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Genetic Risk Score of NOS Gene Variants Associated with Myocardial Infarction Correlates with Coronary Incidence across Europe  

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Coronary artery disease (CAD) mortality and morbidity is present in the European continent in a four-fold gradient across populations, from the South (Spain and France) with the lowest CAD mortality, towards the North (Finland and UK). This observed gradient has not been fully explained by classical or single genetic risk factors, resulting in some cases in the so called Southern European or Mediterranean paradox. Here we approached population genetic risk estimates using genetic risk scores (GRS) constructed with single nucleotide polymorphisms (SNP) from nitric oxide synthases (NOS) genes. These SNPs appeared to be associated with myocardial infarction (MI) in 2165 cases and 2153 controls. The GRSs were computed in 34 general European populations. Although the contribution of these GRS was lower than 1% between cases and controls, the mean GRS per population was positively correlated with coronary incidence explaining 65–85% of the variation among populations (67% in women and 86% in men). This large contribution to CAD incidence variation among populations might be a result of colinearity with several other common genetic and environmental factors. These results are not consistent with the cardiovascular Mediterranean paradox for genetics and support a CAD genetic architecture mainly based on combinations of common genetic polymorphisms. Population genetic risk scores is a promising approach in public health interventions to develop lifestyle programs and prevent intermediate risk factors in certain subpopulations with specific genetic predisposition. PMID:24806096

Carreras-Torres, Robert; Kundu, Suman; Zanetti, Daniela; Esteban, Esther

2014-01-01

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Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction  

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Background: Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. Method: We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m2), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ? 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. Results: Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. Conclusion: We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients. PMID:25356178

Omer, Gedikli; Gokhan, Aksan; Adem, Uzun; Sabri, Demircan; Korhan, Soylu

2014-01-01

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Validation of grace risk score in predicting in-hospital mortality in patients with non ST-elevation myocardial infarction and unstable angina  

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Objective: To validate the global registry of acute coronary event (grace) risk score in a Pakistani population at Tabba Heart Institute Karachi in patients with non ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA). Methods: In this prospective Observational registry study, 530 adults hospitalized patients with a diagnosis of Non-ST-Elevation Myocardial Infarction and unstable angina were enrolled between March 2012 and August 2012 at the Tabba Heart Institute, Karachi, Pakistan. For each patient, the grace risk score was calculated and its discrimination evaluated and correlated with in-hospital mortality using the Kendall's tau-b bivariate correlation test. Each patient was grouped either into high, intermediate or low risk groups according to their GRS. Results: A total of 530 patients with NSTEMI and UA were included; the overall mean grace risk score in our population wa+-41.56. The GRACE Risk Score showed good discrimination, with Area under the ROC curve of 0.803 (95% CI 0.705-0.902, P < 0.001). During the in-hospital stay, total of 19 (3.6%) patients died, and out of those 15 (8.4%) patients belonged to high risk group. Conclusion: GRACE RS strongly validates the in-hospital mortality among our patient population presenting with a wide spectrum of complications. However, more multicentre registries on a larger population with long term follow up are required to study detailed trends in our population. (author)

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Comparison of prognostic value of echographic [corrected] risk score with the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry in Acute Coronary Events (GRACE) risk scores in acute coronary syndrome.  

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Risk stratification in patients with acute coronary syndromes (ACS) is achieved today by clinical models, "blind" to the prognostic support of imaging methods. To assess the value of simple at rest cardiac chest sonography in predicting the intra- and extrahospital risk of death or myocardial infarction, we enrolled 470 consecutive in-patients (312 men, age 71 ± 12 years) who had been admitted for ACS. On admission, all had received a clinical score using the Global Registry in Acute Coronary Events and Thrombolysis in Myocardial Infarction systems and, within 1 to 12 hours, a comprehensive cardiac-chest ultrasound scan. Each of the 16 echocardiographic parameters evaluating left and right, systolic and diastolic, ventricular function and structure, was scored from 0 (normal) to 3 (severely abnormal). The median follow-up was 5 months (interquartile range 1 to 10). Patients with hard events (n = 102) could be separated from patients without events (n = 368) using the Global Registry in Acute Coronary Events score, Thrombolysis in Myocardial Infarction score, and several echocardiographic parameters. On multivariate Cox analysis, ejection fraction (hazard ratio 1.45, 95% confidence interval 1.02 to 2.08, p = 0.040), tricuspid annular plane systolic excursion (hazard ratio 1.66, 95% confidence interval 1.13 to 2.45, p = 0.010) and ultrasound lung comets (hazard ratio 1.69, 95% confidence interval 1.25 to 2.27, p = 0.001) were independent predictors of cardiac events. The 3-variable echocardiographic score (from 0, normal to 9, severe abnormalities in ejection fraction, ultrasound lung comets, and tricuspid annular plane systolic excursion) effectively stratified patients and added value (hazard ratio 2.52, 95% confidence interval 1.89 to 3.37, p <0.0001) to the Global Registry in Acute Coronary Events score (hazard ratio 1.60, 95% confidence interval 1.07 to 2.39, p = 0.003). In conclusion, for patients with ACS, effective risk stratification can be achieved with cardiac and chest ultrasound imaging parameters, adding prognostic value to the clinical risk scores. PMID:21126614

Bedetti, Gigliola; Gargani, Luna; Sicari, Rosa; Gianfaldoni, Maria Luisa; Molinaro, Sabrina; Picano, Eugenio

2010-12-15

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Coronary artery calcium scoring in myocardial infarction  

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Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) Somatom Volume Zoom Siemens, and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of pa are relatively poor in large number of patients. (author)

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Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction  

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Background The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI. Methods We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by ?2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed ?2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles. PMID:25029471

Correia, Luis C. L.; Garcia, Guilherme; Kalil, Felipe; Ferreira, Felipe; Carvalhal, Manuela; Oliveira, Ruan; Silva, Andre; Vasconcelos, Isis; Henri, Caio; Noya-Rabelo, Marcia

2014-01-01

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Usefulness of the CHADS2 Score for Prognostic Stratification of Patients With Acute Myocardial Infarction.  

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The Thrombolysis In Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS2 score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS2 score for 747 consecutive patients with AMI. The study end point was the combined occurrence of MACE, including death, nonfatal myocardial infarction, and ischemic stroke. All patients were followed up for at least 3 years or until the occurrence of a major event. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of each score at different time points. Higher CHADS2 scores were associated with adverse outcome at discharge and 1-year and 3-year follow-ups (chi-square test for linear trend, p <0.001). Both CHADS2 score and GRACE RS demonstrated better discrimination than TIMI RS in predicting 1-year and 3-year MACE (p <0.001). Multivariate Cox regression analysis revealed that the CHADS2 score was an independent predictor of future MACE in patients with AMI (hazard ratio 1.349, 95% confidence interval 1.196 to 1.522). In conclusion, the CHADS2 score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI. PMID:25205632

Huang, Shao-Sung; Chen, Ying-Hwa; Chan, Wan-Leong; Huang, Po-Hsun; Chen, Jaw-Wen; Lin, Shing-Jong

2014-11-01

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Greek stroke score, Siriraj score and allen score in clinical diagnosis of intracerebral hemorrhage and infarct: Validation and comparison study  

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Full Text Available AIM: To compare Greek stroke score with available previous two stroke scores for the diagnosis of cerebral ischemia and hemorrhage in acute stroke patients, and validate the Greek stroke score. SETTING: A tertiary hospital in India. MATERIALS AND METHODS: In a prospective study acute stroke patients were evaluated with Greek stroke score, Allen score and Siriraj stroke score. Comparability (Kappa Statistics and validity (sensitivity, specificity, negative predictive value and positive predictive value of the Greek stroke score and previous scores were tested. RESULT: Out of the 91 patients enrolled in the study, 47 patients had cerebral infarction and 44 patients had hemorrhage by CT scan. Allen score was uncertain / equivocal in 39 patients, Siriraj Stroke score in 22 and Greek stroke score in 47 patients. Sensitivity, Specificity, positive predictive value, negative predictive value for Allen score were 0.5(95% CI:0.34,0.58, 0.94(95% CI:0.86,0.98, 0.81(95% CI:0.56,0.95, 0.78(95% CI: 0.71,0.81 for Siriraj score were 0.75(95% CI: 0.63,0.84, 0.81(95% CI: 0.71,0.89, 0.77(95% CI: 0.65,0.86, 0.78(95% CI 0.69,0.86 and for Greek Score were 0.42(95% CI: 0.23,0.53, 0.93(95% CI: 0.87,0.98, 0.71(95% CI:0.39,0.91, 0.81(95% CI:0.75,0.85 respectively. Greek stroke score was compared with previous scores using kappa statistics which revealed substantial strength of agreement between the Allen Score for certain results. CONCLUSION: The overall comparability of Greek stroke score and Allen score was better as compared to Greek stroke score and Siriraj stroke score. Greek Stroke score was more specific in diagnosing hemorrhage as compared to Siriraj score. However, all these stroke scores lack accuracy hence could not be applied safely to guide the physician in management of stroke.

Soman Aamod

2004-10-01

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Cardiac risk stratification: Role of the coronary calcium score  

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Full Text Available Rakesh K Sharma1, Rajiv K Sharma1, Donald J Voelker1, Vibhuti N Singh2, Deepak Pahuja3, Teresa Nash1, Hanumanth K Reddy11Medical Center of South Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Bayfront Medical Center, St Petersburg, Florida; 3Saint Vincent Health Center, Erie, PA, USAAbstract: Coronary artery calcium (CAC is an integral part of atherosclerotic coronary heart disease (CHD. CHD is the leading cause of death in industrialized nations and there is a constant effort to develop preventative strategies. The emphasis is on risk stratification and primary risk prevention in asymptomatic patients to decrease cardiovascular mortality and morbidity. The Framingham Risk Score predicts CHD events only moderately well where family history is not included as a risk factor. There has been an exploration for new tests for better risk stratification and risk factor modification. While the Framingham Risk Score, European Systematic Coronary Risk Evaluation Project, and European Prospective Cardiovascular Munster study remain excellent tools for risk factor modification, the CAC score may have additional benefit in risk assessment. There have been several studies supporting the role of CAC score for prediction of myocardial infarction and cardiovascular mortality. It has been shown to have great scope in risk stratification of asymptomatic patients in the emergency room. Additionally, it may help in assessment of progression or regression of coronary artery disease. Furthermore, the CAC score may help differentiate ischemic from nonischemic cardiomyopathy.Keywords: coronary calcium scoring, coronary artery disease, CAC, cardiomyopathy, angiography, chest pain, Framingham, risk stratification, risk factors

Rakesh K Sharma

2010-07-01

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Scoring systems in high risk pregnancy.  

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Antenatal care serves the purpose of screening malformations and detecting treatable medical conditions as well as identifying high risk pregnancies (HRP). HRP scoring systems require reliable statistics, well-defined objectives, the definition of high risk conditions, and the recognition of the capabilities of these systems. Primary care doctors can take advantage of the modified Al-Zahraa University (Z.U.H.) high risk score for prenatal risk assessing cardiovascular, renal, and metabolic history as well as anatomic abnormalities; the modified Bishop scoring system for assessment of the state of the uterine cervix (1964); the Zatuchni-Andros criteria for scoring of breech delivery (1967); the fetal heart rate tracing score as modified later Kaar to predict feto-placental functions (1980); and the biophysical profile scoring technique. Secondary and tertiary care doctors are recommended to use scores relating to maternal factors, placental factors, and fetal factors in addition to the modified Z.U.H. high risk score. The Apgar score is used for the assessment of the newborn after delivery. These scoring systems are not perfect, as false positives and false negatives do occur that could be minimized by finer screening using clinical tests. PMID:12317329

Fatouh, A A; Fakhr, M M

1991-01-01

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Difference in MRI findings and risk factors between multiple infarction without dementia and multi-infarct dementia  

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MRI findings and risk factors for vascular dementia were evaluated with multi-variate analysis in 96 multi-infarct patients without dementia and 40 multi-infarct patients with dementia (MID). Only subjects with small infarcts in the territory of the perforator artery or deep white matter were studied. The diagnosis of MID was diagnosed according to DMS-III criteria and Hachinski's ischemia score. Location and area of patchy high-intensity areas including small infarcts, the degree of periventricular high intensity (PVH), and the degree of brain atrophy were examined with MR images. Independent variables were: history of hypertension, diabetes mellitus, other complications; systolic and diastolic blood pressure, atherosclerotic index, hematocrit, history of smoking, level of education, and activities of daily life (ADL). Hayashi's quantification method II was used to analyze the data. The most significant correlation was found between history of hypertension and dementia (partial correlation coefficient: 0.39). Significant correlations were also found between ADL and dementia (0.32), between thalamic infarction and dementia (0.31), and between PVH and dementia (0.27). Age, brain atrophy index, and history of diabetes mellitus contributed little to dementia. The contribution to dementia did not differ significantly between right and left patchy high-intensity areas on MR images. Location of infarcts, except for bilateral thalamic infarcts and large PVH, contributed little to dementia. Thus it would be difficult to base a prediction of the prevalence of vascular dementia on MRI findings. However, both hypertention and ADL contribute to vascular dementia and both are treatable, which may be significant for the prevention of dementia. (author)

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Leukocytosis: a risk factor for myocardial infarction  

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Full Text Available Suman K KotlaDepartment of Internal Medicine, Memorial Medical Center, Johnstown, PA, USAAbstract: Myocardial infarction commonly results from atherosclerotic lesions in the coronary arteries. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic disease. In this case report, we present an unusual leukostatic complication in a patient with acute myeloblastic leukemia and extreme hyperleukocytosis who presented with an acute myocardial infarction that resolved after leukopheresis. Myocardial infarction as the initial presentation of acute leukemia has been reported only rarely.Keywords: leukocytosis, myocardial infarction, leukostasis

Kotla SK

2012-05-01

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Greek stroke score, Siriraj score and allen score in clinical diagnosis of intracerebral hemorrhage and infarct: Validation and comparison study  

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AIM: To compare Greek stroke score with available previous two stroke scores for the diagnosis of cerebral ischemia and hemorrhage in acute stroke patients, and validate the Greek stroke score. SETTING: A tertiary hospital in India. MATERIALS AND METHODS: In a prospective study acute stroke patients were evaluated with Greek stroke score, Allen score and Siriraj stroke score. Comparability (Kappa Statistics) and validity (sensitivity, specificity, negative predictive value and positive predic...

Soman Aamod; Joshi Shashank; Tarvade Sanjay; Jayaram S

2004-01-01

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Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months  

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Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. There was a statistically significant association between all sites of infarction (P = 0.0001-0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001-0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24-10.74), with 'bilateral infarctions' 8.50 (CI 2.49-28.59), with basal ganglia infarction 5.73 (CI 2.60-12.64), and for hemispheric infarction 2.30 (CI 1.00-5.28). Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT. (orig.)

Andronikou, Savvas [University of Stellenbosch, Department of Radiology, Tygerberg Hospital, P.O. Box 19063, Tygerberg (South Africa); Wilmshurst, Jo; Hatherill, Mark [University of Cape Town, Pediatric Neurology, Red Cross Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); VanToorn, Ronald [University of Stellenbosch, Department of Pediatric Neurology, Tygerberg Hospital, Cape Town (South Africa)

2006-12-15

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Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months  

International Nuclear Information System (INIS)

Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. There was a statistically significant association between all sites of infarction (P = 0.0001-0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001-0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24-10.74), with 'bilateral infarctions' 8.50 (CI 2.49-28.59), with basal ganglia infarction 5.73 (CI 2.60-12.64), and for hemispheric infarction 2.30 (CI 1.00-5.28). Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT. (orig.)

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Comparison of the Prognostic Value of an Echographic Risk Score with the TIMI and the GRACE Risk Scores in Acute Coronary Syndrome  

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Risk stratification in patients with acute coronary syndromes (ACS) is achieved today by clinical models, "blind" to the prognostic support of imaging methods. To assess the value of simple at rest cardiac chest sonography in predicting the intra- and extrahospital risk of death or myocardial infarction, we enrolled 470 consecutive in-patients (312 men, age 71 ± 12 years) who had been admitted for ACS. On admission, all had received a clinical score using the Global Registry in Acute Coronar...

Bedetti, Gigliola; Gargani, Luna; Sicari, Rosa; Gianfaldoni, Maria Luisa; Molinaro, Sabrina; Picano, Eugenio

2010-01-01

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Irregularly shaped lacunar infarction: risk factors and clinical significance / Infartos lacunares com morfologia irregular: fatores de risco e significado clinico  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese Objetivo Estudar as diferentes formas dos infartos lacunares agudos, investigando os fatores de risco e o significado clinico daqueles com morfologia irregular. Métodos Os 204 pacientes com infartos lacunares agudos foram classificados em dois grupos: aqueles com morfologia regular e aqueles com [...] morfologia irregular. Foram estudadas as características dos dois grupos e caracterizados os fatores de risco para infartos irregulares, deterioração neurológica e altos escores da escala de Rankin modificada. Resultados Variabilidade da pressão arterial é fator de risco independente para infartos lacunares irregulares. Tamanho do infarto, prevalência de leucoaraiose e formato irregular dos infartos lacunares são fatores de risco independentes para escores mais elevados na escala de Rankin modificada. Conclusões Variabilidade da pressão arterial está relacionada ao formato irregular dos infartos lacunares agudos. Este tipo de infarto e a leucoaraiose podem estar relacionado a desfechos clínicos desfavoráveis. Abstract in english Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. T [...] he characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.

Chao, Feng; Yu, Xu; Ting, Hua; Xue-Yuan, Liu; Min, Fang.

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Irregularly shaped lacunar infarction: risk factors and clinical significance / Infartos lacunares com morfologia irregular: fatores de risco e significado clinico  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Objetivo Estudar as diferentes formas dos infartos lacunares agudos, investigando os fatores de risco e o significado clinico daqueles com morfologia irregular. Métodos Os 204 pacientes com infartos lacunares agudos foram classificados em dois grupos: aqueles com morfologia regular e aqueles com [...] morfologia irregular. Foram estudadas as características dos dois grupos e caracterizados os fatores de risco para infartos irregulares, deterioração neurológica e altos escores da escala de Rankin modificada. Resultados Variabilidade da pressão arterial é fator de risco independente para infartos lacunares irregulares. Tamanho do infarto, prevalência de leucoaraiose e formato irregular dos infartos lacunares são fatores de risco independentes para escores mais elevados na escala de Rankin modificada. Conclusões Variabilidade da pressão arterial está relacionada ao formato irregular dos infartos lacunares agudos. Este tipo de infarto e a leucoaraiose podem estar relacionado a desfechos clínicos desfavoráveis. Abstract in english Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. T [...] he characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.

Chao, Feng; Yu, Xu; Ting, Hua; Xue-Yuan, Liu; Min, Fang.

2013-10-01

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Risk Factors And Seasonal-Diurinal Variatons In Lacunar Infarctions  

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Lacunar infarctions are deeply located ischemic infarctions smaller than 1.5 cm in diameter. Patients hospitalized in our neurology clinic in between 2001 and 2005 with signs of lacunar infarction and in whom diagnosis were confirmed with neuroimaging studies, were included in this study. Risk factors and time of symptom-onset were re-evaluated by use of phone calls with them and/or their relatives. Eighty-one patients with mean age of 64.6 were involved in the study. Forty-three of them (%53...

Alemdar, Murat; Iseri, Pervin; Kamaci, Senol; Efendi, Husnu; Budak, Faik; Komsuoglu, Sezer Sener

2006-01-01

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Perioperative Anaphylactic Risk Score For Risk-Oriented Premedication  

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Basing on the current knowledge, this paper is aimed to review the core characteristics of the most relevant therapeutic agents (steroids and antihistamines), administered to prevent perioperative anaphylaxis. Moreover, the Authors propose the validation of a Global Anaphylactic Risk Score, built up by recording the individual scores related to the most relevant anaphylaxis parameters (i.e. medical history, symptoms and medication for asthma, rhinitis and urticaria etc) and by adding them on all together; the score could be used in the preoperative phase to evaluate the global anaphylactic risk and to prescribe risk-oriented premedication protocols. PMID:24251246

Manfredi, Giacomo; Pezzuto, F.; Balestrini, A.; Lo Schiavo, M.; Montera, M.C.; Pio, A.; Iannelli, M.; Gargano, D.; Bianchi, M.J.; Casale, G.; Galimberti, M.; Triggiani, M.; Piazza, O.

 
 
 
 
21

Heart rate turbulence as risk-predictor after myocardial infarction  

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Full Text Available Heart Rate Turbulence (HRT is the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes (VPC. HRT is composed of a brief heart rate acceleration followed by a gradual heart rate deceleration. In high risk patients after myocardial infarction (MI HRT is blunted or diminished. Since its first description in 1999 HRT emerged as one of the most potent risk factors after MI. Predictive power of HRT has been studied in more than 10,000 post-infarction patients. This review is intended to provide an overview of HRT as risk predictor after MI.

ChristineStefanieZuern

2011-12-01

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Clinical discriminators between acute brain hemorrhage and infarction: a practical score for early patient identification  

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Full Text Available New treatments for acute stroke require a rapid triage system, which minimizes treatment delays and maximizes selection of eligible patients. Our aim was to create a score for assessing the probability of brain hemorrhage among patients with acute stroke based upon clinical information. Of 1805 patients in the Stroke Data Bank, 1273 had infarction (INF and 237 had parenchymatous hemorrhage (HEM verified by CT. INF and HEM discriminators were determined by logistic regression and used to create a score. ROC curve was used to choose the cut-point for predicting HEM (score <= 2, with sensitivity of 76% and specificity of 83%. External validation was done using the NOMASS cohort. Although the use of a practical score by emergency personnel cannot replace the gold-standard brain image differentiation of HEM from INF for thrombolytic therapy, this score can help to select patients for stroke trials and pre-hospital treatments, alert CT scan technicians, and warn stroke teams of incoming patients to reduce treatment delays.

Massaro Ayrton R.

2002-01-01

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Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention.  

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Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction (NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention (PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed. PMID:25228966

Brogan, Richard A; Malkin, Christopher J; Batin, Phillip D; Simms, Alexander D; McLenachan, James M; Gale, Christopher P

2014-08-26

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The Role of Unknown Risk Factors in Myocardial Infarction  

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Full Text Available Objectives: To evaluate risk factors in myocardial infarction like age, sex, smoking, diabetes mellitus, hyperlipidemia, hypertension, positive family history, high level of cholesterol, stress and poor physical activity.Methods: This is a retrospective study on 163 myocardial infarction cases, conducted in the cardiology ward and CCU at a General Public Hospital, Baroda. A number of risk factors identified and evaluated in these patients included: hyperlipidemia, hypertension, diabetes mellitus, smoking, physical activity, stress, age, and sex.  Results: The majority of our patients were old men in the age range of 60 - 69 years. Amongst all patients 36.7% were smokers, 61.3% were type A personality group, 18.5% were active, 81.5% were physically inactive, 28.9% had hypertension, 23.3% were diabetic, 17.5% had hyperlipidemia and 33.2% had positive family history of myocardial infarction.Conclusions: In regard of increasing rate of cardiovascular diseases and myocardial infarction even amongst the young population, and because of considerable need to improve vascular risk detection, much research over the past decade has focused on identification of novel atherosclerotic risk factors, and some of these new risk factors are identified and some may be unknown. Amongst the new risk factors, inflammation has an important role, other risk factors that must be assessed are homocysteine, serum amyloid. So we recommend that governments and heart associations must introduce new plans and policies in order to tackle the problem and reduce the frequency of cardiovascular disease. This requires the understanding of the conventional or classic risk factors and also the less known and new risk factors and ways which they may be prevented. 

Nita A Tanna

2013-07-01

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Class of Antiretroviral Drugs and the Risk of Myocardial Infarction  

DEFF Research Database (Denmark)

BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction. METHODS: We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined. RESULTS: Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively. CONCLUSIONS: Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors. Copyright 2007 Massachusetts Medical Society. Udgivelsesdato: Apr 26

Friis-MØller, Nina; Reiss, P.

2007-01-01

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Postoperative myocardial infarction and cardiac death. Predictive value of dipyridamole-thallium imaging and five clinical scoring systems based on multifactorial analysis.  

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Sixty-six patients unable to complete a standard preoperative exercise test because of physical limitations were studied to determine the predictive value of individual clinical parameters, of clinical scoring systems based on multifactorial analysis, and of dipyridamole-thallium imaging before major general and vascular surgery. Study endpoints were limited to postoperative myocardial infarction or cardiac death before hospital discharge. There were nine postoperative cardiac events (seven deaths and two nonfatal infarctions). There was no statistical correlation between cardiac events and preoperative clinical descriptors, including individual clinical parameters, the Dripps-American Surgical Association score, the Goldman Cardiac Risk Index score, the Detsky Modified Cardiac Risk Index score, Eagle's clinical markers of low surgical risk, and the probability of postoperative events as determined by Cooperman's equation. There were no cardiac events in 30 patients with normal dipyridamole-thallium scans or in nine patients with fixed myocardial perfusion defects. Of 21 patients with reversible perfusion defects who underwent surgery, nine had a postoperative cardiac event (sensitivity, 100%; specificity, 43%). In the six other patients with reversible defects, preoperative angiography showed severe coronary disease or cardiomyopathy. Thus in patients unable to complete a standard exercise stress test, postoperative outcome cannot be predicted clinically before major general and vascular surgery, whereas dipyridamole-thallium imaging successfully identified all patients who sustained a postoperative cardiac event. PMID:2294849

Lette, J; Waters, D; Lassonde, J; Dubé, S; Heyen, F; Picard, M; Morin, M

1990-01-01

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Postoperative myocardial infarction and cardiac death. Predictive value of dipyridamole-thallium imaging and five clinical scoring systems based on multifactorial analysis  

International Nuclear Information System (INIS)

Sixty-six patients unable to complete a standard preoperative exercise test because of physical limitations were studied to determine the predictive value of individual clinical parameters, of clinical scoring systems based on multifactorial analysis, and of dipyridamole-thallium imaging before major general and vascular surgery. Study endpoints were limited to postoperative myocardial infarction or cardiac death before hospital discharge. There were nine postoperative cardiac events (seven deaths and two nonfatal infarctions). There was no statistical correlation between cardiac events and preoperative clinical descriptors, including individual clinical parameters, the Dripps-American Surgical Association score, the Goldman Cardiac Risk Index score, the Detsky Modified Cardiac Risk Index score, Eagle's clinical markers of low surgical risk, and the probability of postoperative events as determined by Cooperman's equation. There were no cardiac events in 30 patients with normal dipyridamole-thallium scans or in nine patients with fixed myocardial perfusion defects. Of 21 patients with reversible perfusion defects who underwent surgery, nine had a postoperative cardiac event (sensitivity, 100%; specificity, 43%). In the six other patients with reversible defects, preoperative angiography showed severe coronary disease or cardiomyopathy. Thus in patients unable to complete a standard exercise stress test, postoperative outcome cannot be predicted clinically before majorannot be predicted clinically before major general and vascular surgery, whereas dipyridamole-thallium imaging successfully identified all patients who sustained a postoperative cardiac event

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Recalibration of the SCORE risk chart for the Russian population.  

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Persisting high levels of cardiovascular mortality in Russia present a specific case among developed countries. Application of cardiovascular risk prediction models holds great potential for primary prevention in this country. Using a unique set of cohort follow-up data from Moscow and Saint Petersburg, this study aims to test and recalibrate the Systematic Coronary Risk Evaluation (SCORE) methods for predicting CVD mortality risks in the general population. The study is based on pooled epidemiological cohort data covering the period 1975-2001. The algorithms from the SCORE project were used for the calibration of the SCORE equation for the Moscow and St. Petersburg populations (SCORE-MoSP). Age-specific 10-year cumulative cardiovascular mortality rates were estimated according to the original SCORE-High and SCORE-Low equations and compared to the estimates based on the recalibrated SCORE-MoSP model and observed CVD mortality rates. Ten-year risk prediction charts for CVD mortality were derived and compared using conventional SCORE-High and recalibrated SCORE-MoSP methods. The original SCORE-High model tends to substantially under-estimate 10-year cardiovascular mortality risk for females. The SCORE-MoSP model provided better results which were closer to the observed rates. For males, both the SCORE-High and SCORE-MoSP provided similar estimates which tend to under-estimate CVD mortality risk at younger ages. These differences are also reflected in the risk prediction charts. Using non-calibrated scoring models for Russia may lead to substantial under-estimation of cardiovascular mortality risk in some groups of individuals. Although the SCORE-MoSP provide better results for females, more complex scoring methods involving a wider range of risk factors are needed. PMID:25179794

Jdanov, Dmitri A; Deev, Alexander D; Jasilionis, Domantas; Shalnova, Svetlana A; Shkolnikova, Maria A; Shkolnikov, Vladimir M

2014-09-01

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Risk Factors And Seasonal-Diurinal Variatons In Lacunar Infarctions  

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Full Text Available Lacunar infarctions are deeply located ischemic infarctions smaller than 1.5 cm in diameter. Patients hospitalized in our neurology clinic in between 2001 and 2005 with signs of lacunar infarction and in whom diagnosis were confirmed with neuroimaging studies, were included in this study. Risk factors and time of symptom-onset were re-evaluated by use of phone calls with them and/or their relatives. Eighty-one patients with mean age of 64.6 were involved in the study. Forty-three of them (%53 were female. The lesion was in left hemisphere in forty-five patients (%55.6, and in right hemisphere in remaining 36 (%44.4 ones. There was at least one vascular risk factor in 80 of them (%98.8, and a cardiac one in 6 patients (%7.4. Sixty-five patients (%80.2 had multiple vascular risk factors. There was hypertension in 68 (%83.9, dyslipidemia in 48 (%59.2, smoking in 26 (%32.1, and diabetes mellitus in 22 (%27.2 of them. Among 16 patients with single risk factor, 10 patients had hypertension and 6 patients had dyslipidemia. In 34 of them (%41.9, symptoms had appeared during night-time (sleeping + first hour of awakeness, and in 47 of them (%58.1 during day-time. The disease was seen during winter in 17 (21%, spring in 22 (27.2%, summer in 19 (23.4%, and autumn in 23 (28.3% of them. After analyses were corrected according to risk factors, sex and age, any seasonal-diurnal variation or side differences were not detected. Presence of many patients with single risk factor reveals the importance of primary prophylaxis clearly. High frequency of multiple risk factors underlines needs for use of preventive treatment carefully in these patients.

Murat ALEMDAR

2006-06-01

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The relationship of montreal cognitive assessment scores to framingham coronary and stroke risk scores  

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Full Text Available We examined the relationship between a brief cognitive screening measure and Framingham Coronary and Stroke Risk scores. We administered the Montreal Cognitive Assessment (MoCA to participants in the Dallas Heart Study, a community-based multiethnic study investigating the development of atherosclerosis. The composition of the group was 50% African American, 36% Caucasian and 14% Hispanic. There were 765 subjects (mean age 51 years who had both Coronary and Stroke Risk scores and an additional 144 subjects with only Coronary Risk scores available. There was a small significant inverse relationship between MoCA and Framingham Coronary and Stroke Risk scores. MoCA scores were influenced by education, but were not influenced by age or by the presence of one or more apoE4 alleles.

Myron Frederick Weiner

2011-07-01

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[Based on propensity score methods analysis of outcomes of parenterally administered shuxuetong in treatment of cerebral infarction].  

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Hospital information system (HIS) data from 18 hospitals was analyzed. 107 723 cases were divided into two groups, those that received Shuxuetong and those that did not. Patients, 18 to 80 years old, suffering from cerebral infarction, whose treatment outcome was clear were selected. Resulting in 7 520 cases in the treatment group and 3 353 who did not receive parenterally administered Shuxuetong. Using propensity score, confounding factors were balanced between the two groups, three logistic regression methods were used to compare the groups following treatment for cerebral infarction. The three methods of comparison indicated that the use of Shuxuetong significantly increased cure rates compared to the control group. Therefore, based on existing data, for the treatment of cerebral infarction, the outcomes are more effective when combination therapy including Shuxuetong is used. PMID:24471348

Jiang, Jun-Jie; Li, Lin; Xie, Yan-Ming; Yang, Hu; Zhuang, Yan

2013-09-01

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Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol  

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Full Text Available Abstract Background Cardiovascular disease (CVD is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, Regicor, SCORE, and DORICA to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain in the period 1981-2008 (2059 transplants corresponding to 1794 patients. The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease. Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry, and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk Reduction, RRR (Relative Risk Reduction and NNT (Number Needed to Treat. The ability of different cardiovascular risk scores to predict cardiovascular events will be analyzed by using the c index and the area under ROC curves. Based on the competing risks analysis, a nomogram to predict the probability of cardiovascular events after kidney transplantation will be developed. Discussion This study will make it possible to determine the post-transplant incidence of cardiovascular events in a large cohort of renal transplant recipients in Spain, to confirm the relationship between traditional and transplant-specific cardiovascular risk factors and CVD, and to develop a score to predict the risk of CVD in these patients.

Lorenzo-Aguiar Dolores

2011-01-01

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Thrombotic risk assessment in APS: the Global APS Score (GAPSS).  

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Recently, we developed a risk score for antiphospholipid syndrome (APS) (Global APS Score or GAPSS). This score derived from the combination of independent risk factors for thrombosis and pregnancy loss, taking into account the antiphospholipid antibodies (aPL) profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors, and the autoimmune antibodies profile. We demonstrate that risk profile in APS can be successfully assessed, suggesting that GAPSS can be a potential quantitative marker of APS-related clinical manifestations. PMID:25228728

Sciascia, S; Bertolaccini, Ml

2014-10-01

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Comparison of different electrocardiographic scoring systems for detection of any previous myocardial infarction as assessed with cardiovascular magnetic resonance imaging.  

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Although electrocardiography is frequently used as an initial test to detect or rule out previous myocardial infarction (MI), the diagnostic performance of commonly used electrocardiographic scoring systems is not well described. We aimed to determine the diagnostic accuracy of (1) the Universal Definition, (2) Minnesota ECG Code (MC), (3) Selvester QRS Score, and (4) assessment by cardiologists using late gadolinium enhancement cardiovascular magnetic resonance imaging as the reference standard. Additionally, the effect of electrocardiographic patterns and infarct characteristics on detecting previous MI was evaluated. The 3-month follow-up electrocardiograms of 78 patients with first-time reperfused ST elevation MI were pooled with electrocardiograms of 36 healthy controls. All 114 electrocardiograms were randomly analyzed, blinded to clinical and LGE-CMR data. The sensitivity of the Universal Definition, MC, Selvester QRS Score, and cardiologists to detect previous MI was 33%, 79%, 90%, and 67%, respectively; specificity 97%, 72%, 31%, and 89%, respectively; diagnostic accuracy 54%, 77%, 71%, and 74%, respectively. Probability of detecting MI by cardiologists increased with an increasing number (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.30 to 3.09), width (OR 1.02, 95% CI 1.01 to 1.03), and depth (OR 1.16, 95% CI 1.07 to 1.27) of Q waves as well as increasing infarct size (OR 1.15, 95% CI 1.06 to 1.25) and transmurality (OR 1.05, 95% CI 1.01 to 1.08; p detect previous MI. The diagnostic performance of all 4 electrocardiographic scoring systems was modest and related to the number, depth, and width of Q waves as well as increasing infarct size and transmurality. In conclusion, the exclusion of a previous MI based solely on electrocardiographic findings should be done with caution. Future studies are needed to define which patients should be referred to additional diagnostic testing. PMID:23827406

Jaarsma, Caroline; Bekkers, Sebastiaan C; Haidari, Zaki; Smulders, Martijn W; Nelemans, Patricia J; Gorgels, Anton P; Crijns, Harry J; Wildberger, Joachim E; Schalla, Simon

2013-10-15

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[Assessment of cardiovascular risk in hypertensive patients: comparison among scores].  

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At present, a correct and thorough risk evaluation represents the best prognostic and therapeutic approach for hypertensive patients. Recent European and American guidelines recommend a global stratification of the cardiovascular risk of hypertensive patients, based on the evaluation of risk factors, organ damage, and the clinical conditions associated with hypertension. A similar approach uses numerical risk scores that transform the percentage risk, calculated from large populations, into absolute values. These scores have been calculated by different research groups and scientific organizations with the aim of better defining the real risk of a given population over time. Many of these risk scores have been conceived by American and European scientific groups on the basis of the epidemiology of different risk variables in the respective populations; in general, north American hypertensives are exposed to a higher cardiovascular risk compared to Europeans and some European countries have a higher risk than others. The present review underlines the pivotal role of a correct risk evaluation of hypertension as reported in the guidelines. We briefly analyze the principal studies on risk scores: we compare the advantages and disadvantages of the different scores, as well as the similarities and differences, in order to demonstrate not only their utility, but also the possible equivalence of the different parameters considered. PMID:15568607

Del Colle, Sara; Rabbia, Franco; Mulatero, Paolo; Veglio, Franco

2004-09-01

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The relationship between neutrophil to lymphocyte ratio and SYNTAX score in patients with ST-segment elevation myocardial infarction  

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Full Text Available Objective: We aimed to assess relationship between the severity of coronary atherosclerosis assessed by SYNTAX score (SS and neutrophil to lymphocyte ratio (NLR in patients with ST elevation myocardial infarction (STEMI. Methods: After accounting for exclusion criteria, a total of 291 patient with STEMI in whom primary percutaneous coronary intervention was performed were retrospectively included (216 male, 75 female; mean age 61.6+14.0 years. Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. Monitoring for major adverse cardiac events (MACEs was performed during the in hospital follow-up period. Results: The SS high group leukocyte (p=0.009, neutrophil (p=0.008, NLR (p=0.048, peak troponin (p<0.001, peak CK-MB (p=0.001 lactate dehydrogenase (p=0.005, aspartate aminotransferase (p=0.004 values were significantly higher compared with SSlow and SSmid groups. SS was increased, left ventricular ejection fraction was decrease (p<0.001 and left ventricular systolic diameter was increased (p=0.007. The in-hospital death rate and MACEs were greater in the high SS group than in the other groups (p<0.001 both of. Conclusion: We found that high NLR was significantly and correlated increased with SS. In addition, high SS were significantly associated with increased in-hospital MACE and in-hospital death. Further prospective studies assessing the predictive role of both SS and NLR in conjunction for risk stratification might improve risk prediction in patients with STEMI. J Clin Exp Invest 2014; 5 (2: 211-218

Halit Acet

2014-06-01

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Risk score for contrast induced nephropathy following percutaneous coronary intervention  

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Full Text Available Contrast-induced nephropathy (CIN is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 µmol/L with the highest score(7, followed by shock (3, female gender, multivessel PCI and diabetes mellitus had the same score (2. Patients were further risk stratified into low risk score (< 4, moderate (5-8, high (9-12, and, very high risk score (>_ 12. The developed CIN model demonstrated good dis-criminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multi-center trials.

Ghani Amal

2009-01-01

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Long term results of ST-segment elevation myocardial infarction versus non-ST-segment elevation myocardial infarction after off-pump coronary artery bypass grafting: propensity score matching analysis.  

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There is no consensus as to which acute myocardial infarction subtype poses a greater risk after coronary artery bypass grafting (CABG). We compared the early and the long term results of off-pump coronary artery bypass grafting (OPCAB) between patients with STEMI (group I, n = 83), and NSTEMI (group II, n = 237). Group I had higher EuroSCORE, prevalence of emergency surgery, preoperative intra-aortic balloon pump use, preoperative emergency percutaneous transluminal coronary angioplasty, and preoperative thrombolytic use than group II. There were no significant differences in 30-day mortality and major adverse cardiac and cerebrovascular event (MACCE) between groups. Overall 8-yr survival was 93% and 87% in groups I and II, respectively. Freedom from MACCE after 8 yr was 92% and 93% in groups I and II, respectively. After propensity score matching analysis, there were no significant differences in preoperative parameters, postoperative in-hospital outcomes, and long-term clinical outcomes. Surgical results of OPCAB in patients with acute myocardial infarction show good results in terms of long-term survival and freedom from MACCE, with no significant differences in clinical outcomes between STEMI and NSTEMI groups. PMID:22323862

Hong, Soonchang; Youn, Young-Nam; Yi, Gijong; Yoo, Kyung-Jong

2012-02-01

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Risk factors in young patients of acute myocardial infarction  

International Nuclear Information System (INIS)

Background: Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of first Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. Methods: We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Results: Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Conhat is 94% had 3 or more risk factors. Conclusion: Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us. (author)

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Online risk engines and scoring tools in endocrinology  

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With evolution of evidence-based medicine, risk prediction equations have been formulated and validated. Such risk engines and scoring systems are able to predict disease outcome and risks of possible complications with varying degrees of accuracy. From health policy makers point of view it helps in appropriate disbursement of available resources for greatest benefit of population at risk. Understandably, the accuracy of prediction of different risk engines and scoring systems are highly variable and has several limitations. Each risk engine or clinical scoring tool is derived from data obtained from a particular population and its results are not generalizable and hence its ability to predict risk/outcome in a different population with differences in ethnicity, ages, and differences in distribution of risk factors over time both within and between populations. These scoring systems and risk engines to begin with were available for manual calculations and references/use of formula and paper charts were essential. However, with evolution of information technology such calculations became easier to make with use of online web-based tools. In recent times with advancement of android technology, easy to download apps (applications) has helped further to have the benefits of these online risk engines and scoring systems at our finger tips. PMID:24910820

Chakraborty, Partha Pratim; Ghosh, Sujoy; Kalra, Sanjay

2013-01-01

 
 
 
 
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Evaluation of cardiovascular risk predicted by different SCORE equations: The Netherlands as an example  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: In Europe, for primary prevention of cardiovascular diseases (CVD), the Systematic COronary Risk Evaluation (SCORE) risk charts for high-risk and low-risk regions (SCORE-high and SCORE-low, respectively) are used. For the Dutch ‘Clinical Practice Guideline for Cardiovascular Risk Management’ an adapted SCORE risk chart (SCORE-NL) was developed in collaboration with the SCORE group. We evaluated these three SCORE equations using Dutch risk factor and mortality data. Design: Pro...

Dis, S. J.; Kromhout, D.; Geleijnse, J. M.; Boer, J. M. A.; Verschuren, W. M. M.

2010-01-01

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The Value of Simplified Selvester QRS Scoring System in Predicting ST-segment Resolution after Thrombolysis in Patients with Acute Myocardial Infarction  

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ABSTRACT Background: Selvester QRS scoring system was developed for estimating the infarct size from the electrocardiogram (ECG). Objective: To evaluate the predictive value of the simplified version of this scoring system on ST-segment resolution (STR) mortality in patients with acute ST-elevation myocardial infarction (STEMI) undergoing thrombolytic therapy (TLT). Methods: We enrolled 100 consecutive patients with their first acute STEMI within 12 hours of onset of chest pain who...

Samad Ghaffari; Babak Kazemi; Gholamreza Saeidi; Nariman Sepehrvand; Leili Pourafkari

2014-01-01

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Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart  

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Full Text Available

Aim: Risk charts and risk score, based on the global absolute risk, are key tools for CVD risk assessment. When applied to the population from which they derive, they provide the best estimate of CVD risk. That is why the CUORE Project has among its objectives the assessment of the Italian population’s cardiovascular risk, identifying the model for the prediction of coronary and cerebrovascular events in 10 years.

Methods: Data fromdifferent cohorts enrolled in the North, Centre and South of Italy between the 1980s and the 1990s were used. From the 7,056 men and 12,574 women aged 35-69 years, free of cardiovascular disease at base-line and followed up for a mean time of 10 years for total and cause-specific mortality and non fatal cerebrovascular and coronary events, 894 major cardiovascular events (596 coronary and 298 cerebrovascular were identified and validated. To assess 10-year cardiovascular risk, the risk score and risk chart were developed for men and women separately, considering the first major coronary or cerebrovascular event as the endpoint.

Results: The risk score is applied tomen andwomen aged 35-69 years and includes age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment using continuous values when possible. The risk chart is applied to persons aged 40-69 years and includes the same risk factors as risk score, except for HDL-cholesterol and hypertension treatment, and uses categorical values for all variables.

Conclusions: The risk score and risk chart are easy-to-use tools which enable general practitioners and specialists to achieve an objective evaluation of the absolute global cardiovascular risk of middle-aged persons in primary prevention.

Simona Giampaoli

2007-06-01

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Risk score for contrast induced nephropathy following percutaneous coronary intervention  

International Nuclear Information System (INIS)

Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 micron mol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score (12). The developed CIN model demonstrated good discriminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multicenter trials. (author)

45

Applying polygenic risk scores to postpartum depression.  

