RESUMEN
Objective To develop a diagnostic rule for detection of patients (pts) with high probability of subclinical atherosclerosis among those with high or very high cardiovascular (CV) risk.Materials and Methods This cross-sectional study enrolled 52 pts (32 men [62â%]), aged 40 to 65 years [mean age 54.6±8.0]) with high or very high CV risk (5-9 and ≥10â% by The Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT) angiography and calcium scoring. Traditional risk factors (RFs) (family history of premature CVD, smoking, overweightâ/âobesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoBâ/âApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality.Results All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. 26 multiple linear logistic models for any subclinical atherosclerosis were developed based on obtained diagnostic features. Taking into account R-square = 0.344 (p=0.0008), the best fitting model was follows: subclinical coronary atherosclerosis= -1.576 + 0.234 x SCORE ≥5â% + 0.541 x hs CRP >2 gâ/âl +0.015 x heart rate (bpm) +0.311 family history of premature CVD. The developed algorithm had sensitivity of 63â% and specificity of 80â%.Conclusion The created diagnostic model diagnostic model suggests the presence of subclinical coronary atherosclerosis in patients with highâ/âvery high CV risk with a high degree of probability. This easy-to-use method can be used in routine clinical practice to improve risk stratification and management choices in high-risk pts.
Asunto(s)
Enfermedad de la Arteria Coronaria , Diabetes Mellitus Tipo 2 , Adulto , Anciano , Aterosclerosis , Biomarcadores , Enfermedades Cardiovasculares , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
PURPOSE: The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk. METHODS: This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. RESULTS: All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05). CONCLUSION: Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis.
Asunto(s)
Aterosclerosis , Enfermedades Cardiovasculares , Adulto , Anciano , Aterosclerosis/diagnóstico , Biomarcadores , Estudios Transversales , Diabetes Mellitus Tipo 2 , Humanos , Persona de Mediana Edad , Análisis de la Onda del Pulso , Factores de RiesgoRESUMEN
The purpose of the study was a comparative study of antiplatelet activity of acetylsalicylic acid drugs, produced in gastro-resistant form trombopol 75 mg and aspirin cardio 100 mg in patients with high risk of cardiovascular events. Effect of trombopol 75 mg versus 100 mg aspirin cardio on platelet aggregation in 30 patients with high risk of cardiovascular events during 3 week treatment period was studied. Design method: blind, randomized, crossover method. Three weeks before the initial therapy, for those patients, who received antiplatelet platelet therapy at the time of inclusion in the study, this therapy was withdrew ("wash-out period"), after which patient was given one of the study drug (sequence of courses was s determined according to the scheme of randomization) with the recommendation of taking it daily in the morning at the same time. At each visit, before the next dose of the drug, blood samples for determination of ADP-induced platelet aggregation were taken, physical examination, measurement of blood pressure (BP) and heart rate were recorded, adverse events were recorded. Follow-up visit was performed 3 weeks later. 21 days after first study drug withdrawal, a second similar course of therapy with another drug was performed. Antiplatelet efficacy of aspirin was assessed by its effect on spontaneous and ADP- induced platelet aggregation. Aggregation activity was determined by turbidometric method by changing of translucent ability of the blood sample during the formation of aggregates after 2 minutes of exposure. As an inducer of aggregation ADP solutions of three concentrations (0.5, 1 and 2 mM) were used. No significant difference between compared drugs in influence on aggregation ability of platelets after 3 weeks of daily intake was found. No adverse events associated with taking of studied drugs were registered. It was concluded that, generic APD - trombopol 75 mg and aspirin cardio 100 mg were equivalent on antiplatelet efficacy and tolerability.
