scholarly journals Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature

Cureus ◽  
2021 ◽  
Author(s):  
Kelechi E Emmanuel ◽  
Mahmoud Nassar ◽  
Nso Nso
Keyword(s):  
Cardiovascular Disease ◽  
Prognostic Value ◽  
Medical Literature ◽  
Asymptomatic Patients ◽  
History Of ◽  
Cardiovascular Testing

The burden of cardiovascular disease risk factors in the Middle East: A systematic review and meta-analysis focusing on primary prevention

2020 ◽  
Vol 18 ◽  
Author(s):  
Akshaya Srikanth Bhagavathula ◽  
Abdullah Shehab ◽  
Anhar Ullah ◽  
Jamal Rahmani
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Family History ◽  
Primary Prevention ◽  
Middle East ◽  
Disease Risk ◽  
Meta Analysis ◽  
Middle Eastern ◽  
History Of

Background: The increasing incidence of cardiovascular disease (CVD) threatens the Middle Eastern population. Several epidemiological studies have assessed CVD and its risk factors in terms of the primary prevention of CVD in the Middle East. Therefore, summarizing the information from these studies is essential. Aim: We conducted a systematic review to assess the prevalence of CVD and its major risk factors among Middle Eastern adults based on the literature published between January 1, 2012 and December 31, 2018 and carried out a meta-analysis. Methods: We searched electronic databases such as PubMed/Medline, ScienceDirect, Embase and Google Scholar to identify literature published from January 1, 2012 to December 31, 2018. All the original articles that investigated the prevalence of CVD and reported at least one of the following factors were included: hypertension, diabetes, dyslipidaemia, smoking and family history of CVD. To summarize CVD prevalence, we performed a random-effects meta-analysis. Results: A total of 41 potentially relevant articles were included, and 32 were included in the meta-analysis (n=191,979). The overall prevalence of CVD was 10.1% (95% confidence interval (CI): 7.1-14.3%, p<0.001) in the Middle East. A high prevalence of CVD risk factors, such as dyslipidaemia (43.3%; 95% CI: 21.5-68%), hypertension (26.2%; 95% CI: 19.6-34%) and diabetes (16%; 95% CI: 9.9-24.8%), was observed. The prevalence rates of other risk factors, such as smoking (12.4%; 95% CI: 7.7-19.4%) and family history of CVD (18.7%; 95% CI: 15.4-22.5%), were also high. Conclusion: The prevalence of CVD is high (10.1%) in the Middle East. The burden of dyslipidaemia (43.3%) in this region is twice as high as that of hypertension (26.2%) and diabetes mellitus (16%). Multifaceted interventions are urgently needed for the primary prevention of CVD in this region.

scholarly journals All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study

2021 ◽  
Author(s):  
Jawad H Butt ◽  
Emil L Fosbøl ◽  
Thomas A Gerds ◽  
Charlotte Andersson ◽  
Kristian Kragholm ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Location Of Death ◽  
All Cause Mortality ◽  
History Of ◽  
Adjusted Incidence Rate ◽  
Artery Disease ◽  
Adjusted Incidence ◽  
Overall Mortality

Abstract Background On 13 March 2020, the Danish authorities imposed extensive nationwide lockdown measures to prevent the spread of the coronavirus disease 2019 (COVID-19) and reallocated limited healthcare resources. We investigated mortality rates, overall and according to location, in patients with established cardiovascular disease before, during, and after these lockdown measures. Methods and results Using Danish nationwide registries, we identified a dynamic cohort comprising all Danish citizens with cardiovascular disease (i.e. a history of ischaemic heart disease, ischaemic stroke, heart failure, atrial fibrillation, or peripheral artery disease) alive on 2 January 2019 and 2020. The cohort was followed from 2 January 2019/2020 until death or 16/15 October 2019/2020. The cohort comprised 340 392 and 347 136 patients with cardiovascular disease in 2019 and 2020, respectively. The overall, in-hospital, and out-of-hospital mortality rate in 2020 before lockdown was significantly lower compared with the same period in 2019 [adjusted incidence rate ratio (IRR) 0.91, 95% confidence interval (CI) CI 0.87–0.95; IRR 0.95, 95% CI 0.89–1.02; and IRR 0.87, 95% CI 0.83–0.93, respectively]. The overall mortality rate during and after lockdown was not significantly different compared with the same period in 2019 (IRR 0.99, 95% CI 0.97–1.02). However, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during and after lockdown compared with the same period in 2019 (in-hospital, IRR 0.92, 95% CI 0.88–0.96; out-of-hospital, IRR 1.04, 95% CI1.01–1.08). These trends were consistent irrespective of sex and age. Conclusions Among patients with established cardiovascular disease, the in-hospital mortality rate was lower and out-of-hospital mortality rate higher during lockdown compared with the same period in the preceding year, irrespective of age and sex.