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The etiology of major depressive disorder (MDD) is likely to be heterogeneous, but postpartum depression (PPD) is hypothesized to represent a more homogenous subset of MDD. We use genome-wide SNP data to explore this hypothesis. We assembled a total cohort of 1,420 self-report cases of PPD and 9,473 controls with genome-wide genotypes from Australia, The Netherlands, Sweden and the UK. We estimated the total variance attributable to genotyped variants. We used association results from the Psychiatric Genomics Consortia (PGC) of bipolar disorder (BPD) and MDD to create polygenic scores in PPD and related MDD data sets to estimate the genetic overlap between the disorders. We estimated that the percentage of variance on the liability scale explained by common genetic variants to be 0.22 with a standard error of 0.12, p?=?0.02. The proportion of variance (R (2)) from a logistic regression of PPD case/control status in all four cohorts on a SNP profile score weighted by PGC-BPD association results was small (0.1 %) but significant (p?=?0.004) indicating a genetic overlap between BPD and PPD. The results were highly significant in the Australian and Dutch cohorts (R (2)?>?1.1 %, p?

Byrne, Enda M; Carrillo-Roa, Tania; Penninx, Brenda W J H; Sallis, Hannah M; Viktorin, Alexander; Chapman, Brett; Henders, Anjali K; Pergadia, Michele L; Heath, Andrew C; Madden, Pamela A F; Sullivan, Patrick F; Boschloo, Lynn; van Grootheest, Gerard; McMahon, George; Lawlor, Debbie A; Landén, Mikael; Lichtenstein, Paul; Magnusson, Patrik K E; Evans, David M; Montgomery, Grant W; Boomsma, Dorret I; Martin, Nicholas G; Meltzer-Brody, Samantha; Wray, Naomi R

2014-12-01

46

Alcohol Intake, Myocardial Infarction, Biochemical Risk Factors, and Alcohol Dehydrogenase Genotypes  

DEFF Research Database (Denmark)

  Background- The risk of myocardial infarction is lower among light-to-moderate alcohol drinkers compared with abstainers. We tested associations between alcohol intake and risk of myocardial infarction and risk factors and whether these associations are modified by variations in alcohol dehydrogenases. Methods and Results- We used information on 9584 men and women from the Danish general population in the Copenhagen City Heart Study. During follow-up, from 1991 to 2007, 663 incident cases of myocardial infarction occurred. We observed that increasing alcohol intake was associated with decreasing risk of myocardial infarction, decreasing low-density lipoprotein cholesterol and fibrinogen, increasing diastolic and systolic blood pressure and high-density lipoprotein cholesterol, and with U-shaped nonfasting triglycerides. In contrast, ADH1B and ADH1C genotypes were not associated with risk of myocardial infarction or with any of the cardiovascular biochemical risk factors, and there was no indication that associations between alcohol intake and myocardial infarction and between alcohol intake and risk factors were modified by genotypes. Conclusions- Increasing alcohol intake is associated with decreasing risk of myocardial infarction, decreasing low-density lipoprotein cholesterol and fibrinogen, increasing diastolic and systolic blood pressure and high-density lipoprotein cholesterol, and U-shaped nonfasting triglycerides. These associations were not modified by ADH1B and ADH1C are genotypes. Udgivelsesdato: 2009

Tolstrup, Janne Schurmann; GrØnbæk, Morten

2009-01-01

47

Predicting long-term cardiovascular risk using the mayo clinic cardiovascular risk score in a referral population.  

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Exercise testing provides valuable information but is rarely integrated to derive a risk prediction model in a referral population. In this study, we assessed the predictive value of conventional cardiovascular risk factors and exercise test parameters in 6,546 consecutive adults referred for exercise testing, who were followed for a period of 8.1 ± 3.7 years for incident myocardial infarction, coronary revascularization, and cardiovascular death. A risk prediction model was developed, and cross-validation of model was performed by splitting the data set into 10 equal random subsets, with model fitting based on 9 of the 10 subsets and testing in of the remaining subset, repeated in all 10 possible ways. The best performing model was chosen based on measurements of model discrimination and stability. A risk score was constructed from the final model, with points assigned for the presence of each predictor based on the regression coefficients. Using both conventional risk factors and exercise test parameters, a total of 9 variables were identified as independent and robust predictors and were included in a risk score. The prognostic ability of this model was compared with that of the Adult Treatment Panel III model using the net reclassification and integrated discrimination index. From the cross-validation results, the c statistic of 0.77 for the final model indicated strong predictive power. In conclusion, we developed, tested, and internally validated a novel risk prediction model using exercise treadmill testing parameters. PMID:25052544

Dhoble, Abhijeet; Lahr, Brian D; Allison, Thomas G; Bailey, Kent R; Thomas, Randal J; Lopez-Jimenez, Francisco; Kullo, Iftikhar J; Gupta, Bhanu; Kopecky, Stephen L

2014-09-01

48

Atrial Fibrillation and the Risk of Myocardial Infarction  

Science.gov (United States)

IMPORTANCE Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. OBJECTIVE To examine the risk of incident MI associated with AF. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort of 23 928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009. MAIN OUTCOMES AND MEASURES Expert-adjudicated total MI events (fatal and nonfatal). RESULTS Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52–2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26–2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure–lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41–3.31]) than in men (HR, 1.39 [95% CI, 0.91–2.10]) and in blacks (HR, 2.53 [95% CI, 1.67–3.86]) than in whites (HR, 1.26 [95% CI, 0.83–1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (?75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16–3.35] and HR, 1.60 [95% CI, 1.11–2.30], respectively); for interaction, P = .44. CONCLUSIONS AND RELEVANCE AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI. PMID:24190540

Soliman, Elsayed Z.; Safford, Monika M.; Muntner, Paul; Khodneva, Yulia; Dawood, Farah Z.; Zakai, Neil A.; Thacker, Evan L.; Judd, Suzanne; Howard, Virginia J.; Howard, George; Herrington, David M.; Cushman, Mary

2014-01-01

49

Scoring Of High Risk Mothers And Related Outcome  

Directory of Open Access Journals (Sweden)

Full Text Available In a study of 777 mothers delivering at Dufferin Hospital, Lucknow, 195 (25.1 % mothers were in O risk group, 321 (41.3% in 1-3 risk group, 199(25.6% in 4-6 risk group and 62 (7.9 % in risk group 7 +. On the other hand, caesarean section increased from 3(1.5 % in ‘O� risk mothers to 25 (40.4% in 7 + risk score mothers. The incidence of low birth weight was lowest (5/ 1000 births when risk score was 0 and highest (432.8 / 1000 births when risk score was 7 +. Out of a total of 777 mothers, 222 (28.5% had postnatal complications. In ‘O� risk group, out of 195 mothers only 24 (12.3 % had postnatal complications, while 37 (59.7 % out of 62 had complications in 7 + group. The maternal mortality rate was 1.3 / 1000 live births. Perinatal mortality rate was 61.6 /1000 total births and neonatal mortality rate was 47.7/1000 live births.

Krishnan V

1988-01-01

50

A case-control study of physical activity patterns and risk of non-fatal myocardial infarction  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The interactive effects of different types of physical activity on cardiovascular disease (CVD risk have not been fully considered in previous studies. We aimed to identify physical activity patterns that take into account combinations of physical activities and examine the association between derived physical activity patterns and risk of acute myocardial infarction (AMI. Methods We examined the relationship between physical activity patterns, identified by principal component analysis (PCA, and AMI risk in a case-control study of myocardial infarction in Costa Rica (N=4172, 1994-2004. The component scores derived from PCA and total METS were used in natural cubic spline models to assess the association between physical activity and AMI risk. Results Four physical activity patterns were retained from PCA that were characterized as the rest/sleep, agricultural job, light indoor activity, and manual labor job patterns. The light indoor activity and rest/sleep patterns showed an inverse linear relation (P for linearity=0.001 and a U-shaped association (P for non-linearity=0.03 with AMI risk, respectively. There was an inverse association between total activity-related energy expenditure and AMI risk but it reached a plateau at high levels of physical activity (P for non-linearity=0.01. Conclusions These data suggest that a light indoor activity pattern is associated with reduced AMI risk. PCA provides a new approach to investigate the relationship between physical activity and CVD risk.

Gong Jian

2013-02-01

51

Risk factors for post-traumatic massive cerebral infarction secondary to space-occupying epidural hematoma.  

Science.gov (United States)

Post-traumatic massive cerebral infarction (MCI) is a fatal complication of concurrent epidural hematoma (EDH) and brain herniation that commonly requires an aggressive decompressive craniectomy. The risk factors and surgical indications of MCI have not been fully elucidated. In this retrospective study, post-traumatic MCI was diagnosed in 32 of 176 patients. The performance of a decompressive craniectomy simultaneously with the initial hematoma-evacuation surgery improved their functional outcomes, compared with delayed surgery (on the 6-month Extended Glasgow Outcome Scale, 5.6±1.5 vs. 3.4±0.6; pmydriasis (OR, 7.08; p=0.004), preoperative brain herniation for longer than 90?min (OR, 6.41; p<0.001), and a Glasgow Coma Score of 3-5 points (OR, 2.86; p<0.053). Multi-variate logistic regression analysis revealed no significant association between post-traumatic MCI and age, gender, mid-line shift, Rotterdam computed tomography score, intraoperative hypotension, or serum concentrations of sodium or glucose. Incidence of post-traumatic MCI increased from 16.4% in those having any two of the six risk factors to 47.7% in those having any three or more of the six risk factors (p<0.001). Patients with concurrent EDH and brain herniation exhibited an increased risk for post-traumatic MCI with the accumulation of several critical clinical factors. Early decompressive craniectomy based on accurate risk estimation is recommended in efforts to improve patient functional outcomes. PMID:24773559

Wang, Wen-hao; Hu, Lian-shui; Lin, Hong; Li, Jun; Luo, Fei; Huang, Wei; Lin, Jun-ming; Cai, Gen-ping; Liu, Chang-chun

2014-08-15

52

Genetic polymorphisms in the ESR1 gene and cerebral infarction risk: a meta-analysis.  

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A number of studies have documented that estrogen receptor ? (ESR1) may play an important role in the development and progression of cerebral infarction, but many existing studies have yielded inconclusive results. This meta-analysis was performed to evaluate the relationships between ESR1 genetic polymorphisms and cerebral infarction risk. The PubMed, CISCOM, CINAHL, Web of Science, Google Scholar, EBSCO, Cochrane Library, and CBM databases were searched for relevant articles published before October 1, 2013, without any language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Seven case-control studies were included with a total of 1471 patients with cerebral infarction and 4688 healthy control subjects. Two common single-nucleotide polymorphisms (SNPs) in the ESR1 gene (rs2234693 T>C and rs9340799?A>G) were assessed. Our meta-analysis results revealed that ESR1 genetic polymorphisms might increase the risk of cerebral infarction. Subgroup analysis by SNP type indicated that both rs2234693 and rs9340799 polymorphisms in the ESR1 gene were strongly associated with an increased risk of cerebral infarction. Further subgroup analysis by ethnicity showed significant associations between ESR1 genetic polymorphisms and increased risk of cerebral infarction among both Asians and Caucasians. In the stratified subgroup analysis by gender, the results suggested that ESR1 genetic polymorphisms were associated with an increased risk of cerebral infarction in the female population. However, there were no statistically significant associations between ESR1 genetic polymorphisms and cerebral infarction risk in the male population. Meta-regression analyses also confirmed that gender might be a main source of heterogeneity. Our findings indicate that ESR1 genetic polymorphisms may contribute to the development of cerebral infarction, especially in the female population. PMID:24772998

Gao, Hong-Hua; Gao, Lian-Bo; Wen, Jia-Mei

2014-09-01

53

Clopidogrel discontinuation after myocardial infarction and risk of thrombosis : a nationwide cohort study  

DEFF Research Database (Denmark)

The benefit of extending clopidogrel treatment beyond the 12-month period recommended in current guidelines after myocardial infarction (MI) is debated. We analysed the risk of adverse cardiovascular outcomes after discontinuation of 12 months of clopidogrel treatment.

Charlot, Mette; Nielsen, Lars Hougaard

2012-01-01

54

Use of CHADS2 and CHA2DS2-VASc Scores to Predict Subsequent Myocardial Infarction, Stroke, and Death in Patients with Acute Coronary Syndrome: Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry  

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Background Acute coronary syndrome (ACS) patients have a wide spectrum of risks for subsequent cardiovascular events and death. However, there is no simple, convenience scoring system to identify risk of adverse outcomes. We investigated whether CHADS2 and CHA2DS2-VASc scores were useful tools to assess the risk for adverse events among ACS patients. Methods This observational prospective study was conducted at 39 hospitals. Totally 3,183 patients with ACS were enrolled, and CHADS2 and CHA2DS2-VASc scores were calculated. The primary endpoint was occurrence of adverse event, including subsequent myocardial infarction, stroke, or death, within 1 year of discharge. Results CHADS2 and CHA2DS2-VASc scores were significant predictors of adverse events in separate multivariate regression analyses. A Kaplan-Meier analysis of CHADS2 and CHA2DS2-VASc scores of ?2 showed a higher rate of adverse events as compared with scores of <2 (P<0.001;log-rank test). CHA2DS2-VASc score was better than CHADS2 score in predicting subsequent adverse events; the area under the receiver operating characteristic curve increased from 0.66 to 0.70 (p<0.001). Patients with CHADS2 scores of 0 or 1 were further classified according to CHA2DS2-VASc score, using a cutoff value of 2. The rate of adverse events significantly differed between those with a score of <2 and those with a score of ?2 (4.1% vs.10.7%, P<0.001). Conclusions CHADS2 and CHA2DS2-VASc scores were useful predictors of subsequent adverse events in ACS patients. PMID:25343586

Chua, Su-Kiat; Lo, Huey-Ming; Chiu, Chiung-Zuan; Shyu, Kou-Gi

2014-01-01

55

Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction / Valor Prognóstico do Escore TIMI versus Escore GRACE no Infarto com Supradesnível do Segmento ST  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Fundamento: O Escore TIMI para infarto com supradesnível do segmento ST (IAMcSST) foi criado e validado especificamente para este cenário clínico, enquanto o Escore GRACE é genérico para qualquer tipo de síndrome coronariana aguda. Objetivo: Identificar qual dos escores, TIMI ou GRACE, apresen [...] ta melhor desempenho prognóstico em pacientes com IAMcSST. Métodos: Foram incluídos 152 indivíduos consecutivamente internados por IAMcSST. Os escores TIMI e GRACE foram testados quanto a sua capacidade discriminatória (estatística-C) e calibração (teste Hosmer-Lemeshow), em relação ao desfecho óbito hospitalar. Resultados: O Escore TIMI apresentou distribuição equitativa de pacientes nas faixas de baixo, intermediário e alto risco (39%, 27% e 34%, respectivamente), diferente do Escore GRACE que apresentou distribuição predominante em baixo risco (80%, 13% e 7%, respectivamente). A letalidade da amostra foi de 11%. A estatística-C do Escore TIMI foi de 0,87 (95% IC = 0,76 - 0,98), semelhante ao GRACE (0,87; 95% IC = 0,75-0,99) - p = 0,71. O Escore TIMI apresentou calibração satisfatória, representada por ?2 de 1,4 (p = 0,92), nitidamente superior à calibração do Escore GRACE, que apresentou ?2 de 14 (p = 0,08). Esta calibração se reflete em incidências esperadas para as faixas de baixo, intermediário e alto risco de acordo com o Escore TIMI (0%, 4,9% e 25%, respectivamente), diferente do GRACE (2,4%, 25% e 73%) que caracterizou inadequadamente a faixa intermediária. Conclusão: Os escores TIMI e GRACE apresentam semelhante capacidade discriminatória em relação a óbito hospitalar, porém o Escore TIMI possui calibração superior ao GRACE. Para populações de risco diferente da nossa amostra, esta conclusão deve ser validada por futuros trabalhos. Abstract in english Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better pro [...] gnostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by ?2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed ?2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Luis C. L., Correia; Guilherme, Garcia; Felipe, Kalil; Felipe, Ferreira; Manuela, Carvalhal; Ruan, Oliveira; André, Silva; Isis, Vasconcelos; Caio, Henri; Márcia, Noya-Rabelo.

2014-08-01

56

Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction / Valor Prognóstico do Escore TIMI versus Escore GRACE no Infarto com Supradesnível do Segmento ST  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Fundamento: O Escore TIMI para infarto com supradesnível do segmento ST (IAMcSST) foi criado e validado especificamente para este cenário clínico, enquanto o Escore GRACE é genérico para qualquer tipo de síndrome coronariana aguda. Objetivo: Identificar qual dos escores, TIMI ou GRACE, apresen [...] ta melhor desempenho prognóstico em pacientes com IAMcSST. Métodos: Foram incluídos 152 indivíduos consecutivamente internados por IAMcSST. Os escores TIMI e GRACE foram testados quanto a sua capacidade discriminatória (estatística-C) e calibração (teste Hosmer-Lemeshow), em relação ao desfecho óbito hospitalar. Resultados: O Escore TIMI apresentou distribuição equitativa de pacientes nas faixas de baixo, intermediário e alto risco (39%, 27% e 34%, respectivamente), diferente do Escore GRACE que apresentou distribuição predominante em baixo risco (80%, 13% e 7%, respectivamente). A letalidade da amostra foi de 11%. A estatística-C do Escore TIMI foi de 0,87 (95% IC = 0,76 - 0,98), semelhante ao GRACE (0,87; 95% IC = 0,75-0,99) - p = 0,71. O Escore TIMI apresentou calibração satisfatória, representada por ?2 de 1,4 (p = 0,92), nitidamente superior à calibração do Escore GRACE, que apresentou ?2 de 14 (p = 0,08). Esta calibração se reflete em incidências esperadas para as faixas de baixo, intermediário e alto risco de acordo com o Escore TIMI (0%, 4,9% e 25%, respectivamente), diferente do GRACE (2,4%, 25% e 73%) que caracterizou inadequadamente a faixa intermediária. Conclusão: Os escores TIMI e GRACE apresentam semelhante capacidade discriminatória em relação a óbito hospitalar, porém o Escore TIMI possui calibração superior ao GRACE. Para populações de risco diferente da nossa amostra, esta conclusão deve ser validada por futuros trabalhos. Abstract in english Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better pro [...] gnostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by ?2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed ?2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Luis C. L., Correia; Guilherme, Garcia; Felipe, Kalil; Felipe, Ferreira; Manuela, Carvalhal; Ruan, Oliveira; André, Silva; Isis, Vasconcelos; Caio, Henri; Márcia, Noya-Rabelo.

57

Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction / Valor Prognóstico do Escore TIMI versus Escore GRACE no Infarto com Supradesnível do Segmento ST  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Fundamento: O Escore TIMI para infarto com supradesnível do segmento ST (IAMcSST) foi criado e validado especificamente para este cenário clínico, enquanto o Escore GRACE é genérico para qualquer tipo de síndrome coronariana aguda. Objetivo: Identificar qual dos escores, TIMI ou GRACE, apresen [...] ta melhor desempenho prognóstico em pacientes com IAMcSST. Métodos: Foram incluídos 152 indivíduos consecutivamente internados por IAMcSST. Os escores TIMI e GRACE foram testados quanto a sua capacidade discriminatória (estatística-C) e calibração (teste Hosmer-Lemeshow), em relação ao desfecho óbito hospitalar. Resultados: O Escore TIMI apresentou distribuição equitativa de pacientes nas faixas de baixo, intermediário e alto risco (39%, 27% e 34%, respectivamente), diferente do Escore GRACE que apresentou distribuição predominante em baixo risco (80%, 13% e 7%, respectivamente). A letalidade da amostra foi de 11%. A estatística-C do Escore TIMI foi de 0,87 (95% IC = 0,76 - 0,98), semelhante ao GRACE (0,87; 95% IC = 0,75-0,99) - p = 0,71. O Escore TIMI apresentou calibração satisfatória, representada por ?2 de 1,4 (p = 0,92), nitidamente superior à calibração do Escore GRACE, que apresentou ?2 de 14 (p = 0,08). Esta calibração se reflete em incidências esperadas para as faixas de baixo, intermediário e alto risco de acordo com o Escore TIMI (0%, 4,9% e 25%, respectivamente), diferente do GRACE (2,4%, 25% e 73%) que caracterizou inadequadamente a faixa intermediária. Conclusão: Os escores TIMI e GRACE apresentam semelhante capacidade discriminatória em relação a óbito hospitalar, porém o Escore TIMI possui calibração superior ao GRACE. Para populações de risco diferente da nossa amostra, esta conclusão deve ser validada por futuros trabalhos. Abstract in english Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better pro [...] gnostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by ?2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed ?2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

Luis C. L., Correia; Guilherme, Garcia; Felipe, Kalil; Felipe, Ferreira; Manuela, Carvalhal; Ruan, Oliveira; André, Silva; Isis, Vasconcelos; Caio, Henri; Márcia, Noya-Rabelo.

2014-07-15

58

Score tests for independence in semiparametric competing risks models.  

Science.gov (United States)

A popular model for competing risks postulates the existence of a latent unobserved failure time for each risk. Assuming that these underlying failure times are independent is attractive since it allows standard statistical tools for right-censored lifetime data to be used in the analysis. This paper proposes simple independence score tests for the validity of this assumption when the individual risks are modeled using semiparametric proportional hazards regressions. It assumes that covariates are available, making the model identifiable. The score tests are derived for alternatives that specify that copulas are responsible for a possible dependency between the competing risks. The test statistics are constructed by adding to the partial likelihoods for the individual risks an explanatory variable for the dependency between the risks. A variance estimator is derived by writing the score function and the Fisher information matrix for the marginal models as stochastic integrals. Pitman efficiencies are used to compare test statistics. A simulation study and a numerical example illustrate the methodology proposed in this paper. PMID:19714463

Saïd, Mériem; Ghazzali, Nadia; Rivest, Louis-Paul

2009-12-01

59

Weak Prediction Power of the Framingham Risk Score for Coronary Artery Disease in Nonagenarians  

Science.gov (United States)

Background Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age. Methods Data on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared. Results One hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87–0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P?=?0.3792). Conclusion We found weak prediction power of FRS for CAD in nonagenarians. PMID:25393521

Yayan, Josef

2014-01-01

60

Feasibility of an automated quantitative computed tomography angiography-derived risk score for risk stratification of patients with suspected coronary artery disease.  

Science.gov (United States)

Coronary computed tomography angiography (CTA) has important prognostic value. Additionally, quantitative CTA (QCT) provides a more detailed accurate assessment of coronary artery disease (CAD) on CTA. Potentially, a risk score incorporating all quantitative stenosis parameters allows accurate risk stratification. Therefore, the purpose of this study was to determine if an automatic quantitative assessment of CAD using QCT combined into a CTA risk score allows risk stratification of patients. In 300 patients, QCT was performed to automatically detect and quantify all lesions in the coronary tree. Using QCT, a novel CTA risk score was calculated based on plaque extent, severity, composition, and location on a segment basis. During follow-up, the composite end point of all-cause mortality, revascularization, and nonfatal infarction was recorded. In total, 10% of patients experienced an event during a median follow-up of 2.14 years. The CTA risk score was significantly higher in patients with an event (12.5 [interquartile range 8.6 to 16.4] vs 1.7 [interquartile range 0 to 8.4], p <0.001). In 127 patients with obstructive CAD (?50% stenosis), 27 events were recorded, all in patients with a high CTA risk score. In conclusion, the present study demonstrated that a fully automatic QCT analysis of CAD is feasible and can be applied for risk stratification of patients with suspected CAD. Furthermore, a novel CTA risk score incorporating location, severity, and composition of coronary lesion was developed. This score may improve risk stratification but needs to be confirmed in larger studies. PMID:24798123

de Graaf, Michiel A; Broersen, Alexander; Ahmed, Wehab; Kitslaar, Pieter H; Dijkstra, Jouke; Kroft, Lucia J; Delgado, Victoria; Bax, Jeroen J; Reiber, Johan H C; Scholte, Arthur J

2014-06-15

 
 
 
 
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Potential demographic and baselines variables for risk stratification of high-risk post-myocardial infarction patients in the era of implantable cardioverter-defibrillator - a prognostic indicator  

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BACKGROUND: Risk stratification after myocardial infarction (MI) remains expensive and disappointing. We designed a prognostic indicator using demographic information to select patients at risk of dying after MI. METHOD AND RESULTS: We combined individual patient data from the placebo arms of EMIAT, CAMIAT, TRACE and DIAMOND-MI with LVEF 10 ventricular premature beats/hour or a run of ventricular tachycardia). Risk factors for mortality beginning at day 45 post-MI up to 2 years were examined using Cox regression analysis. Risk scores were derived from the equation of a Cox regression model containing only significant variables. The prognostic index was the sum of the individual contribution from the risk factors. 2707 patients were pooled (age: 66 (23-92) years, 78.8% M) with 480 deaths at 2-years (44% arrhythmic and 35.6% non-arrhythmic cardiac deaths). Variables predicting mortality were age, sex, previous MI or angina, hypertension, diabetes, systolic blood pressure, heart rate, NYHA functional class and non-Q wave infarct on electrocardiogram. Distinct survival curves were obtained for 3 risk groups based on the median and inter-quartile range for the prognostic index. In the high-risk group, up to 40% of patients died (all-cause mortality), 19.1% died of arrhythmic and 18.2% died of non-arrhythmic cardiac causes at 2-years. CONCLUSION: In post-MI patients with LVEF Udgivelsesdato: 2008/5/7

Yap, Yee Guan; Duong, Trinh

2008-01-01

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C-Reactive protein predicts acute myocardial infarction during high-risk noncardiac and vascular surgery  

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Full Text Available BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged >50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T and/or total creatine phosphokinase and the MB fraction (CPK-T/MB were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations, were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005. All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.

Oscar M. Martins

2011-01-01

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Myocardial infarction and risk of suicide: a population-based case-control study  

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Myocardial infarction (MI) is associated with an increased risk of anxiety, depression, low quality of life, and all-cause mortality. Whether MI is associated with an increased risk of suicide is unknown. We examined the association between MI and suicide.

Larsen, Karen Kjær; Agerbo, Esben

2010-01-01

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Coronary age as a risk factor in the modified Framingham risk score  

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Full Text Available Abstract Background Clinical guidelines emphasize risk assessment as vital to patient selection for medical primary intervention. However, risk assessment methods are restricted in their ability to predict further coronary events. The most widely accepted tool in the United States is the Framingham risk score. In these equations age is a powerful risk factor. Although the extent of coronary atherosclerosis increases with age, there is large inter-individual variability in the rate of development and progression of this disease. This fact limits the utility of Framingham scoring when applied to individuals. Electron beam tomography (EBT, which measures coronary calcium, provides a non-invasive method for assessing coronary plaque burden, thus offering the possibility of providing a more accurate estimate of an individual's "arterial age" than from chronological age alone. Methods In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS to modify the Framingham Risk Assessment (FRA. Using this method, a coronary artery calcium (CAC age equivalent is generated that replaces chronological age in Framingham scoring. Results and discussion Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%. Conclusion Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only may increase the predicted risk for some patients, but also may decrease the predicted risk for others, making it a more precise adjustment than other methods.

Whitcomb Brian W

2004-04-01

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Low integrated DNA repair score and lung cancer risk.  

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DNA repair is a prime mechanism for preventing DNA damage, mutation, and cancers. Adopting a functional approach, we examined the association with lung cancer risk of an integrated DNA repair score, measured by a panel of three enzymatic DNA repair activities in peripheral blood mononuclear cells. The panel included assays for AP endonuclease 1 (APE1), 8-oxoguanine DNA glycosylase (OGG1), and methylpurine DNA glycosylase (MPG), all of which repair oxidative DNA damage as part of the base excision repair pathways. A blinded population-based case-control study was conducted with 96 patients with lung cancer and 96 control subjects matched by gender, age (±1 year), place of residence, and ethnic group (Jews/non-Jews). The three DNA repair activities were measured, and an integrated DNA repair OMA (OGG1, MPG, and APE1) score was calculated for each individual. Conditional logistic regression analysis revealed that individuals in the lowest tertile of the integrated DNA repair OMA score had an increased risk of lung cancer compared with the highest tertile, with OR = 9.7; 95% confidence interval (CI), 3.1-29.8; P assessment, assisting prevention and referral to early detection by technologies such as low-dose computed tomography scanning. PMID:24356339

Sevilya, Ziv; Leitner-Dagan, Yael; Pinchev, Mila; Kremer, Ran; Elinger, Dalia; Rennert, Hedy S; Schechtman, Edna; Freedman, Laurence S; Rennert, Gad; Paz-Elizur, Tamar; Livneh, Zvi

2014-04-01

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Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction.  

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Patients with left ventricular (LV) systolic dysfunction after myocardial infarction (MI) are at particularly high risk for recurrent adverse outcomes. The magnitude of the decrease in risk associated with smoking cessation after MI has not been well described in patients with LV dysfunction after MI. We aimed to quantify the risk decrease associated with smoking cessation in subjects with LV dysfunction after MI. The Survival and Ventricular Enlargement (SAVE) trial randomized 2,231 subjects with LV dysfunction 3 to 16 days after MI. Smoking status was assessed at randomization and at regular intervals during a median follow-up of 42 months. Propensity score-adjusted Cox proportional hazard models were used to quantify the decrease in risk of all-cause mortality, death or recurrent MI, and death or heart failure (HF) hospitalization associated with smoking cessation. In baseline smokers who survived to 6 months without interval events, smoking cessation at 6-month follow-up was associated with a significantly lower adjusted risk of all-cause mortality (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.31 to 0.91), death or recurrent MI (HR 0.68, 95% CI 0.47 to 0.99), and death or HF hospitalization (HR 0.65, 95% CI 0.46 to 0.92). In conclusion, in patients with LV dysfunction after MI, smoking cessation is associated with a 40% lower hazard of all-cause mortality and a 30% lower hazard of death or recurrent MI or death or HF hospitalization. These findings indicate that smoking cessation is beneficial after high-risk MI and highlight the importance of smoking cessation as a therapeutic target in patients with LV dysfunction after MI. PMID:20854949

Shah, Amil M; Pfeffer, Marc A; Hartley, L Howard; Moyé, Lemuel A; Gersh, Bernard J; Rutherford, John D; Lamas, Gervasio A; Rouleau, Jean L; Braunwald, Eugene; Solomon, Scott D

2010-10-01

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Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome  

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Full Text Available Halvor Naess, Fredrik RomiDepartment of Neurology, Haukeland University Hospital, N-5021 Bergen, NorwayBackground: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction.Methods: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain, neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution as dependent variables.Results: Multivariate analysis showed that patients with spinal cord infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral infarction. Functional score (BI was lower among patients with spinal cord infarctions 1 week after onset of symptoms (P < 0.001. Odds ratio for being discharged home was 5.5 for patients with spinal cord infarction compared to cerebral infarction after adjusting for BI scored 1 week after onset (P = 0.019.Conclusion: Patients with spinal cord infarction have a risk factor profile that differs significantly from that of patients with cerebral infarction, although there are some parallels to cerebral infarction caused by atherosclerosis. Patients with spinal cord infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.Keywords: spinal cord infarction, cerebral infarction, risk factors, short-term outcome

Romi F

2011-08-01

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Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients: A case control study  

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Full Text Available Mohammad Shojaie, Morteza Pourahmad, Ahad Eshraghian, Hamid Reza Izadi, Farzan NaghshvarPeymanieh Hospital, Internal Medicine Department, Jahrom University of Medical Sciences, Jahrom, Fars, IranBackground: Premature myocardial infarction with life-threatening complications may become epidemic in some Asian and African countries and especially Iran. Fibrinogen is considered as one of the probable risk factors of myocardial infarction. The aim of our study was to assess fibrinogen levels as an etiology of premature myocardial infarction in young Iranian men.Findings: A case-control study was conducted between May 2005 and May 2007 to investigate the association between serum total fibrinogen level and myocardial infarction in men aged younger than 55 years admitted to the cardiac care units of Peymanieh and Motahari Hospitals affiliated to Jahrom University of Medical Sciences, Iran. The mean age of patients was 45.2 ± 4 years in patients with premature myocardial infarction and 47.06 ± 4.5 years in the control group (p = 0.085. There were no statistically significant relationships between the two groups in history of premature myocardial infarction in their first-degree relatives (p = 0.05, cigarette smoking (p = 0.46, diabetes (p = 0.49, or hypertension (p = 1. The mean plasma fibrinogen in patients (354.9 ± 60 mg/dL was elevated markedly compared with the control group (329 ± 73 mg/dL. Hyperfibrinogenemia (>340 mg/dL was detected in 81.8% of patients and 57.5% of controls (95% confidence interval, odds ratio = 3.3; p = 0.036.Conclusion: This study introduced fibrinogen as a risk factor for premature coronary artery disease in Iranian men.Keywords: myocardial infarction, cigarette, hypertension, diabetes, fibrinogen

Mohammad Shojaie

2009-08-01

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Risk for Myocardial Infarction and Stroke after Community-Acquired Bacteremia : A 20-Year Population-Based Cohort Study  

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Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia.

Dalager-Pedersen, Michael; SØgaard, Mette

2014-01-01

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Risk score algorithm for treatment of persistent apical periodontitis.  

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Persistent apical periodontitis related to a nonvital tooth that does not resolve following root canal treatment may be compatible with health and may not require further intervention. This research aimed to develop a Deterioration Risk Score (DRS) to differentiate lesions requiring further intervention from lesions likely to be compatible with health. In this cross-sectional study, patient records (2003-2008) were screened for root-filled teeth with periapical radiolucency visible on periapical radiographs taken at treatment and at recruitment at least 4 yr later. The final sample consisted of 228 lesions in 182 patients. Potential demographic and treatment risk factors were screened against 3 categorical outcomes (improved/unchanged/deteriorated), and a multivariate independent multinomial probit regression model was built. A 5-level DRS was constructed by summing values of adjusted regression coefficients in the model, based on predicted probabilities of deterioration. Most lesions (127, 55.7%) had improved over time, while 32 (14.0%) remained unchanged, and 69 (30.3%) had deteriorated. Significant predictors of deterioration were as follows: time since treatment (relative risk [RR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, p = .030, rounded beta value = 1, for every year increase after 4 yr), current pain (RR: 3.79, 95% CI: 1.48-9.70, p = .005, rounded beta value = 13), sinus tract present (RR: 4.13, 95% CI: 1.11-15.29, p = .034, rounded beta value = 14), and lesion size (RR: 7.20, 95% CI: 3.70-14.02, p 40, very high risk. DRS could help the clinician identify persistent apical periodontitis at low risk for deterioration, and it would not require intervention. When validated, this tool could reduce the risk of overtreatment and contribute toward targeted care and better efficiency in the timely management of disease. PMID:25190267

Yu, V S; Khin, L W; Hsu, C S; Yee, R; Messer, H H

2014-11-01

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Assessment of global cardiovascular risk and risk factors in Portugal according to the SCORE® model  

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Abstract Background/objective Cardiovascular diseases (CVD) are the leading cause of mortality in European countries. This study aimed at estimating the 10-year risk of fatal CVD in Portuguese adults and to assess the prevalence of major cardiovascular risk factors, according to the SCORE® risk prediction system. Subjects and methods A cross-sectional survey was carried out in 60 community pharmacies (CP) from October 2005 to January 2006 in a sample of CP users (=40 and =65 years). Dat...

Martins, Sofia Oliveira; Silva, Polybio Serra E.; Papoila, Ana; Caramona, Margarida; Mil, Jan Foppe; Cabrita, Jose?

2008-01-01

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Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST TIMI risk score validation for patients with acute coronary syndrome without ST elevation  

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Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIMI (Thrombolysis in Myocardial Infarction en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5% pacientes tenían riesgo bajo, 106 (52% riesgo intermedio, y 46 (22.5% riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Non-ST elevation acute coronary syndromes (NSTE-ACS are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26.4% of patients were categorized as "non coronary chest pain". Applying the TIMI risk score, 52 (25.5% patients had low risk, 106 (52% intermediated risk, and 46 (22.5% high risk. The global mortality was 12.3%. We found a progressively and significant increase in the rate of combined events as the TIMI score increase (p < 0.001. We conclude that in our population, the intermediated and high TIMI risk score was well related to newer cardiovascular events at 6 month follow-up.

Rodrigo H. Bagur

2009-10-01

73

SCORING ASSESSMENT AND FORECASTING MODELS BANKRUPTCY RISK OF COMPANIES  

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Full Text Available Bankruptcy risk made the subject of many research studies that aim at identifying the time of the bankruptcy, the factors that compete to achieve this state, the indicators that best express this orientation (the bankruptcy. The threats to enterprises require the managers knowledge of continually economic and financial situations, and vulnerable areas with development potential. Managers need to identify and properly manage the threats that would prevent achieving the targets. In terms of methods known in the literature of assessment and evaluation of bankruptcy risk they are static, functional, strategic, and scoring nonfinancial models. This article addresses Altman and Conan-Holder-known internationally as the model developed at national level by two teachers from prestigious universities in our country-the Robu-Mironiuc model. Those models are applied to data released by the profit and loss account and balance sheet Turism Covasna company over which bankruptcy risk analysis is performed. The results of the analysis are interpreted while trying to formulate solutions to the economic and financial viability of the entity.

SUSU Stefanita

2014-07-01

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Metabolic syndrome and Framingham risk score in obese young adults  

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Full Text Available Background: The increase number of the metabolic syndrome (MetS among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD which can be estimated by Framingham risk score (FRS. The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ? 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001, followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001, low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003, and impaired fasting glucose (p = 0.03. Four subjects had FRS ? 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154. There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately. (Med J Indones. 2013;22:100-6Keywords: Abdominal obesity, Framingham risk score, metabolic syndrome, young adults

Felix F. Widjaja

2013-06-01

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Coronary calcium score as a predictor for coronary artery disease and cardiac events in Japanese high-risk patients  

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Although the coronary artery calcium (CAC) score as measured with computed tomography (CT) is associated with cardiovascular mortality and morbidity in Western countries, little is known in Asian populations. Three hundred and seventeen Japanese patients (205 men and 112 women) were followed in the study and they underwent both coronary angiography and CT for CAC measurements. The frequencies of angiographic coronary artery disease (CAD) were 5%, 36%, 76%, 80%, and 94% (P1,000 (n=49), respectively. In the average of 6.0 (range, 1-10) years follow-up period, 34 patients died including 13 from reasons of cardiac disease. In a Cox proportional hazard model after adjustment for age and sex, traditional coronary risk factors, previous myocardial infarction, and the need for revascularization, the hazard ratio for cardiac mortality in patients with a CAC score >1,000 was 2.98 (95% confidence interval: 1.15-9.40) compared with those with a CAC score=0-100. The CAC score has a predictive value for angiographical CAD and long-term mortality from cardiac disease in Japanese high-risk patients who undergo coronary angiography. (author)

76

Using the Framingham Risk Score to Evaluate Immigrant Effect on Cardiovascular Disease Risk in Mexican Americans  

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Background This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. Methods and Results Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. Conclusions This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed. PMID:22643615

Salinas, Jennifer J.; Abdelbary, Bassent; Wilson, Jeffrey; Hossain, Monir; Fisher-Hoch, Susan; McCormick, Joseph

2013-01-01

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Risk Assessment Using Two Different Diagnostic Tools: Metabolic Syndrome and Cardiovascular Risk Score (SCORE—Data from a Weight Reduction Intervention Study  

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Full Text Available Objective: Risk score models and the diagnosis of a metabolic syndrome are useful for cardiovascular (CV risk prediction. The identification of individuals with high CV and metabolic risk is essential to provide appropriate prevention and therapy. The present study aims at clarifying whether these indicators are altered by a weight reduction programme. Additionally, which diagnostic tool has a better predictive value is examined. Method: One hundred and twenty overweight and obese subjects aged 30 60 years were included in a 12-week weight reduction programme. The CV risk was assessed by means of German multiple-used risk charts (SCORE at baseline and at the end of the trial. Furthermore, the prevalence of the metabolic syndrome (three out of five risk factors was quantified. Results: The initial prevalence of the metabolic syndrome was 63.3% (n = 76 and decreased to 41.7% (n = 50 by the end of the intervention. The SCORE also decreased significantly after twelve weeks (p 5% was comparatively low (t0: 7.4%, n = 7; t12: 5.3%, n = 5. Conclusion: The weight reduction concept was applicable to improve the CV risk SCORE and decrease the prevalence of the metabolic syndrome. The CV 10-year risk calculated using German risk charts (SCORE probably underestimated the risk of CV diseases in this collective. In this case, the diagnosis of a metabolic syndrome is more meaningful than risk SCORE calculations.

Janina Willers

2013-09-01

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SCORE underestimates cardiovascular risk (CVR of HIV+ patients  

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Full Text Available The new European Guidelines of Dislipidemia Management of the European Societies of Cardiology and Arteriosclerosis consider HIV+ as patients at high risk of developing cardiovascular events and deaths. The objective of the study was to evaluate cardiovascular events and deaths in a series of HIV+ patients. Observational, cross-sectional study, including a cohort of HIV+ and HIV? patients from 2008. CVR was calculated using the SCORE-CVR chart. Variation on lipid profile and incidence of cardiovascular events, cardiovascular death or death related to any cause were recorded. Data was analyzed using SPSS version 20.0 for MAC. 154 HIV+ and 155 HIV? patients were included. Mean age: 44.8±9.5 vs 55.2±14.3 y and 69.5% vs 49% males respectively (p<0.01. Mean time since HIV+ diagnosis was 11±6.2 y. Mean BMI and systolic blood pressure were lower in HIV+ (25.1±6.7 kg/m2 vs 28.7±5.1 kg/m2, (p<0.01 and 119.6±19.4 vs 124.7±14.7 mmHg, (p=0.044; respectively. A lower proportion of hypertense, diabetic and obese patients was observed in HIV+ (25.5% vs 6.5%; 20.6% vs 3.9% and 36.8% vs 12.3% but a larger proportion of smokers (68.8% vs 29.7% was observed (p<0.01 in all cases. Mean cholesterol and LDLc were lower in HIV+ (191.2±41.4 vs 218.5±44.6 mg/dl and 109.5±33.9 vs 134.6±37.7 mg/dl; p<0.01; respectively but with a lower mean HDLc and higher TG (50.3±19 mg/dl vs 55.2±14.9 mg/dl; p=0.013 and 156.7±85.7 vs 135.8±66.2 mg/dl; p=0.017; respectively. There was no significant difference in mean CVR-SCORE (3.5±3.6% vs 4.4±3.8%; p=0.091. With this SCORE, 5.2±5.3 and 6.7±5.8 cardiovascular events or deaths should be expected in HIV+ and HIV? respectively at 10 y. Four years later cholesterol, LDLc, HDLc, TG in HIV+ and HIV? patients did not vary compared with those obtained 4 y before. 5 events and 1 death were seen at 4 y follow-up in HIV+, and in HIV? patients. The incidence of events in HIV+ patients is similar to the expected according to their SCORE at 10 y. We could suppose that once the 10 y follow-up is reached, this incidence would be higher. On the other side, in HIV? at 4 y just 3 events ocurred, far from the 6.7 events expected. There were no significant differences between lipid profiles in any of the cohorts. Lipid profile with low HDLc and high TG is persistent in HIV+ patients at 4 y follow-up. Understimation of CVR in HIV+ patients by SCORE charts could be present as soon as 4 y after the first assesment. This supports the stratification of HIV+ patients as high-risk patients in new guidelines.

R Ramírez

2012-11-01

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The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size  

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Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

Chao Feng

2013-01-01

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The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size  

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Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought [...] to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

Chao, Feng; Xue, Bai; Yu, Xu; Ting, Hua; Xue-Yuan, Liu.

 
 
 
 
81

Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization  

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Full Text Available OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorporeal circulation. We assessed 178 patients (89 patients in each group undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002. This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001. Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.

José Ribamar Costa Jr.

2003-03-01

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Frequency of risk factors of cerebral infarction in stroke patients. a study of 100 cases in naseer teaching hospital, peshawar  

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To study the risk factors of cerebral infarction in stroke patients. It is a descriptive hospital based study conducted at the Department of Medicine, Naseer Teaching Hospital, Peshawar from January 2005 to December 2005. One hundred patients of stroke with cerebral infarction confirmed on C.T. scan brain and more than twenty years of age were included. Risk factors for cerebral infarction were defined in terms of hypertension, diabetes mellitus, ischemic heart disease, smoking, dyslipidaemia, TIAs (transient ischemic attacks), carotid artery stenosis and family history of stroke. Data of 100 cases with cerebral infarction was recorded. Most of the patients had more than one risk factors for cerebral infarction. hypertension was commonest risk factor (55%), smoking (30%), ischemic heart disease (34%), diabetes mellitus) (26%), hyperlipedaemia (30%), atrial fibrillation (25%), carotid artery stenosis (27%), obesity (15%) and family history of stroke (12%). 39% of patients had physical inactivity. Males were slightly predominant than females (51% vs 49%) and mean age was 50 years. females were rather older with mean age of 53 years. Cerebral infarction accounts for 80% to 85% of cases of stroke, which is a common neurological disorder. It increases a burden of disability and misery for patients and their families. Most of the risk factors of cerebral infarction are modifiable, its prevention should be the main cause of concern for the community. (author)or the community. (author)

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Relation of asymmetric dimethylarginine levels with conventional risk score systems in the healthy subjects with positive family history for coronary artery disease  

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Full Text Available Objective: Coronary artery disease is the most common cause of death in Turkey and the world. Asymmetric dimethylarginine is the major inhibitor of nitric oxide synthesis in humans. It has been shown that increased levels of asymmetric dimethylarginine is associated with endothelial dysfunction and increased atherogenesis. In this study, we aimed to investigate whether asymmetric dimethylarginine level is related with conventional risk score systems in subjects who had family history of coronary artery disease. Methods: Fifty two subjects within 20-40 years old of whom first degree relatives had myocardial infarction at young ages and 26 age and sex matched control subjects were included in this cross-sectional observational study. Frequency of diabetes, hyperlipidemia, smoking and serum levels of homocysteine, high-sensitive C-reactive protein (hsCRP and asymmetric dimethylarginine were compared between risk group and control subjects. Relation of asymmetric dimethylarginine level with Framingham and TEKHARF risk scores was also compared. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively.Results: Fasting serum glucose, triglyceride, high-density lipoprotein, diastolic blood pressure, waist circumference and TEKHARF scores were increased in the subjects who had family history of myocardial infarction. Total cholesterol, low-density lipoprotein, hsCRP, homocysteine, creatinine and Framingham risk score were similar in studied groups . Asymmetric dimethylarginine levels were 0.1µmol/L higher in the risk group; however this difference could not reach significance (0.7±0.1 µmol/l vs 0.8±0.1 µmol/l; p=0.061. Conclusion: Measurement of serum asymmetric dimethylarginine levels did not reveal utility in defining conventional coronary artery disease risk score systems in cases that had positive family history. Larger studies including patients with different risk tertiles are needed.