Asunto(s)
Aspirina , Enfermedades Cardiovasculares/tratamiento farmacológico , Agregación Plaquetaria/efectos de los fármacos , Adenosina Difosfato/metabolismo , Administración Oral , Anciano , Aspirina/administración & dosificación , Aspirina/efectos adversos , Aspirina/farmacocinética , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/fisiopatología , Formas de Dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Monitoreo de Drogas/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacocinética , Equivalencia Terapéutica , Resultado del TratamientoRESUMEN
Blood pressure (BP) elevation is associated with lowered sensitivity to pain and increased risk of painless myocardial ischemia. However relationship between frequency of episodes of symptomless myocardial ischemia and BP level in patients with normal or low BP has not been elucidated. In 74 men with ischemic heart disease and stable class I-III effort angina blood pressure was measured on the day of 24-hour ECG monitoring. Ranges of systolic (S) and diastolic (D) BP values were 93-159 and 65-104 mm Hg, respectively. Episodes of painless ischemia were most frequent in highest (4-th) (SBP>=142, DBP>=93 mm Hg) and least frequent in the 2nd (SBP 120-126, DAD 79-86 mm Hg.) quartile of BP distribution. In patients with lower BP (1st quartile) frequency of episodes of painless ischemia was significantly higher as compared with patients of the 2nd quartile. Thus relationship between frequency of episodes of painless ischemia and BP level in patients with stable effort angina was J-shaped: sensitivity to ischemia was lowered and frequency of painless ischemia increased both at highest and lowest values of BP.
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Angina de Pecho/epidemiología , Hipertensión/epidemiología , Isquemia Miocárdica/epidemiología , Umbral del Dolor , Dolor/epidemiología , Angina de Pecho/diagnóstico , Humanos , Hipertensión/diagnóstico , Incidencia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Dolor/diagnóstico , Dimensión del Dolor , Prevalencia , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Paired exercise tests with single doses of verapamil, nifedipine, propranolol, buccal nitroglycerin (trinitrolong), sustained release oral nitroglycerin, and placebo were performed in 101 patients with stable class II-III angina and the drug causing longest exercise duration was selected for long term therapy. Efficacy of a selected drug was compared with magnitude of its hypotensive effect. The latter was calculated as difference between blood pressure (BP) before and 2 hours after drug administration. Lower quintile of distribution of BP differences (systolic BP difference >20 mm Hg and/or diastolic BP difference >15 mm Hg) was considered as excessive hypotensive effect of a study drug (EHESD) single dose. Exercise duration before ST-segment depression was significantly shorter (p<0.05) in cases with EHESD compared with those without EHESD. After 1 month of therapy total daily number of episodes of myocardial ischemia decreased by 3.2+/-3.0 and 1.8+/-1.2 in patients without and with EHESD, respectively (p<0.02). At the same time number of episodes of painless ischemia increased more than 2 times in patients with EHESD (p<0.01). Registration of EHESD at initial stages of treatment with short acting antianginal drugs appears to be a reliable marker of increased frequency of painless episodes of myocardial ischemia and low efficacy of regular use of these drugs.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Presión Sanguínea/efectos de los fármacos , Electrocardiografía , Prueba de Esfuerzo , Nifedipino/farmacología , Nitroglicerina/farmacología , Propranolol/farmacología , Vasodilatadores/farmacología , Verapamilo/farmacología , Adulto , Angina de Pecho/diagnóstico , Angina de Pecho/fisiopatología , Distribución de Chi-Cuadrado , Interpretación Estadística de Datos , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Ambulatorio , Nifedipino/administración & dosificación , Nifedipino/uso terapéutico , Nitroglicerina/administración & dosificación , Nitroglicerina/uso terapéutico , Placebos , Propranolol/administración & dosificación , Propranolol/uso terapéutico , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéutico , Verapamilo/administración & dosificación , Verapamilo/uso terapéuticoRESUMEN
Effects of the standard doses of telmisartan (20-80 mg) and enalapril (5-10 mg) on the arterial pressure (AP, circadian monitoring), psychological state (Minnesota Multiphase Personality Inventory questionnaire, Russian version), and quality of life (General Well-Being Questionnaire) were studied in a randomized, parallel group trial in 30 patients with stable, soft-to-moderate arterial hypertension. The initial control 2-week period was followed by a 12-week period of active therapy. It was established that the long-term administration of both drugs in standard doses produced comparable antihypertensive effect, reliably reducing the averaged AP characteristics. Both drugs also improved the quality of life: enalapril influenced predominantly the psychological score, while telmisartan increased both psychological score and social score. Long-term administration of both drugs had a positive effect on the psychological state of hypertensive patients.