Cardiovascular risk assessment and triptans.

At least 25% of coronary patients have sudden death or nonfatal myocardial infarction without prior symptoms.1 Therefore, the search for coronary patients with subclinical disease who could potentially benefit from intensive primary prevention efforts is critically important. The American Heart Association’s (AHA) Prevention V Conference, “Beyond Secondary Prevention: Identifying the High Risk Patient for Primary Prevention,” addressed ways to identify more patients who are asymptomatic and clinically free of coronary heart disease (CHD) but at sufficiently high risk for a future coronary event to justify more intensive risk reduction efforts.2 In this report, we amplify on key findings and recommendations of the AHA Prevention V conference, highlight new research since the conference, and propose an approach to the use of office-based testing and additional noninvasive procedures in selected patients to better define their coronary event risk. The recommendations are concordant with the recently released approach to risk assessment and management from the third report of the Adult Treatment Panel of the National Cholesterol Education Program (ATP-III).3 Enthusiasm for primary prevention and risk assessment in asymptomatic people has been spurred by recent advances in prevention research. Lipid-lowering trials demonstrated that primary prevention of coronary events is feasible, evidenced by the West of Scotland Coronary Primary Prevention Study (WOSCOPS) trial4 of hypercholesterolemic men and by the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) trial5 in average or typical risk men and women with only moderate lipid abnormalities. Aspirin6 or ACE inhibitors7 can also reduce risk in selected asymptomatic, high-risk people. Emerging coronary risk factors have been described including inflammatory, infectious, and thrombotic markers,8 and there has been a steady flow of reports that focus attention on potential new ways of predicting coronary risk.9 In addition, noninvasive tests for subclinical atherosclerotic disease are available …

The purpose of the study was to investigate the associations of abdominal obesity and overall obesity with the risk of acute coronary events. Body mass index indicating overall obesity and waist-to-hip ratio and waist circumference indicating abdominal obesity were measured for 1346 Finnish men aged 42-60 years who had neither cardiovascular disease nor cancer at baseline. There were 123 acute coronary events during an average follow-up of 10.6 years. In Cox regression analyses adjusted for confounding factors, waist-to-hip ratio (P=0.009), waist circumference (P=0.010) and body mass index (P=0.013) as continuous variables were associated directly with the risk of coronary events. These associations were in part explained by blood pressure, diabetes, fasting serum insulin, serum lipids, plasma fibrinogen, and serum uric acid. Waist-to-hip ratio of > or =0.91 was associated with a nearly threefold risk of coronary events. Waist-to-hip ratio provided additional information beyond body mass index in predicting coronary heart disease, whereas body mass index did not add to the predictive value of waist-to-hip ratio. Abdominal obesity combined with smoking and poor cardiorespiratory fitness increased the risk of coronary events 5.5 and 5.1 times, respectively. Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity. Since the effect of abdominal obesity was strongest in smoking and unfit men, the strategy for lifestyle modification to prevent coronary heart disease should address these issues jointly.

P68 Obesity is an important risk factor for coronary heart disease (CHD), but the relative importance of overall and abdominal obesity is unclear. Abdominal obesity has been linked to several atherogenic disorders through which it could increase coronary risk. We investigated the associations of overall and abdominal obesity with the risk of acute coronary events and possible biological mechanisms underlying the relationships in a prospective population-based study among 1346 men aged 42-60 years in Finland. Body mass index (BMI) was used as a measure of overall obesity and waist-to-hip ratio (WHR) and waist circumference (WC) were used as measures of abdominal obesity. Data on acute coronary events were obtained by computer linkage to national hospital discharge and death certificate registers. There were 111 acute coronary events during an average follow up of 10 years. Men with the WHR of 0.91-0.94, 0.95-0.98 and >0.98 (three highest quartiles) had a 3.34-fold (95% CI 1.57-7.10, p=0.002), 2.97-fold (1.39-6.34, 0.005) and 3.40-fold (1.61-7.18, 0.001) risk of acute coronary events, respectively, compared with men with the WHR of <0.91 (lowest quartile) adjusting for confounders. Men with the WC of 83.5-89.5 cm, 90.0-95.5 cm and >95.5 cm (three highest quartiles) had a 1.29-fold (0.71-2.37), 1.70-fold (0.96-3.02) and 1.94-fold (1.10-3.40, 0.021) risk of acute coronary events compared with men with the WC of <83.5 cm (lowest quartile). These associations were partly explained by serum HDL cholesterol, triglycerides and apolipoprotein B, systolic and diastolic blood pressure, diabetes, fasting serum insulin, plasma fibrinogen and serum uric acid. BMI had a markedly weaker association with coronary risk than WHR or WC. Men with both overall and abdominal obesity (BMI ≥25.0 kg/m 2 and WHR ≥0.91) had a 4.56-fold risk of acute coronary events compared with men without obesity. This study indicates that even mild abdominal obesity is independently associated with increased risk of CHD, and that the association is partly explained by other coronary risk factors. This study also suggests that abdominal obesity has a stronger association with coronary risk than overall obesity.