Hulusi Sat?lm??o?lu

2011-03-01

84

Risk of myocardial infarction in parents of HIV-infected Individuals: a population-based Cohort Study  

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Previous studies have indicated an increased risk of myocardial infarction (MI) in HIV infected individuals especially after start of highly active antiretroviral therapy (HAART). It is however controversial whether the increased risk of atherosclerotic disease is exclusively associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents of HIV-infected individuals.

Rasmussen, Line D; Omland, Lars H

2010-01-01

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Risk scores for diabetes and impaired glycaemia in the Middle East and North Africa  

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AIMS: To develop risk scores for diabetes and diabetes or impaired glycaemia for individuals living in the Middle East and North Africa region. In addition, to derive national risk scores for Algeria, Saudi Arabia and the United Arab Emirates and to compare the performance of the regional risk scores with the national risk scores. METHODS: An opportunistic sample of 6588 individuals aged 30-75 years was screened. Screening consisted of a questionnaire and a clinical examination including measurement of HbA(1c). Two regional risk scores and national risk scores for each of the three countries were derived separately by stepwise backwards multiple logistic regression with diabetes [HbA(1c) ? 48 mmol/mol (? 6.5%)] and diabetes or impaired glycaemia [HbA(1c) ? 42 mmol/mol (? 6.0%)] as outcome. The performance of the regional and national risk scores was compared in data from each country by receiver operating characteristic analysis. RESULTS: The eight risk scores all included age and BMI, while additional variables differed between the scores. The areas under the receiver operating characteristic curves were between 0.67 and 0.70, and for sensitivities approximately 75%; specificities varied between 50% and 57%. The regional and the national risk scores performed equally well in the three national samples. CONCLUSIONS: Two regional risk scores for diabetes and diabetes or impaired glycaemia applicable to the Middle East and North Africa region were identified. The regional risk scores performed as well as the national risk scores derived in the same manner.

Handlos, Line Neerup; Witte, Daniel Rinse

2013-01-01

86

The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction  

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Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown.

Shah, Amil M; Uno, Hajime

2010-01-01

87

Mortality Risk Prediction by Application of PRISM Scoring System in Pediatric Intensive Care Unit  

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Full Text Available Objective: The Pediatric Risk of Mortality (PRISM score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU. Herein, evaluate the efficacy of PRISM score in prediction of mortality rate in PICU.Methods: In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox, Logistic regression model using SPSS 15.Findings: Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P?0.001. A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%.Conclusion: PRISM score is a good predictor for evaluation of mortality risk in PICU.

Mahdi Mohammadi

2013-10-01

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Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population : a nationwide propensity score-matched study  

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Aim: To evaluate the effect of statins on reducing new-onset atrial fibrillation (AF) in a large real-world post-myocardial infarction (MI) population. Subsequently, to test if different statin doses, various types and compliance affected the incidence of new-onset AF post MI.Methods: All patients with first-time acute MI between 1997 and 2009 in Denmark and claimed prescriptions of statins after discharge were identified from the Danish nationwide administrative registers. Patients with a history of AF were excluded. Risk of new-onset AF according to statin use were analysed by multivariable time-dependent Cox regressions models adjusted for age, gender, year, concomitant medication, and comorbidity, and additionally in a propensity score-matched analysis.Results: A total of 89,703 patients with average follow up of 5.0 ± 3.5 years were included in this study. In the 56,044 patients receiving statins, 5698 (10%) had new-onset AF vs. 5010 (15%) in the 33,659 patients serving as controls. The adjusted Cox regression analysis showed significant reduction in new-onset AF (HR 0.83, 95% CI 0.80-0.87, p <0.001) in statin users. Adjustment for propensity score yielded nearly identical results (HR 0.82, 95% CI 0.78-0.85, p <0.001). Furthermore, patients compliant to statin treatment had significant reduction in new-onset AF (HR 0.84, 95% CI 0.80-0.87, p <0.001). Finally, simvastatin and atorvastatin were significantly more effective than pravastatin (both p <0.01) in reducing new-onset AF.Conclusions: Statin therapy was significantly associated with less new-onset AF in a nationwide cohort of post-MI patients. Furthermore, statins showed a type-dependent effect in preventing new-onset AF. These results support the beneficial effect of statin therapy beyond lipid lowering in patients with MI and underline the importance of statin adherence and choice of statin type.

Bang, Casper N; Gislason, Gunnar H

2012-01-01

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Derivation and validation of QStroke score for predicting risk of ischaemic stroke in primary care and comparison with other risk scores: a prospective open cohort study  

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Objective To develop and validate a risk algorithm (QStroke) to estimate risk of stroke or transient ischaemic attack in patients without prior stroke or transient ischaemic attack at baseline; to compare (a) QStroke with CHADS2 and CHA2DS2VASc scores in patients with atrial fibrillation and (b) the performance of QStroke with the Framingham stroke score in the full population free of stroke or transient ischaemic attack.

Hippisley-cox, Julia; Coupland, Carol; Brindle, Peter

2013-01-01

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FAMILY HISTORY OF DISEASE AS A RISK FACTOR OF ACUTE MYOCARDIAL INFARCTION  

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Full Text Available Myocardial infarction (MI is a complex disease that begins with a lifelong interaction between genetics and environmental factors. The aim of the study was to identify family history as a risk factor of myocardial infarction in examined population in the Municipality of Nis.We used a case-control study with 100 patients with a first MI (in the period 1998-2000 and 100 controls, matched with respect to sex and age (± 2 years from the Municipality of Nis.Data was obtained from the epidemiological questionnaire. The Yates c2 test, odds ratio-OR and their 99% interval of confident were used as statistical procedures.The results showed that statistical significance for MI was present among all three degrees of relatives of subjects who have had an acute MI, and for hypertension, hypercholesterolemia and stroke among first and second - degree relatives. The subjects with family history of hypercholesterolemia had 12.43 times higher risk of disease (p = 0,000 and in the case of family history of MI before the age of 55, the risk was almost 10 times (p = 0,000 higher. Almost 4 times higher risk of disease was registered in subjects with family history of hypertension (p < 0,00001 and stroke (before 65 years of age - (p < 00005; a two-fold higher risk was registered in subjects with diagnoses of diabetes (p < 0,05 and other cardiovascular diseases (unless hypertension (p < 0,01 in the nearest relatives before the age of 55.We concluded that family history of diseases on the sample of the Municipality of Nis inhabitants was very important risk factor, mostly in the first-degree relatives. Genetic epidemiology is the future for all investigations between different population, and special attention should be paid to investigations and findings of different genes and loci which are very important for myocardial infarction occurrence, which would allow a new approach to preventive medicine.

Zoran Velickovic

2006-10-01

91

The interleukin-1 cluster, dyslipidaemia and risk of myocardial infarction  

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Full Text Available Abstract Coronary heart disease (CHD is among the most serious worldwide health problems. Recent genetic studies have robustly identified a number of polymorphic loci throughout the genome that are associated with disease risk but it is certain that more remain to be discovered. It is well established that inflammation plays a key role in the pathophysiology of CHD. Determining whether or not polymorphisms in genes involved in the inflammatory cascade affect the risk of CHD is of considerable interest with respect to understanding the direction of the causal arrow between increased expression of inflammatory genes and CHD. Establishing an association between the variation in inflammatory genes and CHD would provide conceptual support for the use of appropriately specific anti-inflammatory agents in CHD prevention and, potentially, suggest new therapeutic targets. This month in BMC Medicine, Benjamin Brown and colleagues adopt a family-based case-control association study design to address this question. In a large number of CHD cases and healthy sibling controls genotyped for 51 mainly coding single nucleotide polymorphisms (SNPs, they find evidence for the association of a common haplotype at the Interleukin-1 (IL-1 cluster with CHD which appears to be stronger in younger cases without hypercholesterolaemia. They also find suggestive evidence for an association between this same haplotype and hypercholesterolaemia. If replicated in other cohorts, these results could be of substantial importance in advancing the understanding of the way in which inflammatory genes affect coronary heart disease risk. See the associated research paper by Brown et al: http://www.biomedcentral.com/1741-7015/8/5

Keavney Bernard

2010-01-01

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Usefulness of residual ischemic myocardium within prior infarct zone for identifying patients at high risk late after acute myocardial infarction  

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was excluded as an endpoint, TI-201 redistribution limited to the prior infarct zone was the only significant predictor of cardiac events. All 8 cardiac events occurred in patients with T1-201 redistribution limited to the infart zone

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Poor predictive ability of the risk chart SCORE in a Danish population  

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In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.

Saidj, Madina; JØrgensen, Torben

2013-01-01

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Cardiovascular risk scores do not account for the effect of treatment: a review  

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OBJECTIVE: To compare the strengths and limitations of cardiovascular risk scores available for clinicians in assessing the global (absolute) risk of cardiovascular disease. DESIGN: Review of cardiovascular risk scores. DATA SOURCES: Medline (1966 to May 2009) using a mixture of MeSH terms and free text for the keywords 'cardiovascular', 'risk prediction' and 'cohort studies'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: A study was eligible if it fulfilled the following criteria: (1) it was a...

Liew, Sm; Doust, J.; Glasziou, P.

2011-01-01

95

The development and validation of a risk score for predicting microalbuminuria in type 2 diabetic patients  

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Full Text Available Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set. The model evaluated at a tertiary hospital (validation set. A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ? 2 was 0.28, with moderate risk (scores 2.5 to 5.5 was 0.86, and high risk (scores ? 6 was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81 and 0.758 (95% CI 0.70 - 0.80, respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.

Jayanton Patumanond

2012-05-01

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Prognostic implications of cardiac scintigraphic parameters obtained in the early phase of acute myocardial infarction  

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A cohort of 76 patients with acute myocardial infarction was studied with infarct-avid scan, radionuclide ventriculography, and thallium-201 myocardial perfusion scintigraphy. Infarct area, left ventricular ejection fraction, and defect score were calculated as radionuclide indices of the extent of myocardial infarction. The correlation was studied between these indices and cardiac events (death, congestive heart failure, postinfarction angina, and recurrence of myocardial infarction) in the first postinfarction year. High-risk patients (nonsurvivors and patients who developed heart failure) had a larger infarct area, a lower left ventricular ejection fraction, and a larger defect score than the others. Univariate linear discriminant analysis was done to determine the optimal threshold of these parameters for distinguishing high-risk patients from others. Radionuclide parameters obtained in the early phase of acute myocardial infarction were useful for detecting both patients with grave complications and those with poor late prognosis during a mean follow-up period of 2.6 years

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MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT  

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Full Text Available Risk analysis materializes in: applying to the weightings of risk factors the level of risk assessment, on risk factors, based on the assessments made by auditors regarding: the functionality of internal control, the influence of quantitative and qualitative elements; determination of the total risk score, which represents a sum of weights between the appreciation level of each risk and the weightings of risk factors.

FRANCA DUMITRU

2012-11-01

98

Vertebral Fracture Risk (VFR) Score for Fracture Prediction in Postmenopausal Women  

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Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by follow-up after 6.3 years) from healthy controls at baseline.

Lillholm, M.; Ghosh, A.

2011-01-01

99

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction  

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Full Text Available Patricia RE Harris,1 Phyllis K Stein,2 Gordon L Fung,3 Barbara J Drew4 1Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San Francisco, CA, USA; 2Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA; 3Cardiology Services, Department of Medicine, 4School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San Francisco, CA, USA Background: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI or unstable angina. Methods: Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ?18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI risk scores were chosen for analysis (n = 166. Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year. Results: In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725 and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695 endpoints, outperforming either measure alone. Conclusion: Measurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina. Keywords: acute coronary syndrome, electrocardiographic monitoring, heart rate turbulence, non-ST elevation myocardial infarction, outcomes, prognosis, unstable angina

Harris PRE

2013-08-01

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Mean systolic annular velocity and strain score index: new and non-invasive parameters for the evaluation of acute myocardial infarction patients  

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Full Text Available Objective: To evaluate the diagnostic value of mean annular velocity (MAV and strain score index (SSI for determination of the left ventricular systolic dysfunction in patients with first acute myocardial infarction (AMI. Methods: Seventy-one patients (55 male, mean age: 59±12 years with first acute ST-elevation myocardial infarction and 30 healthy subjects were included in this cross-sectional and observational study. Echocardiography with tissue Doppler and strain analysis was performed during initial hospital admission. Peak systolic myocardial velocities were recorded from 4 different sites on the mitral annulus. A MAV value was calculated and the peak systolic strain values of 12 segments were measured and a mean SSI was calculated. ROC curve analysis was used in order to determine cut-off values for MAV and SSI. Results: The patients with AMI had a significantly reduced MAV compared with healthy subjects (5.52±1.78 cm/s vs 9.80±1.13 cm/s, p<0.001. In ROC analysis, a cut-off value of 8.41 cm/s (AUC 0.915, 95%CI 0.887-0.952, p<0.001 for MAV differentiated AMI patients from controls with 97.2% sensitivity and 93.3% specificity. The patients with AMI have also decreased SSI (11.23±2.83 vs 19.11±2.05, p<0.001. A cut-off value of 15.35% differentiated AMI patients from controls with 94.4% sensitivity and 100% specificity (ROC AUC 0.945, 95%CI 0.901-0.972, p<0.001. There was a good correlation between left ventricular EF and MAV (r=0.73, p<0.001 and SSI (r=0.66, p<0.001.Conclusion: The patients with first myocardial infarction have decreased mean systolic annular velocity and mean systolic strain score index.

Ergün Bar?? Kaya

2010-06-01

 
 
 
 
101

Risk for myocardial infarction and stroke after community-acquired bacteremia : a 20-year population-based cohort study  

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BACKGROUND: Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia. METHODS AND RESULTS: This population-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI, 15.38-28.29) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days after bacteremia in comparison with population controls (adjusted hazard ratio, 1.64; 95% CI, 1.18-2.27), but not versus hospitalized controls (adjusted hazard ratio, 0.95; 95% CI, 0.69-1.32). No differences in cardiovascular risk were seen after >6 months. Increased 30-day risks were consistently found for a variety of etiologic agents and infectious foci. CONCLUSIONS: Community-acquired bacteremia is associated with increased short-term risk of myocardial infarction and stroke.

Dalager-Pedersen, Michael; SØgaard, Mette

2014-01-01

102

Comparison of visual scoring and quantitative planimetry methods for estimation of global infarct size on delayed enhanced cardiac MRI and validation with myocardial enzymes  

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Purpose: Although delayed enhanced CMR has become a reference method for infarct size quantification, there is no ideal method to quantify total infarct size in a routine clinical practice. In a prospective study we compared the performance and post-processing time of a global visual scoring method to standard quantitative planimetry and we compared both methods to the peak values of myocardial biomarkers. Materials and methods: This study had local ethics committee approval; all patients gave written informed consent. One hundred and three patients admitted with reperfused AMI to our intensive care unit had a complete CMR study with gadolinium-contrast injection 4 {+-} 2 days after admission. A global visual score was defined on a 17-segment model and compared with the quantitative planimetric evaluation of hyperenhancement. The peak values of serum Troponin I (TnI) and creatine kinase (CK) release were measured in each patient. Results: The mean percentage of total left ventricular myocardium with hyperenhancement determined by the quantitative planimetry method was (20.1 {+-} 14.6) with a range of 1-68%. There was an excellent correlation between quantitative planimetry and visual global scoring for the hyperenhancement extent's measurement (r = 0.94; y = 1.093x + 0.87; SEE = 1.2; P < 0.001) The Bland-Altman plot showed a good concordance between the two approaches (mean of the differences = 1.9% with a standard deviation of 4.7). Mean post-processing time for quantitative planimetry was significantly longer than visual scoring post-processing time (23.7 {+-} 5.7 min vs 5.0 {+-} 1.1 min respectively, P < 0.001). Correlation between peak CK and quantitative planimetry was r = 0.82 (P < 0.001) and r = 0.83 (P < 0.001) with visual global scoring. Correlation between peak Troponin I and quantitative planimetry was r = 0.86 (P < 0.001) and r = 0.85 (P < 0.001) with visual global scoring. Conclusion: A visual approach based on a 17-segment model allows a rapid and accurate assessment of the myocardial global delayed enhancement. This scoring method could be used on a daily practice and useful for the management strategy of post-MI patients.

Mewton, Nathan, E-mail: nmewton@gmail.com [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France); Revel, Didier [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France); Bonnefoy, Eric [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); Ovize, Michel [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); INSERM Unite 886 (France); Croisille, Pierre [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France)

2011-04-15

103

Long-term recording of cardiac arrhythmias with an implantable cardiac monitor in patients with reduced ejection fraction after acute myocardial infarction: the Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) study  

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Knowledge about the incidence of cardiac arrhythmias after acute myocardial infarction has been limited by the lack of traditional ECG recording systems to document and confirm asymptomatic and symptomatic arrhythmias. The Cardiac Arrhythmias and Risk Stratification After Myocardial Infarction (CARISMA) trial was designed to study the incidence and prognostic significance of arrhythmias documented by an implantable cardiac monitor among patients with acute myocardial infarction and reduced left ventricular ejection fraction.

Bloch Thomsen, Poul Erik; Jons, Christian

2010-01-01

104

Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction  

DEFF Research Database (Denmark)

The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic: <100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.7 months of follow-up. Antecedent hypertension independently increased the risk of heart failure (hazard ratio [HR]: 1.19; 95% CI: 1.08 to 1.32), stroke (HR: 1.27; 95% CI: 1.02 to 1.58), cardiovascular death (HR: 1.11; 95% CI: 1.01 to 1.22), and the composite of death, myocardial infarction, heart failure, stroke, or cardiac arrest (HR: 1.13; 95% CI: 1.06 to 1.21). While low blood pressure in the postmyocardial infarction period was associated with increased risk of adverse events, patients with elevated blood pressure (n=1226) were at significantly higher risk of stroke (adjusted HR: 1.64; 95% CI: 1.17 to 2.29) and combined cardiovascular events (adjusted HR: 1.14; 95% CI: 1.00 to 1.31). Six months after a high-risk myocardial infarction, elevated systolic blood pressure, a potentially modifiable risk factor, is associated with an increased risk of subsequent stroke and cardiovascular events. Whether aggressive antihypertensive treatment can reduce this risk remains unknown Udgivelsesdato: 2008/1

Thune, J.J.; Signorovitch, J.

2007-01-01

105

A Risk Prediction Score for Invasive Mold Disease in Patients with Hematological Malignancies  

Science.gov (United States)

Background A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. Methods We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. Results Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate “screening-out” of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis. PMID:24086555

Stanzani, Marta; Lewis, Russell E.; Fiacchini, Mauro; Ricci, Paolo; Tumietto, Fabio; Viale, Pierluigi; Ambretti, Simone; Baccarani, Michele; Cavo, Michele; Vianelli, Nicola

2013-01-01

106

Barriers to cardiovascular disease risk scoring and primary prevention in Europe.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The prevalence and burden of cardiovascular disease (CVD) is high, and it remains the leading cause of death worldwide. Unfortunately, many individuals who are at high risk for CVD are not recognized and/or treated. Therefore, programs are available to ensure individuals at risk for CVD are identified through appropriate risk classification and offered optimal preventative interventions. The use of algorithms to determine a global risk score may help to achieve these goals. Such global risk-s...

Hobbs, Fd; Jukema, Jw; Da Silva, Pm; Mccormack, T.; Catapano, Al

2010-01-01

107

Coronary angiographic findings in diagnostically manifested myocardial infarctions: Their relationship to psychlosocial and somatic risk factors  

International Nuclear Information System (INIS)

The investigation was meant as an attempt to illustrate coronary arteriosclerosis as the cause of myocardial infarction and the mechanisms of its development as well as the conditions influencing it. The paper consists of two parts: 1) Literature part: In this part, risk factors of coronary arteriosclerosis and the mechanism of its effects (as far as known) are introduced. The results obtained by other authors are also summarized. 2) Empiric part: The following empiric part covers the author's own results which are discussed and compared to the results obtained by other authors. (orig./MG)

108

The accuracy of the Framingham risk-score in different socioeconomic groups: a prospective study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

BACKGROUND: The primary prevention of cardiovascular disease involves using the Framingham risk score to identify high risk patients and then prescribe preventive treatments. AIM: To examine the performance of the Framingham risk score in different socioeconomic groups in a population with high rates of cardiovascular disease. DESIGN OF STUDY: A prospective study. SETTING: West of Scotland. METHOD: The observed 10-year cardiovascular disease and coronary heart disease mortality rates in 5626 ...

Brindle, P. M.; Mcconnachie, A.; Upton, M.; Hart, C.; Davey Smith, G.; Watt, G. C. M.

2005-01-01

109

Validation of a new risk score to predict contrast-induced nephropathy after percutaneous coronary intervention.  

Science.gov (United States)

Contrast-induced nephropathy (CIN) is a frequent, potentially lethal complication of percutaneous coronary interventions (PCIs). We prospectively validated the diagnostic performance of a simple CIN risk score in a large multicenter international cohort of patients who underwent PCI. About 2,882 consecutive patients treated with elective or urgent PCI were enrolled. A simple CIN risk score was calculated for all patients by allocating points according to a prespecified scale (pre-existing renal disease = 2; metformin use = 2; previous PCI = 1; peripheral arterial disease = 2; and injected volume of contrast medium ?300 ml = 1). CIN was defined as an increase, compared with baseline, of serum creatinine by ?25%, or by ?0.5 mg/dl, 48 hours after PCI. CIN occurred in 15.7% of the study population. The predictive accuracy of the CIN risk score was good (c-statistic 0.741, 95% confidence interval 0.713 to 0.769). Receiver-operating characteristic analysis identified a score of ?3 as having the best diagnostic accuracy. Examination of the performance of the proposed risk score using different definitions of CIN yielded a robust predictive ability. The score exhibited good discrimination (area under the curve ?0.700) across all predefined subgroups of the study population. Compared with 2 previously published risk scores for CIN, our score demonstrated higher discriminative ability and resulted in a net reclassification improvement and an integrated discrimination improvement (p management of patients at risk for CIN. PMID:24630389

Tziakas, Dimitrios; Chalikias, Georgios; Stakos, Dimitrios; Altun, Armagan; Sivri, Nasir; Yetkin, Ertan; Gur, Mustafa; Stankovic, Goran; Mehmedbegovic, Zlatko; Voudris, Vassilis; Chatzikyriakou, Sofia; Garcia-Moll, Xavier; Serra, Antonio; Passadakis, Ploumis; Thodis, Elias; Vargemezis, Vassilis; Kaski, Juan Carlos; Konstantinides, Stavros

2014-05-01

110

DESIGN AND STUDY OF ONLINE FUZZY RISK SCORE ANALYZER FOR DIABETES MELLITUS  

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Full Text Available The aim of this study is to determine the risks of various subjects to type 2 Diabetes and its dependence on the different subject records. A Fuzzy based system was designed to find the risk scores for diabetes based on risk score derived from Chennai Urban Rural Epidemiology Study (CURES. The risk score that has been adapted into the system is referred to as Indian Diabetes Risk Score (IDRS. The variables employed in it are age, gender, waist, exercise and history of diabetes. A database of subject records was collected from hundred random individuals from southern regions of India. A comparative study was performed on these records between the normal and fuzzified risk score based on IDRS. The program has been designed using Lab VIEW with Fuzzy System Designer being used for fuzzy rule execution. The details are transmitted online through web page to the physicians who can provide assistance in prevention of diabetes. The obtained risk scores of the subjects are used to improve the lifestyle and delay the onset of diabetes to the maximum possible. This system can be implemented in rural regions where experienced medical assistance may not be available. This system would form an ideal part of the current developments in medicine where physical physician presence is not required due to the buttress provided by advancements in computer technology. The aim of this study is to determine the risks of various subjects to type 2 Diabetes and its dependence on the different subject records. A Fuzzy based system was designed to find the risk scores for diabetes based on risk score derived from Chennai Urban Rural Epidemiology Study (CURES. The risk score that has been adapted into the system is referred to as Indian Diabetes Risk Score (IDRS. The variables employed in it are age, gender, waist, exercise and history of diabetes. A database of subject records was collected from hundred random individuals from southern regions of India. A comparative study was performed on these records between the normal and fuzzified risk score based on IDRS. The program has been designed using Lab VIEW with Fuzzy System Designer being used for fuzzy rule execution. The details are transmitted online through web page to the physicians who can provide assistance in prevention of diabetes. The obtained risk scores of the subjects are used to improve the lifestyle and delay the onset of diabetes to the maximum possible. This system can be implemented in rural regions where experienced medical assistance may not be available. This system would form an ideal part of the current developments in medicine where physical physician presence is not required due to the buttress provided by advancements in computer technology.

SunithaKarnam Anantha

2013-01-01

111

Comparison of carotid artery intima - media thickness and risk factors of atherosclerosis in lacunar versus non-lacunar cerebral infarcts  

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Full Text Available

BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT, and lacunar versus non-lacunar infarcts.
METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.
RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes,
smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity,
atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P = 0.02, and hypertension
(P = 0.02 had a significantly higher percentage of history of prior CVA (P = 0.03 and a significantly higher percentage
of non-lacunar infarct.
CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies should be done in our country to find ways to prevent stroke and its complications.
KEY WORDS: Lacunar infarction, risk factors, ultrasonography.

Seyed Ali Mousavi

2007-07-01

112

[Obstructive sleep apnoea syndrome in patients with acute myocardial infarction: the efficacy of treatment and risk factors].  

Science.gov (United States)

The study included 112 patients with acute myocardial infarction and elevated ST segment on ECG depending on the presence of obstructive sleep apnoea syndrome (OSAS). Dynamic analysis clinico-instrumental characteristics after the hospital-based treatment revealed insufficient reduction of ST segment by day 14 of therapy that correlated with severity of the disease estimated from the apnoea/hypopnoea index. Only these patients responded to the treatment by a decrease of the left ventricular ejection fraction as a marker of systolic dysfunction. Apnoea/hypopnoea index over 15 episodes/hr, the history of diabetes mellitus and anterior myocardial infarction were the most significant factors determining the relative risk of OSAS influence on the development of myocardial infarction. The authors emphasize the importance of early diagnostics of OSAS in patients with acute myocardial infarction and the necessity of cardiorespiratory monitoring in addition to hemodynamic one. PMID:23516866

Ivanov, A P; Kliuvkin, D V; Rostorotskaia, V V; El'gardt, I A

2012-01-01

113

Biomarkers in acute myocardial infarction  

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Full Text Available Abstract Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic accuracy. However, it is important to note that only troponin has been used to direct therapeutic intervention and none of the new prognostic biomarkers have been tested and proven to alter outcome of therapeutic intervention. Novel biomarkers have improved prediction of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. Randomised trials are urgently needed to address this translational gap before the use of novel biomarkers becomes common practice to facilitate tailored treatment following an acute coronary event.

Ng Leong L

2010-06-01

114

Relation Between ABO Blood Groups, Cardiovascular Risk Factors and Acute Myocardial Infarction  

Directory of Open Access Journals (Sweden)

Full Text Available Different risk factors affect development of atherosclerosis and Coronary Artery Disease (CAD. These factors are believed to be of value in prediction and prevention of coronary events. Here in we report the relation between blood groups, cardiovascular risk factors and Myocardial Infarction incidence. Measurements were made in samples obtained from 500 patients who had admitted to Cardiac Care Unit (CCU of Madani heart center of Tabriz, Iran due to first Acute Myocardial Infarction (AMI from Jan 2005 to April 2007. Participants provided blood samples for Cholesterol, Glucose (Fasting Blood Sugar (FBS, Cardiac enzymes and Blood Groups (BG. Standard 12-lead electrocardiograms were obtained immediately after admission. Patients were also asked about current smoking history, Hypertension (HTN and Diabetes Mellitus (DM history. Analysis showed significant differences between the frequency of ABO blood groups and AMI, Smoking, Serum Cholesterol, but non significant relation with HTN, DM and the location of MI. In individuals the incidence of AMI was higher in those with BG A; while, sleeping MI was higher in group O. AMI was less frequent in BG AB. The mean serum cholesterol level and positive current smoking history were significantly higher in AMI patients with BG A. Blood group A is related to the higher incidence of AMI, hypercholesterolemia and positive current smoking history, but the findings don`t support the view that ABO blood groups and AMI are related to HTN, DM and location of MI.

2008-01-01

115

A Statistical Study of Socio-economic and Physical Risk Factors of Myocardial Infarction  

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Full Text Available A sample of 506 patients from various hospitals in Peshawar was examined to determine significant socio-economic and physical risk factors of Myocardial Infarction (heart attack. The factors examined were smoking (S, hypertension (H, cholesterol (C, diabetes (D, family history (F, residence (R, own a house (OH, number of dependents (ND, household income (I, obesity and lack of exercise (E. The response variable MI was binary. Therefore, logistic regression was applied (using GLIM and SPSS packages to analyze the data and to select a parsimonious model. Logistic regression models have been obtained indicating significant risk factors for both sexes, for males and for females separately. The best-selected model for both sexes is of factors S, F, D, H and C. The best-selected model for males is of factors CIFH, S, H, D, C and F, while the best-selected model for females is of factors D, H, C and F.

M. Alamgir

2005-07-01

116

Elevated triglycerides and risk of myocardial infarction in HIV-positive persons  

DEFF Research Database (Denmark)

Objectives: To explore the relationship between elevated triglyceride levels and the risk of myocardial infarction (MI) in HIV-positive persons after adjustment for total cholesterol (TC), high-density lipoprotein–cholesterol (HDL-C) and nonlipid risk factors. Background: Although elevated triglyceride levels are commonly noted in HIV-positive individuals, it is unclear whether they represent an independent risk factor for MI. Methods: The incidence of MI during follow-up was stratified according to the latest triglyceride level. Multivariable Poisson regression models were used to describe the independent association between the latest triglyceride level and MI risk after adjusting for TC and HDL-C, nonlipids cardiovascular disease (CVD) risk factors, HIV and treatment-related factors. Results: The 33 308 persons included in the study from 1999 to 2008 experienced 580 MIs over 178 835 person-years. Unadjusted, the risk of MI increased by 67% [relative risk (RR) 1.67, 95% confidence interval 1.54–1.80] per doubling in triglyceride level. After adjustment for the latest TC and HDL-C level, the RR dropped to 1.33 (95% confidence interval 1.21–1.45); this effect was further attenuated by other CVD risk factors and the RR was reduced to 1.17 (95% confidence interval 1.06–1.29). In models that additionally adjusted for HIV and treatment factors, the risk was further diminished, although remained significant (RR 1.11, 95% confidence interval 1.01–1.23). Conclusion: Higher triglyceride levels were marginally independently associated with an increased risk of MI in HIV-positive persons, although the extent of reduction in RR after taking account of latest TC, latest HDL-C and other confounders suggests that any independent effect is small.

Worm, Signe W; Kamara, David Alim

2011-01-01

117

A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis  

DEFF Research Database (Denmark)

BackgroundPrognostic information for asymptomatic patients with aortic stenosis (AS) from prospective studies is scarce and there is no risk score available to assess mortality.ObjectivesTo develop an easily calculable score, from which clinicians could stratify patients into high and lower risk of mortality, using data from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.MethodA search for significant prognostic factors (p

Holme, Ingar; Pedersen, Terje R

2012-01-01

118

High risk scoring for prediction of pregnancy outcome: a prospective study  

Directory of Open Access Journals (Sweden)

Results: Out of 415 women, 96 (59% were High Risk, 191 (46% were Low risk and 128 (31% were No risk. In High risk group there were 59 perinatal deaths and perinatal mortality rate was very high (614 per 1000 live births. Conclusions: The risk scoring system can thus be used not only as a test for predicting perinatal mortality but also as a simple and cost effective screening tool for identifying pregnancies at higher risk of perinatal mortality and morbidity so that these are subjected to the special and lsquo;high risk' care they need. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 516-522

Sapna Jain

2014-06-01

119

Prothrombotic gene variants as risk factors of acute myocardial infarction in young women  

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Full Text Available Abstract Background Acute myocardial infarction (AMI in young women represent an extreme phenotype associated with a higher mortality compared with similarly aged men. Prothrombotic gene variants could play a role as risk factors for AMI at young age. Methods We studied Factor V Leiden, FII G20210A, MTHFR C677T and beta-fibrinogen -455G>A variants by real-time PCR in 955 young AMI (362 females and in 698 AMI (245 females patients. The data were compared to those obtained in 909 unrelated subjects (458 females from the general population of the same geographical area (southern Italy. Results In young AMI females, the allelic frequency of either FV Leiden and of FII G20210A was significantly higher versus the general population (O.R.: 3.67 for FV Leiden and O.R.: 3.84 for FII G20210A; p Discussion and conclusion Our data confirm that young AMI in females is a peculiar phenotype with specific risk factors as the increased plasma procoagulant activity of FV and FII. On the contrary, the homozygous state for the 677T MTHFR variant may cause increased levels of homocysteine and/or an altered folate status and thus an increased risk for AMI, particularly in males. The knowledge of such risk factors (that may be easily identified by molecular analysis may help to improve prevention strategies for acute coronary diseases in specific risk-group subjects.

Tomaiuolo Rossella

2012-11-01

120

[Importance of modern genome-wide studies for the risk of myocardial infarction].  

Science.gov (United States)

The individual genetic susceptibility is a cornerstone in the pathogenesis of coronary artery disease (CAD). The search for the genetic background and the subsequently altered molecular mechanisms has been ineffective for several years. The increase in genome-wide association studies in recent years has changed the scenario and more than 40 variants have so far been identified to be highly significantly associated with CAD and the risk of myocardial infarction (MI). Whereas most of these findings affect frequent polymorphisms, exome-wide sequencing in families with a high prevalence of CAD revealed mutations with a high penetrance and as a consequence a high risk of suffering from MI. The findings allow a deeper insight into functional mechanisms involved in the pathogenesis of atherosclerosis. Furthermore, the data enables validation of the numerous epidemiologically identified risk markers with respect to the causal role in the development of CAD, making the genetic architecture of CAD much more transparent. Nevertheless, individual risk prediction has only made weak progress in the face of the new findings. Every individual without exception carries numerous risk alleles even when the number and effect strength shows individual differences. Thus, a varying degree of genetic susceptibility is shared by all of us. Current research is therefore focusing on the functional integration of genetic information to discover new approaches to prevention and therapy. PMID:24399470

Kessler, T; Erdmann, J; Schunkert, H

2014-02-01

 
 
 
 
121

Are the myocardial infarction risk factors the same in survived and dead patients  

International Nuclear Information System (INIS)

Coronary heart disease is one of the most common diseases causing mortality and morbidity in industrialized and developing countries. The first presentation in 25% of cases is sudden cardiac death. The most common risk factors in dead people are hypercholesterolemia. This study was carried out to compare the prevalence of risk factors in patients hospitalized in CCU's and cardiology departments (case group) and people who died because of sudden death myocardial infarction before arriving at hospitals (control group). This study was a case-control one, carried out on 154 patients and 112 dead persons. The questionnaires were completed after referring to their first relatives and the documents, in control group and in case group, were completed from patients and their records in hospitals. Then history of risk factor were compared. The ratio of men/women in the first group (hospitalized patients) was 3 and the second group (dead patients) were 1.7 (P=0.000). The peak ages in men of both groups were 60 to 69 years old, 2-3 times more than women in both groups. The most prevalent risk factor in women of both groups was hypertension, the same as in men of the control group. But the most prevalent risk factor in men of the case group was smoking (P=0.000). So, primary prevention which has a great role in controlling coronary artery disease is suggested

122

An obesity genetic risk score predicts risk of insulin resistance among Chinese children.  

Science.gov (United States)

A great number of body mass index (BMI)/obesity-related loci have been identified by recent genome-wide association studies. The objective of the study is to investigate the associations of 11 obesity-related loci with insulin resistance (IR) in a Chinese children population. Participants included 3,468 Chinese children, aged 6-18 years. The 75 percentile (equal to 2.93) of homeostasis model assessment of IR (HOMA-IR) index was considered as the cut-off of IR. A total of 868 IR cases and 2,600 control children were identified. In age- and sex-adjusted model, only two SNPs in/near GNPDA2 and KCTD15 genes were significantly associated with risk of IR [GNPDA2 rs10938397: allelic odds ratio (OR) = 1.19, 95 % confidence interval (CI) 1.06-1.34, P = 0.003; KCTD15 rs29941: allelic OR = 1.15, 95 % CI = 1.01-1.31, P = 0.034]; genetic risk score was also significantly associated risk of IR (OR = 1.08, 95 % 1.04-1.12, P = 1.18 × 10(-4)). After additional adjustment for BMI, none remained significant. The associations of GNPDA2 rs10938397 and the SNPs in combination with risk of IR remained statistically significant after correction for multiple testing. The present study demonstrated that the associations of GNPDA2 rs10938397 and the SNPs in combination with risk of IR were statistically significant, which were dependent on BMI. PMID:24619288

Xi, Bo; Zhao, Xiaoyuan; Shen, Yue; Wu, Lijun; Hou, Dongqing; Cheng, Hong; Mi, Jie

2014-12-01

123

How much does HDL cholesterol add to risk estimation? A report from the SCORE Investigators.  

LENUS (Irish Health Repository)

Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC\\/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation.

Cooney, Marie Therese

2009-06-01

124

Development and validation of a risk factor scoring system for first-trimester prediction of preeclampsia.  

Science.gov (United States)

Objective?The aim of this study was to develop a multiparameter risk-based scoring system for first-trimester prediction of preeclampsia and to validate this scoring system in our patient population. Study Design?Secondary analysis of a prospective cohort of 1,200 patients presenting for first-trimester aneuploidy screening. Maternal serum pregnancy-associated plasma protein A (PAPP-A) levels were measured and bilateral uterine artery (UA) Doppler studies performed. Using the first half of the study population, a prediction model for preeclampsia was created. Test performance characteristics were used to determine the optimal score for predicting preeclampsia. This model was then validated in the second half of the population. Results?Significant risk factors and their weighted scores derived from the prediction model were chronic hypertension (4), history of preeclampsia (3), pregestational diabetes (2), body mass index???30 kg/m(2) (2), bilateral UA notching (1), and PAPP-A MoM?risk scoring system was 0.76 (95% confidence interval [CI], 0.69-0.83), and the optimal threshold for predicting preeclampsia was a total score of???6. This AUC did not differ significantly from the AUC observed in our validation cohort (AUC, 0.78 [95% CI, 0.69-0.86]; p?=?0.75]. Conclusion?Our proposed risk factor scoring system demonstrates modest accuracy but excellent reproducibility for first-trimester prediction of preeclampsia. PMID:24705967

Goetzinger, Katherine R; Tuuli, Methodius G; Cahill, Alison G; Macones, George A; Odibo, Anthony O

2014-12-01

125

Low adiponectin levels and increased risk of type 2 diabetes in patients with myocardial infarction  

DEFF Research Database (Denmark)

OBJECTIVE: Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake in skeletal muscle and insulin secretion. In healthy humans, low plasma adiponectin levels associate with increased risk of T2DM; however, the relationship between adiponectin and T2DM in patients with MI has never been investigated. RESEARCH DESIGN AND METHODS: We prospectively included 666 patients with ST-segment elevation MI, without diabetes, treated with percutaneous coronary intervention, from September 2006 to December 2008 at a tertiary cardiac center. Blood samples were drawn before intervention, and total plasma adiponectin was measured in all samples. During follow-up (median 5.7 years [interquartile range 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS: Low adiponectin levels were associated with increased risk of T2DM (P < 0.001). Even after adjustment for confounding risk factors (age, sex, hypertension, hypercholesterolemia, current smoking, previous MI, BMI, blood glucose, total cholesterol, HDL, LDL, triglyceride, estimated glomerular filtration rate, C-reactive protein, peak troponin I, and proatrial natriuretic peptide), low adiponectin levels remained an independent predictor of T2DM (hazard ratio [HR] 5.8 [2.3-15.0]; P < 0.001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P < 0.001). CONCLUSIONS: Low plasma adiponectin levels are independently associated with increased risk of T2DM in patients with MI and added significantly to the predictive value of blood glucose.

Lindberg, SØren; Jensen, Jan S

2014-01-01

126

Frequency, clinical features and risk factors of lacunar infarction (data from a stroke registry in South India.  

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Full Text Available Analysis of 893 patients of ischaemic stroke in the stroke registry of Nizam?s institute of Medical Sciences, Hyderabad is presented. 16% of them had lacunar infarction. The mean age at presentation was 56.9 years and male to female ratio was 3.5:1. The common risk factors included hypertension(62%,diabetes(38% and smoking(28%. Six percent had an underlying cardiac source of embolism and none had significant (>50% extracranial carotid atherosclerosis. In 22% of patients, no obvious risk factors could be identified. The frequency of risk factors was similar in patients with lacunar and non- lacunar infarctions. However, patients with lacunar infarction had higher frequency of diabetes and absence of significant (>50% extracranial carotid artery disease. Pure motor hemiparesis was the presenting syndrome in 45% patients. Ataxic hemiparesis and sensorimotor stroke accounted for 18% each and dysarthria-clumsy hand syndrome for 14%. This study suggests that the frequency, risk factors and clinical profile of lacunar infarction in our stroke registry is similar to most of the western stroke registries.

Kaul S

2000-04-01

127

Time-perspective in cardiovascular risk of NSAID use after first-time myocardial infarction  

DEFF Research Database (Denmark)

PURPOSE OF REVIEW: Despite the fact that NSAIDs are not recommended among patients with established cardiovascular disease, many patients receive NSAID treatment for a short period of time. However, up until recently, data on the relationship between treatment duration and associated cardiovascular risk were sparse and have not been summarized. RECENT FINDINGS: A series of recent studies of patients with prior myocardial infarction (MI) demonstrated that short-term treatment with most NSAIDs is associated with an increased cardiovascular risk relative to no NSAID treatment. These studies furthermore demonstrated that NSAID use among patients with first-time MI was associated with persistently increased risk of all-cause mortality and of a composite of coronary death or nonfatal recurrent MI for at least 5 years thereafter. SUMMARY: The present review indicates that there is no apparent well-tolerated therapeutic window for associated cardiovascular risk and NSAID use in patients with prior MI. Further randomized studies are warranted to evaluate the cardiovascular safety of NSAIDs, but, at this point, the overall evidence suggests advising caution in using NSAIDs at all times after MI. Legislation bodies need to address this issue of public health proportions, as studies have shown that utilization rates of NSAID keep increasing.

Olsen, A. M.; Gislason, G. H.

2013-01-01

128

Depression in silent lacunar infarction: a cross-sectional study of its association with location of silent lacunar infarction and vascular risk factors.  

