RESUMEN
OBJECTIVE: To analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance. METHODS: A total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model. RESULTS: The prevalence of frailty in elderly patients with CHD was 30.07%. The multiple factor analysis revealed that poor health status (OR = 28.169)/general health status (OR = 18.120), age (OR = 1.046), social activities (OR = 0.673), impaired instrumental ability of daily living (OR = 2.384) were independent risk factors for frailty (all P < 0.05). The area under the ROC curve of the nomograph prediction model was 0.847 (95% CI: 0.809 ~ 0.878, P < 0.001), with a sensitivity of 0.801, and specificity of 0.793; the Hosmer- Lemeshow χ2 value was 12.646 (P = 0.125). The model validation results indicated that the C value of 0.839(95% CI: 0.802 ~ 0.879) and Brier score of 0.139, demonstrating good consistency between predicted and actual values. CONCLUSION: The prevalence of frailty is high among elderly patients with CHD, and it is influenced by various factors such as health status, age, lack of social participation, and impaired ability of daily life. These factors have certain predictive value for identifying frailty early and intervention in elderly patients with CHD.
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Enfermedad Coronaria , Fragilidad , Evaluación Geriátrica , Humanos , Anciano , Masculino , Femenino , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/diagnóstico , Fragilidad/epidemiología , Fragilidad/diagnóstico , Medición de Riesgo/métodos , Evaluación Geriátrica/métodos , Anciano de 80 o más Años , Anciano Frágil , China/epidemiología , Nomogramas , Factores de Riesgo , Actividades Cotidianas , Persona de Mediana EdadRESUMEN
BACKGROUND: Coronary heart disease (CHD) and stroke have become the leading cause of premature mortality and morbidity worldwide. Therefore, sensitive and accurate biomarkers for early detection of CHD and stroke are urgently needed for effective prevention and treatment. We aim to investigate the association between blood-based HYAL2 methylation and the risk of CHD and stroke in Chinese population. METHODS: In a prospective nested case-control study comprising 171 CHD cases, 139 stroke cases, who developed the diseases after recruitment and 356 controls who remained healthy during the 2.5 years of follow-up time, the methylation level of HYAL2 in the peripheral blood was quantified using mass spectrometry, and the association was calculated by logistic regression adjusted for covariant. RESULTS: Significant association between HYAL2 methylation in the peripheral blood and increased risk of preclinical CHD and stroke were identified [odds ratios (ORs) per - 10% methylation: 1.35-1.64, p ≤ 0.045 for HYAL2_CpG_1, HYAL2_CpG_2 and HYAL2_CpG_3 in CHD; ORs per - 10% methylation: 0.76-1.64, p ≤ 0.033 for HYAL2_CpG_2 and HYAL2_CpG_4 in stroke]. The association in CHD was further enhanced by female gender, younger age (< 70 years old), without the history of hypertension and cancer. The combination of four HYAL2 methylation sites showed an effective discrimination of CHD and stroke cases without hypertension from controls [area under curve (AUC) = 0.78 and 0.75, respectively]. CONCLUSIONS: This study presents a strong association of altered HYAL2 methylation in peripheral blood with preclinical CHD and stroke, providing a novel biomarker for risk assessment and early detection of cardiovascular diseases.
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Biomarcadores , Enfermedad Coronaria , Metilación de ADN , Hialuronoglucosaminidasa , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Persona de Mediana Edad , Metilación de ADN/genética , Estudios de Casos y Controles , Accidente Cerebrovascular/genética , Accidente Cerebrovascular/sangre , Estudios Prospectivos , Enfermedad Coronaria/genética , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Anciano , Biomarcadores/sangre , Hialuronoglucosaminidasa/genética , Hialuronoglucosaminidasa/sangre , China , Proteínas Ligadas a GPI/genética , Proteínas Ligadas a GPI/sangre , Diagnóstico Precoz , Moléculas de Adhesión CelularRESUMEN
BACKGROUND: The incidence of coronary heart disease (CHD) in youth is rapidly increasing but difficultly recognized in the early stage. METHODS AND RESULTS: In this retrospective study, 194 CHD patients under the age of 45 who previously experienced chest pain symptoms and 170 non-CHD patients were included and demographic data were collected. Systemic inflammation index (SII) and systemic inflammation response index (SIRI) were increased in young CHD patients (p < 001). Spearman's correlation analysis showed that both SII and SIRI were negatively correlated with HDL and positively correlated with hypertension, Gensini score, and hsTnI. Logistic regression analysis indicated that SII and SIRI were independently associated with the presence of CHD in youth with chest pain symptoms. The area under the ROC curve (AUC) of the SII model for young CHD patients was 0.805 (0.728-0.869), and the sensitivity and specificity were 0.65 and 0.823, respectively. Meanwhile, the AUC for the SIRI model was 0.812 (0.739-0.872), and the sensitivity and specificity were 0.673 and 0.8022. The calibration curves of both SII and SIRI models are in good agreement with the actual curves. And the decision curves of both models indicated their clinical practicality. CONCLUSION: SII and SIRI are independent risk factors for CHD in young adults, which can quickly and effectively identify CHD patients among young adults who have previously experienced chest pain symptoms.