No accord for the ACCORD-Lipid trial results

Introduction. There are data on the effects of dust on the respiratory system and the cardiovascular system. The main measures for preventing diseases of the circulatory system aimed to identify and eliminate risk factors. However, the prevalence of risk factors for coronary heart disease among coal mine workers with anthracosilicosis has not been sufficiently studied, determining the study's relevance. The study aimed to learn the frequency of risk factors for coronary heart disease in coal industry workers with anthracosilicosis. Materials and methods. We examined 269 miners working in conditions of dustiness exceeding the maximum permissible concentration by ten or more times: 139 miners with a previously established diagnosis of anthracosilicosis and 130 miners of the control group without dust pathology of the lungs. All of them underwent a comprehensive clinical, instrumental, and laboratory examination of the respiratory and cardiovascular systems to detect anthracosilicosis and coronary heart disease, as well as to assess its risk factors. Results. In miners with anthracosilicosis, coronary heart disease was 3.5 times more common (30.94%) than in the control group (8.46%). We have identified a high incidence of coronary heart disease in the age group of 45 and more years and with the experience of working in dust conditions of 20 and more years. In miners with anthracosilicosis combined with coronary heart disease, arterial hypertension was 1.6 times more common (58.14%) than without concomitant coronary heart disease - 35.42%. Miners with a combination of anthracosilicosis and coronary heart disease were three times more likely (20.93%) than those without coronary heart disease (6.25%) to have a metabolic syndrome. According to the Tanner index, significant risk factors for coronary heart disease were the presence of an andromorphic constitutional-morphological type and the formation of a complication of anthracosilicosis - respiratory failure. The evaluation of biochemical blood tests showed that the most significant markers of coronary heart disease risk were hyperhomocysteinemia, increased levels of C-reactive protein, fibrinogen, and soluble fibrin-monomer complexes. Conclusions. We found that the most significant risk of developing coronary heart disease in miners is 45 years and older. There are also other risk factors: work experience in harmful working conditions of 20 years or more; the presence of arterial hypertension; metabolic syndrome; andromorphic constitutional-morphological type according to the Tanner index. Risk factors are respiratory failure, hyperhomocysteinemia, hyperfibrinogenemia, increased soluble fibrin-monomer complexes, and C - reactive protein. It is necessary to consider all risks in developing programs of medical and preventive measures for employees of the coal industry.

Lifetime risk of developing coronary heart disease

The prevalence of hypercholesterolemia, according to the guidelines of the National Cholesterol Education Program, has been determined in a national survey of diabetes and glucose intolerance. Rates of elevated total cholesterol in people with diabetes in the United States are only slightly greater than in those without diabetes after adjusting for age and sex. Nevertheless, high or borderline high total cholesterol is common in diabetes and is present in 70% of adults with diagnosed diabetes and 77% with undiagnosed diabetes in the U.S. population. Of these individuals, 95% have evidence of coronary heart disease or two or more risk factors for heart disease and should therefore have their low-density lipoprotein (LDL) cholesterol measured. Based on our national data, LDL cholesterol levels warranting dietary treatment for hypercholesterolemia would be expected in 85% of these people. Although elevated LDL cholesterol is uncommon in people with diabetes who have total cholesterol of less than 200 mg/dl, other risk factors for coronary heart disease are very frequent (100% of men, 73% of women), and low total and LDL cholesterol may mask low high-density lipoprotein cholesterol. Therefore, investigation of blood lipid levels and coronary heart disease risk factors should be routine in all patients with diabetes, and treatment strategies should include management of lipid disorders and the multiple other risk factors for coronary heart disease that are highly prevalent in these patients.