Science.gov (United States)

Most previous studies reported a close link between fresh infarcts and post-stroke depression. However, studies on the relation of depression and silent lacunar infarction (SLI) are limited. This study aims to analyze the effects of SLI and the vascular risk factors on depression. A total of 243 patients with SLI were divided into depression and non-depression groups. The presence and location of SLI were evaluated with magnetic resonance imaging. Depression was assessed with the Patient Health Questionnaire-9 and vascular risks factors were collected. We used t tests and ? (2) test to compare the baseline characteristics of the two groups and the multivariate logistic regression model to identify the risk factors for depression. Univariate analysis results showed that the proportion of patients with SLI in basal ganglia was significantly higher in the depression group (65.0 versus 32.8 %; P depression group, and multiple prevalent factors had significant differences between the two groups. However, on multivariate logistic analysis, some of these factors were eliminated, and SLI in basal ganglia remained an independent predictor of depression with an odds ratio of 3.128 (P = 0.018). In addition, vascular risk factors, including high body mass index level, presence of inflammation markers (e.g., CRP, TNF-?, Hs-CRP, and IL-6), and lack of physical activity, were associated with depression. Our findings suggest that SLI in basal ganglia is associated with a higher risk of depression. Vascular risk factors, which are intertwined, may propose the pathological basis of depression in SLI. PMID:24752391

Wu, Ri-Han; Li, Qiang; Tan, Yan; Liu, Xue-Yuan; Huang, Jing

2014-10-01

129

Cardiovascular disease risk score prediction models for women and its applicability to Asians  

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Full Text Available Louise GH Goh,1 Satvinder S Dhaliwal,1 Timothy A Welborn,2 Peter L Thompson,2–4 Bruce R Maycock,1 Deborah A Kerr,1 Andy H Lee,1 Dean Bertolatti,1 Karin M Clark,1 Rakhshanda Naheed,1 Ranil Coorey,1 Phillip R Della5 1School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Harry Perkins Institute for Medical Research, Perth, WA, Australia; 5School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia Purpose: Although elevated cardiovascular disease (CVD risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence. Conclusion: In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation. Keywords: cardiovascular disease prevention, risk assessment, epidemiology, Asia, female

Goh LGH

2014-03-01

130

Troponin I level in risk stratification of non-ST-elevation myocardial infarction in smokers  

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A prospective study was carried out to evaluate the role of troponin I in risk stratification of non-ST-elevation myocardial infarction in 40 smoker and 40 non-smoker patients. The troponin I was significantly higher (p<0.001) in smokers (35.5 ± 5.22 ng/mL) than non-smoker (0.27 ± 0.01 ng/mL). The duration of hospital stay was longer in Group I (106.6 ± 2.36 hour) than in Group II (49.20 ± 1.01 hour). The major adverse cardiac event was higher in smoker (71.79%) compared to non-smokers (1...

Iram Shahriar, Shahina Sobhan And Ziarrat Islam

2010-01-01

131

Valproate attenuates the risk of myocardial infarction in patients with epilepsy: a nationwide cohort study  

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Purpose Patients with epilepsy have increased risk of myocardial infarction (MI). Valproate can exert anti-atherosclerotic effects. We therefore examined the risk of MI in patients with epilepsy receiving valproate. Methods Two cohorts of patients with valproate-treated epilepsy and sex- and age-matched individuals (controls) from the general Danish population were identified by individual-level-linkage of nationwide registries and followed for 10 years. The two cohorts comprised patients treated with valproate at baseline and valproate-naive patients initiating treatment in the study period, respectively. The hazard ratios (HR) of MI and all-cause death were estimated by two different Cox proportional-hazard models; valproate treatment was analysed as a baseline categorical covariate in the first cohort and as a time-dependent exposure covariate in the second cohort. Results The two cohorts comprised 53 086 and 102 003 individuals, respectively. In the first cohort, the risk of MI was decreased (FIR 0.75, 95% confidence interval 0.59-0.97) while the risk of all-cause death was increased (HR 2.11, 95% confidence interval 1.95-2.28), compared to the controls. In the second cohort, the risk of MI was decreased (HR 0.62, 95% confidence interval 0.53-0.73) while the risk of all-cause death was similar to the controls (HR 1.02, 95% confidence interval 0.97-1.07). Conclusions In this nationwide pharmacoepidemiological study, we found a consistent association between valproate treatment and a reduced risk of MI in patients with epilepsy. Copyright (C) 2010 John Wiley & Sons, Ltd.

Abildstrom, S. Z.

2011-01-01

132

Dutch women with a low birth weight have an increased risk of myocardial infarction later in life: a case control study  

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Abstract Background To investigate whether low birth weight increases the risk of myocardial infarction later in life in women. Methods Nationwide population-based case-control study. Patients and controls: 152 patients with a first myocardial infarction before the age of 50 years in the Netherlands. 568 control women who had not had a myocardial infarction stratified for age, calendar year of the index event, and area of residence. Results Birth w...

Rosendaal Frits R; Hage Ronella M; Kapiteijn Kitty; Tanis Bea C; Helmerhorst Frans M

2005-01-01

133

Low amniotic fluid index in high risk pregnancy and poor apgar score at birth  

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To determine the accuracy of antepartum Amniotic Fluid Index (AFI) of 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of < 5 cm as a predictor of adverse outcome at birth (Apgar score of < 6 at 5 minutes of birth) in high-risk pregnancy were calculated. Only 8 neonates of 50 women with low AFI had low Apgar score. Similarly, 6 neonates of 50 women with normal AFI had poor Apgar score. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of AFI as test were 57.1%, 51.3%, 16%, 88% and 52% respectively. Low AFI is a poo88% and 52% respectively. Low AFI is a poor predictor of adverse outcome for high-risk term patients. AFI is not a good screening test for high-risk pregnant women at term for birth of an infant with low Apgar score. (author)

134

Correlation between the FINish diabetes risk score and the severity of coronary artery disease  

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Full Text Available Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC which includes age, body mass index (BMI, waist circumference, physical (in activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD, our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR, leucocytes, C-reactive protein (CRP, total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen. The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively (age, body mass index-BMI, waist circumference and the severity of CAD according to the SYNTAX score (p < 0.001 and the number of diseased coronary arteries (p < 0.001. The patients with higher FINDRISC score (groups II and III had more severe and extensive CAD according to the SYNTAX score than the group I. The odds ratio with 95% confidence intervals (CI between the group III and the group I was 5.143 (95% CI 1.299-20.360, p = 0.002 and between the group II and the group I 5.867 (95% CI 1.590- 21.525, p = 0.007. There were no differences in odds ratio for multivessel disease according to FINDRISC score between the group II and the group III [1.141; (95% CI 0.348-3.734. In the group I mean SYNTAX score was 5.18, and more than 70% of patients had normal coronary angiogram. In the group II mean SYNTAX score was 17.06, and more than 70% of patients had 2-vessel disease and 3- vessel disease, and in the group III mean SYNTAX score was 18.89, and 2-vessel and 3-vessel disease had 36.36% and 31.82% patients, respectively. In multiple regression analysis, where SYNTAX score was dependent variable, and age, BMI, waist circumference, FINDRISC score were independent variables, we found that only FINDRISC score was independent predictor of SYNTAX score. Conclusion. The obtained results suggest a statistically significant correlation between the FINDRISC score and its parameters (age, BMI, waist circumference and the severity of CAD according to the SYNTAX score and the number of diseased coronary arteries. The FINDRISC score may be useful in identifying patients at the high risk for coronary artery disease.

?uri? Predrag

2014-01-01

135

Propensity score-matched analysis of effects of clinical characteristics and treatment on gender difference in outcomes after acute myocardial infarction.  

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The greater mortality observed in women compared to men after acute myocardial infarction remains unexplained. Using an analysis of pairs, matched on a conditional probability of being male (propensity score), we assessed the effect of the baseline characteristics and management on 30-day mortality. Consecutive patients were included from January 2006 to December 2007. Two propensity scores (for being male) were calculated, 1 from the baseline characteristics and 1 from both the baseline characteristics and treatment. Two matched cohorts were composed using 1:1 matching and computed using the best 8 digits of the propensity score. Paired analyses were performed using conditional regression analysis. During the study period, 3,510 patients were included in the registry; 1,119 (32%) were women. Compared to the men, the women were 10 years older, had more co-morbidities, less often underwent angiography and reperfusion, and received less medical treatment. The 30-day mortality rate was 12.3% (130 of 1,060) for the women and 7.2% (167 of 2,324) for the men (p <0.001). The 2 matched populations represented 1,298 and 1,168 patients. After matching using the baseline characteristics, the only difference in treatment was a lower rate of angiography and reperfusion, with a trend toward greater 30-day mortality in women. After matching using both baseline characteristics and treatment, the 30-day mortality was similar for the men and women, suggesting that the increased use of invasive procedures in women could potentially be beneficial. In conclusion, compared to men, the 30-day mortality is greater in women and explained primarily by differences in baseline characteristics and to a lesser degree by differences in management. The difference in the use of invasive procedures persisted after matching by characteristics. In contrast, after matching using the baseline characteristics and treatment, the 30-day mortality was comparable across the genders. PMID:21741026

Schiele, François; Meneveau, Nicolas; Seronde, Marie-France; Descotes-Genon, Vincent; Chopard, Romain; Janin, Sebastien; Briand, Florent; Guignier, Alexandre; Ecarnot, Fiona; Bassand, Jean-Pierre

2011-09-15

136

A scoring system to predict superinfections in high-risk febrile neutropenic children with cancer  

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Full Text Available SciELO Mexico | Language: English Abstract in english Background. No scoring system has been published to date to assess the risk of superinfections (SI) for high-risk children with febrile neutropenia (HRFN). Methods. SI diagnoses during or 1 week after initiating antibiotic therapy in HRFN children were evaluated. Eight hundred and forty-nine episode [...] s of febrile neutropenia (FN) were included in a prospective study to evaluate a scoring system designed to identify SI. Results. In the derivation set (566 episodes), 17% had SI. A multivariate analysis identified the following significant SI-related risk factors: acute lymphoblastic leukemia-acute myeloid leukemia (ALL-AML, OR, 1.87; 95% CI, 1.13-3.10), central venous catheter (OR, 2.11; 95% CI, 1.23-3.62), and febrile episode occurring within 10 days after chemotherapy (OR, 1.86; 95% CI, 1.09-3.15). A SI scoring system could be built: 1 point for ALL-AML, 1 point for the presence of a central venous catheter, and 1 point for the febrile episode occurring within 10 days after chemotherapy. If patients collected 3 points, then their risk of SI was 25.8%. With 2 points the risk was 16.7%, and with one minimum score of 1 point, their risk was 10.9%. The sensitivity to predict SS was 100% and its negative predictive value (NPV) was 100%. In the validation set (283 episodes), 49 (17%) children had SI. For children with scores > 0, the scoring system yielded a sensitivity of 100%, and a NPV of 100% for predicting SI. Conclusions. The use of a SI score for HRFN patients was statistically validated by these results. A better initial predictive approach may allow improved therapeutic decisions for these children.

Hugo, Paganini; Juliana, Caccavo; Clarisa, Aguirre; Sandra, Gómez; Pedro, Zubizarreta.

2011-02-01

137

A risk score development for diabetic retinopathy screening in Isfahan-Iran  

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  • BACKGROUND: The purpose of this study was to develop a simple risk score as screening tool for retinopathy in type II diabetic patients.
  • METHODS: A cross-sectional study was carried out recruiting 3734  atients with type II diabetes in an outpatient clinic in Isfahan ndocrinology and Metabolism Research Center (IEMRC, Iran. The logistic regression was used as a model to predict diabetic retinopathy. The cut-off value for the risk score was determined using the Receiver  perating Characteristic (ROC curve procedure.
  • RESULTS: According to final models, being male, having lower body mass index (BMI, being older, longer duration of diabetes and higher HbA1c were correlated with increased risk of diabetic retinopathy. Area under the Curve (ROC was 0.704 (95% CI: 0.685-0.723. A value ; 52.5 had the optimum sensitivity (60% and specificity (69% for determining diabetic retinopathy.
  • CONCLUSIONS: The results indicated that risk factors for retinopathy were sex, BMI, age, duration of diabetes and HbA1c levels. In onclusion, applying developed retinopathy risk score is a practical way to identify patients who are at high risk for developing diabetic retinopathy for an early treatment.
  • KEYWORDS: Retinopathy risk score, sensitivity, specificity, receiver operating characteristic curve.

Sayed Mohsen Hosseini

2009-04-01

138

Feasibility, reliability and women's views of a risk scoring system for cervical neoplasia in primary care.  

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BACKGROUND. A risk assessment scale for cervical neoplasia has been developed which gives a risk score based on four factors: level of education, current smoking status, number of years of oral contraceptive use and number of sexual partners ever. AIM. A pilot study was undertaken to determine the feasibility and acceptability of a self-report data form, used to assess risk of cervical neoplasia, and the test-retest reliability of women's responses to the questions. METHOD. A sample of women ...

Wilkinson, C. E.; Peters, T. J.; Harvey, I. M.; Stott, N. C.

1994-01-01

139

A multilocus genetic risk score for coronary heart disease: case-control and prospective cohort analyses  

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Summary Background Comparison of patients with coronary heart disease and controls in genome-wide association studies has revealed several single nucleotide polymorphisms (SNPs) associated with coronary heart disease. We aimed to establish the external validity of these findings and to obtain more precise risk estimates using a prospective cohort design. Methods We tested 13 recently discovered SNPs for association with coronary heart disease in a case-control design including participants differing from those in the discovery samples (3829 participants with prevalent coronary heart disease and 48?897 controls free of the disease) and a prospective cohort design including 30?725 participants free of cardiovascular disease from Finland and Sweden. We modelled the 13 SNPs as a multilocus genetic risk score and used Cox proportional hazards models to estimate the association of genetic risk score with incident coronary heart disease. For case-control analyses we analysed associations between individual SNPs and quintiles of genetic risk score using logistic regression. Findings In prospective cohort analyses, 1264 participants had a first coronary heart disease event during a median 10·7 years' follow-up (IQR 6·7–13·6). Genetic risk score was associated with a first coronary heart disease event. When compared with the bottom quintile of genetic risk score, participants in the top quintile were at 1·66-times increased risk of coronary heart disease in a model adjusting for traditional risk factors (95% CI 1·35–2·04, p value for linear trend=7·3×10?10). Adjustment for family history did not change these estimates. Genetic risk score did not improve C index over traditional risk factors and family history (p=0·19), nor did it have a significant effect on net reclassification improvement (2·2%, p=0·18); however, it did have a small effect on integrated discrimination index (0·004, p=0·0006). Results of the case-control analyses were similar to those of the prospective cohort analyses. Interpretation Using a genetic risk score based on 13 SNPs associated with coronary heart disease, we can identify the 20% of individuals of European ancestry who are at roughly 70% increased risk of a first coronary heart disease event. The potential clinical use of this panel of SNPs remains to be defined. Funding The Wellcome Trust; Academy of Finland Center of Excellence for Complex Disease Genetics; US National Institutes of Health; the Donovan Family Foundation. PMID:20971364

Ripatti, Samuli; Tikkanen, Emmi; Orho-Melander, Marju; Havulinna, Aki S; Silander, Kaisa; Sharma, Amitabh; Guiducci, Candace; Perola, Markus; Jula, Antti; Sinisalo, Juha; Lokki, Marja-Liisa; Nieminen, Markku S; Melander, Olle; Salomaa, Veikko; Peltonen, Leena; Kathiresan, Sekar

2010-01-01

140

Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study  

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BACKGROUND: Sulfonylureas have been linked to an increased cardiovascular risk by inhibition of myocardial preconditioning. Whether individual sulfonylureas affect outcomes in diabetic patients after emergent percutaneous coronary intervention for myocardial infarction is unknown. METHODS: All Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular mortality and morbidity associated with sulfonylureas. RESULTS: A total of 926 patients were included and 163 (17.6%) patients died during the first year of which 155 (16.7%) were cardiovascular deaths. The most common treatment was sulfonylureas which were received by 271 (29.3%) patients, and 129 (13.9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes mellitus undergoing emergent percutaneous coronary intervention after myocardial infarction. Early reperfusion therapy is the mainstay in modern treatment of myocardial infarction and the time may have come to discard glyburide in favour of sulfonylureas that do not appear to confer increased cardiovascular risk.

JØrgensen, C H; Gislason, G H

2011-01-01

 
 
 
 
141

A Combined Healthy Lifestyle Score and Risk of Pancreatic Cancer - A Large Cohort Study  

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Background Smoking, alcohol use, diet, body mass index (BMI), and physical activity have been studied independently in relation to pancreatic cancer. We generated a healthy lifestyle score to investigate their joint effect on pancreatic cancer risk. Methods In the prospective National Institutes of Health-AARP Diet and Health Study, a total of 450,416 participants aged 50–71 years completed the baseline food frequency questionnaire (1995–1996) eliciting diet and lifestyle information and were followed up through December 2003. We identified 1,057 eligible incident pancreatic cancer cases. Participants were scored for five modifiable lifestyle factors as “unhealthy” (0 points) or “healthy” (1 point) based on current epidemiologic evidence. Participants received 1 point for each respective lifestyle factor: nonsmoking, limited alcohol use, adherence to the Mediterranean dietary pattern, 18 ? BMI <25 kg/m2, or regular physical activity. A combined score (0–5 points) was calculated by summing the scores from the five factors. Cox proportional hazards regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for pancreatic cancer. Results Compared to the lowest combined score (0 points), the highest score (5 points) was associated with a 58% reduction in risk of developing pancreatic cancer in all participants (RR, 0.42; 95% CI, 0.26–0.66, P trend < .001). Scores of less than 5 points explained 27% of pancreatic cancer cases in our population. Conclusion This large study suggests that having a high, as opposed to a low, score on an index combining five modifiable lifestyle factors substantially reduces one’s risk of pancreatic cancer. PMID:19398688

Jiao, Li; Mitrou, Panagiota N.; Reedy, Jill; Graubard, Barry I.; Hollenbeck, Albert R.; Schatzkin, Arthur; Stolzenberg-Solomon, Rachael

2012-01-01

142

Preoperative risk score predicting 90-day mortality after liver resection in a population-based study.  

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The impact of important preexisting comorbidities, such as liver and renal disease, on the outcome of liver resection remains unclear. Identification of patients at risk of mortality will aid in improving preoperative preparations. The purpose of this study is to develop and validate a population-based score based on available preoperative and predictable parameters predicting 90-day mortality after liver resection using data from a hepatitis endemic country.We identified 13,159 patients who underwent liver resection between 2002 and 2006 in the Taiwan National Health Insurance Research Database. In a randomly selected half of the total patients, multivariate logistic regression analysis was used to develop a prediction score for estimating the risk of 90-day mortality by patient demographics, preoperative liver disease and comorbidities, indication for surgery, and procedure type. The score was validated with the remaining half of the patients.Overall 90-day mortality was 3.9%. Predictive characteristics included in the model were age, preexisting cirrhosis-related complications, ischemic heart disease, heart failure, cerebrovascular disease, renal disease, malignancy, and procedure type. Four risk groups were stratified by mortality scores of 1.1%, 2.2%, 7.7%, and 15%. Preexisting renal disease and cirrhosis-related complications were the strongest predictors. The score discriminated well in both the derivation and validation sets with c-statistics of 0.75 and 0.75, respectively.This population-based score could identify patients at risk of 90-day mortality before liver resection. Preexisting renal disease and cirrhosis-related complications had the strongest influence on mortality. This score enables preoperative risk stratification, decision-making, quality assessment, and counseling for individual patients. PMID:25211044

Chang, Chun-Ming; Yin, Wen-Yao; Su, Yu-Chieh; Wei, Chang-Kao; Lee, Cheng-Hung; Juang, Shiun-Yang; Chen, Yi-Ting; Chen, Jin-Cherng; Lee, Ching-Chih

2014-09-01

143

Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction  

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Risk stratification after uncomplicated myocardial infarction is major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period.

Bigi, Riccardo; Fiorentini, Cesare

1997-01-01

144

Performance of angiographic, electrocardiographic and MRI methods to assess the area at risk in acute myocardial infarction.  

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Objective Validation of methods to assess the area at risk (AAR) in patients with ST elevation myocardial infarction is limited. A study was undertaken to test different AAR methods using established physiological concepts to provide a reference standard. Main outcome measured In 78 reperfused patients with first ST elevation myocardial infarction, AAR was measured by electrocardiographic (Aldrich), angiographic (Bypass Angioplasty Revascularization Investigation (BARI), APPROACH) and cardiovascular magnetic resonance methods (T2-weighted hyperintensity and delayed enhanced endocardial surface area (ESA)). The following established physiological concepts were used to evaluate the AAR METHODS: (1) AAR size is always ? infarct size (IS); (2) in transmural infarcts AAR size=IS; (3) correlation between AAR size and IS increases as infarct transmurality increases; and (4) myocardial salvage ((AAR-IS)/AAR×100) is inversely related to infarct transmurality. Results Overall, 65%, 87%, 76%, 87% and 97% of patients using the Aldrich, BARI, APPROACH, T2-weighted hyperintensity and ESA methods obeyed the concept that AAR size is ?IS. In patients with transmural infarcts (n=22), Bland-Altman analysis showed poor agreement (wide 95% limits of agreement) between AAR size and IS for the BARI, Aldrich and APPROACH methods (95% CI -22.9 to 29.6, 95% CI -28.3 to 21.3 and 95% CI -16.9 to 20.0, respectively) and better agreement for T2-weighted hyperintensity and ESA (95% CI -6.9 to 16.6 and 95% CI -4.3 to 18.0, respectively). Increasing correlation between AAR size and IS with increasing infarct transmurality was observed for the APPROACH, T2-weighted hyperintensity and ESA methods, with ESA having the highest correlation (r=0.93, pAPPROACH, T2-weighted hyperintensity and ESA methods, respectively, where higher percentages represent better concordance with the concept that the extent of salvage should be inversely related to infarct transmurality. Conclusions For measuring AAR, cardiovascular magnetic resonance methods are better than angiographic methods, which are better than electrocardiographic methods. Overall, ESA performed best for measuring AAR in vivo. PMID:21930725

Versteylen, Mathijs O; Bekkers, Sebastiaan C A M; Smulders, Martijn W; Winkens, Bjorn; Mihl, Casper; Winkens, Mark H M; Leiner, Tim; Waltenberger, Johannes L; Kim, Raymond J; Gorgels, Anton P M

2012-01-01

145

External validation of Indian diabetes risk score in a rural community of central India  

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Full Text Available Aim: To find whether the individuals of 45 years and more of rural area who are in higher tertile of Indian Diabetes Risk Score i.e. of IDRS of >60 as compared to those who are in lower tertile i.e. of <30, have high frequency of hyperglycemia, impaired glucose tolerance, and manifest diabetes mellitus. Methods: A cross-sectional community based study. The study was conducted in three pre-identified villages. For all consenting and the eligible subjects, the medical student visited their house and the fasting capillary blood glucose was done by One touch blood glucose monitoring system. Four simple questions and one anthropometric measurement for waist circumference helped in deriving the information for Indian Diabetes Risk Score from the same subject. Results: The Indian Diabetes Risk Score (IDRS (consisting of the factors like age, abdominal obesity, physical inactivity and the family history which predicted diabetes mellitus in the subject, its sensitivity was 97.50% and specificity of 87.89% when the score of >/+ 60 was externally validated on our rural population. Conclusion: Our study demonstrated that the Indian Diabetes Risk Score (IDRS can be reliably applied as effective tool for the mass screening of diabetes in the community.

Bharati Taksande

2012-02-01

146

Risk Score Model for Predicting Sonographic Non-Alcoholic Fatty Liver Disease in Children and Adolescents  

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Full Text Available Objective: This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease (NAFLD. Methods:This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic (ROC curve procedure. Findings:Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD. Conclusion:This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group.

Parinaz Poursafa

2011-06-01

147

Risk Score Model for Predicting Sonographic Non-alcoholic Fatty Liver Disease in Children and Adolescents  

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Full Text Available Objective: This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease (NAFLD.Methods:This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic (ROC curve procedure.Findings:Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD.Conclusion:This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group.

Sayed-Mohsen Hosseini

2011-06-01

148

Early risk predictors of sudden cardiac death after myocardial infarction: Results of follow up of 881 patients  

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Full Text Available Introduction: It has been shown that depolarization disorders, autonomic dysfunction, and systolic dysfunction of the left ventricle are associated with sudden cardiac death after myocardial infarction. Objective: The Objective of study was to examine the prognostic value of the most important predictors in the first week after myocardial infarction. Method: Study included 881 patients who were followed up from 1 to 60 months. During the first week after myocardial infarction, following examination were performed: ECG with standard leads and X, Y, Z orthogonal leads, vectorcardiogram, QT interval, late potentials, short-time spectral analysis of RR variability, nonlinear (Poincare plot analysis and echocardiogram. Results: In univariate analysis, the following parameters measured on the first day were important predictors of sudden cardiac death: lower LF/HF ratio(<1.5 (p=0.000, T wave inversion in X lead (p=0.000, high P wave in D2 lead (p=0.030, and diminished systolic function (p=0.000. In multivariate analysis, the following parameters were significant risk predictors: T wave inversion in X lead, lower LF/HF ratio, positive late potentials and the left ventricle systolic dysfunction. Conclusion: The parameters of the left ventricle systolic dysfunction with sympathicovagal imbalance and electric instability are the key risk predictors in the first few days after myocardial infarction.

Milovanovi? Branislav

2006-01-01

149

Risk factors for post-acute myocardial infarction depression in elderly  

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Full Text Available Objective: To determine risk factors for development of post-acute ST elevation myocardial infarction (STEMI depression in elderly. Material and Methods: We included 104 elderly patients diagnosed with STEMI. Clinical, lab and imagistic data was recorded in the first week after STEMI. Six months after STEMI patients were evaluated for the presence of depression. Results: Bivariate analysis showed statistically significant association between post-STEMI depression and sex, arterial hypertension, type 2 diabetes, socio-economic status, presence of family, left ventricular ejection fraction, Lown classification and HDL-cholesterol values. Multivariate analysis determined that following parameters increased the probability of onset of depression six months post-STEMI in elderly: sex (OR – 3.2, type 2 diabetes (OR – 2.6, poor socio-economic status (OR – 3.5 and absence of family (OR – 4.2. Conclusion: diabetes, precarious socio-economic status, absence of family and female sex were risk factors for post-STEMI depression.

Cristina Mo?u?an

2011-12-01

150

Lifestyle variables and the risk of myocardial infarction in the General Practice Research Database  

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Full Text Available Abstract Background The primary objective of this study is to estimate the association between body mass index (BMI and the risk of first acute myocardial infarction (AMI. As a secondary objective, we considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk. Methods This study was conducted in the general practice research database (GPRD which is a database based on general practitioner records and is a representative sample of the United Kingdom population. We matched cases of first AMI as identified by diagnostic codes with up to 10 controls between January 1st, 2001 and December 31st, 2005 using incidence density sampling. We used multiple imputation to account for missing data. Results We identified 19,353 cases of first AMI which were matched on index date, GPRD practice and age to 192,821 controls. There was a modest amount of missing data in the database, and the patients with missing data had different risks than those with recorded values. We adjusted our analysis for each lifestyle variable jointly and also for age, sex, and number of hospitalizations in the past year. Although a record of underweight (BMI 2 did not alter the risk for AMI (adjusted odds ratio (OR: 1.00; 95% confidence interval (CI: 0.87–1.11 when compared with normal BMI (18.0–24.9 kg/m2, obesity (BMI ?30 kg/m2 predicted an increased risk (adjusted OR: 1.41; 95% CI: 1.35–1.47. A history of smoking also predicted an increased risk of AMI (adjusted OR: 1.81; 95% CI: 1.75–1.87 as did heavy alcohol use (adjusted OR: 1.15; 95% CI: 1.06–1.26. Conclusion This study illustrates that obesity, smoking and heavy alcohol use, as recorded during routine care by a general practitioner, are important predictors of an increased risk of a first AMI. In contrast, low BMI does not increase the risk of a first AMI.

Brophy James M

2007-12-01

151

Development of an Adverse Drug Reaction Risk Assessment Score among Hospitalized Patients with Chronic Kidney Disease  

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Background Adverse drug reactions (ADRs) represent a major burden on the healthcare system. Chronic kidney disease (CKD) patients are particularly vulnerable to ADRs because they are usually on multiple drug regimens, have multiple comorbidities, and because of alteration in their pharmacokinetics and pharmacodynamic parameters. Therefore, one step towards reducing this burden is to identify patients who are at increased risk of an ADR. Objective To develop a method of identifying CKD patients who are at increased risk for experiencing ADRs during hospitalisation. Materials and Methods Factors associated with ADRs were identified by using demographic, clinical and laboratory variables of patients with CKD stages 3 to 5 (estimated glomerular filtration rate, 10–59 ml/min/1.73 m2) who were admitted between January 1, 2012, and December 31, 2012, to the renal unit of Dubai Hospital. An ADR risk score was developed by constructing a series of logistic regression models. The overall model performance for sequential models was evaluated using Akaike Information Criterion for goodness of fit. Odd ratios of the variables retained in the best model were used to compute the risk scores. Results Of 512 patients (mean [SD] age, 60 [16] years), 62 (12.1%) experienced an ADR during their hospitalisation. An ADR risk score included age 65 years or more, female sex, conservatively managed end-stage renal disease, vascular disease, serum level of C-reactive protein more than 10 mg/L, serum level of albumin less than 3.5 g/dL, and the use of 8 medications or more during hospitalization. The C statistic, which assesses the ability of the risk score to predict ADRs, was 0.838; 95% CI, 0.784–0.892). Conclusion A score using routinely available patient data can be used to identify CKD patients who are at increased risk of ADRs. PMID:24755778

Saheb Sharif-Askari, Fatemeh; Syed Sulaiman, Syed Azhar; Saheb Sharif-Askari, Narjes; Al Sayed Hussain, Ali

2014-01-01

152

Risk Score and Metastasectomy Independently Impact Prognosis in Patients with Recurrent Renal Cell Carcinoma  

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Purpose To evaluate the prognostic roles of metastasectomy and an established risk stratification system for patients experiencing a disease recurrence following nephrectomy for non-metastatic renal cell carcinoma (RCC). Methods A retrospective analysis was performed on 129 patients with localized RCC treated by partial or radical nephrectomy and subsequently diagnosed with disease recurrence. At the time of recurrence, a previously validated risk score based on Karnofsky performance status, interval from nephrectomy, and serum hemoglobin, calcium, and lactate dehydrogenase levels was used to categorize patients as favorable, intermediate, or poor-risk. Survival from recurrence was assessed based on risk categorization and metastasectomy Results Median time from nephrectomy to recurrence was 16 months. Median and two-year survival rates were strongly associated with the risk score (favorable-risk: 73 months and 81%; intermediate-risk: 28 months and 54%; poor-risk: 6 months and 11%; log-rank<0.001). Metastasectomy was performed in 44 patients (34%) and found to be of clinical benefit across the various risk categories (interaction analysis, p=0.8). On multivariate analysis, a better risk category (p<0.001) and undergoing a metastasectomy (p<0.001) were each independently associated with a more favorable survival and when combined provided six different risk categories with an estimated two-year survival ranging from 0 – 93%. Conclusions The clinical course for patients with an RCC recurrence following nephrectomy can be variable and is independently impacted by an objectively obtained risk score and whether the patient undergoes a metastasectomy. PMID:18635225

Eggener, Scott E; Yossepowitch, Ofer; Kundu, Shilajit; Motzer, Robert J; Russo, Paul

2008-01-01

153

Risk prediction is improved by adding markers of subclinical organ damage to SCORE  

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Aims It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects. Methods and results In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR >/= 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE >/= 5% and 7.3 (3.2-16.1) for SCORE /= 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P /= 5% to include subjects with 1%

Sehestedt, Thomas; Jeppesen, JØrgen

2009-01-01

154

Impact of acute hyperglycemia on myocardial infarct size, area at risk and salvage in patients with ST elevation myocardial infarction and the association with exenatide treatment - results from a randomized study  

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Hyperglycemia upon admission in ST-segment elevation myocardial infarction (STEMI) patients occurs frequently and is associated with adverse outcome. It is however unsettled whether elevated blood glucose is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this sub-study were to evaluate the association between hyperglycemia and infarct size, myocardial salvage and area-at-risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area-at-risk and infarct size compared to patients with normoglycemia, but the salvage index and infarct size adjusting for area-at-risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon admission and infarct size in STEMI patients is a consequence of a larger myocardial area-at-risk but not on a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of admission glucose levels. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of myocardium at risk and injury.

BØtker, Hans Erik; Kim, Won Yong

2014-01-01

155

The Relationship of Gensini Score with the Cardiovascular Risk of Patients with Indication of Angiography  

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Full Text Available Background: This study was designed to explore the contribution of risk factors for coronary artery disease (CAD in patients with indication for coronary angiography. Coronary angiography is defined as the radiographic visualization of the coronary vessels after injection of radio opaque contrast media. Despite the recognition of risk factors for CAD, the association between related risk factors and angiographic findings remains controversial. The aim of the present study was to explore the association between Gensini scores and major cardiovascular risk factors in patients with indications for coronary angiography. Methods: We retrospectively enrolled 495 patients who had been hospitalized at Dr. Shariati Hospital during September 2009 to September 2010 and had undergone coronary angiography. The patients were evaluated for the severity of coronary lesions on the angiogram by Gensini scoring system. The patients were also evaluated for the presence or absence of DM, hypertension, family history of cardiac diseases, low HDL, hyperlipoproteinemia, hypertriglyceridemia and cigarette smoking. Statistical analysis wad done to find any relationship between Gensini scores and cardiovascular risk factors.Results: The study population consisted of 249 men (50.3% and 245 woman (49.5% with a mean age of 58.1±10.3 years. A positive correlation was found between age (P=0.04, sex (P=0.008, HDL (P=0.04 smoking (P=0.0001 and diabetes (P<0.013 with Gensini scores.Conclusion: In patients with indications of angiography, Gensini scores provide valuable prognostic information on cardiovascular risk factors. Age, sex, HDL, smoking and diabetes are related to the severity of coronary lesions on the angiograms.

Abbas Mohagheghi M.D.

2011-06-01

156

Derivation and Validation of the Denver Human Immunodeficiency Virus (HIV) Risk Score for Targeted HIV Screening  

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Targeted screening remains an important approach to human immunodeficiency virus (HIV) testing. The authors aimed to derive and validate an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexually transmitted disease clinic in Denver, Colorado (1996–2008). With multivariable logistic regression, they developed a risk score from 48 candidate variables using newly identified HIV infection as the outcome. Validation was performed usi...

Haukoos, Jason S.; Lyons, Michael S.; Lindsell, Christopher J.; Hopkins, Emily; Bender, Brooke; Rothman, Richard E.; Hsieh, Yu-hsiang; Maclaren, Lynsay A.; Thrun, Mark W.; Sasson, Comilla; Byyny, Richard L.

2012-01-01

157

Escores de risco nas intervenções em valvopatia / Risk scores in valvular heart disease interventions  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Os escores de risco utilizados assistencialmente em clínica de valvopatia já apresentam validações em todo mundo, entretanto, os dados não são homogêneos. As características epidemiológicas de cada população requerem uma validação local dessas ferramentas de risco. A troca valvar percutânea, que já [...] é uma realidade em doença valvar (principalmente na estenose aórtica), está indicada em pacientes com risco cirúrgico elevado ou considerado proibitivo. Os estudos com essa nova estratégia de tratamento utilizam os escores de risco como um dos critérios de inclusão e são escassos trabalhos que utilizam tais ferramentas como preditoras de risco. Os escores de risco depois de validados em suas respectivas populações vieram para somar com a prática clínica (individualização da conduta) na definição da conduta em clínica de valvopatia. Abstract in english The risk scores used as assistance agents in valve diseases are validated worldwide; however, the data are not homogeneous. The epidemiological characteristics of each population require local validation of these risk tools. The percutaneous valve replacement, which is a reality in valvular diseases [...] (especially aortic stenosis), is indicated for patients with high or prohibitive surgical risk. Studies with this new treatment strategy use risk scores as criteria for inclusion and there are few studies that use such tools as predictors of risk. The risk scores, after due validation in their relevant populations, are combined with clinical practice (individualization of conduct) in the definition of the conduct to be adopted in the clinical practice of valvular heart disease.

Ricardo, Casalino; Flávio, Tarassoutchi.

158

Escores de risco nas intervenções em valvopatia / Risk scores in valvular heart disease interventions  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Os escores de risco utilizados assistencialmente em clínica de valvopatia já apresentam validações em todo mundo, entretanto, os dados não são homogêneos. As características epidemiológicas de cada população requerem uma validação local dessas ferramentas de risco. A troca valvar percutânea, que já [...] é uma realidade em doença valvar (principalmente na estenose aórtica), está indicada em pacientes com risco cirúrgico elevado ou considerado proibitivo. Os estudos com essa nova estratégia de tratamento utilizam os escores de risco como um dos critérios de inclusão e são escassos trabalhos que utilizam tais ferramentas como preditoras de risco. Os escores de risco depois de validados em suas respectivas populações vieram para somar com a prática clínica (individualização da conduta) na definição da conduta em clínica de valvopatia. Abstract in english The risk scores used as assistance agents in valve diseases are validated worldwide; however, the data are not homogeneous. The epidemiological characteristics of each population require local validation of these risk tools. The percutaneous valve replacement, which is a reality in valvular diseases [...] (especially aortic stenosis), is indicated for patients with high or prohibitive surgical risk. Studies with this new treatment strategy use risk scores as criteria for inclusion and there are few studies that use such tools as predictors of risk. The risk scores, after due validation in their relevant populations, are combined with clinical practice (individualization of conduct) in the definition of the conduct to be adopted in the clinical practice of valvular heart disease.

Ricardo, Casalino; Flávio, Tarassoutchi.

2012-05-01

159

Abacavir and risk of myocardial infarction in HIV-infected patients on highly active antiretroviral therapy: a population-based nationwide cohort study  

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Objective The aim of the study was to examine whether exposure to abacavir increases the risk for myocardial infarction (MI). Design, setting and subjects This was a prospective nationwide cohort study which included all Danish HIV-infected patients on highly active antiretroviral therapy (HAART) from 1995 to 2005 (N=2952). Data on hospitalization for MI and comorbidity were obtained from Danish medical databases. Hospitalization rates for MI after HAART initiation were calculated for patients who used abacavir and those who did not. We used Cox's regression to compute incidence rate ratios (IRR) as a measure of relative risk for MI, while controlling for potential confounders (as separate variables and via propensity score) including comorbidity. Main outcome Relative risk of hospitalization with MI in abacavir users compared with abacavir nonusers. Results Hospitalization rates for MI were 2.4/1000 person-years (PYR) [95% confidence interval (CI) 1.7-3.4] for abacavir nonusers and 5.7/1000 PYR (95% CI 4.1-7.9) for abacavir users. The risk of MI increased after initiation of abacavir [unadjusted IRR=2.22 (95% CI 1.31-3.76); IRR adjusted for confounders=2.00 (95% CI 1.10-3.64); IRR adjusted for propensity score=2.00 (95% CI 1.07-3.76)]. This effect was also observed among patients initiating abacavir within 2 years after the start of HAART and among patients who started abacavir as part of a triple nucleoside reverse transcriptase inhibitor (NRTI) regimen. Conclusions We confirmed the association between abacavir use and increased risk of MI. Further studies are needed to control for potential confounding not measured in research to date.

Obel, N; Farkas, Dk

2009-01-01

160

SNPs in microRNA binding sites in 3'-UTRs of RAAS genes influence arterial blood pressure and risk of myocardial infarction  

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We hypothesized that single nucleotide polymorphisms (SNPs) located in microRNA (miR) binding sites in genes of the renin angiotensin aldosterone system (RAAS) can influence blood pressure and risk of myocardial infarction.

Nossent, Anne Yaël; Hansen, Jakob Liebe

2011-01-01

 
 
 
 
161

Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type  

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ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population.

Sode, Birgitte F; Allin, Kristine H

2013-01-01

162

Development and validation of a postpartum depression risk score in delivered women, Iran  

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Background: Investigators describe a dramatic increase in the incidence of mood disorder after childbirth, with the largest risk in the 90 days after delivery. This study is designed to develop a relatively simple screening tool and validate it from the significant variables associated with postpartum depression (PPD) to detect delivered women at high risk of having PPD. Materials and Methods: In the cross-sectional study, 6,627 from a total of 7,300 delivered women, 2-12 months after delivery were recruited and screened for PPD. Split-half validation was used to develop the risk score. The training data set was used to develop the model, and the validation data set was used to validate the developed the risk factors of postpartum depression risk score using multiple logistic regression analysis to compute the ? coefficients and odds ratio (OR) for the dependent variables associated with possible PPD in this study. Calibration was checked using the Hosmer and Lemeshow test. A score for independent variables contributing to PPD was calculated. Cutoff points using a trade-off between the sensitivity and specificity of risk scores derived from PPD model using the Receiver Operating Characteristic (ROC) curve. Results: The predicted and observed PPD were not different (P value = 0.885). The aROC with area under the curve (S.E.) of 0.611 (0.008) for predicting PPD using the suggested cut-off point of -0.702, the proportion of participants screening positive for PPD was 70.9% (sensitivity) (CI 95%; 69.5, 72.3) while the proportion screening negative was 60.1% (specificity) (CI 95%; 58.2, 62.1). Conclusion: Despite of the relatively low sensitivity and specificity in this study, it could be a simple, practical and useful screening tool to identify individual at high risk for PPD in the target population. PMID:23833583

Maracy, Mohammad R.; Kheirabadi, Gholam R.

2012-01-01

163

Utility of Framingham risk score in urban emergency department patients with asymptomatic hypertension.  

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Hypertension (HTN) is the primary population-attributable risk for the development of heart failure (HF); a disease with devastating consequences particularly in urban centers where morbidity and mortality are more pronounced. The Framingham Risk Profile (FRP) is widely used to quantify risk for cardiovascular disease (CVD), but its applicability in an urban population who utilize the emergency department (ED) for primary care is unknown. The objective of this study is to evaluate FRP scores in ED patients with asymptomatic HTN and subclinical hypertensive heart disease (SHHD). This is a substudy of a prospective randomized clinical trial designed to evaluate optimal blood pressure (BP) targets. Eligible patients were screened with echocardiography for the presence of SHHD and FRP scores were calculated. One hundred forty-nine patients enrolled in the study, 133 (89.2%) of whom had detectable SHHD. Mean [SD] calculated FRP scores were statistically similar for patients with SHHD versus those without (general CVD: 20.2 [8.5] vs. 15.6 [8.7]; P = 0.13 and HF calibrated: 2.4 [1.0] vs. 1.8 [1.0]; P = 0.12) corresponding to a calculated risk of 15%-30% for subsequent development of CVD. The HF-specific risk score for patients with SHHD was 2.4, which equates to a 2.5% risk of HF development in 10 years. The FRP correctly identified those with SHHD as high-risk for general CVD but appeared to underestimate the likelihood of HF. Recalibration of the HF adjustment factor and inclusion of additional data elements such as echocardiography is needed to enhance applicability of the FRP in this setting. PMID:25062396

Brody, Aaron M; Flack, John M; Ference, Brian A; Levy, Phillip D

2014-09-01

164

Walk score and risk of stroke and stroke subtypes among town residents  

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Background Regular physical activity, including light-to-moderate activity, such as walking, has well-established benefits for reducing the risk of ischemic stroke. It remains unknown, however, whether the characteristics of cities themselves can influence the risk of stroke by promoting such activity. Objectives We tested the hypothesis that how walkable a city will be associated with the risk of ischemic stroke in persons residing in that city. Methods We calculated the age-adjusted annual incidence rates of ischemic stroke among residents in each of the 63 cities in Minnesota for which Walk Scores were available using 2011 Minnesota Hospital Association (MHA) data. Walk Score®, an online service, uses an exclusive algorithm to compute a walkability score between 0 and 100 for any location within the United States. The score is calculated based on the distance to amenities in nine categories (grocery, restaurants, shopping, coffee, banks, parks, schools, books, and entertainment) weighed according to their importance. Results There are 2,910,435 persons residing in the 63 Minnesota cities in our data (average population per town is 46,197). The average Walk Score of the 63 towns in Minnesota was 34, ranging from 14 to 69. The average median age of residents was similar in tertiles of towns based on Walk Score as follows: ?25 (n=9) 36 years; 26–50 (n=46) 37 years; and 51–100 (n=8) 35 years. The age-adjusted incidence of ischemic stroke was similar in tertiles of towns based on Walk Score as follows: ?25 (n=9) 341 per 100,000; 26–50 (n=46) 308 per 100,000; and 51–100 (n=8) 330 per 100,000 residents. The correlation between age-adjusted ischemic stroke incidence and Walk Score was low (R2=0.09) within Minnesota. Conclusions The ready availability of indices such as Walk Score make them attractive options for ischemic stroke risk correlation. Despite the lack of relationship in our study, further studies are required to measure the magnitude and health benefits of light-to-moderate activities performed within a town.

Qureshi, Adnan I; Adil, Malik M; Miller, Zachariah; Suri, Mariam; Rahim, Basit; Gilani, Sarwat I; Gilani, Waqas I

2014-01-01

165

Association of Cardiovascular Risk Using Nonlinear Heart Rate Variability Measures with the Framingham Risk Score in a Rural Population  

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Full Text Available Cardiovascular risk can be calculated using the Framingham cardiovascular disease (CVD risk score and provides a risk stratification from mild to very high CVD risk percentage over 10 years. This equation represents a complex interaction between age, gender, cholesterol status, blood pressure, diabetes status and smoking. Heart rate variability (HRV is a measure of how the autonomic nervous system modulates the heart rate. HRV measures are sensitive to age, gender, disease status such as diabetes and hypertension and processes leading to atherosclerosis. We investigated whether HRV measures are a suitable, simple, noninvasive alternative to differentiate between the four main Framingham associated CVD risk categories. In this study we applied the tone-entropy (T-E algorithm and complex correlation measure (CCM for analysis of heart rate variability obtained from 20 minute ECG recordings and correlated the HRV score with the stratification results using the Framingham risk equation. Both entropy and CCM had significant analysis of variance (ANOVA results (F172, 3 = 9.51; <0.0001. Bonferroni post hoc analysis indicated a significant difference between mild, high and very high cardiac risk groups applying tone-entropy (p<0.01. CCM detected a difference in temporal dynamics of the RR intervals between the mild and very high CVD risk groups (p<0.01. Our results indicate a good agreement between the T-E and CCM algorithm and the Framingham CVD risk score, suggesting that this algorithm may be of use for initial screening of cardiovascular risk as it is noninvasive, economical and easy to use in clinical practice.