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Enfermedad Coronaria , Inflamación , Humanos , Masculino , Femenino , Enfermedad Coronaria/inmunología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/sangre , Estudios Retrospectivos , Inflamación/inmunología , Inflamación/sangre , Inflamación/diagnóstico , Adulto , Adulto Joven , Curva ROC , Adolescente , Factores de Riesgo , Dolor en el Pecho/inmunología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/epidemiología , Dolor en el Pecho/etiología , Biomarcadores/sangreRESUMEN
The use of 3 biomarkers - cystatin-C (Cys-C), retinol-binding protein (RBP), and ischemia-modified albumin (IMA) - for the clinical classification and outcome of coronary heart disease (CHD) has not been adequately evaluated. We explored the serum levels of these 3 markers and evaluated their diagnostic and prognostic values in patients with CHD. This retrospective case-control study, conducted between June 2017 and June 2018, included 201 patients with CHD hospitalized at the Henan Provincial People's Hospital and 127 healthy individuals from Henan Provincial People's Hospital as controls. Cys-C, RBP, IMA levels, and other laboratory parameters in the 2 groups were determined, and patient outcomes were analyzed. Cys-C, RBP, and IMA levels were higher in the case group than in the control group (Pâ <â .05). Logistic regression analysis confirmed that these 3 biomarkers were independent risk factors for CHD. Each indicator has clinical significance in the diagnosis and prognosis of CHD, with RBP being the most significant. The AUC value for CHD detection using a combination of the 3 indicators was 0.783, and the sensitivity and specificity values were 78% and 74.6%, respectively. Simultaneous detection of Cys-C, RBP, and IMA could be an optimal method for early diagnosis and prognosis of CHD.
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Biomarcadores , Enfermedad Coronaria , Cistatina C , Proteínas de Unión al Retinol , Albúmina Sérica Humana , Humanos , Masculino , Femenino , Persona de Mediana Edad , Cistatina C/sangre , Biomarcadores/sangre , Estudios Retrospectivos , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Pronóstico , Estudios de Casos y Controles , Anciano , Albúmina Sérica Humana/análisis , Proteínas de Unión al Retinol/análisis , Sensibilidad y Especificidad , China/epidemiologíaRESUMEN
Sodium is crucial for maintaining cardiovascular health, especially in relation to heart failure. The impact of baseline serum sodium concentrations on the outcomes of newly diagnosed coronary heart disease (CHD) without heart failure remains unclear. This prospective cohort study included 681 patients who were newly diagnosed with CHD. Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to assess the relationship between serum sodium concentrations and major adverse cardiovascular events. The improvement in traditional prediction models by the addition of serum sodium concentrations was assessed using changes in the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During a median follow-up of 51.04 months (IQR: 40.88-53.80 months), 131 events were recorded. Multivariate Cox proportional hazards models showed that the L2 group (136-138.9 mmol/L) had the highest MACE risk. Compared to L2, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the L1 (130-135.9 mmol/L), L3 (139-140.9 mmol/L), L4 (141-142.9 mmol/L), and L5 (143-147.0 mmol/L) groups were 0.31 (0.14-0.70, P = 0.005), 0.48 (030-0.78, P = 0.003), 0.56 (0.34-0.92, P = 0.022), and 0.37 (0.22-0.64, P < 0.001), respectively. Including serum sodium concentrations in the prediction model significantly improved the C-statistic from 0.647 to 0.679 (P = 0.022), with an NRI of 0.338 (P < 0.001) and an IDI of 0.026 (P < 0.001). RCS analysis showed a nonlinear relationship: within the 130-138 mmol/L sodium range, MACE risk gradually increased with higher sodium levels (HR 1.39, 95% CI 1.09-1.76, P = 0.008); whereas within the 138-147 mmol/L range, the risk gradually decreased (HR 0.88, 95% CI 0.80-0.98, P = 0.014). Baseline serum sodium concentrations are significantly associated with long-term cardiovascular risk in newly diagnosed CHD patients, showing an inverted U-shaped relationship, whereas low serum sodium may be specifically linked to higher risks of death and nonfatal myocardial infarction. Further research is needed to explore the impact of long-term changes in serum sodium concentrations on disease prognosis.