scholarly journals Safety of hydroxychloroquine and darunavir or lopinavir in COVID-19 infection

2020 ◽  
Author(s):  
Etienne Meriglier ◽  
Claire Rivoisy ◽  
Mojgan Hessamfar ◽  
Noelle Bernard ◽  
Ines Aureau ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Clinical Practice ◽  
Combination Therapy ◽  
Observational Cohort Study ◽  
Potential Drug ◽  
Clinical Evaluations ◽  
History Of ◽  
Observational Cohort ◽  
Ecg Abnormalities

Abstract Background Combination therapy with hydroxychloroquine and darunavir/ritonavir or lopinavir/ritonavir has been suggested as an approach to improve the outcome of patients with moderate/severe COVID-19 infection. Objectives To examine the safety of combination therapy with hydroxychloroquine and darunavir/ritonavir or lopinavir/ritonavir. Methods This was an observational cohort study of patients hospitalized for COVID-19 pneumonia treated with hydroxychloroquine and darunavir/ritonavir or lopinavir/ritonavir. Clinical evaluations, electrocardiograms and the pharmacokinetics of hydroxychloroquine, darunavir and lopinavir were examined according to clinical practice and guidelines. Results Twenty-one patients received hydroxychloroquine with lopinavir/ritonavir (median age 68 years; 10 males) and 25 received hydroxychloroquine with darunavir/ritonavir (median age 71 years; 15 males). During treatment, eight patients (17.4%) developed ECG abnormalities. Ten patients discontinued treatment, including seven for ECG abnormalities a median of 5 (range 2–6) days after starting treatment. All ECG abnormalities reversed 1–2 days after interrupting treatment. Four patients died within 14 days. ECG abnormalities were significantly associated with age over 70 years, coexisting conditions (such as hypertension, chronic cardiovascular disease and kidney failure) and initial potential drug interactions, but not with the hydroxychloroquine concentration. Conclusions Of the patients with COVID-19 who received hydroxychloroquine with lopinavir or darunavir, 17% had ECG abnormalities, mainly related to age or in those with a history of cardiovascular disease.

Visit-to-visit blood pressure variability in patients with type 2 diabetes with and without previous history of cardiovascular disease

2020 ◽  
Vol 38 (9) ◽  
pp. 1737-1744
Author(s):  
Maria Grazia Radaelli ◽  
Stefano Ciardullo ◽  
Silvia Perra ◽  
Rosa Cannistraci ◽  
Eleonora Bianconi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Blood Pressure Variability ◽  
Previous History ◽  
History Of

scholarly journals Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318764
Author(s):  
Jiesuck Park ◽  
Yeonyee Elizabeth Yoon ◽  
Kyoung Min Kim ◽  
In-Chang Hwang ◽  
Wonjae Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Cardiovascular Disease ◽  
Clinical Diagnosis ◽  
Bone Mineral ◽  
Prognostic Value ◽  
Clinical Risk Factors ◽  
Mineral Density ◽  
Clinical Risk ◽  
Incremental Prognostic Value

ObjectiveWe investigated whether the evaluation of bone mineral density (BMD) provides independent and incremental prognostic value for predicting atherosclerotic cardiovascular disease (ASCVD) in women.MethodsA total of 12 681 women aged 50–80 years (mean, 63.0±7.8 years) who underwent dual-energy X-ray absorptiometry were retrospectively analysed. We assessed the hazard ratio (HR) for ASCVD events (ASCVD death, non-fatal myocardial infarction and ischaemic stroke) according to the BMD or a clinical diagnosis of osteopenia or osteoporosis, with adjustment for clinical risk factors, including age, body mass index, hypertension, type 2 diabetes, hyperlipidaemia, current smoking and previous fracture. We also evaluated whether the addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors improved the prediction for ASCVD events.ResultsIn total, 468 women (3.7%) experienced ASCVD events during follow-up (median, 9.2 years). Lower BMD at the lumbar spine, femur neck and total hip was independently associated with higher risk for ASCVD events (adjusted HR per 1-standard deviation decrease in BMD: 1.16, p<0.001; 1.29, p<0.001; 1.38, p<0.001; respectively). A clinical diagnosis of osteoporosis was also independently associated with higher risk for ASCVD events (adjusted HR: 1.79, p<0.001). The addition of BMD or a clinical diagnosis of osteopenia or osteoporosis to clinical risk factors demonstrated significant incremental value in discriminating ASCVD events (addition of total hip BMD, p for difference <0.001).ConclusionThe evaluation of BMD provides independent and incremental prognostic value for ASCVD in women and thus may improve risk stratification in women.