HerbertFJelinek

2013-07-01

166

What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk  

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Full Text Available Abstract Background The coronary artery calcium (CAC score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female, we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham to 6–9%; if her score were over 100, however (a 17% chance, her risk estimate would be markedly higher (25–51% in 10 years. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.

Pletcher Mark J

2004-08-01

167

Risk Factors for Premature Myocardial Infarction: A Matched Case-Control Study  

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Full Text Available

Background: Myocardial infarction in young age is increasing. Identifying risk factors could be important for health promotion. We studied classic atherosclerotic risk factors in premature myocardial infarction.

Methods: In this matched case-control study, which was conducted from 2005 to 2007 in Birjand County, the east of Iran, atherosclerotic risk factors (hypertension, family history of coronary artery diseases, obesity, diabetes mellitus, dyslipidemia of 98 patients affected by acute myocardial infarction aged under 50 years were compared with that of 98 healthy neighborhood controls.

Results: Mean levels of cholesterol, triglyceride, low-density lipoprotein, as well as systolic blood pressure and body mass index were significantly higher in cases than in controls. There was a positive association between coronary artery disease at younger age and dyslipidemia OR=2.8 [95% CI: 1.5, 5.2], smoking OR=6.4 [95% CI: 3.0, 13.5], systolic hypertension OR=3.1 [95% CI: 1.5, 6.3], family history of coronary artery diseases OR=10.9 [95% CI: 3.2, 37.9] and diabetes OR=2.5 [95% CI: 1.04, 6.2].

Conclusion: Smoking, systolic hypertension and dyslipidemia were the most common risk factors among patients with premature myocardial infarction.<

Seyed Ali Moezy

2011-07-01

168

The East London glaucoma prediction score:web-based validation of glaucoma risk screening tool  

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Full Text Available AIM:It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific.METHOD:The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described:Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment.RESULTS:Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed:Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%.CONCLUSION:Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables.

Cook Stephen

2013-02-01

169

Comparison of accuracy of diabetes risk score and components of the metabolic syndrome in assessing risk of incident type 2 diabetes in Inter99 cohort  

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Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously developed diabetes risk score, PreDx® Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood.

Shafizadeh, Tracy B; Moler, Edward J

2011-01-01

170

Impact of framingham risk score, flow-mediated dilation, pulse wave velocity, and biomarkers for cardiovascular events in stable angina.  

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Although the age-adjusted Framingham risk score (AFRS), flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV), high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and free fatty acid (FFA) can predict future cardiovascular events (CVEs), a comparison of these risk assessments for patients with stable angina has not been reported. We enrolled 203 patients with stable angina who had been scheduled for coronary angiography (CAG). After CAG, 134 patients showed significant coronary artery disease. During 4.2 yr follow-up, 36 patients (18%) showed CVEs, including myocardial infarction, de-novo coronary artery revascularization, in-stent restenosis, stroke, and cardiovascular death. ROC analysis showed that AFRS, FMD, baPWV, and hsCRP could predict CVEs (with AUC values of 0.752, 0.707, 0.659, and 0.702, respectively, all P<0.001 except baPWV P=0.003). A Cox proportional hazard analysis showed that AFRS and FMD were independent predictors of CVEs (HR, 2.945; 95% CI, 1.572-5.522; P=0.001 and HR, 0.914; 95% CI, 0.826-0.989; P=0.008, respectively). However, there was no difference in predictive power between combining AFRS plus FMD and AFRS alone (AUC 0.752 vs. 0.763; z=1.358, P=0.175). In patients with stable angina, AFRS and FMD are independent predictors of CVEs. However, there is no additive value of FMD on the AFRS in predicting CVEs. PMID:25368493

Park, Kyoung-Ha; Han, Sang Jin; Kim, Hyun-Sook; Kim, Min-Kyu; Jo, Sang Ho; Kim, Sung-Ai; Park, Woo Jung

2014-10-01

171

A Bayesian Framework for Automated Cardiovascular Risk Scoring on Standard Lumbar Radiographs  

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We present a fully automated framework for scoring a patients risk of cardiovascular disease (CVD) and mortality from a standard lateral radiograph of the lumbar aorta. The framework segments abdominal aortic calcifications for computing a CVD risk score and performs a survival analysis to validate the score. Since the aorta is invisible on X-ray images, its position is reasoned from (1) the shape and location of the lumbar vertebrae and (2) the location, shape, and orientation of potential calcifications. The proposed framework follows the principle of Bayesian inference, which has several advantages in the complex task of segmenting aortic calcifications. Bayesian modeling allows us to compute CVD risk scores conditioned on the seen calcifications by formulating distributions, dependencies, and constraints on the unknown parameters. We evaluate the framework on two datasets consisting of 351 and 462 standard lumbar radiographs, respectively. Promising results indicate that the framework has potential applications in diagnosis, treatment planning, and the study of drug effects related to CVD.

Petersen, Peter Kersten; Ganz, Melanie

2011-01-01

172

To Construct A Forecasting Model of the Anthropometric Chronic Disease Risk Factor Score  

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Full Text Available Background: Many health indices have a relationship with anthropometric indices. Thisresearch attempts to provide a new measurement: a chronic disease risk factorscore built into the regression model. This new model will help peoplevisualize their health status and get multiple information during the processof the healthy examination.Methods: Data from 8,034 subjects were collected from the data bank of the HealthExamination Center in Chang Gung Memorial Hospital. Related anthropometricindices and biochemical factors were selected and used to construct aregression model. The anthropometric indices used were body mass index,waist hip ratio, waist hip area ratio, health index, waist leg ratio and trunk legratio. Biochemical data included blood pressure, glucose, triglyceride, cholesteroland uric acid, combined to form an anthropometric chronic diseaserisk factor score.Results: Subjects under 45 years of age had the highest chronic disease risk factorscore, and were selected to construct a regression model. The R-square ofthis model is 0.355; its predictive error is near 12%. After verification with atesting group, the regression model could be used to predict health status.Conclusion: The purpose of this study was to develop a new anthropometric chronic diseaserisk factor score by combining anthropometric indices and biochemicaldata. A multiple regression model was used to illustrate health status viaanthropometric chronic disease risk factor scores for the subjects participatingin the health examination. The results show that the chronic disease riskfactor score is useful for prescribing relevant medical treatment as well as forother research.

Yi-Chou Chuang

2006-04-01

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Risk scoring systems for adults admitted to the emergency department: a systematic review  

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Full Text Available Abstract Background Patients referred to a medical admission unit (MAU represent a broad spectrum of disease severity. In the interest of allocating resources to those who might potentially benefit most from clinical interventions, several scoring systems have been proposed as a triaging tool. Even though most scoring systems are not meant to be used on an individual level, they can support the more inexperienced doctors and nurses in assessing the risk of deterioration of their patients. We therefore performed a systematic review on the level of evidence of literature on scoring systems developed or validated in the MAU. We hypothesized that existing scoring systems would have a low level of evidence and only few systems would have been externally validated. Methods We conducted a systematic search using Medline, EMBASE and the Cochrane Library, according to the PRISMA guidelines, on scoring systems developed to assess medical patients at admission. The primary endpoints were in-hospital mortality or transfer to the intensive care unit. Studies derived for only a single or few diagnoses were excluded. The ability to identify patients at risk (discriminatory power and agreement between observed and predicted outcome (calibration along with the method of derivation and validation (application on a new cohort were extracted. Results We identified 1,655 articles. Thirty were selected for further review and 10 were included in this review. Eight systems used vital signs as variables and two relied mostly on blood tests. Nine systems were derived using regression analysis and eight included patients admitted to a MAU. Six systems used in-hospital mortality as their primary endpoint. Discriminatory power was specified for eight of the scoring systems and was acceptable or better in five of these. The calibration was only specified for four scoring systems. In none of the studies impact analysis or inter-observer reliability were analyzed. None of the systems reached the highest level of evidence. Conclusions None of the 10 scoring systems presented in this article are perfect and all have their weaknesses. More research is needed before the use of scoring systems can be fully implemented to the risk assessment of acutely admitted medical patients.

Knudsen Torben

2010-02-01

174

Risk reduction of brain infarction during carotid endarterectomy or stenting using sonolysis - Prospective randomized study pilot data  

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Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm risk reduction of brain infarction during endarterectomy (CEA) and stenting (CAS) of the internal carotid artery (ICA) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe, additional interest was to assess impact of new brain ischemic lesions on cognitive functions. Methods: All consecutive patients 1/ with ICA stenosis >70%, 2/ indicated to CEA or CAS, 3/ with signed informed consent, were enrolled to the prospective study during 17 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions >0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated using T-test. Results: 97 patients were included into the study. Out of the 47 patients randomized to sonolysis group (Group 1) 25 underwent CEA (Group 1a) and 22 CAS (Group 1b). Out of the 50 patients randomized to control group (Group 2), 22 underwent CEA (Group 2a) and 28 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 14 (29.8%) patients in Group 1-4 (16.0%) in Group 1a and 10 (45.5%) in Group 1b. In Group 2, new ischemic brain infarctions were found in 18 (36.0%) patients-6 (27.3%) in Group 2a and 12 (42.9%) in Group 2b (p>0.05 in all cases). New ischemic brain infarctions >0.5 cm3 were found in 4 (8.5 %) patients in Group 1 and in 11 (22.0 %) patients in Group 2 (p= 0.017). No significant differences were found in cognitive tests results between subgroups (p>0.05 in all tests). Conclusion: Sonolysis seems to be effective in the prevention of large ischemic brain infarctions during CEA and CAS.

Kuliha, Martin; Školoudík, David; Martin Roubec, Martin; Herzig, Roman; Procházka, Václav; Jonszta, Tomáš; Kraj?a, Jan; Czerný, Dan; Hrbá?, Tomáš; Otáhal, David; Langová, Kate?ina

2012-11-01

175

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging  

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To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

176

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging  

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To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 {+-} 4.6 vs -5.9 {+-} 7.4, P < 0.001) and CSR (-86.4 {+-} 33.3 vs -73.5 {+-} 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

Wong, Dennis T.L.; Weightman, Michael J.; Baumert, Mathias; Tayeb, Hussam; Richardson, James D.; Puri, Rishi; Bertaso, Angela G.; Roberts-Thomson, Kurt C.; Sanders, Prashanthan; Worthley, Matthew I. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Worthley, Stephen G. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Royal Adelaide Hospital, Cardiovascular Investigational Unit, SA (Australia)

2012-08-15

177

A clinically useful risk-score for chronic kidney disease in HIV infection  

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Introduction Development of a simple, widely applicable risk score for chronic kidney disease (CKD) allows comparisons of risks or benefits of starting potentially nephrotoxic antiretrovirals (ARVs) as part of a treatment regimen. Materials and Methods A total of 18,055 HIV-positive persons from the Data on Adverse Drugs (D:A:D) study with >3 estimated glomerular filtration rates (eGFRs) >1/1/2004 were included. Persons with use of tenofovir (TDF), atazanavir (ritonavir boosted (ATV/r) and unboosted (ATV)), lopinavir (LPV/r) and other boosted protease inhibitors (bPIs) before baseline (first eGFR >60 ml/min/1.73?m2 after 1/1/2004) were excluded. CKD was defined as confirmed (>3 months apart) eGFR 5 points) risk of developing CKD. Increased incidence of CKD associated with starting ARVs was modelled by including ARVs as time-updated variables. The risk score was externally validated on two independent cohorts. Results A total of 641 persons developed CKD during 103,278.5 PYFU (incidence 6.2/1000 PYFU, 95% CI 5.7–6.7). Older age, intravenous drug use, HCV+ antibody status, lower baseline eGFR, female gender, lower CD4 nadir, hypertension, diabetes and cardiovascular disease predicted CKD and were included in the risk score (Figure 1). The incidence of CKD in those at low, medium and high risk was 0.8/1000 PYFU (95% CI 0.6–1.0), 5.6 (95% CI 4.5–6.7) and 37.4 (95% CI 34.0–40.7) (Figure 1). The risk score showed good discrimination (Harrell's c statistic 0.92, 95% CI 0.90–0.93). The number needed to harm (NNTH) in patients starting ATV or LPV/r was 1395, 142 or 20, respectively, among those with low, medium or high risk. NNTH were 603, 61 and 9 for those with a low, medium or high risk starting TDF, ATV/r or bPIs. The risk score was externally validated on 2603 persons from the Royal Free Hospital clinic cohort (94 events, incidence 5.1/1000 PYFU; 95% CI 4.1–6.1) and 2013 persons from the control arms of SMART/ESPRIT (32 events, incidence 3.8/1000 PYFU; 95% CI 2.5–5.1). External validation showed consistent CKD rates across risk groups (Figure 2). Interpretation Traditional and HIV-related risk factors were predictive of CKD; all are routinely available, making the risk score easy to incorporate into clinical practise and of direct relevance for clinical decision making. NNTH in persons starting potentially nephrotoxic ARVs at high risk of CKD were low, and alternative ARVs may be more appropriate. PMID:25394023

Mocroft, Amanda; Lundgren, Jens; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Debbie; Heuhaus, Jacquie; Fux, Christophe; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret; Ryom, Lene

2014-01-01

178

Analysis of surgical site infection after musculoskeletal tumor surgery: risk assessment using a new scoring system.  

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Surgical site infection (SSI) has not been extensively studied in musculoskeletal tumors (MST) owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases) treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P = 0.0002) and intraoperative blood loss (P = 0.0005) was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI) index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials). The MOSI index (0-4 points) score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points). The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI. PMID:24672281

Nagano, Satoshi; Yokouchi, Masahiro; Setoguchi, Takao; Sasaki, Hiromi; Shimada, Hirofumi; Kawamura, Ichiro; Ishidou, Yasuhiro; Kamizono, Junichi; Yamamoto, Takuya; Kawamura, Hideki; Komiya, Setsuro

2014-01-01

179

Hyperhomocysteinemia, a Risk Factor for Myocardial Infarction in Patients with Type-2 Diabetes in Southern Sindh, Pakistan  

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Full Text Available Hyperhomocysteinemia is a major risk factor for Myocardial Infarction (MI in patients with type 2 diabetes, in general population of Pakistan. However, the role of increase plasma homocysteine level in the development of Coronary Heart Disease (CHD in patients with type 2 diabetes is still unknown. Therefore this study was designed to determine the relation ship between plasma homocysteine level and the incidence of MI in patients with type 2 diabetes. The study group consists of 107 patients (71 male and 36 female who are admitted in different hospital of Hyderabad and Mirpurkhas with myocardial infarction. Plasma total homocysteine level, lipid profile and HbA1c were measured. All patients were identified as diabetic by using WHO criteria. Group A indicates patients (Diabetes Mellitus [DM] with Myocardial Infarction ([MI] n = 107 Group B include controls (non-Diabetes Mellitus [non-DM] having MI. The plasma homocysteine level was significantly high in patients then in control (21.3±1.8 Vs 13.9±1.2 ?mol/L, p = 0.0008. It seems clear relationship between hyperhomocystenia and an increase risk of MI in patients with type 2 diabetes.

Arshad Hussain Laghari

2009-01-01

180

Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults  

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Evidence suggests that sitting time is adversely associated with health risks. However, previous epidemiological studies have mainly addressed mortality whereas little is known of the risk of coronary heart disease. This study aimed to investigate total sitting time and risk of myocardial infarction, coronary heart disease incidence and all-cause mortality.

Petersen, Christina BjØrk; GrØnbæk, Morten

2014-01-01

 
 
 
 
181

Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome  

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Background Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. Objective To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. Methods A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. Results The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Conclusion Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases. PMID:24652053

Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andreia da Silva; Macagnan, Fabricio Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo

2014-01-01

182

Prognostic score for predicting risk of dementia over 10 years while accounting for competing risk of death.  

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Early detection of subjects at high risk of developing dementia is essential. By dealing with censoring and competing risk of death, we developed a score for predicting 10-year dementia risk by combining cognitive tests, and we assessed whether inclusion of cognitive change over the previous year increased its discrimination. Data came from the French prospective cohort study Personnes Agées QUID (PAQUID) and included 3,777 subjects aged 65 years or older (1988-1998). The combined prediction score was estimated by means of an illness-death model handling interval censoring and competing risk of death. Its predictive ability was measured using the receiver operating characteristic (ROC) curve, with 2 different definitions depending on the way subjects who died without a dementia diagnosis were considered. To account for right-censoring and interval censoring, we estimated the ROC curves by means of a weighting approach and a model-based imputation estimator. The combined score exhibited an area under the ROC curve (AUROC) of 0.81 for discriminating future demented subjects from subjects alive and nondemented 10 years later and an AUROC of 0.75 for discriminating future demented subjects from all other subjects (including deceased persons). Adjustment for cognitive change over the previous year did not improve prediction. PMID:25190680

Jacqmin-Gadda, Hélène; Blanche, Paul; Chary, Emilie; Loubère, Lucie; Amieva, Hélène; Dartigues, Jean-François

2014-10-15

183

Evaluation of framingham and systematic coronary risk evaluation scores by coronary computed tomographic angiography in asymptomatic adults.  

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Recently, coronary computed tomographic angiography (CCTA) was introduced as a tool for the early detection of coronary atherosclerosis. However, a disagreement exists regarding the accuracy of CCTA for the prediction of future cardiovascular risk compared to conventional clinical risks scores (e.g., Framingham and Systematic Coronary Risk Evaluation [SCORE] scores). The aim of the present study was to compare these 2 methods in asymptomatic Israeli subjects. CCTA was performed in 190 asymptomatic patients with ?1 atherogenic risk factor as the primary screening tool for the presence of cardiovascular disease. The calcium score (CS) was measured in these subjects as a part of CCTA. In addition, the Framingham and SCORE scores were calculated, and statistical analysis using regression models was performed. The study included 190 subjects (84% men). The mean age was 55 ± 9.7 years. A significant correlation with the CS and plaque severity detected by CCTA was found when comparing the risk factors calculated by the SCORE and Framingham scores. A SCORE calculation of >2 versus 100 (42.9% vs 21.9; odds ratio [OR] 2.68, p = 0.001). When comparing high-risk (>4) and low-risk (20) versus low-risk Framingham (100 (53.3% vs 28.6%; OR 3.18, p = 0.001). A high-risk versus low-risk SCORE score was related to greater plaque severity (79.2% vs 59.4%, respectively; OR 2.6, p = 0.001). A high-risk versus low-risk Framingham score was also related to greater plaque severity (93.3% vs 59%, respectively; OR 3.18, p = 0.001). The variables best predicting the severity of artery stenosis were age, gender, diabetes, and hypertension. In conclusion, the results of the present study indicate that the results of the Framingham and SCORE scores compared to those obtained using CCTA are good predictors of coronary artery disease. The use of these clinical scores seems important in identifying patients at risk of coronary atherosclerosis and treating them properly before the development of symptoms and also to help prevent the use of unnecessary invasive procedures. PMID:23273527

Schneer, Sonya; Bachar, Gil N; Atar, Eli; Koronowski, Ran; Dicker, Dror

2013-03-01

184

Early prediction of mortality in patients with acute myocardial infarction: a prospective study of clinical and radionuclide risk factors  

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To examine the prognostic value of early radionuclide imaging in patients with transmural acute myocardial infarction, 222 patients in Killip class I and II were studied prospectively within 24 hours of the onset of symptoms. The 30-day mortality rate for the entire group was 11% (25 of 222). Univariate analysis indicated that an initial radionuclide left ventricular ejection fraction (EF) of less than 0.30 was associated with the greatest relative risk (RR = 6.6), although the percent of abnormally contracting regions (RR = 3.9) and thallium-201 defect index (RR = 3.3) were also significant risk factors. Stepwise logistic regression indicated that addition of EF resulted in the greatest improvement over the best clinical model (Killip class and chest radiographic findings) for the prediction of 30-day mortality (chi 2 improvement = 12.8, p less than 0.0005). Using the optimal model for prediction of mortality (EF and Killip class), a high-risk group with a 30-day mortality rate of 39% (90-day mortality 47%) and a low-risk group with a 30-day mortality rate of 3% (90-day mortality 4%) was identified. In clinically stable patients with transmural acute myocardial infarction, early assessment of EF in conjunction with clinical evaluation, is a valuable method for early identification of high-risk subsets

185

Risk Prediction Score for Severe High Altitude Illness: A Cohort Study  

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Background Risk prediction of acute mountain sickness, high altitude (HA) pulmonary or cerebral edema is currently based on clinical assessment. Our objective was to develop a risk prediction score of Severe High Altitude Illness (SHAI) combining clinical and physiological factors. Study population was 1017 sea-level subjects who performed a hypoxia exercise test before a stay at HA. The outcome was the occurrence of SHAI during HA exposure. Two scores were built, according to the presence (PRE, n?=?537) or absence (ABS, n?=?480) of previous experience at HA, using multivariate logistic regression. Calibration was evaluated by Hosmer-Lemeshow chisquare test and discrimination by Area Under ROC Curve (AUC) and Net Reclassification Index (NRI). Results The score was a linear combination of history of SHAI, ventilatory and cardiac response to hypoxia at exercise, speed of ascent, desaturation during hypoxic exercise, history of migraine, geographical location, female sex, age under 46 and regular physical activity. In the PRE/ABS groups, the score ranged from 0 to 12/10, a cut-off of 5/5.5 gave a sensitivity of 87%/87% and a specificity of 82%/73%. Adding physiological variables via the hypoxic exercise test improved the discrimination ability of the models: AUC increased by 7% to 0.91 (95%CI: 0.87–0.93) and 17% to 0.89 (95%CI: 0.85–0.91), NRI was 30% and 54% in the PRE and ABS groups respectively. A score computed with ten clinical, environmental and physiological factors accurately predicted the risk of SHAI in a large cohort of sea-level residents visiting HA regions. PMID:25068815

Canoui-Poitrine, Florence; Veerabudun, Kalaivani; Larmignat, Philippe; Letournel, Murielle

2014-01-01

186

Predicting PTSD using the New York Risk Score with genotype data: potential clinical and research opportunities  

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Full Text Available Joseph A Boscarino,1,2 H Lester Kirchner,3,4 Stuart N Hoffman,5 Porat M Erlich1,4 1Center for Health Research, Geisinger Clinic, Danville, 2Department of Psychiatry, Temple University School of Medicine, Philadelphia, 3Division of Medicine, Geisinger Clinic, Danville, 4Department of Medicine, Temple University School of Medicine, Philadelphia, 5Department of Neurology, Geisinger Clinic, Danville, PA, USA Background: We previously developed a post-traumatic stress disorder (PTSD screening instrument, ie, the New York PTSD Risk Score (NYPRS, that was effective in predicting PTSD. In the present study, we assessed a version of this risk score that also included genetic information. Methods: Utilizing diagnostic testing methods, we hierarchically examined different prediction variables identified in previous NYPRS research, including genetic risk-allele information, to assess lifetime and current PTSD status among a population of trauma-exposed adults. Results: We found that, in predicting lifetime PTSD, the area under the receiver operating characteristic curve (AUC for the Primary Care PTSD Screen alone was 0.865. When we added psychosocial predictors from the original NYPRS to the model, including depression, sleep disturbance, and a measure of health care access, the AUC increased to 0.902, which was a significant improvement (P = 0.0021. When genetic information was added in the form of a count of PTSD risk alleles located within FKBP, COMT, CHRNA5, and CRHR1 genetic loci (coded 0–6, the AUC increased to 0.920, which was also a significant improvement (P = 0.0178. The results for current PTSD were similar. In the final model for current PTSD with the psychosocial risk factors included, genotype resulted in a prediction weight of 17 for each risk allele present, indicating that a person with six risk alleles or more would receive a PTSD risk score of 17 × 6 = 102, the highest risk score for any of the predictors studied. Conclusion: Genetic information added to the NYPRS helped improve the accuracy of prediction results for a screening instrument that already had high AUC test results. This improvement was achieved by increasing PTSD prediction specificity. Further research validation is advised. Keywords: post-traumatic stress disorder, psychological trauma, diagnostic screening, test development, genotype, single nucleotide polymorphism

Boscarino JA

2013-04-01

187

Real-life evaluation of European and American high-risk strategies for primary prevention of cardiovascular disease in patients with first myocardial infarction  

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Objective To determine the detection rate (sensitivity) of the high-risk strategy recommended in the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE/UK) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cardiovascular disease (CVD) prevention. In particular, to evaluate the ability to ensure statin therapy to contemporary Europeans destined for a first myocardial infarction (MI). Design 393 consecutive statin-naïve, CVD-free patients without diabetes hospitalised for a first MI, 247 of whom were 40–75?years of age. We assumed they had undergone a health check the day before their MI and estimated the predicted risk. Primary outcome Sensitivity of the risk-based eligibility for primary prevention with statins recommended by the guidelines. Results All recommended risk scores rank-ordered patients similarly, but the sensitivity of the cut point above which statin therapy should be considered differed substantially. In younger patients (age 40–60), 62% of men and 13% of women qualified for statin therapy by ACC/AHA criteria, compared with only 2% of men and no women using the ESC criteria recommended for most non-Eastern European countries. In those 60–75?years of age, the ACC/AHA guidelines captured all men and 85% of women, compared with 12% and 2%, respectively, using the new ESC guideline. This guideline restricted the eligibility for primary prevention with statins substantially by reclassifying many European countries from ‘high-risk’ to ‘low-risk’, whereas the eligibility was expanded in the ACC/AHA and the new NICE/UK guidelines by lowering the decision threshold. Conclusions The 2012 ESC guidelines differ substantially from the 2013 ACC/AHA and 2014 NICE/UK guidelines in ability to secure statin therapy to those destined for a first MI. A great opportunity for primary prevention with statins remains unexploited in Europe. PMID:25326211

Mortensen, Martin B; Falk, Erling

2014-01-01

188

Real-life evaluation of European and American high-risk strategies for primary prevention of cardiovascular disease in patients with first myocardial infarction  

DEFF Research Database (Denmark)

OBJECTIVE: To determine the detection rate (sensitivity) of the high-risk strategy recommended in the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE/UK) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cardiovascular disease (CVD) prevention. In particular, to evaluate the ability to ensure statin therapy to contemporary Europeans destined for a first myocardial infarction (MI). DESIGN: 393 consecutive statin-naïve, CVD-free patients without diabetes hospitalised for a first MI, 247 of whom were 40-75?years of age. We assumed they had undergone a health check the day before their MI and estimated the predicted risk. PRIMARY OUTCOME: Sensitivity of the risk-based eligibility for primary prevention with statins recommended by the guidelines. RESULTS: All recommended risk scores rank-ordered patients similarly, but the sensitivity of the cut point above which statin therapy should be considered differed substantially. In younger patients (age 40-60), 62% of men and 13% of women qualified for statin therapy by ACC/AHA criteria, compared with only 2% of men and no women using the ESC criteria recommended for most non-Eastern European countries. In those 60-75?years of age, the ACC/AHA guidelines captured all men and 85% of women, compared with 12% and 2%, respectively, using the new ESC guideline. This guideline restricted the eligibility for primary prevention with statins substantially by reclassifying many European countries from 'high-risk' to 'low-risk', whereas the eligibility was expanded in the ACC/AHA and the new NICE/UK guidelines by lowering the decision threshold. CONCLUSIONS: The 2012 ESC guidelines differ substantially from the 2013 ACC/AHA and 2014 NICE/UK guidelines in ability to secure statin therapy to those destined for a first MI. A great opportunity for primary prevention with statins remains unexploited in Europe.

Mortensen, Martin B; Falk, Erling

2014-01-01

189

Predicting survival in heart failure : a risk score based on 39 372 patients from 30 studies  

DEFF Research Database (Denmark)

AimsUsing a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF).Methods and resultsThe MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced and preserved left-ventricular ejection fraction (EF), from 30 cohort studies, six of which were clinical trials. 40.2% of patients died during a median follow-up of 2.5 years. Using multivariable piecewise Poisson regression methods with stepwise variable selection, a final model included 13 highly significant independent predictors of mortality in the following order of predictive strength: age, lower EF, NYHA class, serum creatinine, diabetes, not prescribed beta-blocker, lower systolic BP, lower body mass, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and not prescribed ACE-inhibitor or angiotensin-receptor blockers. In preserved EF, age was more predictive and systolic BP wasless predictive of mortality than in reduced EF. Conversion into an easy-to-use integer risk score identified a very marked gradient in risk, with 3-year mortality rates of 10 and 70% in the bottom quintile and top decile of risk, respectively.ConclusionIn patients with HF of both reduced and preserved EF, the influences of readily available predictors of mortality can be quantified in an integer score accessible by an easy-to-use website www.heartfailurerisk.org. The score has the potential for widespread implementation in a clinical setting.

Pocock, Stuart J; Ariti, Cono A

2012-01-01

190

Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?  

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Aim: Various studies have shown that one of these predisposing risk factors, namely the anatomical narrowness of the upper airway, is linked to insulin resistance, atherosclerosis, obesity, and HT related diseases. This study investigates the possible relation between HT and the Modified Mallampati Score (MMS) which is linked to the anatomical narrowness of the upper airway at the oropharynx level. Material and Method: The study covers a total of 138 adults of which 57 are women (41.3%) and 8...

Güçlü Beriat; Aycan Erkan; Cem Dogan; Berkay Ekici; Asl?han Alhan; Hasan Töre; Sinan Kocatürk

2012-01-01

191

Risk score to stratify children with suspected serious bacterial infection: observational cohort study.  

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Objectives: To derive and validate a clinical score to risk stratify children presenting with acute infection. Study design and participants: Observational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome. Clinical predictors of serious bacterial infection (SBI) were explored in multivariate logistic regression models using part o...

Brent, Aj; Lakhanpaul, M.; Thompson, M.; Collier, J.; Ray, S.; Ninis, N.; Levin, M.; Macfaul, R.

2011-01-01

192

Accuracy of two scoring systems for risk stratification in thoracic surgery†  

Science.gov (United States)

We investigate the suitability of the two existing risk stratification systems available for predicting mortality in a cohort of patients undergoing lung resection under a single surgeon. Data from the 290 consecutive patients who underwent pulmonary resection between January 2008 and January 2011 were extracted from a prospective clinical data base. In-hospital mortality risk scores are calculated for every patient by using Thoracoscore and ESOS.01 and were compared with actual in-hospital mortality. The receiver operating characteristic (ROC) curve was used to establish how well the systems rank for predicting patient mortality. Actual in-hospital mortality was 3.1% (n = 9). Thoracoscore and ESOS values (mean ± SEM) were 4.93 ± 0.32 and 4.08 ± 0.41, respectively. The area under the ROC curve values for ESOS and Thoracoscore were 0.8 and 0.6, respectively. ESOS was reasonably accurate at predicting the overall mortality (sensitivity 88% and specificity 67%), whereas Thoracoscore was a weaker predictor of mortality (sensitivity 67% and specificity 53%). The ESOS score had better predictive values in our patient population and might be easier to calculate. Because of their low specificity, the use of these scores should be limited to the assessment of outcomes of surgical cohorts, but they are not designed to predict risks for individual patients. PMID:22361128

Barua, Anupama; Handagala, Sumana D.; Socci, Laura; Barua, Biplab; Malik, Munib; Johnstone, Natalie; Martin-Ucar, Antonio E.

2012-01-01

193

Accuracy of two scoring systems for risk stratification in thoracic surgery.  

Science.gov (United States)

We investigate the suitability of the two existing risk stratification systems available for predicting mortality in a cohort of patients undergoing lung resection under a single surgeon. Data from the 290 consecutive patients who underwent pulmonary resection between January 2008 and January 2011 were extracted from a prospective clinical data base. In-hospital mortality risk scores are calculated for every patient by using Thoracoscore and ESOS.01 and were compared with actual in-hospital mortality. The receiver operating characteristic (ROC) curve was used to establish how well the systems rank for predicting patient mortality. Actual in-hospital mortality was 3.1% (n = 9). Thoracoscore and ESOS values (mean ± SEM) were 4.93 ± 0.32 and 4.08 ± 0.41, respectively. The area under the ROC curve values for ESOS and Thoracoscore were 0.8 and 0.6, respectively. ESOS was reasonably accurate at predicting the overall mortality (sensitivity 88% and specificity 67%), whereas Thoracoscore was a weaker predictor of mortality (sensitivity 67% and specificity 53%). The ESOS score had better predictive values in our patient population and might be easier to calculate. Because of their low specificity, the use of these scores should be limited to the assessment of outcomes of surgical cohorts, but they are not designed to predict risks for individual patients. PMID:22361128

Barua, Anupama; Handagala, Sumana D; Socci, Laura; Barua, Biplab; Malik, Munib; Johnstone, Natalie; Martin-Ucar, Antonio E

2012-05-01

194

Synergetic effects of cigarette smoking, systolic blood pressure, and psychosocial risk factors for lung cancer, cardiac infarct and apoplexy cerebri.  

Science.gov (United States)

With 1,353 inhabitants of a Yugoslavian town, a prospective investigation was carried out during the years 1965-1975. At the beginning, physical and psychosocial risk factors for cancer and other internal diseases were determined; during the next 10 years the incidence of these diseases was recorded. The strongest physical and psychosocial risk factors for lung cancer, cardiac infarct, and apoplexia cerebri were investigated with respect to 'synergetic' effects (interaction nonlinearities), i.e., a dependence of the effect of one variable upon the value of another. They were always present, and the efficacy of physical risk factors was always wholly dependent upon the presence of psychosocial risk factors, while the latter were sometimes quite effective even in the absence of physical ones. PMID:7280168

Grossarth-Maticek, R

1980-01-01

195

Attributable risks for acute myocardial infarction in four countries of Latin America  

Scientific Electronic Library Online (English)

Full Text Available SciELO Argentina | Language: English Abstract in spanish Este estudio caso-control y multicéntrico, investigó en cuatro países de América, la proporción de casos de infarto agudo de miocardio (IAM) atribuidos al colesterol, tabaquismo, hipertensión, índice de masa corporal e historia familiar de enfermedad coronaria (riesgo atribuible, RA). Los RA fueron [...] estimados a partir de la información de 1060 casos de IAM y 1071 controles de Argentina, 323 casos de IAM y 314 controles de Cuba, 200 casos de IAM y 200 controles de México y 266 casos de IAM y 264 controles de Venezuela. Los RA fueron obtenidos a partir de la prevalencia de los factores de riesgo coronario en los casos y sus correspondientes Odds Ratios (OR) obtenidos luego de un análisis multivariado. Los RA para IAM observados para hipercolesterolemia fueron los siguientes: Venezuela 27%, México 3%, Cuba 30% y Argentina 36%; para diabetes: Venezuela 10%, México 15%, Cuba 5% y Argentina 7% y para índice de masa corporal: Venezuela 12%, México 3%, Cuba 19% y Argentina 17%. El mismo factor de riesgo tendría diferentes RA en diferentes poblaciones. Juntos el colesterol sérico, el tabaquismo, la hipertensión, el índice de masa corporal y la historia familiar de enfermedad coronaria fueron responsables del 76% de todos los casos de IAM en Venezuela, 70% en México, 81% en Cuba y 79% en Argentina. El conocimiento del RA tendría importantes implicancias en las estrategias de salud pública, especialmente en aquellos países con limitados recursos sanitarios. Abstract in english This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated [...] using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.

M., Ciruzzi; H., Schargrodsky; P., Pramparo; E., Rivas Estany; L., Rodriguez Naude; R., De la Noval Garcia; S., Gaxiola Cazarez; E., Meaney; A., Nass; B., Finizola; L., Castillo.

196

Attributable risks for acute myocardial infarction in four countries of Latin America  

Directory of Open Access Journals (Sweden)

Full Text Available This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR. AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.Este estudio caso-control y multicéntrico, investigó en cuatro países de América, la proporción de casos de infarto agudo de miocardio (IAM atribuidos al colesterol, tabaquismo, hipertensión, índice de masa corporal e historia familiar de enfermedad coronaria (riesgo atribuible, RA. Los RA fueron estimados a partir de la información de 1060 casos de IAM y 1071 controles de Argentina, 323 casos de IAM y 314 controles de Cuba, 200 casos de IAM y 200 controles de México y 266 casos de IAM y 264 controles de Venezuela. Los RA fueron obtenidos a partir de la prevalencia de los factores de riesgo coronario en los casos y sus correspondientes Odds Ratios (OR obtenidos luego de un análisis multivariado. Los RA para IAM observados para hipercolesterolemia fueron los siguientes: Venezuela 27%, México 3%, Cuba 30% y Argentina 36%; para diabetes: Venezuela 10%, México 15%, Cuba 5% y Argentina 7% y para índice de masa corporal: Venezuela 12%, México 3%, Cuba 19% y Argentina 17%. El mismo factor de riesgo tendría diferentes RA en diferentes poblaciones. Juntos el colesterol sérico, el tabaquismo, la hipertensión, el índice de masa corporal y la historia familiar de enfermedad coronaria fueron responsables del 76% de todos los casos de IAM en Venezuela, 70% en México, 81% en Cuba y 79% en Argentina. El conocimiento del RA tendría importantes implicancias en las estrategias de salud pública, especialmente en aquellos países con limitados recursos sanitarios.

M. Ciruzzi

2003-12-01

197

Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

Bates Tom

2007-06-01

198

Risk factors and myocardial infarction in patients with obstructive sleep apnea: impact of ?2-adrenergic receptor polymorphisms  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The increased sympathetic nervous activity in patients with obstructive sleep apnea (OSA is largely responsible for the high prevalence of arterial hypertension, and it is suggested to adversely affect triglyceride and high-density lipoprotein (HDL cholesterol levels in these patients. The functionally relevant polymorphisms of the ?2-adrenergic receptor (Arg-47Cys/Arg16Gly and Gln27Glu have been shown to exert modifying effects on these risk factors in previous studies, but results are inconsistent. Methods We investigated a group of 429 patients (55 ± 10.7 years; 361 men, 68 women with moderate to severe obstructive sleep apnea (apnea/hypopnea index (AHI 29.1 ± 23.1/h and, on average, a high cardiovascular risk profile (body mass index 31.1 ± 5.6, with hypertension in 60.1%, dyslipidemia in 49.2%, and diabetes in 17.2% of patients. We typed the ?2-adrenergic receptor polymorphisms and investigated the five most frequent haplotypes for their modifying effects on OSA-induced changes in blood pressure, heart rate, and lipid levels. The prevalence of cardiovascular risk factors and coronary heart disease (n = 55, 12.8% and survived myocardial infarction (n = 27, 6.3% were compared between the genotypes and haplotypes. Results Multivariate linear/logistic regressions revealed a significant and independent (from BMI, age, sex, presence of diabetes, use of antidiabetic, lipid-lowering, and antihypertensive medication influence of AHI on daytime systolic and diastolic blood pressure, heart rate, prevalence of hypertension, and triglyceride and HDL levels. The ?2-adrenergic receptor genotypes and haplotypes showed no modifying effects on these relationships or on the prevalence of dyslipidemia, diabetes, and coronary heart disease, yet, for all three polymorphisms, heterozygous carriers had a significantly lower relative risk for myocardial infarction (Arg-47Cys: n = 195, odds ratio (OR = 0.32, P = 0.012; Arg16Gly: n = 197, OR = 0.39, P = 0.031; Gln27Glu: OR = 0.37, P = 0.023. Carriers of the most frequent haplotype (n = 113 (haplotype 1; heterozygous for all three polymorphisms showed a five-fold lower prevalence of survived myocardial infarction (OR = 0.21, P = 0.023. Conclusion Our study showed no significant modifying effect of the functionally relevant ?2-adrenergic receptor polymorphisms on OSA-induced blood pressure, heart rate, or lipid changes. Nevertheless, heterozygosity of these polymorphisms is associated with a lower prevalence of survived myocardial infarction in this group with, on average, a high cardiovascular risk profile.

Mügge Andreas

2007-01-01

199

71?Percutaneous Coronary Intervention (PCI) Risk Scores Predicting Inpatient Mortality and Major Adverse Cardiac Events (MACE) are Poorly Concordant in High Risk Patients.  

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BACKGROUND: High-risk percutaneous coronary intervention (PCI) procedures are being performed in greater numbers, in older patients with multiple comorbidities, and increasingly in the setting of acute coronary syndromes. Estimating inpatient PCI mortality and MACE risk (mortality, Q-wave myocardial infarction, urgent coronary artery bypass grafting and stroke) is essential in informing decision-making, consent, and operator and institutional benchmarking. There are a number of currently avai...

Ruparelia, N.; Choudhury, R.; Forfar, C.; Ashrafian, H.; Money-kyrle, A.; Davey, P.; Prendergast, B.; Channon, K.; Banning, A.; Kharbanda, R.

2014-01-01

200

Sudden infant death syndrome in New Zealand: are risk scores useful? New Zealand National Cot Death Study Group.  

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STUDY OBJECTIVE--To evaluate the Christchurch, Invercargill, Dunedin (CID) and Oxford record linkage study (ORLS) risk scores in five regions of New Zealand and examine the effect of risk factors for sudden infant death syndrome (SIDS), such as prone sleeping position, maternal smoking, breast feeding, measures of illness, the use of antenatal classes, community health care, and medical services on a high and low risk group delineated by the CID score. DESIGN--This was a case-control study of...

Williams, S. M.; Taylor, B. J.; Mitchell, E. A.; Scragg, R.; Ford, R. P.; Stewart, A. W.

1995-01-01

 
 
 
 
201

Integrative prognostic risk score in acute myeloid leukemia with normal karyotype.  

Science.gov (United States)

To integrate available clinical and molecular information for cytogenetically normal acute myeloid leukemia (CN-AML) patients into one risk score, 275 CN-AML patients from multicenter treatment trials AML SHG Hannover 0199 and 0295 and 131 patients from HOVON/SAKK protocols as external controls were evaluated for mutations/polymorphisms in NPM1, FLT3, CEBPA, MLL, NRAS, IDH1/2, and WT1. Transcript levels were quantified for BAALC, ERG, EVI1, ID1, MN1, PRAME, and WT1. Integrative prognostic risk score (IPRS) was modeled in 181 patients based on age, white blood cell count, mutation status of NPM1, FLT3-ITD, CEBPA, single nucleotide polymorphism rs16754, and expression levels of BAALC, ERG, MN1, and WT1 to represent low, intermediate, and high risk of death. Complete remission (P = .005), relapse-free survival (RFS, P < .001), and overall survival (OS, P < .001) were significantly different for the 3 risk groups. In 2 independent validation cohorts of 94 and 131 patients, the IPRS predicted different OS (P < .001) and RFS (P < .001). High-risk patients with related donors had longer OS (P = .016) and RFS (P = .026) compared with patients without related donors. In contrast, intermediate-risk group patients with related donors had shorter OS (P = .003) and RFS (P = .05). Donor availability had no impact on outcome of patients in the low-risk group. Thus, the IPRS may improve consolidation treatment stratification in CN-AML patients. Study registered at www.clinicaltrials.gov as #NCT00209833. PMID:21372155

Damm, Frederik; Heuser, Michael; Morgan, Michael; Wagner, Katharina; Görlich, Kerstin; Grosshennig, Anika; Hamwi, Iyas; Thol, Felicitas; Surdziel, Ewa; Fiedler, Walter; Lübbert, Michael; Kanz, Lothar; Reuter, Christoph; Heil, Gerhard; Delwel, Ruud; Löwenberg, Bob; Valk, Peter J M; Krauter, Jürgen; Ganser, Arnold

2011-04-28

202

Association between certain foods and risk of acute myocardial infarction in women.  

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STUDY OBJECTIVE--To examine the relation between selected foods and acute myocardial infarction in women. DESIGN--Case-control study conducted over five years. SETTING--30 Hospitals with coronary care units in northern Italy. SUBJECTS--287 Women who had had an acute myocardial infarction (median age 49, range 22-69 years) and 649 controls with acute disorders unrelated to ischaemic heart disease (median age 50, range 21-69 years) admitted to hospital during 1983-9. MAIN OUTCOME MEASURES--Freq...

Gramenzi, A.; Gentile, A.; Fasoli, M.; Negri, E.; Parazzini, F.; La Vecchia, C.

