•MI occurred in 3% patients hospitalized for a gastrointestinal bleed.•Type 2 MI is more frequent than type 1 MI during a gastrointestinal bleeding.•Invasive MI management rate were very low in the ...gastrointestinal bleeding setting.•In-hospital mortality was higher with type 1 MI than with type 2 MI during a GIB.•Type 1 and type 2 MI had a similar risk for 6-month MI and related mortality.
Patients with gastrointestinal bleeding (GIB) are at an increased risk of cardiovascular events and myocardial infarction (MI). Myocardial supply-demand mismatch results in type 2 MI(T2MI) and atherosclerotic plaque rupture leads to type 1 MI(T1MI). Data comparing the prognostic impact of these MI types in GIB are sparse.
Patients hospitalized for GIB were identified in the 2019 US Nationwide Readmissions Sample. In this population, we studied the differences in management of T1MI and T2MI, and the association of these MI types with in-hospital mortality and risk for 6-month MI and MI-related mortality.
Of 444,475 patients admitted for a GIB, 12,860 (2.9%) had an MI (1.7% T2MI, 1.2% T1MI). Patients with T1MI were more likely to receive coronary angiography and revascularization than patients with T2MI. In-hospital mortality occurred in 2.0% patients, at a significantly higher rate in patients with an MI (7.9% vs 1.8%; P < 0.001), and higher with T1MI (11.9%) than T2MI (5.3%; P < 0.001). Among the survivors, 2.2% patient had an MI within 6 months, at a significantly higher rate in patients with index MI (13.1% vs 2.0%, adjusted OR 4.3 95% CI 3.83–4.90; P < 0.001). Mortality during the subsequent MI occurred in 0.3% of all patients (12% with an MI), at a 6-fold higher rate in patients with index MI (1.7% vs 0.3%; adjusted OR 3.69 95% CI 2.75–4.95; P < 0.001). The elevated risks were associated with both MI types. The risks for 6-month MI and related mortality were similar between T1MI and T2MI (6-month AMI: adjusted OR for T2MI = 1.03, 95% 0.83–1.29; fatal MI: adjusted OR for T2MI = 1.5, 95% CI 0.85–2.7).
The occurrence of an MI is associated with a substantially elevated risk for subsequent AMI and related mortality in patients hospitalized for a GIB. This future prognostic impact was similar between T1MI and T2MI.
Nowadays there is a lot of interest among the general population regarding the ketogenic diet (KD) and its health benefits. Most people following this diet have a reduced intake of carbohydrates ...which gets replaced by calories coming from fat and protein. Even though KD has shown some limited health benefits, there is no consensus on long-term effects and cardiovascular safety profile, especially the relation of KD to coronary artery disease (CAD). This concern comes predominantly from increased fat intake in KD and other similar diets with decreased carbohydrate intake. One study has shown a link between type 1 diabetes and increased coronary artery calcium scores but, in addition to many other limitations, after adjusting for other cardiovascular risk factors, the association was not significant. Results from a subanalysis of the CARDIA prospective study found that progression of CAD measured by coronary artery calcium was more pronounced in people with low-carbohydrate intake, especially when the compensatory calorie intake was from animal sources as compared to plant-based sources. In addition, other studies have tried to find a link between this type of diet and other traditional cardiovascular risk factors that have been traditionally associated with CAD, especially comparing low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (TAG) levels without clear clinical significance. Other studies found an association between KD and all-cause mortality, but no association with cardiovascular mortality. Lastly, there is an association between animal-based KD and all-cause mortality in patients who have already suffered a myocardial infarction. These findings are modified when accounting for saturated fat intake, which may give us an insight into possible mechanisms to explain these differences.
Type 2 Diabetes Mellitus (T2DM) is a pandemic that affects millions of patients worldwide. Diabetes affects multiple organ systems leading to comorbidities including hypertension. Sodium-glucose ...cotransporter 2 inhibitors (SGLT2i) recently have been approved for the treatment of T2DM and heart failure with reduced and preserved ejection fraction. Retrospective analyses of clinical trials have noted SGLT2 inhibitors to have a promising effect on blood pressure. Moreover, the observed blood pressure reduction is not just an acute effect of treatment initiation but has been shown to have a long-term impact on both systolic and diastolic blood pressure. The mechanism of action leading to the blood pressure reduction is still unclear; however, proposed mechanisms are related to the natriuretic effect, modification of the renin-angiotensin-aldosterone system, and/or the reduction in the sympathetic nervous system, SGLT2i should be considered as second-line medication in those patients with diabetes or heart disease and concomitant hypertension. This article reviews the pharmacology, side effect profile, and clinical trials surrounding the use of SGLT2i for the treatment of hypertension.