Prevalence of Low High-Density Lipoprotein Cholesterol in Patients With Documented Coronary Heart Disease or Risk Equivalent and Controlled Low-Density Lipoprotein Cholesterol

Coronary Calcium Score Improves Classification of Coronary Heart Disease Risk in the Elderly: The Rotterdam Study

As solid-organ transplantation has evolved into a highly effective treatment for end-stage organ disease, the long-term health implications of chronic exposure of recipients to immunosuppressants and other pharmacological agents are becoming more apparent. Coronary heart disease has long been known to plague kidney transplant recipients and more recently has been found to affect heart transplant recipients disproportionately. Coronary heart disease after liver transplantation, however, is less well known. The purpose of this study was to examine risk factors for premature coronary heart disease in asymptomatic adult recipients of liver transplants. Nutrition-related risk factors for coronary heart disease (obesity and hyperlipidemia) were measured in 29 patients before and after liver transplantation. Changes with respect to primary immunosuppression protocol (cyclosporine plus corticosteroid vs tacrolimus plus corticosteroid) were compared. Risk factors that had not been present before transplantation were apparent in both groups by 6 months after transplantation. Although obesity and hyperlipidemia were not found to be independent risk factors for coronary heart disease, they were clinically important when considered in combination. Cyclosporine was associated with significantly higher serum lipid concentrations than was tacrolimus.

Background: Anxiety disorders are common, but their role in cardiovascular risk is underrecognized. Traditional risk factors for coronary heart disease (CHD), such as hypertension and diabetes, are well established, but anxiety may independently influence future heart disease. Emerging evidence suggests anxiety can predict events such as myocardial infarction. We aimed to quantify the association between anxiety disorders and the risk of developing CHD in adults without prior heart disease. Hypothesis and Objectives: We hypothesized that anxiety disorders increase CHD incidence and aimed to determine whether anxiety is an independent risk factor for heart disease. We also examined anxiety subtypes such as generalized anxiety disorder (GAD) and post-traumatic stress disorder (PTSD) for differential associations with CHD. Methods: We conducted a systematic review and meta-analysis. We searched MEDLINE, Scopus, Embase, and Google Scholar for English-language studies from 2010 to 2023. Eligible studies included adults with anxiety (diagnosed by standardized criteria) and measured incident CHD outcomes in individuals free of CHD at baseline. Two reviewers independently extracted data. A random-effects meta-analysis estimated pooled hazard ratios with 95% confidence intervals; heterogeneity was assessed by I2 statistic. Results: A total of ten studies (n=546,802) met inclusion criteria. The pooled hazard ratio for incident CHD (primarily myocardial infarction) in participants with anxiety versus without anxiety was 1.35 with a 95% confidence interval of 1.20–1.52 (p<0.001), indicating a significant association. Subgroup analysis identified generalized anxiety disorder and post-traumatic stress disorder as anxiety subtypes most strongly linked to higher CHD risk. Statistical heterogeneity was moderate (I2=39%, p=0.11). Most studies adjusted for traditional cardiovascular risk factors. Conclusions: These findings provide strong evidence that anxiety disorders, particularly GAD and PTSD, are independently associated with higher CHD risk. Integrating mental health assessment with cardiovascular prevention could help identify modifiable risk factors. We conclude that addressing anxiety may be important in CHD prevention strategies.

The Framingham Heart Study has contributed importantly to understanding of the causes of coronary heart disease (CHD), stroke, and other cardiovascular diseases. Framingham research has helped define the quantitative and additive nature of these causes or, as they are now called, “cardiovascular risk factors.”1 The National Cholesterol Education Program (NCEP)2 3 has made extensive use of Framingham data in developing its strategy for preventing CHD by controlling high cholesterol levels. The NCEP guidelines2 3 adjust the intensity of cholesterol-lowering therapy with absolute risk as determined by summation of risk factors. The National High Blood Pressure Education Program (NHBPEP) has set forth a parallel approach for blood pressure control. In contrast to the NCEP,2 however, earlier NHBPEP reports issued through the Joint National Committee4 did not match the intensity of therapy to absolute risk for CHD. “Normalization” of blood pressure is the essential goal of therapy regardless of risk status. Blood pressure–lowering therapy is carried out as much for prevention of stroke and other cardiovascular complications as for reduction of CHD risk. Nonetheless, risk assessment could be important for making decisions about type and intensity of therapy for hypertension. Thus, the most recent Joint National Committee report5 gives more attention to risk stratification for adjustment of therapy for hypertension. Although Framingham data have already been influential in the development of national guidelines for risk factor management, the opportunity may exist for both cholesterol and blood pressure programs to draw more extensively from Framingham results when formulating improved risk assessment guidelines and recommending more specific strategies for risk factor modification. The American Heart Association has previously used Framingham risk factor data to prepare charts for estimating CHD risk. Framingham investigators of the National Heart, Lung, and Blood Institute prepared the original charts and have now revised …