1990-01-01

203

Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI is unclear. We studied the risk of death or recurrent myocardial infarction (MI in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI. Methods Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens. Results The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference for the composite endpoint of 1.01 (confidence intervals 0.81-1.26 and 1.24 (confidence intervals 0.95-1.62 for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06. Conclusions We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

Køber Lars

2010-01-01

204

A simple score for estimating the long-term risk of fracture in patients with multiple sclerosis  

DEFF Research Database (Denmark)

Objective: To derive a simple score for estimating the long-term risk of osteoporotic and hip fracture in individual patients with MS. Methods: Using the UK General Practice Research Database linked to the National Hospital Registry (1997-2008), we identified patients with incident MS (n = 5,494). They were matched 1:6 by year of birth, sex, and practice with patients without MS (control subjects). Cox proportional hazards models were used to calculate the long-term risk of osteoporotic and hip fracture. We fitted the regression model with general and specific risk factors, and the final Cox model was converted into integer risk scores. Results: In comparison with the FRAX calculator, our risk score contains several new risk factors that have been linked with fracture, which include MS, use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. We estimated the 5- and 10-year risks of osteoporotic and hip fracture in relation to the risk score. The C-statistic was moderate (0.67) for the prediction of osteoporotic fracture and excellent (0.89) for the prediction of hip fracture. Conclusion: This is the first clinical risk score for fracture risk estimation involving MS as a risk factor. Neurology (R) 2012;79:922-928

Bazelier, M. T.; van Staa, T. P.

2012-01-01

205

Impact of acute hyperglycemia on myocardial infarct size, area at risk, and salvage in patients with STEMI and the association with exenatide treatment: results from a randomized study.  

Science.gov (United States)

Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium. PMID:24584550

Lønborg, Jacob; Vejlstrup, Niels; Kelbæk, Henning; Nepper-Christensen, Lars; Jørgensen, Erik; Helqvist, Steffen; Holmvang, Lene; Saunamäki, Kari; Bøtker, Hans Erik; Kim, Won Yong; Clemmensen, Peter; Treiman, Marek; Engstrøm, Thomas

2014-07-01

206

Toenail cerium levels and risk of a first acute myocardial infarction: The EURAMIC and heavy metals study  

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The association between cerium status and risk of first acute myocardial infarction (AMI) was examined in a case-control study in 10 centres from Europe and Israel. Cerium in toenails was assessed by neutron activation analysis in 684 cases and 724 controls aged 70years or younger. Mean concentrations of cerium were 186 and 173mug/kg in cases and controls, respectively. Cerium was positively associated with low socio-economic status, smoking, mercury, zinc and scandium (p0.001). Cases had sig...

Gomez-aracena, J.; Riemersma, R. A.; Veer, P.; Kok, F. J.

2006-01-01

207

Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection  

Science.gov (United States)

OBJECTIVE Diabetic foot infection is the predominant predisposing factor to nontraumatic lower-extremity amputation (LEA), but few studies have investigated which specific risk factors are most associated with LEA. We sought to develop and validate a risk score to aid in the early identification of patients hospitalized for diabetic foot infection who are at highest risk of LEA. RESEARCH DESIGN AND METHODS Using a large, clinical research database (CareFusion), we identified patients hospitalized at 97 hospitals in the U.S. between 2003 and 2007 for culture-documented diabetic foot infection. Candidate risk factors for LEA included demographic data, clinical presentation, chronic diseases, and recent previous hospitalization. We fit a logistic regression model using 75% of the population and converted the model coefficients to a numeric risk score. We then validated the score using the remaining 25% of patients. RESULTS Among 3,018 eligible patients, 21.4% underwent an LEA. The risk factors most highly associated with LEA (P 11,000 per mm3. The model showed good discrimination (c-statistic 0.76) and excellent calibration (Hosmer-Lemeshow, P = 0.63). The risk score stratified patients into five groups, demonstrating a graded relation to LEA risk (P < 0.0001). The LEA rates (derivation and validation cohorts) were 0% for patients with a score of 0 and ~50% for those with a score of ?21. CONCLUSIONS Using a large, hospitalized population, we developed and validated a risk score that seems to accurately stratify the risk of LEA among patients hospitalized for a diabetic foot infection. This score may help to identify high-risk patients upon admission. PMID:21680728

Lipsky, Benjamin A.; Weigelt, John A.; Sun, Xiaowu; Johannes, Richard S.; Derby, Karen G.; Tabak, Ying P.

2011-01-01

208

Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction  

International Nuclear Information System (INIS)

Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c–T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32–2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17–5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13–2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96–2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patientause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

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Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction  

Energy Technology Data Exchange (ETDEWEB)

Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

Nguyen, Paul L., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women' s/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke' s-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

2012-03-15

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Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction  

Science.gov (United States)

Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2....

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Long-term cardiovascular risk of nonsteroidal anti-inflammatory drug use according to time passed after first-time myocardial infarction : a nationwide cohort study  

DEFF Research Database (Denmark)

The cardiovascular risk after the first myocardial infarction (MI) declines rapidly during the first year. We analyzed whether the cardiovascular risk associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with the time elapsed following first-time MI.

Olsen, Anne-Marie Schjerning; FosbØl, Emil L

2012-01-01

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Primeiro escore de risco inflamatório das endopróteses de aorta First inflammatory risk score for aortic endoprostheses  

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Full Text Available OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses. Variáveis inflamatórias avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8, fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1, transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month. Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8, tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1, red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04, type of endoprosthesis (P=0.04, volume of contrast (P=0.02, preoperative IL-8 (P = 0.10, 1 - month ICAM-1 (P=0.03 and 1-month L-selectin (P=0.06. Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe based on numeric intervals of these two variables and the categories would be correlated to clinical findings. CONCLUSION: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.

Edmo Atique Gabriel

2008-12-01

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Cardiovascular Risk Factors in Normolipidemic Acute Myocardial Infarct Patients on Admission – Do Dietary Fruits and Vegetables Offer Any Benefits?  

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Full Text Available Background: Myocardial Infarction (MI is a leading cause of death in India. Whether dietary vitamins could reduce risk of cardiovascular disease among Indians is still not clear and very few studies have addressed the association between dietary vitamin acting as an antioxidant or pro-oxidant and its effect on risk reduction or aggravation in normolipidemic AMI patients. Objective: The goal of the current study was to address the association between dietary vitamin and cardiovascular risk in normolipidemic acute myocardial infarct patients compared with healthy controls. Design: Dietary intake of vitamins was assessed by 131 food frequency questionnaire items in both AMI patients and age/sex-matched controls. The associated changes in risk factors due to antioxidant vitamins intake was also assessed in normolipidemic acute myocardial patients and was compared with controls. Results: Dietary intake of vitamin A, B1, B2, B3 was significantly higher in AMI patients compared to healthy controls but the intake of vitamin C was significantly higher in controls compared to AMI patients. Even though the vitamins intake was higher in patients, the associated cardiovascular risk factors were not reduced compared to controls. The total cholesterol, LDL-c, TAG were significantly higher (p<0.001 in AMI patients except HDL-c which was significantly higher (p<0.001 in controls. The endogenous antioxidants were found to be significantly lowered in patients compared to controls in spite of higher vitamin intake. Similarly the enzymatic antioxidants were also significantly lowered in patients. The mean serum Lipoprotein (a malondialdehyde (MDA and conjugated diene (CD levels in patients were significantly elevated compared with controls. The levels of caeruloplasmin, C-reactive protein, fibrinogen, ischemia-modified albumin were significantly higher but arylesterase activities were lowered in patients. Conclusion: Diets rich in vegetables and fruits do not seem to reduce the cardiovascular risk in normolipidemic AMI patients among Indians and Sri Lankans.

Arun Kumar

2010-10-01

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Comparison of Three Contemporary Risk Scores for Mortality Following Elective Abdominal Aortic Aneurysm Repair  

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Objective/background A number of contemporary risk prediction models for mortality following elective abdominal aortic aneurysm (AAA) repair have been developed. Before a model is used either in clinical practice or to risk-adjust surgical outcome data it is important that its performance is assessed in external validation studies. Methods The British Aneurysm Repair (BAR) score, Medicare, and Vascular Governance North West (VGNW) models were validated using an independent prospectively collected sample of multicentre clinical audit data. Consecutive, data on 1,124 patients undergoing elective AAA repair at 17 hospitals in the north-west of England and Wales between April 2011 and March 2013 were analysed. The outcome measure was in-hospital mortality. Model calibration (observed to expected ratio with chi-square test, calibration plots, calibration intercept and slope) and discrimination (area under receiver operating characteristic curve [AUC]) were assessed in the overall cohort and procedural subgroups. Results The mean age of the population was 74.4 years (SD 7.7); 193 (17.2%) patients were women and the majority of patients (759, 67.5%) underwent endovascular aneurysm repair. All three models demonstrated good calibration in the overall cohort and procedural subgroups. Overall discrimination was excellent for the BAR score (AUC 0.83, 95% confidence interval [CI] 0.76–0.89), and acceptable for the Medicare and VGNW models, with AUCs of 0.78 (95% CI 0.70–0.86) and 0.75 (95% CI 0.65–0.84) respectively. Only the BAR score demonstrated good discrimination in procedural subgroups. Conclusion All three models demonstrated good calibration and discrimination for the prediction of in-hospital mortality following elective AAA repair and are potentially useful. The BAR score has a number of advantages, which include being developed on the most contemporaneous data, excellent overall discrimination, and good performance in procedural subgroups. Regular model validations and recalibration will be essential. PMID:24837173

Grant, S.W.; Hickey, G.L.; Carlson, E.D.; McCollum, C.N.

2014-01-01

215

Risk evaluation for the development of cervical intraepithelial neoplasia: Development and validation of risk-scoring schemes.  

Science.gov (United States)

Cervical cancer screening guidelines do not comprehensively define what constitutes high risk. This study developed and validated simple risk-scoring schemes to improve Papanicolaou smear screening for women at high risk. Four cumulative risk score (CRS) schemes were derived respectively for the development of cervical intraepithelial neoplasia grade 1 (CIN1) and grade 2 or worse (CIN2+) using community-based case-control data (n?=?1523). By calculating the area under the receiver operating characteristic (AU-ROC) curve, these schemes were validated in a Papanicolaou smear follow-up cohort (n?=?967) and a hospital-based cytology screening population (n?=?217). A high DNA load of high-risk human papillomavirus (HR-HPV) was the main predictor for CIN1 and CIN2+, although age, married status combined with the number of sexual partners, active and passive smoking and age at sexual debut also affected associated lesions. In the training set, only the HPV-testing-contained CIN2+ CRS scheme presented an excellent discrimination for identifying CIN2+ (AU-ROC?=?0.866). Using a CRS cutoff value of 4 to identify CIN2+, the sensitivity and specificity of predicting CIN2+ for the 3- and 5-year follow-ups were 100% and 90.8%, and 83.3% and 90.4%, respectively, in the validation cohort. In the hospital-based validation population, the CRS scheme showed comparable discrimination for CIN2+ detection (sensitivity 88.2% and specificity 84.6%). Women with CRS ?4 had a 5.4% and 9.1% of 3- and 5-year cumulative incidence, respectively, and a 40.5-fold hazard ratio of developing CIN2+. In conclusion, combined with HR-HPV testing and verified risk factors, a simple CRS scheme could effectively improve the implementation of CIN2+ screening. PMID:24841989

Lee, Chien-Hung; Peng, Chiung-Yu; Li, Ruei-Nian; Chen, Yu-Chieh; Tsai, Hsiu-Ting; Hung, Yu-Hsiu; Chan, Te-Fu; Huang, Hsiao-Ling; Lai, Tai-Cheng; Wu, Ming-Tsang

2015-01-15

216

A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort  

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Full Text Available Chidchanok Ruengorn1,2, Kittipong Sanichwankul3, Wirat Niwatananun2, Suwat Mahatnirunkul3, Wanida Pumpaisalchai3, Jayanton Patumanond11Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Suanprung Psychiatric Hospital, Chiang Mai, ThailandBackground: In Thailand, risk factors associated with suicide attempts in bipolar disorder (BD are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed.Objective: To develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide.Methods: Medical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58, and seven controls were selected (per suicide case among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431. Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups.Results: Six statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s, number of previous suicide attempts, stressful life event(s, medication adherence, and BD treatment years. A total risk score (possible range -1.5 to 11.5 explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC analysis. Likelihood ratios of suicide attempts with low risk scores (below 2.5, moderate risk scores (2.5–8.0, and high risk scores (above 8.0 were 0.11 (95% CI 0.04–0.32, 1.72 (95% CI 1.41–2.10, and 19.0 (95% CI 6.17–58.16, respectively.Conclusion: The proposed risk-scoring scheme is BD-specific, comprising six key indicators for simple, routine assessment and classification of patients to three risk groups. Further validation is required before adopting this scheme in other clinical settings.Keywords: bipolar disorder, mood disorders, suicidal behavior, screening tool

Patumanond J

2012-04-01

217

Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.  

LENUS (Irish Health Repository)

The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.

Zannad, Faiez

2012-04-01

218

Dutch women with a low birth weight have an increased risk of myocardial infarction later in life: a case control study  

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Full Text Available Abstract Background To investigate whether low birth weight increases the risk of myocardial infarction later in life in women. Methods Nationwide population-based case-control study. Patients and controls: 152 patients with a first myocardial infarction before the age of 50 years in the Netherlands. 568 control women who had not had a myocardial infarction stratified for age, calendar year of the index event, and area of residence. Results Birth weight in the patient group was significantly lower than in control women (3214 vs. 3370 gram, mean difference -156.3 gram (95%CI -9.5 to -303.1. The odds ratio for myocardial infarction, associated with a birth weight lower than 3000 gram (20th percentile in controls compared to higher than 3000 gram was 1.7 (95%CI 1.1–2.7, while the odds ratio for myocardial infarction for children with a low birth weight ( Conclusions Low birth weight is associated with an increased risk of myocardial infarction before age of 50 in Dutch women.

Rosendaal Frits R

2005-01-01

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GENETIC ADDICTION RISK SCORE (GARS ANALYSIS: EXPLORATORY DEVELOPMENT OF POLYMORPHIC RISK ALLELES IN POLY-DRUG ADDICTED MALES  

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Full Text Available There is a need to classify patients at genetic risk for drug seeking behavior prior to or upon entry to residential and or non-residential chemical dependency programs. We have determined based on a literature review, that there are seven risk alleles associated with six candidate genes that were studied in this patient population of recovering poly-drug abusers. To determine risk severity of these 26 patients we calculated the percentage of prevalence of the risk alleles and provided a severity score based on percentage of these alleles. Subjects carry the following risk alleles: DRD2=A1; SLC6A3 (DAT =10R; DRD4=3R or 7R; 5HTTlRP = L or LA; MAO= 3R; and COMT=G. As depicted in table 2 low severity (LS = 1-36%; Moderate Severity =37-50%, and High severity = 51-100%. We studied two distinct ethnic populations group 1 consisted of 16 male Caucasian psycho stimulant addicts and group 2 consisted of 10 Chinese heroin addicted males. Based on this model the 16 subjects tested have at least one risk allele or 100%. Out of the 16 subjects we found 50% (8 HS; 31% (5 MS; and 19% LS (3 subjects. These scores are then converted to a fraction and then represented as a Genetic Addiction Risk Score (GARS whereby we found the average GARS to be: 0.28 low severity, 0.44 moderate severity and 0.58 high severity respectively. Therefore, using this GARS we found that 81% of the patients were at moderate to high risk for addictive behavior. Of particular interest we found that 56% of the subjects carried the DRD2 A1 allele (9/16. Out of the 9 Chinese heroin addicts [one patient not genotyped] (group 2 we found 11% (1 HS; 56% (5 MS; and 33% LS (3 subjects. These scores are then converted to a fraction and then represented as GARS whereby we found the average GARS to be: 0.28 Low Severity; 0.43 moderate severity and 0.54 high severity respectively. Therefore, using GARS we found that 67% of the patients were at moderate to high risk for addictive behavior. Of particular interest we found that 56% of the subjects carried the DRD2 A1 allele (5/9 similar to group 1. Statistical analysis revealed that the groups did not differ in terms of overall severity (67 vs. 81% in these two distinct populations. Combining these two independent study populations reveal that subjects entering a residential treatment facility for poly-drug abuse carry at least one risk allele (100%. We found 74% of the combined 25 subjects (Caucasian and Chinese had a moderate to high GARS. Confirmation of these exploratory results and development of mathematical predictive values of these risk alleles are necessary before any meaningful interpretation of these results are to be considered.

Kenneth Blum et al

2010-07-01

220

Association of a Fasting Glucose Genetic Risk Score With Subclinical Atherosclerosis  

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OBJECTIVE Elevated fasting glucose level is associated with increased carotid intima-media thickness (IMT), a measure of subclinical atherosclerosis. It is unclear if this association is causal. Using the principle of Mendelian randomization, we sought to explore the causal association between circulating glucose and IMT by examining the association of a genetic risk score with IMT. RESEARCH DESIGN AND METHODS The sample was drawn from the Atherosclerosis Risk in Communities (ARIC) study and included 7,260 nondiabetic Caucasian individuals with IMT measurements and relevant genotyping. Components of the fasting glucose genetic risk score (FGGRS) were selected from a fasting glucose genome-wide association study in ARIC. The score was created by combining five single nucleotide polymorphisms (SNPs) (rs780094 [GCKR], rs560887 [G6PC2], rs4607517 [GCK], rs13266634 [SLC30A8], and rs10830963 [MTNR1B]) and weighting each SNP by its strength of association with fasting glucose. IMT was measured through bilateral carotid ultrasound. Mean IMT was regressed on the FGGRS and on the component SNPs, individually. RESULTS The FGGRS was significantly associated (P = 0.009) with mean IMT. The difference in IMT predicted by a 1 SD increment in the FGGRS (0.0048 mm) was not clinically relevant but was larger than would have been predicted based on observed associations between the FFGRS, fasting glucose, and IMT. Additional adjustment for baseline measured glucose in regression models attenuated the association by about one third. CONCLUSIONS The significant association of the FGGRS with IMT suggests a possible causal association of elevated fasting glucose with atherosclerosis, although it may be that these loci influence IMT through nonglucose pathways. PMID:21036910

Rasmussen-Torvik, Laura J.; Li, Man; Kao, Wen H.; Couper, David; Boerwinkle, Eric; Bielinski, Suzette J.; Folsom, Aaron R.; Pankow, James S.

2011-01-01

 
 
 
 
221

Development and validation of a risk score for hospitalization for heart failure in patients with Type 2 Diabetes Mellitus  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background There are no risk scores available for predicting heart failure in Type 2 diabetes mellitus (T2DM). Based on the Hong Kong Diabetes Registry, this study aimed to develop and validate a risk score for predicting heart failure that needs hospitalisation in T2DM. Methods 7067 Hong Kong Chinese diabetes patients without history of heart failure, and without history and clinical evidence of coronary heart disease at baseline were analyzed. The sub...

Lam Christopher W; Ho Chun-Shun; Ko Gary T; Kong Alice P; So Wing-Yee; Ma Ronald C; Yang Xilin; Cockram Clive S; Tong Peter C; Chan Juliana C

2008-01-01

222

Paleolithic and mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas.  

Science.gov (United States)

The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the "Paleolithic" and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991-1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas. PMID:25326623

Whalen, Kristine A; McCullough, Marji; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

2014-12-01

223

High platelet volume and increased risk of myocardial infarction: 39,531 participants from the general population  

DEFF Research Database (Denmark)

BACKGROUND: Active platelets are large and contribute to development of myocardial infarction (MI). Platelet size is measured automatically as mean platelet volume (MPV) together with platelet count. OBJECTIVES: We tested the hypothesis that increased MPV is associated with risk of MI in the general population independent of known cardiovascular risk factors. METHODS: We examined 39,531 men and woman from the Danish general population (the Copenhagen General Population Study), of whom 1300 developed MI. RESULTS: After multifactorial adjustment for known cardiovascular risk factors, risk of MI was increased by 37% (95% CI, 18-59%) in the middle and 30% (12-52%) in the upper vs. the lower tertile of MPV. Compared with the 1st quintile of MPV, there was corresponding increased risk of MI of 13% (-7% to 39%), 35% (11-64%), 31% (8-59%) and 29% (6-57%) in the 2nd, 3rd, 4th and 5th quintile, respectively. Similar values for octiles were increases in MI risk of -3% (-25% to 26%), 15% (-10% to 46%), 31% (1-69%), 32% (5-68%), 31% (2-67%), 27% (-1% to 62%) and 26% (-1% to 61%), respectively, in the 2nd through to the 8th octile vs. the 1st octile of MPV. Use of antiplatelet therapy did not modify these risk estimates. Finally, in prospective, multifactorially adjusted analyses, risk of MI increased by 38% (8-75%) in individuals with MPV = 7.4 vs. < 7.4 fL. CONCLUSIONS: Increased MPV is associated with increased risk of MI independent of known cardiovascular risk factors.

Klovaite, J; Benn, M

2011-01-01

224

Genetic risk score for nonsyndromic cleft lip with or without cleft palate for a Chilean population.  

Science.gov (United States)

It has been widely accepted that nonsyndromic cleft lip with or without cleft palate (NSCLP) depends on the altered function of several genes during craniofacial development. The construction of genetic risk score (GRS) have allowed to estimate the combined effect of risk alleles from genes interacting in different molecular pathways in order to improve an estimation of the individual's susceptibility to a complex disease. The aim of our study was to construct a GRS considering markers showing previous allele/haplotype association with NSCLP in Chile. Considering 10 risk markers from IRF6, MSX1, BMP4 and TGFB3 genes, we estimate a GRS for each of 152 NSCLP cases and 164 controls. GRS showed no significant results when comparing cases and controls for these markers. These results could be explained by a possible indirect relationship of these genes between them in NSCLP which GRS is not capable of detecting and/or the modest number of risk alleles considered herein. PMID:25059012

Blanco, R; Colombo, A; Suazo, J

2014-01-01

225

Cardiovascular risk prediction in the general population with use of suPAR, CRP, and Framingham Risk Score  

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BACKGROUND: The inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR) and C-reactive protein (CRP) independently predict cardiovascular disease (CVD). The prognostic implications of suPAR and CRP combined with Framingham Risk Score (FRS) have not been determined. METHODS: From 1993 to 1994, baseline levels of suPAR and CRP were obtained from 2315 generally healthy Danish individuals (mean [SD] age: 53.9 [10.6] years) who were followed for the composite outcome of ischemic heart disease, stroke and CVD mortality. RESULTS: During a median follow-up of 12.7years, 302 events were recorded. After adjusting for FRS, women with suPAR levels in the highest tertile had a 1.74-fold (95% confidence interval [CI]: 1.08-2.81, p=0.027) and men a 2.09-fold (95% CI: 1.37-3.18, p20%) risk categories, respectively. This was reflected in a significant improvement of C statistics for men (p=0.034) and borderline significant for women (p=0.054), while the integrated discrimination improvement was highlysignificant (P?0.001) for both genders. CONCLUSIONS: suPAR provides prognostic information of CVD risk beyond FRS and improves risk prediction substantially when combined with CRP in this setting.

Olsen, Michael H

2013-01-01

226

Association of uric Acid genetic risk score with blood pressure: the rotterdam study.  

Science.gov (United States)

High levels of serum uric acid are associated with hypertension in observational studies. The aim of this study was to investigate the association of uric acid gene variants with blood pressure. We studied 5791 participants aged ?55 years from the Rotterdam Study. Thirty gene variants identified for serum uric acid level were used to compile genetic risk score (GRS). We used linear regression models to investigate the association of the uric acid GRS with systolic and diastolic blood pressure in the whole study population and separately in participants with and without comorbidities and medication use. In the age- and sex-adjusted model, each SD increase in uric acid GRS was associated with 0.75 mm Hg lower systolic blood pressure (95% confidence interval, -1.31 to -0.19) and 0.42 mm Hg lower diastolic blood pressure (95% confidence interval, -0.72 to -0.13). The association did not attenuate after further adjustment for antihypertensive medication use and conventional cardiovascular risk factors. In subgroup analysis, the association of uric acid GRS with systolic blood pressure was significantly stronger in participants (n=885) on diuretic treatment (P for interaction, 0.007). In conclusion, we found that higher uric acid GRS is associated with lower systolic and diastolic blood pressure. Diuretics treatment may modify the association of uric acid genetic risk score and systolic blood pressure. Our study suggests that genome wide association study's findings can be associated with an intermediate factor or have a pleiotropic role and, therefore, should be applied for Mendelian Randomization with caution. PMID:25185132

Sedaghat, Sanaz; Pazoki, Raha; Uitterlinden, Andre G; Hofman, Albert; Stricker, Bruno H Ch; Ikram, M Arfan; Franco, Oscar H; Dehghan, Abbas

2014-11-01

227

Investigation of the genetic association between quantitative measures of psychosis and schizophrenia : a polygenic risk score analysis  

DEFF Research Database (Denmark)

The presence of subclinical levels of psychosis in the general population may imply that schizophrenia is the extreme expression of more or less continuously distributed traits in the population. In a previous study, we identified five quantitative measures of schizophrenia (positive, negative, disorganisation, mania, and depression scores). The aim of this study is to examine the association between a direct measure of genetic risk of schizophrenia and the five quantitative measures of psychosis. Estimates of the log of the odds ratios of case/control allelic association tests were obtained from the Psychiatric GWAS Consortium (PGC) (minus our sample) which included genome-wide genotype data of 8,690 schizophrenia cases and 11,831 controls. These data were used to calculate genetic risk scores in 314 schizophrenia cases and 148 controls from the Netherlands for whom genotype data and quantitative symptom scores were available. The genetic risk score of schizophrenia was significantly associated with case-control status (p

Derks, Eske M; Vorstman, Jacob A S

2012-01-01

228

Preoperative and long-term cardiac risk assessment. Predictive value of 23 clinical descriptors, 7 multivariate scoring systems, and quantitative dipyridamole imaging in 360 patients.  

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A total of 360 patients underwent preoperative cardiac risk assessment using 23 clinical parameters, seven multivariate clinical scoring systems, and quantitative dipyridamole-thallium imaging to predict postoperative and long-term myocardial infarction and cardiac death after noncardiac surgery. There were 30 postoperative and an additional 13 cumulative long-term cardiac events after an average follow-up of 15 months. Clinical descriptors were not useful in predicting the outcome of individual patients. The postoperative and long-term cardiac event rates were 1% and 3.5%, respectively, in patients with normal scans or fixed perfusion defects, and 17.5% and 22% in patients with reversible defects. Using quantitative indices reflecting the amount of jeopardized myocardium, patients could be stratified by dipyridamole imaging into multiple scintigraphic subsets, with corresponding postoperative and 1-year coronary morbidity and mortality rates ranging from 0.5% to 100% (p = 0.0001). Thus, postoperative and long-term cardiac events cannot be predicted clinically, whereas quantitative dipyridamole imaging accurately identifies high-risk patients who require preoperative coronary angiography. PMID:1503520

Lette, J; Waters, D; Bernier, H; Champagne, P; Lassonde, J; Picard, M; Cerino, M; Nattel, S; Boucher, Y; Heyen, F

1992-08-01

229

An obesity genetic risk score is associated with metabolic syndrome in Chinese children.  

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Recent genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with body mass index (BMI)/obesity. In this study, we aim to examine the associations of obesity related loci with risk of metabolic syndrome (MetS) in a children population from China. A total of 431 children with MetS and 3046 controls were identified based on the modified ATPIII definition. 11 SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, BDNF rs6265, FAIM2 rs7138803, NPC1 rs1805081, SEC16B rs10913469, SH2B1 rs4788102, PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479) were genotyped by TaqMan 7900. Of 11 SNPs, GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 were nominally associated with risk of MetS (GNPDA2 rs10938397: odds ratio (OR)=1.21, 95% confidence interval (CI)=1.04-1.40, P=0.016; BDNF rs6265: OR=1.19, 95% CI=1.03-1.39, P=0.021; FAIM2 rs7138803: OR=1.20, 95% CI=1.02-1.40, P=0.025); genetic risk score (GRS) was significantly associated with risk of MetS (OR=1.09, 95% CI=1.04-1.15, P=5.26×10(-4)). After further adjustment for BMI, none of SNPs were associated with risk of MetS (all P>0.05); the association between GRS and risk of MetS remained nominally (OR=1.02, 95%CI=0.96-1.08, P=0.557). However, after correction for multiple testing, only GRS was statistically associated with risk of MetS in the model without adjustment for BMI. The present study demonstrated that there were nominal associations of GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 with risk of MetS. The SNPs in combination have a significant effect on risk of MetS among Chinese children. These associations above were mediated by adiposity. PMID:24269186

Zhao, Xiaoyuan; Xi, Bo; Shen, Yue; Wu, Lijun; Hou, Dongqing; Cheng, Hong; Mi, Jie

2014-02-10

230

Demographic determinants of risk, colon distribution and density scores of diverticular disease  

Directory of Open Access Journals (Sweden)

Full Text Available AIM: To investigate associations between ethni95% CIty, age and sex and the risk, colon distribution and density scores of diverticular disease (DD.METHODS: Barium enemas were examined in 1000 patients: 410 male, 590 female; 760 whites, 62 Asians, 44 black africans (BAs, and 134 other blacks (OBs. Risks and diverticula density of left-sided DD (LSDD and right-sided-component DD (RSCDD = right-sided DD + right and left DD + Pan-DD were compared using logistic regression.RESULTS: Four hundred and forty-seven patients had DD (322 LSDD and 125 RSCDD. Adjusted risks: (1 LSDD: each year increase in age increased the odds by 6% (95% CI: 5-8, SE: 0.8%, P < 0.001; Asians: odds ratio (OR: 0.23 (95% CI: 0.10-0.53, SE: 0.1, P ? 0.001 and OBs: OR: 0.25 (95% CI: 0.14-0.43, SE: 0.07, P ? 0.001 appeared protected vs Whites; (2 RSCDD: each year increase in age increased the odds by 4% (95% CI: 2-6, SE: 1%, P < 0.001; females were 0.60 times (95% CI: 0.40-0.90, SE: 0.12, P = 0.01 less likely than males to have RSCDD; BAs were 3.51 times (95% CI: 1.70-7.24, SE: 1.30, P < 0.001 more likely than Whites to have RSCDD; and (3 DD density scores: each year increase in age increased the odds of high-density scores by 4% (95% CI: 1-6, SE: 1%, P < 0.001; RSCDD was 2.77 times (95% CI: 1.39-3.32, SE: 0.67, P < 0.001 more likely to be of high density than LSDD. No further significant differences were found in the adjusted models.CONCLUSION: Right colonic DD might be more common and has higher diverticula density in the west than previously reported. BAs appear predisposed to DD, whereas other ethnic differences appear conserved following migration.

Mark Golder, Irina Chis Ster, Pratusha Babu, Amita Sharma, Muhammad Bayat, Abdulkadir Farah

2011-02-01

231

Antipsychotics and risk of first-time hospitalization for myocardial infarction: a population-based case-control study  

DEFF Research Database (Denmark)

Background. Use of antipsychotics has been linked with an adverse cardiovascular risk factor profile and an increased risk of dysrhythmia and sudden cardiac death. However, detailed data on the association between use of antipsychotics and development of atherosclerotic disease are limited. Objective. To examine risk of hospitalization for myocardial infarction (MI) amongst users of antipsychotics compared with non-users. Design and subjects. A population-based case-control study using data from hospital discharge registries in the counties of North Jutland, Viborg and Aarhus, Denmark, and the Danish Civil Registration System. We identified 21 377 cases of first-time hospitalization for MI and 106 885 sex- and age-matched non-MI population controls in the period 1992-2004. All prescriptions for antipsychotics filled prior to the date of admission for MI were retrieved from population-based prescription databases. We used conditional logistic regression to adjust for a wide range of covariates. Results. Current users of atypical [adjusted relative risk: 0.98, 95% confidence interval (CI): 0.88-1.09] and typical antipsychotics (adjusted relative risk: 0.99, 95% CI: 0.96-1.03) had no increased overall risk of being admitted to hospital for MI when compared with non-users of antipsychotics. These findings were consistent in all examined subgroups. Further, we found no association between the cumulative dose of antipsychotics and the risk of hospitalization for MI. Conclusion. These findings do not support the hypothesis that use of antipsychotics and in particular atypical antipsychotics is associated with increased risk of MI

Nakagawa, S; Pedersen, Lene

2006-01-01

232

Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack  

International Nuclear Information System (INIS)

Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD2 scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD2 score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p<0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying causr more and investigate for underlying cause and initiate treatment. (author)

233

Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? : Results from Stockholm Heart Epidemiology Program (SHEEP)  

DEFF Research Database (Denmark)

The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

Hallqvist, J; Diderichsen, Finn

1998-01-01

234

Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause: the Danish Osteoporosis Prevention Study  

DEFF Research Database (Denmark)

In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women. INTRODUCTION: International recommendations highlight the importance of absolute fracture risk in establishing intervention thresholds. The available estimates of long-term risk have been derived by combining relative risks from meta-analyses with U.S. normative BMD data and Swedish fracture incidence records. We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS: We analyzed DXA of the spine and hip from 872 women who were enrolled in the non-hormone replacement therapy (HRT) arms of the study and had not received HRT, bisphosphonates, or raloxifene. We collected verified reports of fractures at each visit. We focused on fractures of the hip, spine, shoulder, and forearm to provide risks comparable with the Kanis algorithm. Accordingly, asymptomatic radiographic vertebral fractures were not included. RESULTS: Seventy-eight women (9%) sustained relevant fractures. The risk of fracture increased by 1.32 (95% CI, 1.02; 1.70) for each unit decrease in femoral neck T score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause.

Abrahamsen, Bo; Vestergaard, Peter

2006-01-01

235

Endothelial nitric oxide synthase gene polymorphisms and the risk of acute myocardial infarction in a South Indian population.  

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Myocardial infarction (MI) is a complex multi-factorial, polygenic disorder which results from an interaction between a person's genetic makeup and various environmental factors. Nitric oxide (NO), a potent vasodilator produced by endothelial cells, plays an important role in the regulation of blood pressure, regional blood flow and also inhibits platelet aggregation, vascular smooth muscle cell proliferation and leukocyte adhesion to vascular endothelium. Our aim was to analyze the association of NOS3 (endothelial nitric oxide synthase 3) 894G>T and -786T>C gene polymorphisms and MI risk in the South Indian population. A total of 287 MI patients, 279 risk control patients and 321 healthy controls were recruited for the retrospective study. Genotyping was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). There was no significant association observed between NOS3 894G>T, -786T>C polymorphisms and MI. A significant difference was observed in the distribution of GT genotype of the NOS3 894G>T polymorphism between the cases and the risk controls (p = 0.05) but the odds ratio (0.6) did not show risk for MI. The present study showed lack of association between NOS3 gene polymorphisms and MI in South Indian population. PMID:23108994

Arun Kumar, Annan Sudarsan; Umamaheswaran, Gurusamy; Padmapriya, Ramamoorthy; Balachandar, Jayaraman; Adithan, Chandrasekaran

2013-02-01

236

Does retirement reduce the risk of myocardial infarction? : A prospective registry linkage study of 617 511 Danish workers  

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BACKGROUND: Recent studies have suggested that retirement may have beneficial effects on health outcomes. In this study we examined whether the risk of myocardial infarction (MI) was reduced following retirement in a Danish population sample. METHODS: Participants were 617 511 Danish workers, born between 1932 and 1948, entering the study at the age of 60, without previous known incidents of ischaemic heart disease. Information on retirement and MI were obtained from Danish national registers. A Cox proportional hazard model was used to address the relation between retirement and onset of MI, while adjusting for age, sex, income, occupational position, education, cohabitation and immigrant status. The participants were followed for up to 7 years. RESULTS: Of the study population, 3% were diagnosed with MI during follow-up. Retirement was associated with a modestly higher risk of MI with a hazard ratio of 1.11 (95% confidence interval: 1.06, 1.16) when comparing retirees with active workers of the same age. CONCLUSIONS: This study does not support the hypothesis that retirement reduces risk of MI. On the contrary, we find that retirement is associated with a modestly increased risk of MI.

Olesen, Kasper; Rugulies, Reiner

2014-01-01

237

Genome-wide association study of coronary and aortic calcification implicates risk loci for coronary artery disease and myocardial infarction.  

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Arterial calcification is a well-known risk factor for coronary artery disease (CAD) and myocardial infarction (MI). We performed a genome-wide association study on coronary artery calcification and aortic calcification as intermediate traits for CAD/MI. We tested ?2.5 million SNPs for association with coronary artery calcification and aortic calcification in 2620 male individuals of the NELSON trial, who underwent chest CT scans. All participants were current or former heavy smokers. No SNPs were associated with aortic calcification on a genome-wide scale. The 9p21 locus was significantly associated with coronary artery calcification (rs1537370, P = 2.3 × 10(-11)). Since this locus corresponds to the strongest SNP association for CAD/MI, we tested 24 published and validated CAD/MI risk SNPs for association with arterial calcification. Besides the CAD/MI SNP at 9p21 (rs4977574, P = 3.1 × 10(-10)), two additional loci at ADAMTS7 (rs3825807, P = 6.5 × 10(-6)) and at PHACTR1 (rs12526453, P = 1.0 × 10(-3)) show a nominally significant association with coronary artery calcification with MI/CAD risk alleles increasing the degree of arterial calcification. The 9p21 locus was also nominally associated with aortic calcification (P = 3.2 × 10(-4)). These findings indicate that these CAD and MI risk loci are likely involved in arterial calcification. PMID:23561647

van Setten, Jessica; Isgum, Ivana; Smolonska, Joanna; Ripke, Stephan; de Jong, Pim A; Oudkerk, Matthijs; de Koning, Harry; Lammers, Jan-Willem J; Zanen, Pieter; Groen, Harry J M; Boezen, H Marike; Postma, Dirkje S; Wijmenga, Cisca; Viergever, Max A; Mali, Willem P Th M; de Bakker, Paul I W

2013-06-01

238

Effect of Factor XIII-A Val34Leu Polymorphism on Myocardial Infarction Risk: A Meta-Analysis.  

Science.gov (United States)

The association between factor XIII-A (FXIII-A) Val34Leu polymorphism and myocardial infarction (MI) risk remained controversial. We performed a meta-analysis. Online databases were searched. Twenty-eight studies were included. The FXIII-A Val34Leu polymorphism was significantly associated with MI risk (odds ratio (OR) = 0.83, 95% confidence interval [CI] 0.76-0.91; P < .0001). This result remained statistically significant when the adjusted ORs were combined (OR = 0.77, 95% CI 0.65-0.92; P = .004). When stratifying for race, this polymorphism showed decreased MI risk in Caucasians. In the subgroup analysis by age group, significant associations were observed in early-onset patients and in late-onset patients. In the subgroup analysis by gender, there was a significant association in women but not in men. In the subgroup analysis stratified by smoking status, MI risk was decreased in both smokers and nonsmokers. This study suggested that FXIIIA Val34Leu polymorphism was a protective factor for MI in caucasians. PMID:24042156

Chen, Fei; Qiao, Qi; Xu, Peng; Fan, Bing; Chen, Zaoping

2014-11-01

239

Coronary artery disease from a perspective of genomic risk score, ethical approaches and suggestions  

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Full Text Available As a leading cause of mortality, coronary artery disease is on the focus of genetic research as a complex trait. Although predictive genetic testing for cardiovascular diseases is on the counter, it is still hard to aggregate information from multiple genetic variants, environmental factors and family history into a single score. Every susceptibility allele provides small contribution to disease formation. Biomarkers play a role in various metabolic pathways. Genetic information and data depend heavily on probabilities. This should be clearly explained by genetic counselor to the patient and relatives who are looking for certain answers. Presence of susceptibility alleles can be a source of anxiety and it may result as a reduced self-confidence in ability to change health behavior. Complex diseases set a new stage to study novel techniques that can elucidate interactions among genetic, environmental and ethnic factors. The cookbook approach to treat a complex disease can often be misleading. Future studies may provide personalized information, which can improve the outcome of standardized treatments. As knowing one’s own genetic risk is becoming a task for the responsible individual, it surely will add new challenges to ethical framework. Publicly marketing genetic tests for complex diseases raises ethical concerns. To avoid discriminatory use of genetic information; genetic risk scoring, therapeutic process, ethical policies must have a multifaceted progress. In this review, we summarized the attempts to resolve ethical issues related to genetic testing in complex diseases to resolve patient autonomy with individual responsibility and to aim the patient beneficence and confidentiality.

Ye?im I??l Ülman

2012-02-01

240

Seed Implant Retention Score Predicts the Risk of Prolonged Urinary Retention After Prostate Brachytherapy  

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Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS). Patients and Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had 125I and 638 patients had 103Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation. The final downsized prostate volume was used for the 424 patients who had neoadjuvant hormone therapy. Retention was defined as reinsertion of a Foley catheter after the implant. Results: Retention developed in 7.4% of patients, with an average duration of 6.7 weeks. On univariate analysis, implant without supplemental external-beam radiation (10% vs. 5.6%; p = 0.02), neoadjuvant hormone therapy (9.4% vs. 5.4%; p = 0.02), baseline ?-blocker use (12.5% vs. 6.3%; p = 0.008), and increased prostate volume (13.4% vs. 6.9% vs. 2.9%, >45 cm3, 25-45 cm3, 3; p = 0.0008) were significantly correlated with increased rates of retention. On multivariate analysis, implant without supplemental external-beam radiation, neoadjuvant hormone therapy, baseline ?-blocker use, and increased prostate volume were correlated with retention. A novel SIRS was modeled as the combined score of these factors, ranging from 0 to 5. There was a significant correlation between the SIRS and retention (p < 0.0001). The rates of retention wn (p < 0.0001). The rates of retention were 0, 4%, 5.6%, 9%, 20.9%, and 36.4% for SIRS of 0 to 5, respectively. Conclusions: The SIRS may identify patients who are at high risk for prolonged retention after prostate brachytherapy. A prospective validation study of the SIRS is planned.

 
 
 
 
241

Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause : the Danish Osteoporosis Prevention Study  

DEFF Research Database (Denmark)

In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women. INTRODUCTION: International recommendations highlight the importance of absolute fracture risk in establishing intervention thresholds. The available estimates of long-term risk have been derived by combining relative risks from meta-analyses with U.S. normative BMD data and Swedish fracture incidence records. We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS: We analyzed DXA of the spine and hip from 872 women who were enrolled in the non-hormone replacement therapy (HRT) arms of the study and had not received HRT, bisphosphonates, or raloxifene. We collected verified reports of fractures at each visit. We focused on fractures of the hip, spine, shoulder, and forearm to provide risks comparable with the Kanis algorithm. Accordingly, asymptomatic radiographic vertebral fractures were not included. RESULTS: Seventy-eight women (9%) sustained relevant fractures. The risk of fracture increased by 1.32 (95% CI, 1.02; 1.70) for each unit decrease in femoral neck T score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracturerisk was higher at each level of BMD T score than expected from the model by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause.

Abrahamsen, Bo; Vestergaard, Peter

2006-01-01

242

Antepartum fetal risk assessment: the role of the fetal biophysical profile score.  

Science.gov (United States)

In the art of medicine we have always known that establishing an accurate diagnosis of health or disease is essential. An active search for the physical signs, both the time honoured and newly discovered, are a crucial step in achieving diagnostic accuracy, in monitoring disease progression, and in assigning prognosis. In extrauterine medicine it is common practice to gather together sets of biophysical data in order to determine immediate health, to monitor condition, and to estimate prognosis: witness the use of vital signs, and, in the newborn, the Apgar score. The providers of perinatal care have known since biblical days that fetal biophysical activities were a reflection of fetal condition (Luke: Chapter 1, Verses 44-45), yet lacked the ability to categorize these activities in an objective and complete manner. The introduction of dynamic ultrasound imaging methods to perinatal medicine at last create the window through which the principles of extrauterine medicine may now be applied to the intrauterine patient--the fetus. Fetal biophysical profile scoring is a method that utilizes this new wealth of information to differentiate the normal fetus from the fetus at risk for death or damage in utero. The method is based on the concept that the discrimination of fetal health and disease improves as more variables are considered. The now extensive clinical experience with the method, in which both overall (gross) and selected (corrected) perinatal death are reduced, while maintaining a remarkably low false negative predictive error, indicate the validity of the concept. Comparative studies lead us to believe that reliance upon single biophysical variables, such as fetal movement counts, or antepartum fetal heart rate monitoring, is no longer of sufficient accuracy to support its use as a sole measure of fetal condition. Looking forward, we anticipate that while the concept on which fetal biophysical profile scoring is based will remain unchanged, inclusion of additional variables is likely to occur. It seems likely that addition of new variables, as may be now measured using high-resolution dynamic ultrasound methods, both B-mode and Doppler, will improve diagnostic accuracy even more. We believe that the application of the current and future modified methods of composite fetal risk assessment will render the occurrence of the tragedy of perinatal loss even more infrequent. While the goal of complete elimination of perinatal deaths remain elusive, this method may be one step towards this goal. PMID:3311513

Manning, F A; Menticoglou, S; Harman, C R; Morrison, I; Lange, I R

1987-03-01

243

Postpartum thromboembolism: Severe events might be preventable using a new risk score model  

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Full Text Available Pelle G Lindqvist1,3, Jelena Torsson2, Åsa Almqvist1, Ola Björgell21Department of Obstetrics and Gynecology; 2Radiology, Malmö University Hospital, Lund University, Malmö, Sweden; 3Department of Obstetrics and Gynecology, Karolinska Hospital, Huddinge, SwedenBackground: Pregnancy-related venous thromboembolism (VTE is a major cause of maternal morbidity and mortality. A new risk assessment model for VTE in relation to pregnancy has been introduced in Sweden. We wished to determine the proportion of preventable VTE cases if the model had been in use and make a brief cost-benefit analysis.Methods: A hospital-based retrospective case-control study of all postpartum thromboembolic instances of deep venous thrombosis and pulmonary embolisms during a 16-year period. Large anamnestic risk factors at the time of delivery were assessed. We correlated the findings with the new Swedish guidelines for thromboprophylaxis.Results: We found 37 cases of postpartum VTE during the study period. Nineteen of all VTE cases (51% and eight out of eleven of cases of pulmonary embolism (73% had two or more large anamnestic risk factors, ie, they would have been subjected to thromboprophylaxis if the new guidelines had been used. The cost of each preventable VTE was lower than treating a VTE.Conclusion: Approximately one-half of postpartum VTE cases and 70% of pulmonary emboli cases have at least two large risk factors and might be preventable using the new algorithm. From the perspective of the health care system the new recommendations appears to be cost-effective.Keywords: thromboprophylaxis, low molecular weight heparin, scoring system, health care financing, ultrasonography, phlebography

Pelle G Lindqvist

2008-08-01

244

Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection  

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Objective: Diabetic foot infection is the predominant predisposing factor to nontraumatic lower-extremity amputation (LEA), but few studies have investigated which specific risk factors are most associated with LEA. We sought to develop and validate a risk score to aid in the early identification of patients hospitalized for diabetic foot infection who are at highest risk of LEA. Research Design and Methods: Using a large, clinical research database (CareFusion), we identified patients hosp...