Polypills for the prevention of Cardiovascular diseases Kolte, Dhaval; Aronow, Wilbert S.; Banach, Maciej
Expert opinion on investigational drugs,
11/1/2016, 2016-Nov, 2016-11-01, 20161101, Letnik:
25, Številka:
11
Journal Article
Recenzirano
Introduction: Cardiovascular diseases (CVD) remain the leading cause of death worldwide with an estimated 17.5 million deaths per year. Since its initial conception over a decade ago, the use of ...cardiovascular polypills has gained increasing momentum as a strategy to lower risk factor levels and prevent CVD. Several new data have emerged including the recent publication of the first outcomes trial using polypills.
Areas covered: In this review, the authors summarize the current literature on the safety, efficacy, and cost-effectiveness of polypills for primary and secondary prevention of CVD, describe the current controversies in this field, and identify important areas for future research. The authors searched PubMed, CENTRAL, and ClinicalTrials.gov from inception till 25 June 2016 using the search term 'polypill.'
Expert opinion: Cardiovascular polypills containing aspirin, statin, and one or more anti-hypertensive medications, along with lifestyle interventions, represent an attractive, safe, and cost-effective strategy for primary and secondary prevention of CVD. Future research efforts should focus on identifying patients who will benefit the most from the use of polypills, marketing several polypills with different components and doses, and developing novel regulatory strategies for making polypills more readily available in all countries worldwide.
Endocardial fibroelastosis emerged as a challenging clinical phenomenon in the 1940s. It is characterized by an atypical proliferation of fibrous and elastic tissue within the heart and is primarily ...observed in childhood, occasionally displaying familial inheritance. While the precise cause remains elusive, various factors, including genetic, infectious, metabolic, autoimmune, oncologic, and medication-related influences, appear to play a role in its pathogenesis. The coexistence of endocardial fibroelastosis with multiple cardiac structural abnormalities manifests in symptoms of congestive heart failure and rhythm abnormalities. Despite its challenging diagnosis, various findings from ECG and imaging have proven beneficial in further evaluation of this condition. Finally, the treatment approach to endocardial fibroelastosis became complex due to addressing its concurrent cardiac abnormalities. Strategies for managing and preventing this condition are still under investigation. In this review, we intend to highlight the existing knowledge and illuminate future considerations regarding the etiology, diagnosis, and management of this disease.
Background
Radiotherapy (RT) is frequently associated with late cardiovascular (CV) complications. The mean cardiac dose from irradiation of a left‐sided breast cancer is much higher than that for a ...right‐sided breast cancer. However, data is limited on the long‐term risks of RT on CV mortality.
Hypothesis
RT for breast cancer is associated with long term CV mortality and left sided RT carries a greater mortality than right sided RT.
Methods
We searched PubMed, Cochrane Central, Embase, EBSCO, Web of Science, and CINAHL databases from inception through December 2015. Studies reporting CV mortality with RT for left‐ vs right‐sided breast cancers were included. The principal outcome of interest was CV mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random‐effects model.
Results
The analysis included 289 109 patients from 13 observational studies. Women who had received RT for left‐sided breast cancer had a higher risk of CV death than those who received RT for a right‐sided breast cancer (RR: 1.12, 95% CI: 1.07‐1.18, P < 0.001; number needed to harm: 353). Difference in CV mortality between left‐ vs right‐sided breast RT was more apparent after 15 years of follow‐up (RR: 1.23, 95% CI: 1.08‐1.41, P < 0.001; number needed to harm: 95).
Conclusions
CV mortality from left‐sided RT was significantly higher compared with right‐sided RT for breast cancer and was more apparent after ≥15 years of follow‐up.
The article reports on a study to evaluate the association, if any, between multiple blood pressure medications and an increased risk of mortality among elderly individuals. The results indicate that ...a relationship was observed between the two.
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