For a prospective study of risk factors for coronary heart disease (CHD), defined as acute nonfatal myocardial infarction and acute fatal CHD, 973 men, all aged 50 years, were recruited from a general Swedish urban population. Of the 855 who agreed to participate, 834 who showed no signs of CHD were selected and observed for nine years and four months. Autopsies were performed on all except two of the 55 patients who died during the study. Forty-four men developed clinical manifestations of CHD during this time; 19 of them died. Using a multiple logistic model, we analyzed nine probable risk factors. The presence of high serum cholesterol, smoking, high systolic blood pressure, dyspnea, and registration by the Temperance Board increased the risk of events related to CHD significantly. The presence of high serum triglycerides, high hematocrit readings, and increased geographic mobility did not cause a significant increase in events related to CHD. Those with sedentary jobs showed a slightly increased tendency to develop manifestations of the disease. The predictive power of the logistic function (with cholesterol, smoking, and systolic blood pressure) was tested in another randomly selected population sample of 5,146 men aged 51-55 years and found to be very accurate. The 10% (decile) of the population that had the highest risk of clinical manifestations of coronary disease and the 10% who had the lowest risk were defined. Manifestations of coronary disease occurred 29 times more frequently in the highest decile than in the lowest decile.

903 CHARLSON COMORBIDITY INDEX IS NOT AN INDEPENDENT PREDICTOR OF OVERALL SURVIVAL IN PATIENTS WITH INTERMEDIATE AND HIGH RISK PROSTATE CANCER TREATED WITH RADICAL PROSTATECTOMY

ABSTRAK Plak ateroklerosis menyebabkan penyakit jantung koroner, yang menjadi penyebab kematian kedua di negara berkembang. Penyakit jantung koroner menyebabkan 17,9 juta kematian pada tahun 2016—31% dari semua kematian di seluruh dunia. Lebih dari tiga perempat kasus kematian di negara berkembangan disebabkan oleh penyakit jantung dan pembuluh darah. Aktivitas fisik yang berlebihan, stres, udara yang dingin, pola hidup yang kurang sehat, dan riwayat penyakit jantung dari keluarga adalah faktor risiko penyakit jantung koroner. Risiko penyakit jantung koroner meningkat pada penderita yang memiliki banyak faktor risiko penyakit jantung. Oleh karena itu, individu dengan faktor risiko ini disarankan melakukan deteksi dini dengan pemeriksaan rekam jantung secara berkala untuk mencegah dan apabila ditemukan gangguan irama jantung, penderita dapat melakukan pemeriksaan lanjutan berdasarkan gejala klinis dan hasil rekam jantung. Kegiatan pengabdian bertujuan untuk deteksi dini penyakit jantung koroner melalui pemeriksaan rekam jantung pada sivitas akademika Universitas Khairun. Metode yang dilakukan adalah pemeriksaan rekam jantung dan melakukan tanya jawab terkait keluhan yang dirasakan saat diperiksa. Hasil yang didapatkan dari kegiatan ini tedapat 14 orang yang memiliki hasil rekam jantung yang bervariasi. Dari kegiatan perlu adanya pemantauan berkala terhadap risiko penyakit jantung koroner agar dapat mencegah terjadinya penyakit jantung dan meningkatkan kualitas kerja sivitas akademika Universitas Khairun. Kata Kunci: Deteksi Dini, Penyakit Jantung Koroner, Pemeriksaan Rekam Jantung ABSTRACT Plaque atherosclerosis causes coronary heart disease, which is the second leading cause of death in developing countries. Coronary heart disease caused 17.9 million deaths in 2016-31% of all deaths worldwide. More than three-quarters of deaths in developing countries are caused by heart and vascular diseases. Excessive physical activity, stress, cold weather, unhealthy lifestyle, and family history of heart disease are risk factors for coronary heart disease. The risk of coronary heart disease increases in patients who have many risk factors for heart disease. Therefore, individuals with these risk factors are advised to do early detection with regular heart record checks to prevent and if heart rhythm disturbances are found, patients can undergo further examination based on clinical symptoms and heart record results. The service activity aims to early detection of coronary heart disease through electrocardiogram checks in the academic community of Khairun University. The method used was heart record examination and questioning related to complaints felt when examined. The results obtained from this activity were 14 people who had varying electrocardiogram results. From the activity, it is necessary to periodically monitor the risk of coronary heart disease in order to prevent the occurrence of heart disease. Keywords: Early Detection, Coronary Heart Disease, Electrocardiogram Examination