Lipsky, Benjamin A.; Weigelt, John A.; Sun, Xiaowu; Derby, Karen G.; Tabak, Ying P.; Johannes, Richard Scott

2011-01-01

245

Impact of Co-morbidity on the Risk of First-Time Myocardial Infarction, Stroke, or Death After Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging  

DEFF Research Database (Denmark)

The impact of co-morbidity on the cardiovascular risk after single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) remains unclear. We examined the association between a normal versus abnormal SPECT MPI scan on 10-year risk of myocardial infarction, stroke, and all-cause death, overall and according to co-morbidity level. We identified all patients without previous myocardial infarction or cerebrovascular disease, who had an SPECT MPI performed at Aarhus University Hospital Skejby during 1999 to 2011. We categorized the SPECT MPI scan as normal (no defects) or abnormal (reversible and/or fixed defects). Using nationwide medical registries, we obtained information on co-morbidity level (using Charlson co-morbidity index) and outcomes. We used Cox regression to compute hazard ratios with 95% confidence intervals (CIs), adjusting for gender, age, and co-morbidity level. Among 7,040 patients, 4,962 (70%) had normal scans and 2,078 (30%) abnormal scans. Patients with a normal versus abnormal scan had a 10-year risk of 5.7% versus 10.9% for myocardial infarction, 6.0% versus 7.8% for stroke, and 16.5% versus 29.0% for all-cause death. After adjustment, an abnormal scan was associated with increased risk of myocardial infarction (adjusted hazard ratio 1.73, 95% CI 1.37 to 2.18) and all-cause death (1.42, 95% CI 1.23 to 1.65) but not stroke (1.12, 95% CI 0.86 to 1.45). Co-morbidity level did not affect substantially the association between the scan result and the outcomes. In conclusion, independently of co-morbidity level, an abnormal SPECT MPI scan was associated with an increased 10-year risk of myocardial infarction and all-cause death but not stroke.

Schelde, Astrid Blicher; Schmidt, Morten

2014-01-01

246

Improved cognition after control of risk factors for multi-infarct dementia  

International Nuclear Information System (INIS)

A cohort of 52 patients (30 men and 22 women) with multi-infarct dementia (MID) has been followed up prospectively for a mean interval of 22.2 months. Clinical course has been documented by serial history taking and interviews and neurological, medical, and psychological examinations, and correlated with measurements of cerebral blood flow. The clinical course and cognitive performance have been compared with those of age-matched normal volunteers and patients with Alzheimer's disease. Patients with MID were subdivided into hypertensive and normotensive groups, and also into those displaying stabilized or improved cognition and those whose condition deteriorated. Among hypertensive patients with MID, improved cognition and clinical course correlated with control of systolic blood pressure within upper limits of normalf (135 to 150 mm Hg), but if systolic blood pressure was reduced below this level, patients with MID deteriorated. Among normotensive patients with MID, improved cognition was associated with cessation of smoking cigarettes

247

Genetic Addiction Risk Score (GARS): Molecular Neurogenetic Evidence for Predisposition to Reward Deficiency Syndrome (RDS).  

Science.gov (United States)

We have published extensively on the neurogenetics of brain reward systems with reference to the genes related to dopaminergic function in particular. In 1996, we coined "Reward Deficiency Syndrome" (RDS), to portray behaviors found to have gene-based association with hypodopaminergic function. RDS as a useful concept has been embraced in many subsequent studies, to increase our understanding of Substance Use Disorder (SUD), addictions, and other obsessive, compulsive, and impulsive behaviors. Interestingly, albeit others, in one published study, we were able to describe lifetime RDS behaviors in a recovering addict (17 years sober) blindly by assessing resultant Genetic Addiction Risk Score (GARS™) data only. We hypothesize that genetic testing at an early age may be an effective preventive strategy to reduce or eliminate pathological substance and behavioral seeking activity. Here, we consider a select number of genes, their polymorphisms, and associated risks for RDS whereby, utilizing GWAS, there is evidence for convergence to reward candidate genes. The evidence presented serves as a plausible brain-print providing relevant genetic information that will reinforce targeted therapies, to improve recovery and prevent relapse on an individualized basis. The primary driver of RDS is a hypodopaminergic trait (genes) as well as epigenetic states (methylation and deacetylation on chromatin structure). We now have entered a new era in addiction medicine that embraces the neuroscience of addiction and RDS as a pathological condition in brain reward circuitry that calls for appropriate evidence-based therapy and early genetic diagnosis and that requires further intensive investigation. PMID:24878765

Blum, Kenneth; Oscar-Berman, Marlene; Demetrovics, Zsolt; Barh, Debmalya; Gold, Mark S

2014-12-01

248

Primeiro escore de risco inflamatório das endopróteses de aorta / First inflammatory risk score for aortic endoprostheses  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses). Variáveis inflamatóri [...] as avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8), fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1), transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P Abstract in english OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-r [...] eactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P

Edmo Atique, Gabriel; Rafael Fagionato, Locali; Priscila Katsumi, Matsoka; Carla Cristina, Romano; Alberto José da Silva, Duarte; Enio, Buffolo.

2008-12-01

249

The Risk Assessment Score in acute whiplash injury predicts outcome and reflects bio-psycho-social factors  

DEFF Research Database (Denmark)

ABSTRACT: Study Design. 1-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle injured controlsObjective. This study investigates a priori determined potential risk factors in order to develop a risk assessment tool, for which the expediency was examinedSummary of Background Data. The Whiplash Associated Disorders (WAD) grading system that emerged from The Quebec Task-force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining bio-psychosocial disability after whiplash and new predictive factors e.g. risk criteria that comprehensively differentiate acute WLP in a bio-psycho-social manner are needed.Methods. Consecutively 141 acute WLP and 40 ankle injured recruited from emergency units were examined after 1 week, 1, 3, 6, 12 months obtaining neck/head VAS score, number-of-non-painful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, strength and duration of neck muscles. Risk factors derived (reduced CROM, intense neckpain/headache, multiple non-pain complaints) were applied in a Risk Assessment Score and divided into 7 risk-strata.Results. A ROC curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1-yr (p <5.4 * 10). Strength measures, psychophysical pain measurements and psychological and social data (reported elsewhere) showed significant relation to risk strata.Conclusion. The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the bio-psycho-social nature of whiplash injuries.

Kasch, Helge; Qerama, Erisela

2011-01-01

250

Genetic risk score associations with cardiovascular disease and mortality in the Diabetes Heart Study.  

Science.gov (United States)

OBJECTIVE Given the high rates of cardiovascular disease (CVD) and associated mortality in individuals with type 2 diabetes, identifying and understanding predictors of CVD events and mortality could help inform clinical management in this high-risk group. Recent large-scale genetic studies may provide additional tools in this regard. RESEARCH DESIGN AND METHODS Genetic risk scores (GRSs) were constructed in 1,175 self-identified European American (EA) individuals comprising the family-based Diabetes Heart Study based on 1) 13 single nucleotide polymorphisms (SNPs) and 2) 30 SNPs with previously documented associations with CVD in genome-wide association studies. Associations between each GRS and a self-reported history of CVD, coronary artery calcified plaque (CAC) determined by noncontrast computed tomography scan, all-cause mortality, and CVD mortality were examined using marginal models with generalized estimating equations and Cox proportional hazards models. RESULTS The weighted 13-SNP GRS was associated with prior CVD (odds ratio [OR] 1.51 [95% CI 1.22-1.86]; P = 0.0002), CAC (?-coefficient [?] 0.22 [0.02-0.43]; P = 0.04) and CVD mortality (hazard ratio [HR] 1.35 [1.10-1.81]; P = 0.04) when adjusting for the other known CVD risk factors: age, sex, type 2 diabetes affection status, BMI, current smoking status, hypertension, and dyslipidemia. The weighted 30-SNP GRS was also associated with prior CVD (OR 1.33 [1.08-1.65]; P = 0.008), CAC (? 0.29 [0.08-0.50]; P = 0.006), all-cause mortality (HR 1.28 [1.05-1.56]; P = 0.01), and CVD mortality (HR 1.46 [1.08-1.96]; P = 0.01). CONCLUSIONS These findings support the utility of two simple GRSs in examining genetic associations for adverse outcomes in EAs with type 2 diabetes. PMID:24574349

Cox, Amanda J; Hsu, Fang-Chi; Ng, Maggie C Y; Langefeld, Carl D; Freedman, Barry I; Carr, J Jeffrey; Bowden, Donald W

2014-04-01

251

Puntaje de riesgo para morbilidad y mortalidad en pacientes sometidos a intervencionismo coronario percutáneo / Morbimortality risk score in patients submitted to percutaneous coronary intervention  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish El objetivo principal de este estudio observacional, fue establecer un puntaje de riesgo para morbilidad y mortalidad intrahospitalaria en pacientes sometidos a intervención coronaria percutánea luego de sufrir alguno de los siguientes síndromes coronarios agudos: angina inestable, infarto agudo del [...] miocardio sin elevación del segmento ST o infarto agudo del miocardio con elevación del segmento ST. Se realizó una recolección de datos clínicos y demográficos a partir de 1.310 pacientes atendidos en la clínica, entre 2003 a 2006, de manera retro-prospectiva, con el fin de elaborar un puntaje válido para la población colombiana. Esto se realizó mediante una base de datos de múltiples variables pre-procedimiento (antecedentes personales), variables intra-procedimiento (tiempo transcurrido desde la hora de la consulta al servicio de urgencias hasta el momento del cateterismo, número de vasos enfermos entre otros) y variables post-procedimientos (complicaciones de morbi-mortalidad). Luego, el análisis de los datos se llevó a cabo mediante un modelo de regresión logística, para determinar cuáles de los factores de riesgo fueron estadísticamente significativos para causar alguno de los resultados evaluados. Los principales resultados evaluados fueron: muerte, eventos hematológicos adversos y estancia hospitalaria. Luego del análisis se encontró que los principales factores relacionados con la morbi-mortalidad de los pacientes fueron el tipo de paciente (o tipo de síndrome coronario sufrido), su edad y su estado hemodinámico al ingreso (presencia de shock cardiogénico). A partir de estos resultados, se desarrolló el puntaje de riesgo a través de las variables pre-operatorias e intra-operatorias. Abstract in english The main objective of this observational study was to establish a mortality risk score for intra-hospital morbidity and mortality in patients submitted to percutaneous coronary intervention (PCI) after having suffered one of the following acute coronary syndromes: unstable angina (UA), acute myocard [...] ial infarction without ST elevation (NSTEMI) or acute myocardial infarct with ST elevation (STEMI). Clinical and demographic data of 1,300 patients treated in the clinic between 2003 and 2006 were recollected in a retrospective way with the aim of obtaining a valid risk score for the Colombian population. This was realized through a data base of multiple pre-procedure variables (personal antecedents), intra-procedure variables (time elapsed since the arrival to ER to the moment of catheterization and number of diseased vessels among others) and post-procedure variables (morbimortality complications). Data analysis was then performed through a logistic regression model in order to determine which risk factors were statistically significant in causing some of the results evaluated. The principal results evaluated were death, adverse hematological events and hospital stay; after the analysis we found that the main factors related to patients’ morbimortality, were the type of patient (or the type of coronary syndrome suffered), age and homodynamic state at admission (presence of cardiogenic shock). From these results a risk score through pre-procedure, post-procedure and intra-hospital variables was developed.

Andrés, Fernández; Carlos A, Tenorio; Carlos A, Eusse; Arturo, Rodríguez; Carlos E, Uribe; Juan P, Villa; Ricardo, Restrepo; Marcela, Mejia; Juliana, Vega; Juan F, Gómez; Gloria, Franco.

2008-04-01

252

Among the risk factors of myocardial infarction, anthropometry has no association: A case control study in the central region of Sri Lanka  

Directory of Open Access Journals (Sweden)

Full Text Available Background: In the face of rising incidence of cardiovascular disease in the globe, the associated risk factors could be country or area specific. This study aimed to identify the important risk factors of myocardial infarction (MI prevailing in the Kandydistrict of Sri Lanka. Methods: In a case control design, the cases were recruited from the Coronary Care Unit, General Hospital Kandy, with the diagnosis of myocardial infarction. Matched controls were selected from the Out Patient Department with other ailments, unrelated to cardiovascular diseases. Results: There were 205 cases and 197 controls with the mean age of 56 years (SD ± 8.4 years and 54 years (SD ± 9.8 years respectively with male: female ratio of 1:0.2. In analysis, hypertension (OR = 5.09, CI = 2.64 - 9.83, type 11 diabetes (OR = 3.45, CI = 1.90 - 6.10, smoking (OR = 1.95, CI= 1.44 - 2.65 and high LDL cholesterol levels (OR = 1.06, CI = 1.04 - 1.06 were identified as the independent risk factors of myocardial infarction. However, the anthropometric measurements, waist hip ratio (OR = 0.64, CI = 0.33 - 1.34 and body mass index ? 25 (OR = 0.75, CI = 0.46 - 1.22 did not show an association with myocardial infarctions. Conclusions: Anthropometric measurements did not qualify as risk factors of myocardial infarction in the local setting even though hypertension, diabetes, smoking and high LDL levels showed a significant association in par with the established data.

Pallegoda Vithanage Ranhith Kumarasiri

2013-07-01

253

Implantable cardioverter-defibrillator registry risk score models for acute procedural complications or death after implantable cardioverter-defibrillator implantation.  

LENUS (Irish Health Repository)

BACKGROUND: Patients undergoing implantable cardioverter-defibrillator (ICD) implantation are at risk of postprocedural complications. However, we do not have a risk stratification schema to identify patients at high and low risk of adverse events. METHODS AND RESULTS: We analyzed data from 268 701 ICD implants submitted to the ICD Registry and developed logistic regression models to identify variables most strongly associated with the risk of acute complications and\\/or in-hospital death. Overall, 3.2% of the population experienced an adverse event. A simple risk score consisting of 10 readily available variables successfully identified patients at high and low risk of complications. The variables included in the score and assigned points included: age >\\/= 70 years (1 point), female (2 points), New York Heart Association class III (1 point) or IV (3 points), atrial fibrillation (1 point), prior valve surgery (3 points), chronic lung disease (2 points), blood urea nitrogen >30 (2 points), reimplantation for reasons other than battery change (6 points), ICD type dual chamber (2 points) or biventricular (4 points), and nonelective ICD implant (3 points). The risk of any in-hospital complication increased from 0.6% among patients with a score of <\\/= 5 (8.4% of the population) to 8.4% among patients with >\\/= 19 risk points (3.9% of the population). CONCLUSIONS: A simple risk score consisting of readily available clinical variables can identify high- and low-risk subsets of patients undergoing ICD implantation. This information can guide the physician in patient selection and determining the intensity of care required post procedure.

Haines, David E

2012-02-01

254

Modelo predictivo de "score" de calcio alto en pacientes con factores de riesgo cardiovascular Predictive model of high calcium score in patients with cardiovascular risk factors  

Directory of Open Access Journals (Sweden)

Full Text Available Introducción: a través de múltiples estudios, se ha encontrado que el "score" de calcio coronario es un buen predictor de enfermedad coronaria, en individuos asintomáticos con uno o más factores de riesgo cardiovascular. Por ello sería ideal realizar esta prueba para estratificar su riesgo, pero esto no es posible en la mayoría de los casos por motivos de índole económica. El modelo que se presenta permite predecir la probabilidad de que un paciente tenga un score de calcio coronario alto, a partir de sus factores de riesgo cardiovascular. Lo novedoso del modelo es que también involucra factores "protectores" que disminuyen dicha probabilidad. Métodos: estudio de casos y controles, en pacientes asintomáticos con factores de riesgo cardiovascular, a quienes se les realizó un PCC. Los casos son pacientes con score de calcio coronario por encima del percentil 75 para su edad y género; la relación control:caso es 2:1. Resultados: las edades oscilaron entre 35 y 75 años; el 14,4% eran de género femenino, el 44,4% tenían historia familiar de CHD, el 34,4% eran hipertensos, el 38,9% colesterol total elevado, el 24,4% colesterol HDL por debajo de 40 mg/dL, el 33,3% colesterol LDL por encima de 160 mg/dL, el 25,6% fumaban, el 23,3% eran sedentarios, el 13,3% consumían licor periódicamente, el 15,6% eran obesos (IMC>30, el 18,9% realizaban ejercicio de manera periódica y 34,4% tomaba estatinas. Los factores de riesgo cardiovascular que se correlacionaron con el score de calcio coronario alto, se consignan en la tabla 1. En el modelo de regresión logística se incluyen los factores que tienen un valor de p tabla 2. La expresión para el modelo sería: Los valores de ci son 1, si el factor está presente y 0 si no lo está. Conclusiones: el anterior modelo no pretende reemplazar la estratificación con el modelo de Framingham, al contrario, es un complemento que permite orientar al médico tratante sobre si es recomendable realizar la prueba del score de calcio coronario a un paciente con factores de riesgo cardiovascular. Se puede observar que muchos de los factores de riesgo que se correlacionan con un valor elevado de "score" de calcio coronario pueden ser modificables: cesar el hábito de fumar o realizar ejercicio.Introduction: it has been found through multiple studies that coronary calcium score is a good predictor of coronary disease in asymptomatic individuals with one or more cardiovascular risk factors; therefore it would be ideal to perform this test in order to stratify its risk, but due to economic factors this is not possible in most cases. The model presented allows predicting the probability that a patient may have a high coronary calcium score by means of his cardiovascular risk factors. The originality of the model is that it also comprises "protector" factors that diminish such probability. Methods: study of cases and controls in asymptomatic patients with cardiovascular risk factors to whom a PCC had been performed. The cases are patients with coronary calcium score greater than percentile 75 for his age and gender; the control case relationship is 2:1. Results: ages ranged between 35 and 75 years; 14.4% were female; 44.4% had family history of CHD; 34.4% were hypertensive; 38.9% had high total cholesterol; 24.4% had HDL cholesterol under 40 mg/dl; 33.3% had LDL cholesterol greater than 160 mg/dl; 25.6% were cigarette smokers; 23.3% were sedentary; 13.3% were periodical alcohol consumers; 15.6% were obese (BMI > 30; 18.9% exercised periodically and 34.4% received statins. Cardiovascular risk factors correlated with high coronary calcium score are recorded in table 1. In the logistic regression model, factors having a p table 2 are obtained. Expression for the model would be: The values of ci values are 1, if the factor is present and 0 if it is not. Conclusions: this model does not pretend to replace stratification through Framinghan model; on the contrary, it is a complement that allows the physician to realize if the coronary calcium score test is recommended for patie

Gloria Franco

2007-12-01

255

Mejoría en el score de riesgo cardiovascular por la cirugía bariátrica / Improvement in the cardiovascular risk score due to bariatric surgery  

Scientific Electronic Library Online (English)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish Introducción: La obesidad se ha considerado como un factor de riesgo para desarrollar eventos coronarios agudos. Los principales factores para desarrollar este tipo de enfermedades están presentes en la mayoría de los pacientes sometidos a cirugía bariátrica. Objetivo: Evaluar el riesgo cardiovascul [...] ar de los pacientes sometidos a cirugía bariátrica en forma preoperatoria y postoperatoria tras un seguimiento a dos años. Sede: Hospital General ''Dr. Manuel Gea González''. Diseño: Estudio retrospectivo, longitudinal, observacional y comparativo. Material y métodos: Pacientes de la clínica de cirugía bariátrica, operados con la técnica de bypass gástrico, calculando el riesgo cardiovascular de forma preoperatoria y posteriormente a dos años de seguimiento. Resultados: Se incluyeron 64 pacientes (13 hombres y 51 mujeres). La edad promedio de los hombres fue 42 años su índice de masa corporal promedio fue 49.44 kg/m², la puntuación del riesgo cardiovascular preoperatoria fue: 5.15 (2-9). Al seguimiento a dos años su índice de masa corporal promedio disminuyó a 36.23 kg/m², la puntuación del riesgo cardiovascular fue: 2.38 (0-5). En las mujeres la edad promedio fue de 36 años, su índice de masa corporal promedio previo a la cirugía fue 45.32 kg/m², la puntuación del riesgo cardiovascular fue: 4.3 (-10 a 13). A un seguimiento de dos años su índice de masa corporal promedio fue 28.64 kg/m² (20.1-42.1), la puntuación del riesgo cardiovascular fue -4.1 (-11 a 8). Conclusión: La cirugía bariátrica no sólo ha demostrado ser un método eficaz y seguro para la disminución del peso corporal en pacientes con obesidad mórbida, también aquí se demuestra que disminuye el riesgo cardiovascular que poseen estos pacientes. Abstract in english Introduction: Obesity has been considered a risk factor for acute coronary events. The main factors to develop this type of diseases are present in most of the patients subjected to bariatric surgery. Objective: To assess the cardiovascular risk of patients subjected to bariatric surgery preoperativ [...] ely and at 2-years follow-up. Setting: General Hospital ''Dr. Manuel Gea González''. Design: Retrospective, longitudinal, observational, and comparative study. Patients and methods: Patients from the bariatric surgery clinic, operated with the gastric bypass technique, calculating the cardiovascular risk preoperatively and at 2-year follow-up. Results: The study included 64 patients (13 men and 51 women). Average age of men was 42 years, their average body mass index was 49.44 kg/m², preoperative cardiovascular risk score was 5.15 (2-9). At 2-year follow-up, their BMI diminished to 36.23 kg/m², the cardiovascular risk score was 2.38 (0-5). In women, average age was of 36 years, their body mass index before surgery was of 45.32 kg/m², the cardiovascular risk score was 4.3 (-10 a 13). At 2-year follow-up, their average body mass index reduced to 28.64 kg/m² (20.1-42.1), and the cardiovascular risk score was -4.1 (-11 to 8). Conclusion: Bariatric surgery has not only been demonstrated as an efficacious and safe method to reduce body weight in patients with morbid obesity but also to diminish the cardiovascular risk depicted by these patients.

Luz Sujey, Romero Loera; María Fernanda, Torres Ruiz; Carlos, Bravo Torreblanca; Itzé, Aguirre Olmedo; José Manuel, Morales Vargas; Luis Eduardo, Cárdenas Lailson.

2012-09-01

256

The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1 : a nationwide cohort study  

DEFF Research Database (Denmark)

North American and European guidelines on atrial fibrillation (AF) are conflicting regarding the classification of patients at low/intermediate risk of stroke. We aimed to investigate if the CHA2DS2-VASc score improved risk stratification of AF patients with a CHADS2 score of 0-1. Using individual-level-linkage of nationwide Danish registries 1997-2008, we identified patients discharged with AF having a CHADS2 score of 0-1 and not treated with vitamin K antagonist or heparin. In patients with a CHADS2 score of 0, 1, and 0-1, rates of stroke/ thromboembolism were determined according to CHA2DS2-VASc score, and the risk associated with increasing CHA2DS2-VASc score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy. The value of adding the extra CHA2DS2-VASc risk factors to the CHADS2 score was evaluated by c-statistics, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI). We included 47,576 patients with a CHADS2 score of 0-1, from these 7,536 (15.8%) were CHA2DS2-VASc score=0, 10,062 (21.2%) were CHA2DS2-VASc score=1, 14,310 (30.1%) were CHA2DS2-VASc score=2, 14,188 (29.8%) were CHA2DS2-VASc score=3, and 1,480 (3.1%) were CHA2DS2-VASc score=4. Of the cohort with a CHADS2 score of 0-1, the stroke/thromboembolism rate per 100 person-years increased with increasing CHA2DS2-VASc score (95% confidence interval): 0.84 (0.65-1.08), 1.79 (1.53-2.09), 3.67 (3.34-4.03), 5.75 (5.33-6.21), and 8.18 (6.68-10.02) at one year follow-up with CHA2DS2-VASc scores of 0, 1, 2, 3, and 4, respectively. Patients with a CHADS2 score=0 were not all 'low risk', with one-year event rates ranging from 0.84 (CHA2DS2-VASc score=0) to 3.2 (CHA2DS2-VASc score=3). Results from Cox regression analyses, NRI, and IDI confirmed the improved predictive ability of the CHA2DS2-VASc score in the AF patients who have a CHADS2 score of 0-1. In conclusion, the CHA2DS2-VASc provides critical information on risk of stroke in AF patients with a CHADS2 score of 0-1 that can aid a decision of using anticoagulation. Even in patients categorised as 'low risk' using a CHADS2 score=0, the CHA2DS2-VASc score significantly improved the predictive value of the CHADS2 score alone and a CHA2DS2-VASc score=0 could clearly identify 'truly low risk' subjects. Use of the CHA2DS2-VASc score would significantly improve classification of AF patients at low and intermediate risk of stroke, compared to the commonly used CHADS2 score.

Olesen, Jonas Bjerring; Torp-Pedersen, Christian

2012-01-01

257

Modelo predictivo de "score" de calcio alto en pacientes con factores de riesgo cardiovascular / Predictive model of high calcium score in patients with cardiovascular risk factors  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Introducción: a través de múltiples estudios, se ha encontrado que el "score" de calcio coronario es un buen predictor de enfermedad coronaria, en individuos asintomáticos con uno o más factores de riesgo cardiovascular. Por ello sería ideal realizar esta prueba para estratificar su riesgo, pero est [...] o no es posible en la mayoría de los casos por motivos de índole económica. El modelo que se presenta permite predecir la probabilidad de que un paciente tenga un score de calcio coronario alto, a partir de sus factores de riesgo cardiovascular. Lo novedoso del modelo es que también involucra factores "protectores" que disminuyen dicha probabilidad. Métodos: estudio de casos y controles, en pacientes asintomáticos con factores de riesgo cardiovascular, a quienes se les realizó un PCC. Los casos son pacientes con score de calcio coronario por encima del percentil 75 para su edad y género; la relación control:caso es 2:1. Resultados: las edades oscilaron entre 35 y 75 años; el 14,4% eran de género femenino, el 44,4% tenían historia familiar de CHD, el 34,4% eran hipertensos, el 38,9% colesterol total elevado, el 24,4% colesterol HDL por debajo de 40 mg/dL, el 33,3% colesterol LDL por encima de 160 mg/dL, el 25,6% fumaban, el 23,3% eran sedentarios, el 13,3% consumían licor periódicamente, el 15,6% eran obesos (IMC>30), el 18,9% realizaban ejercicio de manera periódica y 34,4% tomaba estatinas. Los factores de riesgo cardiovascular que se correlacionaron con el score de calcio coronario alto, se consignan en la tabla 1. En el modelo de regresión logística se incluyen los factores que tienen un valor de p tabla 2. La expresión para el modelo sería: Los valores de ci son 1, si el factor está presente y 0 si no lo está. Conclusiones: el anterior modelo no pretende reemplazar la estratificación con el modelo de Framingham, al contrario, es un complemento que permite orientar al médico tratante sobre si es recomendable realizar la prueba del score de calcio coronario a un paciente con factores de riesgo cardiovascular. Se puede observar que muchos de los factores de riesgo que se correlacionan con un valor elevado de "score" de calcio coronario pueden ser modificables: cesar el hábito de fumar o realizar ejercicio. Abstract in english Introduction: it has been found through multiple studies that coronary calcium score is a good predictor of coronary disease in asymptomatic individuals with one or more cardiovascular risk factors; therefore it would be ideal to perform this test in order to stratify its risk, but due to economic f [...] actors this is not possible in most cases. The model presented allows predicting the probability that a patient may have a high coronary calcium score by means of his cardiovascular risk factors. The originality of the model is that it also comprises "protector" factors that diminish such probability. Methods: study of cases and controls in asymptomatic patients with cardiovascular risk factors to whom a PCC had been performed. The cases are patients with coronary calcium score greater than percentile 75 for his age and gender; the control case relationship is 2:1. Results: ages ranged between 35 and 75 years; 14.4% were female; 44.4% had family history of CHD; 34.4% were hypertensive; 38.9% had high total cholesterol; 24.4% had HDL cholesterol under 40 mg/dl; 33.3% had LDL cholesterol greater than 160 mg/dl; 25.6% were cigarette smokers; 23.3% were sedentary; 13.3% were periodical alcohol consumers; 15.6% were obese (BMI > 30); 18.9% exercised periodically and 34.4% received statins. Cardiovascular risk factors correlated with high coronary calcium score are recorded in table 1. In the logistic regression model, factors having a p table 2 are obtained. Expression for the model would be: The values of ci values are 1, if the factor is present and 0 if it is not. Conclusions: this model does not pretend to replace stratification through Framinghan model; on the contrary, it is a complement tha

Gloria, Franco; Samuel, Jaramillo; José Victor, de Fex; Lina M, Sierra.

258

Modelo predictivo de "score" de calcio alto en pacientes con factores de riesgo cardiovascular / Predictive model of high calcium score in patients with cardiovascular risk factors  

Scientific Electronic Library Online (English)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish Introducción: a través de múltiples estudios, se ha encontrado que el "score" de calcio coronario es un buen predictor de enfermedad coronaria, en individuos asintomáticos con uno o más factores de riesgo cardiovascular. Por ello sería ideal realizar esta prueba para estratificar su riesgo, pero est [...] o no es posible en la mayoría de los casos por motivos de índole económica. El modelo que se presenta permite predecir la probabilidad de que un paciente tenga un score de calcio coronario alto, a partir de sus factores de riesgo cardiovascular. Lo novedoso del modelo es que también involucra factores "protectores" que disminuyen dicha probabilidad. Métodos: estudio de casos y controles, en pacientes asintomáticos con factores de riesgo cardiovascular, a quienes se les realizó un PCC. Los casos son pacientes con score de calcio coronario por encima del percentil 75 para su edad y género; la relación control:caso es 2:1. Resultados: las edades oscilaron entre 35 y 75 años; el 14,4% eran de género femenino, el 44,4% tenían historia familiar de CHD, el 34,4% eran hipertensos, el 38,9% colesterol total elevado, el 24,4% colesterol HDL por debajo de 40 mg/dL, el 33,3% colesterol LDL por encima de 160 mg/dL, el 25,6% fumaban, el 23,3% eran sedentarios, el 13,3% consumían licor periódicamente, el 15,6% eran obesos (IMC>30), el 18,9% realizaban ejercicio de manera periódica y 34,4% tomaba estatinas. Los factores de riesgo cardiovascular que se correlacionaron con el score de calcio coronario alto, se consignan en la tabla 1. En el modelo de regresión logística se incluyen los factores que tienen un valor de p tabla 2. La expresión para el modelo sería: Los valores de ci son 1, si el factor está presente y 0 si no lo está. Conclusiones: el anterior modelo no pretende reemplazar la estratificación con el modelo de Framingham, al contrario, es un complemento que permite orientar al médico tratante sobre si es recomendable realizar la prueba del score de calcio coronario a un paciente con factores de riesgo cardiovascular. Se puede observar que muchos de los factores de riesgo que se correlacionan con un valor elevado de "score" de calcio coronario pueden ser modificables: cesar el hábito de fumar o realizar ejercicio. Abstract in english Introduction: it has been found through multiple studies that coronary calcium score is a good predictor of coronary disease in asymptomatic individuals with one or more cardiovascular risk factors; therefore it would be ideal to perform this test in order to stratify its risk, but due to economic f [...] actors this is not possible in most cases. The model presented allows predicting the probability that a patient may have a high coronary calcium score by means of his cardiovascular risk factors. The originality of the model is that it also comprises "protector" factors that diminish such probability. Methods: study of cases and controls in asymptomatic patients with cardiovascular risk factors to whom a PCC had been performed. The cases are patients with coronary calcium score greater than percentile 75 for his age and gender; the control case relationship is 2:1. Results: ages ranged between 35 and 75 years; 14.4% were female; 44.4% had family history of CHD; 34.4% were hypertensive; 38.9% had high total cholesterol; 24.4% had HDL cholesterol under 40 mg/dl; 33.3% had LDL cholesterol greater than 160 mg/dl; 25.6% were cigarette smokers; 23.3% were sedentary; 13.3% were periodical alcohol consumers; 15.6% were obese (BMI > 30); 18.9% exercised periodically and 34.4% received statins. Cardiovascular risk factors correlated with high coronary calcium score are recorded in table 1. In the logistic regression model, factors having a p table 2 are obtained. Expression for the model would be: The values of ci values are 1, if the factor is present and 0 if it is not. Conclusions: this model does not pretend to replace stratification through Framinghan model; on the contrary, it is a complement tha

Gloria, Franco; Samuel, Jaramillo; José Victor, de Fex; Lina M, Sierra.

2007-12-01

259

Beyond the established risk factors of myocardial infarction : lifestyle factors and novel biomarkers  

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Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (phys...

Wennberg, Patrik

2009-01-01

260

Risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts by 24-hour ambulatory blood pressure monitoring  

International Nuclear Information System (INIS)

Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (?133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertenuture cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

 
 
 
 
261

Influence of gender on the risk of death and adverse events in patients with acute myocardial infarction undergoing pharmacoinvasive strategy.  

Science.gov (United States)

Pharmacoinvasive treatment is an acceptable alternative for patients with ST-segment elevation myocardial infarction (STEMI) in developing countries. The present study evaluated the influence of gender on the risks of death and major adverse cardiovascular events (MACE) in this population. Seven municipal emergency rooms and the Emergency Mobile Healthcare Service in São Paulo treated STEMI patients with tenecteplase. The patients were subsequently transferred to a tertiary teaching hospital for early (12.9 versus 7.9 % (p = 0.09), respectively. By multivariate analysis, diabetes (OR 4.15; 95 % CI 1.86-9.25; p = 0.001), previous stroke (OR 4.81; 95 % CI 1.49-15.52; p = 0.009), and hypothyroidism (OR 3.75; 95 % CI 1.44-9.81; p = 0.007), were independent predictors of mortality, whereas diabetes (OR 2.05; 95 % CI 1.03-4.06; p = 0.04), PVD (OR 2.38; 95 % CI 0.88-6.43; p = 0.08), were predictors of MACE. In STEMI patients undergoing pharmacoinvasive strategy, mortality and MACE rates were twice as high in women; however, this was due to a higher prevalence of risk factors and not gender itself. PMID:24671733

Lanaro, Eduardo; Caixeta, Adriano; Soares, Juliana A; Alves, Cláudia Maria Rodrigues; Barbosa, Adriano Henrique Pereira; Souza, José Augusto Marcondes; Sousa, José Marconi Almeida; Amaral, Amaury; Ferreira, Guilherme M; Moreno, Antônio Célio; Júnior, Iran Gonçalves; Stefanini, Edson; Carvalho, Antônio Carlos

2014-11-01

262

Physical activity levels, sport activities, and risk of acute myocardial infarction: results of the INTERHEART study in China.  

Science.gov (United States)

Physical activity (PA) during leisure time has been inversely associated with cardiovascular disease risk in the Western populations. We evaluated PA at work and leisure time in relation to acute myocardial infarction (AMI) in Chinese population. We conducted a hospital-based case-control study. The cases had first AMI (n = 2909). The controls (n = 2947) were matched to the cases in age and sex. The odds ratios (ORs) of leisure-time PA for strenuous exercise compared to mainly sedentary was 0.74 (95% confidence interval [CI]: 0.61-0.90) and for moderate exercise it was 0.96 (95% CI: 0.85-1.08). Multivariate adjustment did not substantially alter the association. The ORs of work-related PA for heavy PA compared to mainly sedentary was 1.44 (95% CI: 1.06-1.94), for climbing and lifting was 1.00 (95% CI: 0.77-.30), and for walking was 0.90 (95%CI: 0.75-1.07). Leisure-time PA was protective for AMI risk compared to sedentary lifestyles in a population in China. PMID:23324448

Cheng, Xiaoru; Li, Wei; Guo, Jin; Wang, Yang; Gu, Hongqiu; Teo, Koon; Liu, Lisheng; Yusuf, Salim

2014-02-01

263

A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer  

International Nuclear Information System (INIS)

Objective: To describe the risk of acute myocardial infarction (AMI) after radiation therapy (RT) for breast cancer (BrCa) in an exposed population. Methods: We identified and validated cases of AMI (vAMI), by electrocardiographic or enzyme criteria, among all 6680 women who received post-operative RT following lumpectomy or mastectomy, within 12 months following diagnosis of BrCa between 1982 and 1988 in Ontario, Canada. We identified women without vAMI whose death certification was ascribed to AMI (dAMI). We abstracted risk factors and treatment exposures for a random sample of women from the 6680, and for all with vAMI or dAMI. The hazards of vAMI and of dAMI were estimated using multivariate Cox proportional hazards models, corrected for study design. Results: We validated 121 cases of vAMI and identified 92 cases of dAMI. The risk of vAMI associated with RT to the left breast HR = 1.96 (1.09, 3.54) among women at age ? 60 at time of RT, adjusted for history of smoking and prior MI. The adjusted HR dAMI = 1.90 (1.08, 3.35) for exposure to anterior internal mammary node (IMC) RT. Among women who received anterior left breast boost RT, increasing area of the boost is associated with adjusted HR vAMI = 1.02 (1.00, 1.03)/cm2, and adjusted HR dAMI = 1.02 (1.01, 1.03)/cm2. Conclusion: The risks of vAMI and dAMI following RT for BrCa are related to anatomic sites of RT (left breast, area of anterior left breast boost field, and anterior IMC field)ast boost field, and anterior IMC field)

264

Adipose tissue arachidonic acid content is associated with the risk of myocardial infarction : A Danish case-cohort study  

DEFF Research Database (Denmark)

OBJECTIVE: The primary aim of the study was to evaluate the association between adipose tissue arachidonic acid (AA) content and the risk of myocardial infarction (MI). The secondary aim was to assess the correlation between adipose tissue AA and dietary intake of AA and linoleic acid (LA). METHODS: We conducted a case-cohort study nested within the Danish prospective Diet, Cancer and Health (DCH) study. After appropriate exclusions, the study included 2134 incident MI cases. Gluteal adipose tissue biopsies were collected at recruitment, and the fatty acid composition was determined by gas chromatography. A weighted Cox proportional hazards model was used to evaluate the association between adipose tissue AA content and the risk of MI. RESULTS: After adjusting for confounders we found a positive association between adipose tissue AA content and the risk of MI. Hazard ratios (HR) of MI relative to the lowest quintile of adipose tissue AA content, increased across quintiles; second quintile (HR 1.19 95%CI: 0.97-1.45), third (HR 1.24 95%CI: 1.02-1.52), fourth (HR 1.28 95%CI: 1.03-1.60), and fifth quintile (HR 1.39 95%CI: 1.10-1.77). Adipose tissue AA levels were not correlated with dietary intake of AA (r=0.03, 95%CI: -0.01, 0.06) and weakly negatively correlated with dietary intake of LA (r=-0.12, 95%CI: -0.15, -0.08). CONCLUSIONS: The adipose tissue content of AA was positively associated with the risk of MI but did not correlate with dietary intake of neither AA nor LA.

Nielsen, Michael René Skjelbo; Schmidt, Erik Berg

2013-01-01

265

The relationship between Elder Risk Assessment (ERA scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA  

Directory of Open Access Journals (Sweden)

Full Text Available Saurabh Sharma,1 Shruti Datta,1 Shahyar Gharacholou,1,2 Shahzad K Siddique,3 Stephen S Cha,4 Paul Y Takahashi1,5,6 1Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 3Shifa International Hospital, Islamabad, Pakistan; 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; 5Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 6Kogod Center of Aging, Mayo Clinic, Rochester, MN, USA Purpose: The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA score and coronary artery bypass graft (CABG or percutaneous coronary intervention (PCI, in adults over 60 years. Methods: This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results: The records of 12,650 patients were studied. A total of 902 patients (7.1% had either CABG or PCI, with an average age of 74.5 years (±8.3 years. There were 205 patients (23% who experienced CABG or PCI in the highest-score group (top 10% compared with 29 patients (3% in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1–23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001. Conclusion: Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients. Keywords: coronary bypass, geriatrics, mortality, percutaneous coronary intervention

Sharma S

2013-09-01

266

Total Anterior Circulation Infarct’ to Assess Gender Differences  

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Objective: We evaluated the risk factors, demographic, clinical and etiological characteristics of patients with total anterior circulation infarct (TACI). In this study, we aimed to elucidate the impact of gender-based differences on these parameters.Methods: A total of 74 patients with TACI were enrolled in the study. 38 (51.3%) patients were female and 36 (48.6%) were male. We compared the age, previous stroke, prestroke modified Rankin Scale (mRS) scores, National Health Interview Survey ...

I?nanc?, Yusuf; Kaplan, Yu?ksel; Kamis?li, O?zden; Kamis?li, Suat; O?zcan, Cemal

2013-01-01

267

Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?  

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Full Text Available Aim: Various studies have shown that one of these predisposing risk factors, namely the anatomical narrowness of the upper airway, is linked to insulin resistance, atherosclerosis, obesity, and HT related diseases. This study investigates the possible relation between HT and the Modified Mallampati Score (MMS which is linked to the anatomical narrowness of the upper airway at the oropharynx level. Material and Method: The study covers a total of 138 adults of which 57 are women (41.3% and 81 are men (58.7%. The patients were selected among those adults who had presented to the cardiology clinic with a known history of hypertension, without any systemic diseases, not on medication for any reason, and without any anatomical problems that could give way to airway obstruction through a detailed ENT examination. Results: According to MMS the mean figures of systolic and diastolic blood there was a statistically significant relation between HT and MMS (p<0.05. There was also a statistically significant difference between the systolic and diastolic blood pressures of patients with MMS1-MMS2, MMS1-MMS3. The same relation was found between MMS2-MMS3 only regarding the diastolic pressures (p<0.017. Discussion: It is shown that high MMS is related to HT. We think that it would be best for high MMS patients be evaluated concerning HT during the initial examination of the patient by the clinician.

Güçlü Beriat

2012-07-01

268

A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality  

DEFF Research Database (Denmark)

Background: The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals' 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality.Methods: Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment.Results: The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality.Conclusion: The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.

StØvring, Henrik; Harmsen, Charlotte G

2012-01-01

269

Cardiovascular Risk Score, Cognitive Decline, and Dementia in Older Mexican Americans: The Role of Sex and Education  

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Background: The purpose of this study was to examine the associations of cardiovascular disease (CVD) risk with cognitive decline and incidence of dementia and cognitive impairment but not dementia (CIND) and the role of education as a modifier of these effects. Methods and Results: One thousand one hundred sixteen Mexican American elderly were followed annually in the Sacramento Area Latino Study on Aging. Our sex?specific 10?year CVD risk score included baseline age, systolic blood pres...

Hazzouri, Adina Zeki Al; Haan, Mary N.; Neuhaus, John M.; Pletcher, Mark; Peralta, Carmen A.; Lopez, Lenny; Pe?rez Stable, Eliseo J.

2013-01-01

270

Almanac 2012: cardiovascular risk scores. The journals present selected research that has driven recent advances in clinical cardiology  

Directory of Open Access Journals (Sweden)

Full Text Available Global risk scores use individual level information on non-modifiable risk factors (such as age, sex, ethnicity and family history and modifiable risk factors (such as smoking status and blood pressure to predict an individual's absolute risk of an adverse event over a specified period of time in the future. Cardiovascular risk scores have two major uses in practice. First, they can be used to dichotomise people into a group whose baseline risk, and therefore potential absolute benefit, is sufficiently high to justify the costs and risks associated with an intervention (whether treatment or prevention and a group with a lower absolute risk to whom the intervention is usually denied. Second, they can be used to assess the effectiveness of an intervention (such as smoking cessation or antihypertensive treatment at reducing an individual's risk of future adverse events. In this context, they can be helpful in informing patients, motivating them to change their lifestyle, and reinforcing the importance of continued compliance.