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Enfermedad Coronaria , Sodio , Humanos , Sodio/sangre , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Anciano , Insuficiencia Cardíaca/sangre , Modelos de Riesgos Proporcionales , Pronóstico , Factores de Riesgo , Estudios de SeguimientoRESUMEN
This JAMA Clinical Guidelines Synopsis summarizes the 2023 American Heart Association (AHA)/American College of Cardiology (ACC) guideline on management of patients with chronic coronary disease.
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Enfermedad Coronaria , Humanos , Antagonistas Adrenérgicos beta/normas , Antagonistas Adrenérgicos beta/uso terapéutico , Enfermedad Crónica , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/prevención & control , Enfermedad Coronaria/terapia , Dieta Saludable/normas , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Procedimientos Endovasculares/normas , Ejercicio Físico/normas , Inhibidores de Hidroximetilglutaril-CoA Reductasas/normas , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/normas , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico , Guías de Práctica Clínica como AsuntoRESUMEN
One of the causes of coronary heart disease (CHD) is genetic factors. In this study, we explored the relationship between CYP2D7 and TCF20 gene polymorphisms and the risk of CHD in the Han Chinese population. Three single nucleotide polymorphisms (CYP2D7 rs1800754, CYP2D7 rs2743461, and TCF20 rs760648) were selected and genotyped from 490 cases and 480 controls. The odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the association between CYP2D7 and TCF20 polymorphisms and the risk of CHD. The association between clinical indicators and polymorphisms was analyzed using one-way ANOVA and Tukey's HSD. The SNP-SNP interactions were obtained by performing multifactor dimensionality reduction (MDR). CYP2D7 rs1800754 and rs2743461 were closely associated with increased risk of CHD (alleles: p = 0.014, p = 0.031). Stratified analysis showed that CYP2D7 rs1800754 and rs2743461 were associated with an increased risk of CHD in men, age > 60 years, BMI ≥ 24, and smoking. Rs1800754 is also associated with an increased risk of CHD associated with alcohol consumption. In addition, TCF20 rs760648 was associated with a reduced risk of CHD in patients aged ≤ 60 years and with CALs. A significant association was found between CYP2D7 rs1800754 and rs2743461 genotypes and levels of UREA, Cr, and LDL-C; TCF20 rs760648 genotypes and levels of RBC. The MDR analysis showed that the three-locus interaction model was the best in the multi-locus model. In conclusion, CYP2D7 rs1800754 and rs2743461 polymorphisms were associated with CHD risk.
