardial infarction (AMI). Therefore, we examined rates of mortality, recurrent AMI, and recurrent CHD events in the year following AMI overall and by race and sex in the national 5% random sample of Medicare beneficiaries. Methods: Beneficiaries were included if they were enrolled in traditional Medicare fee-for-service coverage (Parts A and B), were not enrolled in a Medicare Advantage plan, and experienced an index AMI (ICD9 410.xx except 410.x2) between January 1, 2001 and December 31, 2009. We used Poisson regression to calculate and examine linear changes in age-adjusted rates for all-cause mortality, recurrent AMI, and recurrent CHD events (defined as a hospitalization for AMI in the primary discharge diagnosis position, percutaneous coronary intervention, or coronary artery bypass graft surgery) during the 365 days following hospital discharge for the index AMI. To provide adequate sample size to investigate trends in outcomes by race-sex groups, we pooled calendar years into 3 time periods (2001-2003, 2004-2006, and 2007-2009). Results: Overall, 48,688 beneficiaries were included; 46% were men, 90% were white, and 7% were black. Changes in pooled 3 year rates for mortality, recurrent AMI, and recurrent CHD in the first year following an index AMI are shown in the table. Overall, we observed a -3.8% change in pooled 3 year age-adjusted rates for mortality, a -15.0% change in pooled 3 year age-adjusted rates for recurrent AMI, and a -11.1% change in pooled 3 year age-adjusted rates for recurrent CHD events. However, mortality following AMI decreased only in white men, and reductions in recurrent AMI or CHD occurred only for white men and women and black men but not black women. Conclusions: Despite the overall favorable trends in lower mortality and recurrent AMI and CHD events following an index AMI, more efforts in reducing disparities in CHD by race and sex are needed.

scholarly journals CARBOHYDRATE METABOLISM DISORDERS AND CORONARY HEART DISEASE: PROGNOSTIC VALUE AND REVASCULARISATION EFFECTIVENESS

2013 ◽  
Vol 12 (3) ◽  
pp. 79-84
Author(s):  
L. V. Kremneva ◽  
T. S. Pursanova ◽  
O. V. Abaturova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Carbohydrate Metabolism ◽  
Prognostic Value ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Myocardial Revascularisation ◽  
Percutaneous Coronary

This literature review presents the data on the prevalence and prognostic value of carbohydrate metabolism disorders, such as Type 2 diabetes mellitus (DM) and pre-diabetes — fasting hyperglycaemia and impaired glucose tolerance), among patients with coronary heart disease (CHD). The authors present the results of large studies on comparative effectiveness of modern pharmacological treatment and myocardial revascularisation (percutaneous coronary intervention and coronary artery bypass graft surgery) in patients with CHD and DM. 

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