scholarly journals AB0444 THROMBOTIC MICROANGIOPATHY AND SJÖGREN SYNDROME, AN UNUSUAL ASSOCIATION. PRESENTATION OF CLINICAL CASE AND SYSTEMATIC REVIEW OF THE LITERATURE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1521.2-1521
Author(s):  
Y. Santamaria ◽  
M. Galvis ◽  
A. Vanegas
Keyword(s):  
Hospital Admission ◽  
Plasma Exchange ◽  
Thrombotic Microangiopathy ◽  
Clinical Case ◽  
Medical Literature ◽  
Sjogren Syndrome ◽  
Plasma Exchange Therapy ◽  
History Of ◽  
The Mean ◽  
Intravenous Steroids

Background:Thrombotic microangiopathy (TMA) is a clinicopathologic diagnosis defined as microangiopathic hemolytic anemia (MAHA) with associated features of thrombocytopenia and end-organ ischemia. Systemic lupus erythematosus, antiphospholipid antibody syndrome, and scleroderma, are within the autoimmune diseases, the more commonly associated with TMA. It has been considered that the association with Sjögren Syndrome (SS) is rare.Objectives:To describe one patient with TMA and SS, and to review all cases reported in the literature.Methods:We notified a clinical case of a patient with Sjögren’s syndrome and TMA. Then, we searched the medical literature finding a total of 17 cases reported with this association until 2019. Before the data obtained were tabulated by trained staff and descriptive, comparing groups and bivariate analysis was performed. The outcome of interest was the death of the patient. Stata 12.0 software was used.Results:A 26-years-old Colombian female presented with a 6-week history of petechiae in lower limbs, gingivorrhagia, menorrhagia and jaundice; and previous history of arthritis and xerostomia. On admission, in the context of severe thrombocytopenia and MAHA, MAT diagnosis was made. During hospitalization we confirm the diagnosis of SS with ANA, antiRo and salivary gland biopsy. The patient was treated with steroids (methylprednisolone 500 mg/day, 3 days), plasma exchange therapy (PLEX) and Cyclophosphamide (750 mg), with recovery of hemoglobin and platelet levels; however, the patient died due to a complication of the PLEX catheter removal procedure.A total of 18 patients diagnosed with de novo or prevalent Sjögren’s syndrome who had hospital admission with a diagnosis of TMA were included. The mean age was 54.55 years (Standard deviation (SD): 12.45) and 83.33% of the patients corresponded to the female gender.At admission, the mean of hemoglobin was 8.45 g/dL (SD: 2.55) and median platelets of 27250/mm3 (interquartile range (IQR) 10500 - 102000) were found. The most frequent clinical manifestations were central nervous system alterations (50%), followed by bleeding in the skin and renal failure (44.44%) and fever (27.78%). The most frequent antibodies found were anti-Ro (100%), anti-nuclear antibodies (80%) and anti-La (75%). The most frequently prescribed treatment was plasma exchange therapy (83.33%), intravenous steroids (61.11%), oral steroids (61.11%) and cyclophosphamide (27.78%). Of the total patients, 38.89% died and 27.7% had some relapse of TMA.In the group comparison analysis, differences were found in intravenous steroid (81.82% in those who lived vs. 28.57% in those who died p=0.039), use of PLEX (100% in those who survived vs. 57.14% in those who died p = 0.043), fever (9.09% in those who survived and 57.14% in those who died, p = 0.047), admission hemoglobin (7.65 g/dL in those who lived vs. 10.22 g/dL in those who died, p = 0.05), final platelets (148,000 in which who lived and 39,000 in those who died p = 0.02). Then, in the logistic regression analysis, an association was found between mortality and use of intravenous steroids (OR: 0.08, 95% CI 0.009 - 0.83, p = 0.35) and fever at admission (OR: 13.33 95% CI: 1.04 - 169.55, p = 0.046).Conclusion:While the association between TMA and SS is uncommon, so far 18 cases have been reported in the world medical literature. It is typically a condition of women age close to 50 years. The most frequent manifestations are neurological. Among the variables evaluated, only the use of endovenous steroids was associated with a decrease in the probability of mortality; on the contrary, the presence of fever at hospital admission increased the probability of death. The results should be evaluated with caution, since, due to the limited availability of information, they may not be generalizable to clinical practice. More information on this should be obtained in the future.Disclosure of Interests:None declared

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