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Pueblo Asiatico , Enfermedad Coronaria , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido Simple , Humanos , Masculino , Persona de Mediana Edad , Femenino , Enfermedad Coronaria/genética , Enfermedad Coronaria/enzimología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/diagnóstico , Estudios de Casos y Controles , China/epidemiología , Factores de Riesgo , Anciano , Pueblo Asiatico/genética , Medición de Riesgo , Fenotipo , Consumo de Bebidas Alcohólicas/genética , Consumo de Bebidas Alcohólicas/efectos adversos , Fumar/efectos adversos , Fumar/genéticaRESUMEN
BACKGROUND: Social determinants of health (SDoH) are associated with cardiovascular risk factors and outcomes; however, they are absent from risk prediction models. We aimed to assess if the addition of SDoH improves the predictive ability of the MESA (Multi-Ethnic Study of Atherosclerosis) Risk Score. METHODS AND RESULTS: This was a community-based prospective population cohort study that enrolled 6286 men and women, ages 45-84 years, who were free of clinical coronary heart disease (CHD) at baseline. Data from 10-year follow-up were examined for CHD events, defined as myocardial infarction, fatal CHD, resuscitated cardiac arrest, and revascularization in cases of anginal symptoms. Participants included 53% women with average age of 62 years. When adjusting for traditional cardiovascular risk factors, SDoH, and coronary artery calcium, economic strain, specifically low family income, was associated with a greater risk of CHD events (hazard ratio [HR], 1.42 [95% CI, 1.17-1.71], P value<0.001). Area under the curve of risk prediction with SDoH was 0.822, compared with 0.816 without SDoH. The calibration slope was 0.860 with SDoH and 0.878 in the original model. CONCLUSIONS: Significant associations were found between economic/financial SDoH and CHD risk factors and outcomes. Incorporation of SDoH into the MESA Risk Score did not improve predictive ability of the model. Our findings do not support the incorporation of SDoH into current risk prediction algorithms.
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Enfermedad Coronaria , Determinantes Sociales de la Salud , Humanos , Femenino , Masculino , Persona de Mediana Edad , Determinantes Sociales de la Salud/etnología , Anciano , Medición de Riesgo , Estudios Prospectivos , Anciano de 80 o más Años , Estados Unidos/epidemiología , Enfermedad Coronaria/etnología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/diagnóstico , Factores de Riesgo , Valor Predictivo de las Pruebas , Factores de Riesgo de Enfermedad Cardiaca , Etnicidad/estadística & datos numéricos , PronósticoRESUMEN
Inflammatory illnesses, such as periodontitis and atherosclerotic coronary heart disease (ASCHD), trigger the production of pro-inflammatory mediators. The aim of this study was to assess the accuracy of using salivary interleukin-1ß (IL-1ß), interleukin-18 (IL-18), and gasdermin D (GSDMD) in discerning patients with periodontitis with and without ASCHD from healthy individuals, and to assess their correlation with clinical periodontal parameters and low-density lipoprotein (LDL) levels. The study involved 120 participants: 30 were healthy subjects (control group, C), 30 had generalized periodontitis (group P), 30 had ASCHD and clinically healthy periodontium (group AS-C), and 30 had ASCHD and generalized periodontitis (group AS-P). Saliva and blood samples were collected, and periodontal characteristics such as plaque index, bleeding on probing, probing pocket depth, and clinical attachment loss were examined. IL-1ß, IL-18, and GSDMD levels from saliva were determined using ELISA. LDL levels were determined from the blood samples. Groups P, AS-C, and AS-P had higher levels of salivary IL-1ß, IL-18, and GSDMD than group C. The receiver operating characteristic (ROC) curves of all biomarkers showed high diagnostic accuracy, with a significant positive correlation with the clinical parameters and LDL levels. The observed correlations between the studied pro-inflammatory mediators and disease severity suggest that these biomarkers could serve as indicators of disease progression in conditions such as periodontitis and ASCHD.
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Biomarcadores , Enfermedad Coronaria , Interleucina-18 , Interleucina-1beta , Saliva , Humanos , Biomarcadores/metabolismo , Biomarcadores/sangre , Saliva/metabolismo , Saliva/química , Interleucina-18/sangre , Interleucina-18/metabolismo , Interleucina-18/análisis , Masculino , Femenino , Interleucina-1beta/sangre , Interleucina-1beta/metabolismo , Interleucina-1beta/análisis , Persona de Mediana Edad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/metabolismo , Enfermedad Coronaria/sangre , Periodontitis/diagnóstico , Periodontitis/metabolismo , Periodontitis/sangre , Adulto , Proteínas de Unión a Fosfato/metabolismo , Curva ROC , Estudios de Casos y Controles , GasderminasRESUMEN
AIMS: To evaluate the correlation between left atrial stiffness index (LASI) and left ventricular diastolic function in patients with coronary heart disease (CHD) by Autostrain LA technique. METHODS: This was a retrospective analysis that included a total of 82 CHD patients who had suitable image quality for left atrial strain measurement. According to the 2016 ASE/EACVI guidelines for the echocardiographic assessment of diastolic dysfunction, the patients were divided into three groups: normal left ventricular diastolic function group (n = 26), indeterminate left ventricular diastolic function (n = 36), and left ventricular diastolic dysfunction (LVDD) (n = 20). The left atrial conduit strain (LAScd), Left atrial contractile strain (LASct), left atrial reservoir strain (LASr) and its derived parameters, including LASI and left atrial filling index (LAFI), were compared among the three groups. Furthermore, we conduct a correlation analysis between LASI and left ventricular diastolic function in patients with CHD. RESULTS: LASr and LAScd in normal group were higher than those in indeterminate group, LASr and LAScd in indeterminate group were higher than those in LVDD group, LASI in normal group was lower than that in indeterminate group, and LASI in indeterminate group was lower than that in LVDD group (P < 0.001). LASct in both normal and indeterminate groups was higher than that in LVDD group (P < 0.05). The LAFI of normal group was lower than that of indeterminate group and LVDD group (P < 0.001). LASI was positively correlated with E/e'(r = 0.822) (P < 0.001). LASr and E/e' were negatively correlated (r = -0.637) (P < 0.001). CONCLUSION: LASI is closely related to the changes of left ventricular diastolic function in CHD patients.
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Función del Atrio Izquierdo , Enfermedad Coronaria , Diástole , Valor Predictivo de las Pruebas , Disfunción Ventricular Izquierda , Función Ventricular Izquierda , Humanos , Femenino , Masculino , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/diagnóstico , Diagnóstico Precoz , Reproducibilidad de los Resultados , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/diagnóstico por imagenRESUMEN
AIMS: To examine the association of Life's Essential 8 (LE8) with the risk of recurrent cardiovascular events among patients with CHD. METHODS: This prospective cohort study included 11,997 patients with CHD from the UK Biobank. The LE8 score was generated using five lifestyle factors (diet, body mass index, physical activity, smoking, and sleep) and three biological factors (blood lipids, blood glucose, and blood pressure). LE8 score ranged from 0 to 100 and was categorized into quartiles. Cox proportional hazards regression models were applied to estimate the hazard ratio (HR) and 95% CI (confidence interval). RESULTS: During a median follow up of 12.5 years, we documented 3366 recurrent cardiovascular events, 1068 myocardial infarction, 1829 heart failure events, 703 strokes, and 934 cardiovascular deaths. The multivariable-adjusted HR (95% CI) for the highest versus the lowest quartile of LE8 score was 0.57 (0.50, 0.65) for recurrent cardiovascular events, 0.66 (0.52, 0.83) for myocardial infarction, 0.54 (0.45, 0.67) for heart failure, 0.50 (0.36, 0.68) for stroke, and 0.46 (0.37, 0.56) for cardiovascular death. Furthermore, the population attributable fraction of the lowest to the highest quartile of LE8 score were ranged from 16.2% to 32.5% for the various cardiovascular outcomes. In addition, biomarkers including renal function and inflammation collectively explained 47.6%-87.7% of the associations between the lifestyle factors and recurrent cardiovascular events. CONCLUSIONS: Better cardiovascular health as measured by LE8 was associated with significantly lower risk of recurrent cardiovascular events among patients with CHD. Clinicians should prioritize educating patients with CHD on the importance of optimal cardiovascular health for secondary prevention. In addition, our findings indicated significant mediation effect of biomarkers involving of glycemic control, renal function, liver function, lipid profile, and systemic inflammation on the associations between overall lifestyle factors and recurrent cardiovascular events.
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Enfermedad Coronaria , Recurrencia , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Estudios de Seguimiento , Estudios de Cohortes , Estilo de Vida , Factores de Riesgo , Reino Unido/epidemiología , Adulto , Enfermedades Cardiovasculares/epidemiologíaRESUMEN
In view of the large and sometimes conflicting body of research, this narrative review summarizes the current evidence on depression screening in patients with coronary heart disease. Depression is a risk factor for development and progression of coronary heart disease. Consequently, many international cardiac guidelines recommend screening for depression in patients with coronary heart disease. However, the efficacy and implementation of these guidelines are debated due to the lack of empirical evidence supporting the benefits of routine depression screening. Studies conducted in cardiac routine care support this assumption: Patients with positive depression screens do not receive adequate follow-up care, which highlights gaps in the detection-to-treatment pathway. Barriers to effective screening and treatment include system-level factors, such as insufficient integration of mental health resources in cardiology, and patient-related factors like stigma and low acceptance of mental health treatment. Innovative interventions that address these barriers and involve patients as active partners in depression care should be developed through a theory-driven, transparent, multistage process involving key stakeholders such as patients, nurses, and cardiologists. A sound methodological evaluation of such multilevel interventions could answer the question of whether early detection of depression in patients with coronary heart disease would lead to health benefits.
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Depresión , Tamizaje Masivo , Humanos , Tamizaje Masivo/métodos , Depresión/diagnóstico , Depresión/terapia , Medicina Basada en la Evidencia , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/psicología , Enfermedad Coronaria/complicaciones , Comorbilidad , Factores de Riesgo , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: The incidence of myocardial infarction (MI) and sudden cardiac death (SCD) is significantly higher in individuals with Type 2 Diabetes Mellitus (T2DM) than in the general population. Strategies for the prevention of fatal arrhythmias are often insufficient, highlighting the need for additional non-invasive diagnostic tools. The T-wave heterogeneity (TWH) index measures variations in ventricular repolarization and has emerged as a promising predictor for severe ventricular arrhythmias. Although the EMPA-REG trial reported reduced cardiovascular mortality with empagliflozin, the underlying mechanisms remain unclear. This study investigates the potential of empagliflozin in mitigating cardiac electrical instability in patients with T2DM and coronary heart disease (CHD) by examining changes in TWH. METHODS: Participants were adult outpatients with T2DM and CHD who exhibited TWH > 80 µV at baseline. They received a 25 mg daily dose of empagliflozin and were evaluated clinically including electrocardiogram (ECG) measurements at baseline and after 4 weeks. TWH was computed from leads V4, V5, and V6 using a validated technique. The primary study outcome was a significant (p < 0.05) change in TWH following empagliflozin administration. RESULTS: An initial review of 6,000 medical records pinpointed 800 patients for TWH evaluation. Of these, 412 exhibited TWH above 80 µV, with 97 completing clinical assessments and 90 meeting the criteria for high cardiovascular risk enrollment. Empagliflozin adherence exceeded 80%, resulting in notable reductions in blood pressure without affecting heart rate. Side effects were generally mild, with 13.3% experiencing Level 1 hypoglycemia, alongside infrequent urinary and genital infections. The treatment consistently reduced mean TWH from 116 to 103 µV (p = 0.01). CONCLUSIONS: The EMPATHY-HEART trial preliminarily suggests that empagliflozin decreases heterogeneity in ventricular repolarization among patients with T2DM and CHD. This reduction in TWH may provide insight into the mechanism behind the decreased cardiovascular mortality observed in previous trials, potentially offering a therapeutic pathway to mitigate the risk of severe arrhythmias in this population. TRIAL REGISTRATION: NCT: 04117763.
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Compuestos de Bencidrilo , Diabetes Mellitus Tipo 2 , Glucósidos , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Humanos , Compuestos de Bencidrilo/uso terapéutico , Compuestos de Bencidrilo/efectos adversos , Glucósidos/uso terapéutico , Glucósidos/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Anciano , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Resultado del Tratamiento , Factores de Tiempo , Potenciales de Acción/efectos de los fármacos , Arritmias Cardíacas/mortalidad , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/diagnóstico , Electrocardiografía , Factores de RiesgoRESUMEN
BACKGROUND: Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely. METHODS: QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes. DISCUSSION: Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery. ETHICS: Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true ).
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Rehabilitación Cardiaca , Estudios Multicéntricos como Asunto , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Mejoramiento de la Calidad/normas , Rehabilitación Cardiaca/normas , Resultado del Tratamiento , Factores de Tiempo , Indicadores de Calidad de la Atención de Salud/normas , Nueva Gales del Sur , Conducta Cooperativa , Victoria , Enfermedad Coronaria/rehabilitación , Enfermedad Coronaria/diagnóstico , Adhesión a Directriz/normas , Costos de la Atención en SaludRESUMEN
Aims/Background Coronary heart disease is a common disease in the elderly and has a complex pathogenesis, which complicates the clinical diagnostic process. Thus, enhancing the diagnostic efficiency for coronary heart disease is imperative to improve the life expectancy of the elderly. This study aimed to explore the diagnostic value of multimodal cardiovascular imaging technology coupled with biomarker detection in elderly patients with coronary heart disease. Methods The medical records of 421 patients with suspected coronary heart disease obtained from the geriatric department of the First Affiliated Hospital of Hebei North University from February 2020 to February 2023 were retrospectively analysed. After excluding 10 patients who did not meet the inclusion criteria, the remaining 411 patients were included in this study. The included subjects had undergone coronary computed tomography angiography and were divided into coronary heart disease group (n=208) and non-coronary heart disease group (n=203) according to the diagnostic results. Multimodal cardiovascular imaging (coronary computed tomography angiography and echocardiography) and detection of serum biomarkers such as small dense low-density lipoprotein, lipoprotein a, and gamma-glutamyl transferase were performed in both groups. The clinical indicators of the two groups were compared, and the combined diagnostic efficacy of multimodal cardiovascular imaging and biomarker detection was evaluated. Results Compared to the non-coronary heart disease group, the coronary heart disease group had significantly higher levels of maximum area stenosis, total plaque volume, total plaque burden and fibrotic plaque volume (p < ..001), and lower left ventricular ejection fraction level (p < ..001). Additionally, the coronary heart disease group exhibited higher levels of left ventricular end-diastolic volume, left ventricular end-systolic volume and stroke volume than the non-coronary heart disease group (p < ..001), and had higher levels of small dense low-density lipoprotein, lipoprotein a and gamma-glutamyl transferase (p < ..001). Our results demonstrated that combined diagnosis had better diagnostic efficacy than individual approaches, marked by higher area under the curve and sensitivity of the former (p < ..001). Conclusion Multimodal cardiovascular imaging technology combined with biomarker detection can distinctly improve the accuracy of coronary heart disease diagnosis in elderly patients.
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Biomarcadores , Angiografía por Tomografía Computarizada , Enfermedad Coronaria , Ecocardiografía , Imagen Multimodal , Humanos , Masculino , Anciano , Femenino , Biomarcadores/sangre , Estudios Retrospectivos , Imagen Multimodal/métodos , Angiografía por Tomografía Computarizada/métodos , Ecocardiografía/métodos , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Angiografía Coronaria , Anciano de 80 o más Años , gamma-Glutamiltransferasa/sangreRESUMEN
BACKGROUND AND AIM: To study the relationships of an Atherogenicity Index (ATI) and a Thrombogenicity Index (THI), with 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE) and cerebrovascular disease or stroke (STR), in 16 international cohorts of middle-aged men. METHODS AND RESULTS: Foods from a dietary survey in subsamples of men in each cohort of the Seven Countries Study (SCS) were chemically analyzed for several types of fatty acids that were converted into ATI and THI identifying each of 16 cohorts. Ecological correlations of the ATI and THI were calculated with the three fatal CVD conditions and with all-cause mortality at 25 and 50 years. Correlation coefficients (Rs) were positive and highly significant between ATI and THI versus CHD mortality, with levels ranging from 0.79 to 0.97, depending on the duration of follow-up and the choice of 10 or of 16 cohorts. This was not the case for HDUE and STR mortality for which Rs were variable and not significant. A strong direct association was also found with all-causes deaths at 25 and 50-years. ATI and THI were also directly related with dietary saturated fat and cholesterol levels and inversely with the Mediterranean Adequacy Index (a score identifying the Mediterranean diet). CONCLUSION: These findings indicate that CHD has a different relationship with dietary lipids intake than HDUE and STR. This suggests that HDUE and STR have different underlying pathways or are different diseases.
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Aterosclerosis , Humanos , Masculino , Persona de Mediana Edad , Estudios de Seguimiento , Factores de Tiempo , Medición de Riesgo , Adulto , Europa (Continente)/epidemiología , Aterosclerosis/mortalidad , Aterosclerosis/epidemiología , Dieta/efectos adversos , Dieta/mortalidad , Grasas de la Dieta/efectos adversos , Causas de Muerte , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/diagnóstico , Ácidos Grasos/efectos adversos , Factores de Riesgo , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Accidente Cerebrovascular/mortalidad , Trastornos Cerebrovasculares/mortalidadRESUMEN
BACKGROUND AND AIM: Accumulating evidence suggests a potential link between thyroid function with hypertension. However, the research results are limited, and there is no research to explore the relationship between central and peripheral thyroid hormones (THs) sensitivity and different grades of hypertension in patients with coronary heart disease (CHD). This study aims to prove the complex interaction between thyroid system and blood pressure, and provides new ideas for the assessment of hypertension in patients with CHD. METHODS AND RESULTS: Calculate parameters representing central and peripheral sensitivity to THs. Logistic regression analysis was used to analyze the relationship between central and peripheral THs sensitivity of CHD patients and different grades of hypertension, especially in different ages, sexes, blood glucose levels, smoking, and drinking statuses. Among the 34,310 participants, 19,610 (57.16 %) were diagnosed with hypertension. The risk of hypertension and TSHI (OR: 0.88; 95 % CI: 0.87-0.90; P < 0.001), TT4RI (OR: 0.998; 95 % CI: 0.998-0.999; P < 0.001), TFQI (OR: 0.63; 95 % CI: 0.60-0.67; P < 0.001), PTFQI (OR: 0.63; 95 % CI: 0.59-0.67; P < 0.001) was negatively associated. The risk of hypertension was positively associated with FT3/FT4 (OR: 1.20; 95 % CI: 1.17-1.22; P < 0.001). After stratified analysis, these associations remained significant at different ages, sexes, blood glucose levels, grades of hypertension, smoking, and drinking statuses (P < 0.001). CONCLUSIONS: This study shows that the decrease in central THs sensitivity index and the increase in peripheral THs sensitivity index are associated with a higher risk of hypertension in CHD patients.
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Biomarcadores , Presión Sanguínea , Hipertensión , Humanos , Masculino , Femenino , Hipertensión/fisiopatología , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/sangre , Estudios Transversales , Persona de Mediana Edad , Anciano , Factores de Riesgo , Biomarcadores/sangre , Medición de Riesgo , China/epidemiología , Hormonas Tiroideas/sangre , Glándula Tiroides/fisiopatología , Índice de Severidad de la Enfermedad , Adulto , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Tirotropina/sangreRESUMEN
BACKGROUND: Comprehensive blood lipoprotein profiles and their association with incident coronary heart disease (CHD) among racially and geographically diverse populations remain understudied. METHODS AND RESULTS: We conducted nested case-control studies of CHD among 3438 individuals (1719 pairs), including 1084 White Americans (542 pairs), 1244 Black Americans (622 pairs), and 1110 Chinese adults (555 pairs). We examined 36 plasma lipids, lipoproteins, and apolipoproteins, measured by nuclear magnetic resonance spectroscopy, with incident CHD among all participants and subgroups by demographics, lifestyle, and metabolic health status using conditional or unconditional logistic regression adjusted for potential confounders. Conventionally measured blood lipids, that is, total cholesterol, triglycerides, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol, were each associated with incident CHD, with odds ratios (ORs) being 1.33, 1.32, 1.24, and 0.79 per 1-SD increase among all participants. Seventeen lipoprotein biomarkers showed numerically stronger associations than conventional lipids, with ORs per 1-SD among all participants ranging from 1.35 to 1.57 and a negative OR of 0.78 (all false discovery rate <0.05), including apolipoprotein B100 to apolipoprotein A1 ratio (OR, 1.57 [95% CI, 1.45-1.7]), low-density lipoprotein-triglycerides (OR, 1.55 [95% CI, 1.43-1.69]), and apolipoprotein B (OR, 1.49 [95% CI, 1.37-1.62]). All these associations were significant and consistent across racial groups and other subgroups defined by age, sex, smoking, obesity, and metabolic health status, including individuals with normal levels of conventionally measured lipids. CONCLUSIONS: Our study highlighted several lipoprotein biomarkers, including apolipoprotein B/ apolipoprotein A1 ratio, apolipoprotein B, and low-density lipoprotein-triglycerides, strongly and consistently associated with incident CHD. Our results suggest that comprehensive lipoprotein measures may complement the standard lipid panel to inform CHD risk among diverse populations.