Jill P. Pell

2013-04-01

271

Models of Assessment of the Credit Risk of Borrowers with a Time Parameter for the Systems of Application Credit Scoring ?????? ?????? ?????????? ????? ????????? ? ????????? ?????????? ??? ?????? ??????????????? ?????????? ????????  

Directory of Open Access Journals (Sweden)

Full Text Available The article considers a concept of introduction of the time factor into the models of application credit scoring as a key characteristic of a default level. Using example of data of the consumption segment of the credit market of Ukraine, the article presents results of modelling the credit risk of potential borrowers (applicants, using approaches of Kaplan-Meier and Cox.? ?????? ??????????? ????????? ???????? ??????? ??????? ? ?????? ??????????????? ?????????? ???????? ??? ???????? ?????????????? ?????? ???????. ?? ??????? ?????? ???????????????? ???????? ?????????? ????? ??????? ???????????? ?????????? ????????????? ?????????? ????? ????????????? ????????? (???????????, ????????? ??????? ???????-?????? ? ?????.

Pisanets Konstantin K.

2013-07-01

272

A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement.  

Science.gov (United States)

Risk stratification tools used in patients with severe aortic stenosis have been mostly derived from surgical series. Although specific predictors of early mortality with transcatheter aortic valve replacement (TAVR) have been identified, the prognostic impact of their combination is unexplored. We sought to develop a simple score, using preprocedural variables, for prediction of 30-day mortality after TAVR. A total of 1,878 patients from a national multicenter registry who underwent TAVR were randomly assigned in a 2:1 manner to development and validation data sets. Baseline characteristics of the 1,256 patients in the development data set were considered as candidate univariate predictors of 30-day mortality. A bootstrap multivariate logistic regression process was used to select correlates of 30-day mortality that were subsequently weighted and integrated into a scoring system. Seven variables were weighted proportionally to their respective odds ratios for 30-day mortality (glomerular filtration rate logistic European System for Cardiac Operative Risk Evaluation in the validation data set, the model showed better discrimination (C statistic 0.71 vs 0.66), goodness of fit (Hosmer-Lemeshow p value 0.81 vs 0.00), and global accuracy (Brier score 0.054 vs 0.073). In conclusion, the risk of 30-day mortality after TAVR may be estimated by combining 7 baseline clinical variables into a simple risk scoring system. PMID:24837264

Capodanno, Davide; Barbanti, Marco; Tamburino, Corrado; D'Errigo, Paola; Ranucci, Marco; Santoro, Gennaro; Santini, Francesco; Onorati, Francesco; Grossi, Claudio; Covello, Remo Daniel; Capranzano, Piera; Rosato, Stefano; Seccareccia, Fulvia

2014-06-01

273

Development of a risk score for low back pain in office workers - a cross-sectional study  

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Full Text Available Abstract Background Low back pain (LBP is common among office workers and is the most common cause of work-related disability in people under 45 years of age. The aetiology of LBP is widely accepted to be multi-factorial. Prognostic research into office workers at risk of developing LBP has received limited attention. The aims of this study were to develop a risk score to identify office workers likely to have LBP and to evaluate its predictive power. Methods 397 office workers filled out a self-administered questionnaire and underwent physical examination. The questionnaire gathered data on individual, work-related physical and psychosocial data as well as the presence of low back pain in the previous 4 weeks. The physical examination included measurement of body weight, height, waist circumference, hamstrings length, spinal scoliosis, spinal curve, Backache Index and lumbar stability. Logistic regression was used to select significant factors associated with LBP to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score. Results The model included six items: previous history of working as an office worker, years of work experience, continuous standing for >2 hrs/d, frequency of forward bending during work day, chair having lumbar support and Backache Index outcome. The risk score for LBP in office workers (The Back pain Risk score for Office Workers: The BROW was built with a risk score ranging from 0 to 9. A cut-off score of ?4 had a sensitivity of 80% and a specificity of 58%. The positive predictive value and negative predictive values were 70% each. Conclusions The BROW is easy and quick to administer. It appears to have reasonable sensitivity, specificity, positive predictive value and negative predictive values for the cut-off point of ?4. The BROW is a promising tool for use to identify office workers in need of early interventions. Further prospective study is needed to validate the predictive performance of the BROW.

Moolkay Patriya

2011-01-01

274

Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction : A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions  

DEFF Research Database (Denmark)

Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes.

Larsen, Karen Kjær; Christensen, Bo

2013-01-01

275

Trombo auricular derecho con riesgo embólico durante infarto agudo de miocardio / Right auricular thrombus with embolic risk during myocardial acute infarction  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Un trombo móvil en la aurícula derecha implica un riesgo elevado de embolismo pulmonar y la presencia del mismo en un paciente con fibrilación auricular en el curso de un infarto agudo de miocardio, es infrecuente. Se presentó una paciente con infarto agudo de miocardio, fibrilación auricular y trom [...] bo móvil en aurícula derecha con riesgo embólico pulmonar, que desapareció luego de tratamiento antiagregante plaquetario y anticoagulante. Abstract in english A mobile thrombus into the right auricle leads to a high risk of pulmonary embolism and its presence in a patient with auricular fibrillation during a acute myocardial infarction is uncommon. This is the case of a female patient presenting with acute myocardial infarction, auricular fibrillation and [...] a mobile thrombus in right auricle with risk of pulmonary embolism, which disappeared after platelet, anticoagulant and anti-aggregating treatment.

Amaury, Flores Sánchez; Damaris, Hernández-Veliz; Biolkis, Zorio Valdés; María Beatriz, Cabalé Vilariño.

276

The progress of interrelationship between myocardial perfusion imaging and coronary artery calcium score in cardiac risk assessment  

International Nuclear Information System (INIS)

Coronary heart disease (CHD) is a common and frequently occurring disease which seriously threaten the health of human beings. So diagnosing CHD early and assessing the cardiac risk accurately and non-invasively that is a clinical problem which is urgent need for solving. Although the effectiveness of risk assessment algorithms have been proved by lots of clinical trials, but still has some limitations. The combination of myocardial perfusion imaging and coronary artery calcium score is promising in CHD diagnosis and cardiac risk assessment. (authors)

277

Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction  

Science.gov (United States)

Background Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR >144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16–4.0, p=0.014). Conclusions This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI. PMID:24751474

Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Barutcu, Ahmet; Altun, Burak; Bekler, Adem; Binnetoglu, Emine; Sen, Hacer; Gunes, Fahri; Gazi, Sabri

2014-01-01

278

Coronary artery calcium score. Influence of the reconstruction interval on cardiac risk stratification in asymptomatic patients using dual-source computed tomography  

International Nuclear Information System (INIS)

To evaluate the impact of the reconstruction interval on coronary calcium score and cardiac risk stratification using dual-source computed tomography (DSCT). Materials and Methods: DSCT coronary calcium scoring was performed in 61 consecutive patients, and five data sets per patient were reconstructed within diastole (50 - 70 % of the R-R interval). The Agatston score, volumetric score and the relative variability were assessed for all reconstructions. To assess the individual cardiovascular risk, patients were assigned to risk groups based on age and gender-matched percentile ranks. Results: The mean Agatston score was 184.8±377.9 (relative variability 47%±52%). The mean volumetric score was 164.4±310.1 (relative variability 49%±58%). There was a negative correlation between the total Agatston score and the relative variability (r = -0.37; p < 0.01). Depending on the reconstruction interval used, 18 predominantly young patients were assigned to more than one risk group. Conclusion: Despite the increased temporal resolution of DSCT examinations, the Agatston and volumetric scores depend on the reconstruction time within the cardiac cycle. The fact that the greatest relative variability for both the Agatston score and the volumetric score was found in young patients with small amounts of coronary calcium may result in different treatment strategies for young patients depending on the reconstruction used. Therefore, more accurate risk stratification may require the e risk stratification may require the analysis of multiple reconstruction intervals. (orig.)

279

Value of negative predischarge exercise testing in identifying patients at low risk after acute myocardial infarction treated by systemic thrombolysis.  

Science.gov (United States)

Although thrombolytic therapy reduces mortality in patients with acute myocardial infarction (AMI), it is associated with a greater incidence of successive coronary events, and there is still no ideal diagnostic and therapeutic strategy for such patients. The present study verifies the value of negative predischarge exercise testing in identifying low-risk patients treated with thrombolysis after AMI. One hundred fifty-seven consecutive patients with an uncomplicated clinical course underwent maximal or symptom-limited exercise testing (Bruce treadmill protocol) within 15 days of AMI in the absence of therapy. The location of the AMI was anterior in 51 patients, inferior in 85 and non-Q-wave in 21. All of the patients were followed for 6 months. Death and nonfatal reinfarction were considered as major coronary events, and the recurrence of angina as a minor event. Exercise test results were negative in 105 patients (group 1) and positive for angina or ST depression greater than or equal to 0.1 mV in 52 (group 2). No deaths occurred during follow-up; there were 3 reinfarctions (3%) and 7 cases (7%) of postinfarction angina in group 1, and 2 reinfarctions (4%) and 21 cases (40%) of postinfarction angina in group 2. By the end of follow-up, 90% of the patients with negative exercise test results were event-free (97% in the case of major events). These results show that thrombolytic therapy does not affect the value of negative postinfarction exercise testing in identifying low-risk patients. PMID:1615866

Piccalò, G; Pirelli, S; Massa, D; Cipriani, M; Sarullo, F M; De Vita, C

1992-07-01

280

Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction.  

LENUS (Irish Health Repository)

BACKGROUND: Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in 3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures. METHODS AND RESULTS: The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3x upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI(4 mm) >\\/=500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI(4 mm) >\\/=500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI(4 mm) (P=0.0002). CONCLUSIONS: NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention.

Goldstein, James A

2012-02-01

 
 
 
 
281

Risk stratification in trauma and haemorrhagic shock: Scoring systems derived from the TraumaRegister DGU(®).  

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Scoring systems commonly attempt to reduce complex clinical situations into one-dimensional values by objectively valuing and combining a variety of clinical aspects. The aim is to allow for a comparison of selected patients or cohorts. To appreciate the true value of scoring systems in patients with multiple injuries it is necessary to understand the different purposes of quantifying the severity of specific injuries and overall trauma load, being: (1) clinical decision making; (2) triage; (3) planning of trauma systems and resources; (4) epidemiological and clinical research; (5) evaluation of outcome and trauma systems, including quality assessment; and (6) estimation of costs and allocation of resources. For the first two, easy-to estimate scores with immediate availability are necessary, mainly based on initial physiology. More sophisticated scores considering age, gender, injury pattern/severity and more are usually used for research and outcome evaluation, once the diagnostic and therapeutic process has been completed. For score development large numbers of data are necessary and thus, it appears as a logical consequence that large registries as the TraumaRegister DGU(®) of the German Trauma Society (TR-DGU) are used to derive and validate clinical scoring systems. A variety of scoring systems have been derived from this registry, the majority of them with focus on hospital mortality. The most important among these systems is probably the RISC score, which is currently used for quality assessment and outcome adjustment in the annual audit reports. This report summarizes the various scoring systems derived from the TraumaRegister DGU(®) over the recent years. PMID:25284230

Wutzler, Sebastian; Maegele, Marc; Wafaisade, Arasch; Wyen, Hendrik; Marzi, Ingo; Lefering, Rolf

2014-10-01

282

Family history of myocardial infarction as an independent risk factor for coronary heart disease.  

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The hypothesis that a family history of heart attack before the age of 60 years is an independent risk factor for coronary heart disease was examined in a random sample of 1044 men aged 40-70. Data on personal and family history, smoking, weight, height, plasma lipid and lipoprotein concentrations, blood pressure, and resting and exercise electrocardiograms were collected according to the standard Lipid Research Clinics protocol. A history of heart attack in first degree relatives was ascerta...

Friedlander, Y.; Kark, J. D.; Stein, Y.

1985-01-01

283

Therapeutic implications of selecting the SCORE (European versus the D'AGOSTINO (American risk charts for cardiovascular risk assessment in hypertensive patients  

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Full Text Available Abstract Background No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR scale and the chart currently recommended in Europe (SCORE with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. Methods A total of 474 hypertensive patients aged 40–65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values ? 20% and ? 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. Results Mean patient age was 54.1 (SD 7.3, and 58.4% were males. A high CVR was found in 17.5% using the SCORE chart (25.3% males, 6.6% females and in 32.7% using the D'Agostino method (56.9% males, 12,7% females. Kappa coefficient was 0.52, and increased to 0.68 when the high CVR threshold was established at 29% according to D'Agostino. Hypertensive patients with high SCORE and non-high D'Agostino (1.7% were characterized by an older age, diabetes, and a lower atherogenic index, while the opposite situation (16.9% was associated to males, hyperlipidaemia, and a higher atherogenic index. Variables with a greater weight in discrepancies were sex and smoking. A 32.0% according to SCORE and 33.5% according to D'Agostino would be candidates to receive antihypertensive treatment, and 15.8% and 27.3% respectively to receive lipid-lowering treatment. Conclusion A moderate to high agreement was found. SCORE may underestimate risk in males with an unfavourable lipid profile, and D'Agostino in diabetics with a lower atherogenic risk. Use of the D'Agostino scale implies treating more patients with lipid-lowering and antihypertensive drugs as compared to SCORE.

Giné-Garriga Maria

2009-05-01

284

Venous infarctions  

International Nuclear Information System (INIS)

Strokes of venous origin are relatively infrequent. They usually cause venous infarcts which can be observed in 2 main circumstances: cerebral thrombophlebitis or dural arteriovenous (A.V.) fistulae drainging into cerebral veins. The authors study the CT and angiographic aspects of these venous infarcts and their evolution. Conventional angiography remains indispensable to confirm the diagnosis. (orig.)

285

Venous infarctions  

International Nuclear Information System (INIS)

Strokes of venous origin are relatively infrequent. They usually cause venous infarcts which can be observed in 2 main circumstances: cerebral thrombophlebitis or dural arteriovenous (AV) fistulae draining into cerebral veins. The authors study the CT and angiographic aspects of these venous infarcts and their evolution. Conventional angiography remains indispensible to confirm the diagnosis

286

Comparing the probability of stroke by the Framingham risk score in hypertensive Korean patients visiting private clinics and tertiary hospitals  

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Full Text Available Abstract Background The purpose of this study was to investigate the pattern of distribution of risk factors for stroke and the 10-year probability of stroke by the Framingham risk score in hypertensive patients visiting private clinics vs. tertiary hospitals. Methods A total of 2,490 hypertensive patients who attended 61 private clinics (1088 patients and 37 tertiary hospitals (1402 patients were enrolled. The risk factors for stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation. Results The proportion of patients who had uncontrolled hypertension despite the use of antihypertensive agents was 49% (66 and 36% of patients cared for at private clinics and tertiary hospitals, respectively; p Conclusions Since the 10-year probability of stroke by the Framingham risk score in hypertensive patients attending tertiary hospitals was higher than the risk for patients attending private clinics. We suggest that the more aggressive interventions are needed to prevent and early detect an attack of stroke in hypertensive patients attending tertiary hospitals.

Choi Cheol

2010-09-01

287

Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients  

DEFF Research Database (Denmark)

To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.

Podlekareva, D N; Grint, D

2013-01-01

288

Coronary artery calcium score. Influence of the reconstruction interval on cardiac risk stratification in asymptomatic patients using dual-source computed tomography  

Energy Technology Data Exchange (ETDEWEB)

To evaluate the impact of the reconstruction interval on coronary calcium score and cardiac risk stratification using dual-source computed tomography (DSCT). Materials and Methods: DSCT coronary calcium scoring was performed in 61 consecutive patients, and five data sets per patient were reconstructed within diastole (50 - 70 % of the R-R interval). The Agatston score, volumetric score and the relative variability were assessed for all reconstructions. To assess the individual cardiovascular risk, patients were assigned to risk groups based on age and gender-matched percentile ranks. Results: The mean Agatston score was 184.8{+-}377.9 (relative variability 47%{+-}52%). The mean volumetric score was 164.4{+-}310.1 (relative variability 49%{+-}58%). There was a negative correlation between the total Agatston score and the relative variability (r = -0.37; p < 0.01). Depending on the reconstruction interval used, 18 predominantly young patients were assigned to more than one risk group. Conclusion: Despite the increased temporal resolution of DSCT examinations, the Agatston and volumetric scores depend on the reconstruction time within the cardiac cycle. The fact that the greatest relative variability for both the Agatston score and the volumetric score was found in young patients with small amounts of coronary calcium may result in different treatment strategies for young patients depending on the reconstruction used. Therefore, more accurate risk stratification may require the analysis of multiple reconstruction intervals. (orig.)

Jensen, Christoph J.; Jochims, M.; Eberle, H.C.; Wolf, A.; Bruder, O. [Elisabeth Krankenhaus Essen (Germany). Klinik fuer Kardiologie und Angiologie; Nassenstein, K.; Forsting, M.; Schlosser, T. [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

2011-03-15

289

The Value of the European Society of Cardiology Guidelines for Refining Stroke Risk Stratification in Patients With Atrial Fibrillation Categorized as Low Risk Using the Anticoagulation and Risk Factors in Atrial Fibrillation Stroke Score : A Nationwide Cohort Study  

DEFF Research Database (Denmark)

BACKGROUND: Our objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as "low risk" using the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc [congestive heart failure, hypertension, age ? 75 years, diabetes, previous stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the low-risk category defined by the ATRIA score. METHODS: In our cohort of 207,543 incident patients with AF from 1999 to 2012, we identified 72,452 subjects who had an ATRIA score of 0 to 5 (low risk). RESULTS: Even among these patients categorized as low risk using the ATRIA score, the 1-year stroke/thromboembolic event rate ranged from 1.13 to 36.94 per 100 person-years, when subdivided by CHA2DS2-VASc scores. In patients with an ATRIA score 0 to 5, C statistics at 1 year follow-up in the Cox regression model were significantly improved from 0.626 (95% CI, 0.612-0.640) to 0.665 (95% CI, 0.651-0.679) when the CHA2DS2-VASc score was used for categorizing stroke risk instead of the ATRIA score (P < .001). CONCLUSIONS: Patients categorized as low risk using an ATRIA score 0 to 5 are not necessarily low risk, with 1-year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the "truly low risk" subjects with AF who do not need any antithrombotic therapy.

Lip, Gregory Y H; Nielsen, Peter BrØnnum

2014-01-01

290

Hip and fragility fracture prediction by 4-item clinical risk score and mobile heel BMD: a women cohort study  

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Full Text Available Abstract Background One in four Swedish women suffers a hip fracture yielding high morbidity and mortality. We wanted to revalidate a 4-item clinical risk score and evaluate a portable heel bone mineral density (BMD technique regarding hip and fragility fracture risk among elderly women. Methods In a population-based prospective cohort study we used clinical risk factors from a baseline questionnaire and heel BMD to predict a two-year hip and fragility fracture outcome for women, in a fracture preventive program. Calcaneal heel BMD was measured by portable dual X-ray laser absorptiometry (DXL and compared to hip BMD, measured with stationary dual X-ray absorptiometry (DXA technique. Results Seven women suffered hip fracture and 14 women fragility fracture/s (at hip, radius, humerus and pelvis among 285 women; 60% having heel BMD ? -2.5 SD. The 4-item FRAMO (Fracture and Mortality Index combined the clinical risk factors age ?80 years, weight Conclusions In a follow-up study we identified high risk groups for hip and fragility fracture with our plain 4-item risk model. Increased fracture risk was also related to decreasing heel BMD in calcaneal bone, measured with a mobile DXL technique. A combination of high FRAMO Index, prior fragility fracture, and very low BMD restricted the high risk group to 11%, among whom most hip fractures occurred (71%. These practical screening methods could eventually reduce hip fracture incidence by concentrating preventive resources to high fracture risk women.

Thulesius Hans

2010-03-01

291

Risk Prediction Scores for Recurrence and Progression of Non-Muscle Invasive Bladder Cancer: An International Validation in Primary Tumours  

Science.gov (United States)

Objective We aimed to determine the validity of two risk scores for patients with non-muscle invasive bladder cancer in different European settings, in patients with primary tumours. Methods We included 1,892 patients with primary stage Ta or T1 non-muscle invasive bladder cancer who underwent a transurethral resection in Spain (n?=?973), the Netherlands (n?=?639), or Denmark (n?=?280). We evaluated recurrence-free survival and progression-free survival according to the European Organisation for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) risk scores for each patient and used the concordance index (c-index) to indicate discriminative ability. Results The 3 cohorts were comparable according to age and sex, but patients from Denmark had a larger proportion of patients with the high stage and grade at diagnosis (p<0.01). At least one recurrence occurred in 839 (44%) patients and 258 (14%) patients had a progression during a median follow-up of 74 months. Patients from Denmark had the highest 10-year recurrence and progression rates (75% and 24%, respectively), whereas patients from Spain had the lowest rates (34% and 10%, respectively). The EORTC and CUETO risk scores both predicted progression better than recurrence with c-indices ranging from 0.72 to 0.82 while for recurrence, those ranged from 0.55 to 0.61. Conclusion The EORTC and CUETO risk scores can reasonably predict progression, while prediction of recurrence is more difficult. New prognostic markers are needed to better predict recurrence of tumours in primary non-muscle invasive bladder cancer patients. PMID:24905984

Vedder, Moniek M.; Marquez, Mirari; de Bekker-Grob, Esther W.; Calle, Malu L.; Dyrskj?t, Lars; Kogevinas, Manoils; Segersten, Ulrika; Malmstrom, Per-Uno; Algaba, Ferran; Beukers, Willemien; ?rntoft, Torben F.; Zwarthoff, Ellen; Real, Francisco X.; Malats, Nuria; Steyerberg, Ewout W.

2014-01-01

292

[Modification of risk factors after cerebral infarct: results of the Klosterneuburg Stroke Databank].  

Science.gov (United States)

A number of studies have shown that reduction of elevated blood pressure and other major risk factors are essential for the primary prevention of stroke. In contrast, only sparce data exist as to the reduction of risk factors in secondary prevention although many patients are only ready to modify their lifestyle after having suffered a stroke. This study reports the results of the one-year follow-up examinations from the Klosterneuburg Stroke Data Bank, a prospective, hospital-based registry. Out of 870 stroke survivors (97.4% follow-up rate) registered between 1988 and 1994 575 patients (69%) had been hypertensive before their index stroke. Out of these, 112 hypertensives (19.7% of all hypertensives) had not received antihypertensive treatment before their index stroke. Compared to all other hypertensive stroke patients they were significantly younger (p = 0.01), more often regular drinkers (p = 0.01), and regular smokers (p = 0.007). They showed significantly less heart diseases (p = 0.03) as well as prior strokes (p = 0.006). 12 months after the index-stroke the rate of untreated hypertension in this group fell to 6.0% (34 patients). In the latter group there were more frequent prior strokes compared to those hypertensives who started regular treatment after their index stroke (p = 0.003). Out of 221 smokers only 115 (52%) had quit smoking within one year after the index-stroke and 110 out of 270 (40.7%) stroke patients that had had regular alcohol intake had stopped drinking. 42 out of 118 (36%) patients who had been regular drinkers and smokers continued to drink and smoke. Regular intake of aspirin was noted more often in those patients who also had regular blood pressure checks (p = 0.009) and regular antihypertensive treatment (p = 0.001). It is concluded that there is insufficient modification of risk factors after stroke and controlled interventional studies in secondary stroke prevention are an important issue. PMID:9139471

Dachenhausen, A; Brainin, M; Steiner, M

1997-01-01

293

High lifetime risk of cardiovascular disease vs low 10-year Framingham risk score in HIV-infected subjects under ART in Spain: the Coronator study  

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Full Text Available Purpose: Due to the relative low age of HIV-infected patients, Framingham risk score (FRS usually estimates a low CVD risk. Lifetime risk estimations use the risk of developing CVD over the course of an individual's remaining lifetime and may be useful in communicating the risk of CVD to young patients. Our aim is to estimate the lifetime risk of CVD in a representative sample of HIV patients under antiretroviral therapy in Spain. Methods: Cross-sectional analysis in 10 HIV units across Spain, including information on demographics, HIV disease status, treatment history and cardiovascular risk factors of subject under ART. Lifetime CVD risk was calculated with the method of Berry et al, which classifies the lifetime risk in five mutually exclusive categories: 1. All risk factors are optimal; 2. At least one risk factor is not optimal; 3. At least one risk factor is elevated; 4. One major risk factor is present; and 5. Two or more major risk factors are present. Risk factors included are cholesterol level, blood pressure, diabetes and tobacco smoking. We grouped these five categories in two major groups, low-risk (groups 1+2+3 and high-risk category (groups 4+5. We calculated the prevalence of having a high lifetime risk, and its crude and aOR (adjusted by age, sex, place of origin, education level, transmission category, time since HIV diagnosis, CDC stage, current and nadir CD4 count, HCV coinfection, time on current and total ART, being on the first ART regimen, and PI vs. NNRTI regimen. Results: We included 839 subjects free of previous CVD disease: 72% men, median age 45.6y, median CD4 count 598 cells, median time since HIV diagnosis 11y, median time on ART 6.3y, 87% had undetectable VL. Estimated 10-year CVD risk was low (<5% in 78% of the patients, and intermediate (5–10% in 20%. Lifetime risk estimation shows a high risk profile for 71.4% of the population studied (?1 major risk factors. Factors significantly and independently associated with an increased lifetime risk were older age, non-Spanish origin and longer time on ART. Adjusted OR for patients on ART longer than 10 years (vs<5 years was 2.2 [95% CI 1.13–4.34]. No relationship was found with current or nadir CD4 lymphocyte counts, CDC stage C, HCV confection or type of ART. Conclusions: There are significant disparities between the low 10y CVD risk estimated with FRS and the elevated lifetime risk in HIV patients on ART. Prolonged ART is associated with an increased CVD lifetime risk.

C Miralles

2012-11-01

294

High lifetime risk of cardiovascular disease vs low 10-year Framingham risk score in HIV-infected subjects under ART in Spain: the Coronator study  

Science.gov (United States)

Purpose Due to the relative low age of HIV-infected patients, Framingham risk score (FRS) usually estimates a low CVD risk. Lifetime risk estimations use the risk of developing CVD over the course of an individual's remaining lifetime and may be useful in communicating the risk of CVD to young patients. Our aim is to estimate the lifetime risk of CVD in a representative sample of HIV patients under antiretroviral therapy in Spain. Methods Cross-sectional analysis in 10 HIV units across Spain, including information on demographics, HIV disease status, treatment history and cardiovascular risk factors of subject under ART. Lifetime CVD risk was calculated with the method of Berry et al, which classifies the lifetime risk in five mutually exclusive categories: 1. All risk factors are optimal; 2. At least one risk factor is not optimal; 3. At least one risk factor is elevated; 4. One major risk factor is present; and 5. Two or more major risk factors are present. Risk factors included are cholesterol level, blood pressure, diabetes and tobacco smoking. We grouped these five categories in two major groups, low-risk (groups 1+2+3) and high-risk category (groups 4+5). We calculated the prevalence of having a high lifetime risk, and its crude and aOR (adjusted by age, sex, place of origin, education level, transmission category, time since HIV diagnosis, CDC stage, current and nadir CD4 count, HCV coinfection, time on current and total ART, being on the first ART regimen, and PI vs. NNRTI regimen). Results We included 839 subjects free of previous CVD disease: 72% men, median age 45.6y, median CD4 count 598 cells, median time since HIV diagnosis 11y, median time on ART 6.3y, 87% had undetectable VL. Estimated 10-year CVD risk was low (<5%) in 78% of the patients, and intermediate (5–10%) in 20%. Lifetime risk estimation shows a high risk profile for 71.4% of the population studied (?1 major risk factors). Factors significantly and independently associated with an increased lifetime risk were older age, non-Spanish origin and longer time on ART. Adjusted OR for patients on ART longer than 10 years (vs<5 years) was 2.2 [95% CI 1.13–4.34]. No relationship was found with current or nadir CD4 lymphocyte counts, CDC stage C, HCV confection or type of ART. Conclusions There are significant disparities between the low 10y CVD risk estimated with FRS and the elevated lifetime risk in HIV patients on ART. Prolonged ART is associated with an increased CVD lifetime risk.

Estrada, V; Masia, M; Iribarren, J; Sanchez-Marcos, C; Lozano, F; Miralles, C; Olalla, J; Santos, J; Bernardino, J; Dronda, F; Domingo, P

2012-01-01

295

Use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs in high doses increases mortality and risk of reinfarction in patients with prior myocardial infarction  

DEFF Research Database (Denmark)

The selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk, but the risk in patients with established cardiovascular disease is unknown. In the present study, we analyzed the risk of rehospitalization for acute myocardial infarction (re-MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with a prior myocardial infarction (MI). We included 58,432 patients discharged alive after a first MI, and subsequent use of all NSAIDs was identified from a nationwide register of drug dispensing from pharmacies. We found a dose-dependent increase in risk of death for both the selective COX-2 inhibitors and the nonselective NSAIDs (all of the drugs tested). There were trends for increased risk of re-MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs (high dosages). Selective COX-2 inhibitors in all dosages and nonselective NSAIDsin high dosages should be used with particular caution in patients with a prior MI Udgivelsesdato: 2008/1

SØrensen, Rikke; AbildstrØm, Steen Zabell

2008-01-01

296

Risk-based priority scoring for Brookhaven National Laboratory environmental restoration programs  

International Nuclear Information System (INIS)

This report describes the process of estimating the risk associated with environmental restoration programs under the Brookhaven National Laboratory Office of Environmental Restoration. The process was part of an effort across all Department of Energy facilities to provide a consistent framework to communicate risk information about the facilities to senior managers in the DOE Office of Environmental Management to foster understanding of risk activities across programs. the risk evaluation was a qualitative exercise. Categories considered included: Public health and safety; site personnel safety and health; compliance; mission impact; cost-effective risk management; environmental protection; inherent worker risk; environmental effects of clean-up; and social, cultural, political, and economic impacts

297

Risk-based priority scoring for Brookhaven National Laboratory environmental restoration programs  

Energy Technology Data Exchange (ETDEWEB)

This report describes the process of estimating the risk associated with environmental restoration programs under the Brookhaven National Laboratory Office of Environmental Restoration. The process was part of an effort across all Department of Energy facilities to provide a consistent framework to communicate risk information about the facilities to senior managers in the DOE Office of Environmental Management to foster understanding of risk activities across programs. the risk evaluation was a qualitative exercise. Categories considered included: Public health and safety; site personnel safety and health; compliance; mission impact; cost-effective risk management; environmental protection; inherent worker risk; environmental effects of clean-up; and social, cultural, political, and economic impacts.

Morris, S.C.; Meinhold, A.F.

1995-05-01

298

Hypertension and the risk of acute myocardial infarction in Argentina. The Argentine Factores de Riesgo Coronario en America del Sur (FRICAS) Investigators.  

Science.gov (United States)

The relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, case-control study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy-two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self-report, when admitted to the medical center. The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08-3.19). The odds ratio was 2.42 (95% confidence interval, 1.88-3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87-5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90-3.24) and to 4.12 (95% confidence interval, 2.83-5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was less-than-or-equal140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96-3.41), and it was 3.42 (95% confidence interval, 2.40-4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was less-than-or-equal90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91-3.22), and if it was >90 mm Hg, it increased nearly four-fold (odds ratio=3.72; 95% confidence interval, 2.33-5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present. In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients. (c) 2001 by CHF, Inc. PMID:11828201

Ciruzzi, M; Pramparo, P; Rozlosnik, J; Zylberstjn, H; Delmonte, H; Haquim, M; Abecasis, B; de La Cruz Ojeda, J; Mele, E; La Vecchia, C; Schargrodsky, H

2001-01-01

299

Effect of serum lipid level change on 10-year coronary heart risk distribution estimated by means of seven different coronary risk scores during one-year treatment  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. This study was done in order to evaluate the effect of serum levels of total cholesterol, triglycerides, low-density lipoprotein- cholesterol and high-density lipoprotein-cholesterol on 10-year coronary heart disease risk distribution change. Material and Methods. This study included 110 subjects of both genders (71 female and 39 male, aged 29 to 73, treated at the Outpatient Department of Atherosclerosis Prevention, Centre for Laboratory Medicine, Clinical Centre Vojvodina. The 10-year coronary heart disease risk was estimated on first examination and after one-year treatment by means of Framingham, PROCAM and SCORE coronary risk scores and their modifications (Framingham Adult Treatment Panel III, Framingham Weibul, PROCAM NS and PROCAM Cox Hazards. Age, gender, systolic and diastolic blood pressure, smoking, positive family history and left ventricular hypertrophy are risk factors involved in the estimation of coronary heart disease besides lipid parameters. Results. There were no significant differences in nutritional status, smoking habits, systolic and diastolic pressure, and no development of diabetes mellitus or cardiovascular incidents during oneyear follow. However, a significant reduction in cholesterol level (p<0.001, triglycerides (p<0.001, low-density lipoprotein cholesterol (p<0.001 and an increase in high-density lipoprotein cholesterol (p<0.02 was present although therapeutic target values were not achieved. In addition, a significant increase was observed in the category of low 10-year coronary heart disease risk (Framingham- p<0.001; Framingham ATP III- p<0.001; Framingham Weibul- p<0.001; PROCAM- p<0.05; PROCAM NSp< 0.05; PROCAM Cox Hazards- p<0.001; SCORE- p<0.001 and a reduction in high-risk category (Framingham- p<0.001; Framingham ATP III- p<0.005; Framingham Weibul- p<0.005; PROCAM- p<0.001; PROCAM NS-p<0.001; PROCAM Cox Hazards- p<0.001; SCORE- p<0.005 in comparison with the risk at the beginning of the study. Conclusion. Our results show that the correction of lipid level after one-year treatment leads to a significant redistribution of 10-year coronary heart disease risk estimated by means of seven different coronary risk scores. This should stimulate patients and doctors to persist in prevention measures.

Eremi?-Koji? Nevena

2014-01-01

300

Usefulness of the Admission Shock Index for Predicting Short-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction.  

Science.gov (United States)

Current risk scores of ST-segment elevation myocardial infarction (STEMI) need sophisticated algorithm and were limited for bedside use. Our study aimed to evaluate the usefulness of admission shock index (SI) for predicting the short-term outcomes in patients with STEMI. Included were 7,187 consecutive patients with STEMI. The admission SI was defined as the ratio of admission heart rate and systolic blood pressure. Patients were divided into 2 groups with SI Myocardial Infarction risk score. In conclusion, admission SI, an easily calculated index at first contact, may be a useful predictor for short-term outcomes especially for acute phase outcomes in patients with STEMI. PMID:25201214

Huang, Bi; Yang, Yanmin; Zhu, Jun; Liang, Yan; Tan, Huiqiong; Yu, Litian; Gao, Xin; Li, Jiandong

2014-11-01

 
 
 
 
301

Development and validation of a risk score for hospitalization for heart failure in patients with Type 2 Diabetes Mellitus  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background There are no risk scores available for predicting heart failure in Type 2 diabetes mellitus (T2DM. Based on the Hong Kong Diabetes Registry, this study aimed to develop and validate a risk score for predicting heart failure that needs hospitalisation in T2DM. Methods 7067 Hong Kong Chinese diabetes patients without history of heart failure, and without history and clinical evidence of coronary heart disease at baseline were analyzed. The subjects have been followed up for a median period of 5.5 years. Data were randomly and evenly assigned to a training dataset and a test dataset. Sex-stratified Cox proportional hazard regression was used to obtain predictors of HF-related hospitalization in the training dataset. Calibration was assessed using Hosmer-Lemeshow test and discrimination was examined using the area under receiver's operating characteristic curve (aROC in the test dataset. Results During the follow-up, 274 patients developed heart failure event/s that needed hospitalisation. Age, body mass index (BMI, spot urinary albumin to creatinine ratio (ACR, HbA1c, blood haemoglobin (Hb at baseline and coronary heart disease during follow-up were predictors of HF-related hospitalization in the training dataset. HF-related hospitalization risk score = 0.0709 × age (year + 0.0627 × BMI (kg/m2 + 0.1363 × HbA1c(% + 0.9915 × Log10(1+ACR (mg/mmol - 0.3606 × Blood Hb(g/dL + 0.8161 × CHD during follow-up (1 if yes. The 5-year probability of heart failure = 1-S0(5EXP{0.9744 × (Risk Score - 2.3961}. Where S0(5 = 0.9888 if male and 0.9809 if female. The predicted and observed 5-year probabilities of HF-related hospitalization were similar (p > 0.20 and the adjusted aROC was 0.920 for 5 years of follow-up. Conclusion The risk score had adequate performance. Further validations in other cohorts of patients with T2DM are needed before clinical use.

Lam Christopher W

2008-04-01

302

Industry-specific risk models for numerical scoring of hazards and prioritization of safety measures  

International Nuclear Information System (INIS)

Risk analysis consists of five cornerstones that have to be viewed in an holistic manner by risk practitioners of any organization regardless of the industry type or nature of its critical infrastructures. The cornerstones are hazard identification, risk assessment and consequence analysis, determination of risk management actions required to reduce risks to acceptable levels, communication of risk insights among the stake-holders, and continuous monitoring and verification to ensure sustained attainment of tolerable risk levels. Our primary objectives in this research are two fold: first, we compare and contrast a wide spectrum of current industry-specific and application-dependent semi-quantitative risk models. Secondly, based on the insights to be gained from the first task, we propose a framework for a robust risk-based approach for conducting security vulnerability assessment (SVA). Risk practitioners of critical infrastructures, such as commercial nuclear power plants, water utilities, chemical plants, transmission and distribution substations... etc., could readily use this proposed approach to classify, evaluate, and prioritize risks to support allocation of resources required to ensure protection of public health and safety. (author)

303

clinical risk factors for osteoporosis in Ireland and the UK: a comparison of FRAX and QFractureScores.  

Science.gov (United States)

Recently two algorithms have become available to estimate the 10-year probability of fracture in patients suspected to have osteoporosis on the basis of clinical risk factors: the FRAX algorithm and QFractureScores algorithm (QFracture). The aim of this study was to compare the performance of these algorithms in a study of fracture patients and controls recruited from six centers in the United Kingdom and Ireland. A total of 246 postmenopausal women aged 50-85 years who had recently suffered a low-trauma fracture were enrolled and their characteristics were compared with 338 female controls who had never suffered a fracture. Femoral bone mineral density was measured by dual-energy X-ray absorptiometry, and fracture risk was calculated using the FRAX and QFracture algorithms. The FRAX algorithm yielded higher scores for fracture risk than the QFracture algorithm. Accordingly, the risk of major fracture in the overall study group was 9.5% for QFracture compared with 15.2% for FRAX. For hip fracture risk the values were 2.9% and 4.7%, respectively. The correlation between FRAX and QFracture was R = 0.803 for major fracture and R = 0.857 for hip fracture (P ? 0.0001). Both algorithms yielded high specificity but poor sensitivity for prediction of osteoporosis. We conclude that the FRAX and QFracture algorithms yield similar results in the estimation of fracture risk. Both of these tools could be of value in primary care to identify patients in the community at risk of osteoporosis and fragility fractures for further investigation and therapeutic intervention. PMID:21647704

Cummins, N M; Poku, E K; Towler, M R; O'Driscoll, O M; Ralston, S H

2011-08-01

304

Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians.  

LENUS (Irish Health Repository)

Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat\\/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.

Cooney, Marie Therese

2009-09-29

305

Edad avanzada y factores de riesgo para infarto agudo de miocardio Risk factors for acute myocardial infarction in the elderly  

Directory of Open Access Journals (Sweden)

Full Text Available Este estudio caso-control analizó en los sujetos añosos el rol de los factores de riesgo coronario en el desarrollo del infarto agudo de miocardio (IAM, estableció la naturaleza de esta asociación y el grado de riesgo. Los datos fueron obtenidos en una investigación que incluyó 1060 casos y 1071 controles, realizada en 35 unidades coronarias de centros médicos de Argentina entre noviembre de 1991 y agosto de 1994. Nuestro análisis se basó en la información de los sujetos mayores de 65 años. Los casos fueron 427 pacientes con un primer IAM. Los controles fueron 396 sujetos sin evidencias clinicas de enfermedad cardiovascular, seleccionados en los mismos centros que los casos. Los Odds Ratios (OR y su intervalo de confianza del 95% (IC 95% se obtuvieron mediante un análisis de regresión logística, incluyendo variables como la edad, educación, clase social, tabaquismo, antecedente de diabetes o hipertensión arterial, índice de masa corporal e historia familiar de enfermedad coronaria. Los factores de riesgo relacionados independientemente con IAM fueron los siguientes: hipercolesterolemia (colesterol sérico > 240 mg/dl: OR=1.76 (IC 95%: 1.25-2.49, tabaquismo: OR=1.6 (IC 95%: 1.06-2.4, hipertensión arterial: OR=2.05 (IC 95%: 1.51-2.73, diabetes OR=1.71 (IC 95%: 1.12-2.70, historia de un familiar con enfermedad coronaria: OR=1.36 (IC 95%: 0.93-1.97 y de dos o más familiares: OR=2.63 (IC 95%: 1.21-5.71. Este estudio, confirma en los sujetos de edad avanzada la importancia de la hipercolesterolemia, del tabaquismo, la hipertesión arterial, la diabetes y la historia familiar de enfermedad coronaria como factores de riesgo de IAMThis case-control study, analized the role of coronary risk factors in acute myocardial infarction (AMI in the elderly, and established the nature of this association and the degree of risk. Data were derived from an investigation (1060 cases and 1071 controls conducted in 35 coronary care units from clinical centres in Argentina between November 1991 and August 1994. Our analysis was based on data collected from subjets over age 65. Cases were 427 patients with AMI and without history of ischaemic heart disease. Controls were 396 subjects identified in the same centres as the cases. Odds ratios (OR estimates and their 95% confidence intervals (CI were derived from multiple logistic regression equations including terms for age, education, social status, smoking status, history of diabetes or hypertension, body mass index and family history of coronary heart disease. The risk factors independently and strongly related to the risk of AMI were the following: hyperlipidemia (serum cholesterol > 240 mg/dl: OR=1.76 (95% CI: 1.25-2.49, smoking habits: OR=1.6 (95% CI: 1.06-2.4, hypertension: OR=2.05 (95% CI: 1.51-2.73, diabetes OR=1.71 (95% CI: 1.12-2.70, one relative with family history of coronary heart disease: OR=1.36 (95% CI: 0.93-1.97 and two or more relatives: OR=2.63 (95% CI: 1.21-5.71. This study confirms in the elderly the importance of hyperlipidemia, tobacco, hypertension, diabetes and family history of coronary heart disease as risks factors of AMI.

M. A. Ciruzzi

2002-12-01

306

Impacto do tipo de procedimento e do fator cirurgião na validação do EuroSCORE / Impact of type of procedure and surgeon on EuroSCORE operative risk validation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Objetivo: O EuroSCORE tem sido utilizado na estimativa de risco em cirurgia cardíaca, apesar de fatores importantes não serem considerados. O objetivo foi validar o EuroSCORE na predição de mortalidade em cirurgia cardiovascular num centro brasileiro, definindo a influência do tipo de procedimento [...] e da equipe cirúrgica responsável pelo paciente. Métodos: No período de janeiro de 2006 a junho de 2011, 2320 pacientes adultos consecutivos foram estudados. De acordo com o EuroSCORE aditivo, os pacientes foram divididos em risco baixo (escore 12). A relação entre a mortalidade observada (O) sobre a esperada (E) de acordo com o EuroSCORE logístico foi calculada para cada um dos grupos, procedimentos e cirurgiões com > de 150 operações, e analisada por regressão logística. Resultados: O EuroSCORE calibrou com a mortalidade observada (O/E=0,94; P Abstract in english Objective: EuroSCORE has been used in cardiac surgery operative risk assessment, despite important variables were not included. The objective of this study was to validate EuroSCORE on mortality prediction in a Brazilian cardiovascular surgery center, defining the influence of type of procedure and [...] surgical team. Methods: Between January 2006 and June 2011, 2320 consecutive adult patients were studied. According to additive EuroSCORE, patients were divided into low risk (score12). The relation between observed mortality (O) and expected mortality (E) according to logistic EuroSCORE was calculated for each of the groups, types of procedures and surgeons with > 150 operations, and analyzed by logistic regression. Results: EuroSCORE correlated to the observed mortality (O/E=0.94; P

Fernando A., Atik; Claudio Ribeiro da, Cunha.

2014-04-01

307

Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction: A Nationwide Cohort Study  

DEFF Research Database (Denmark)

Background- Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). Methods and Results- Patients =30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. Therewere 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). Conclusions- Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.

Schjerning Olsen, Anne-Marie; FosbØl, Emil L

2011-01-01

308

Identifying admitted patients at risk of dying : a prospective observational validation of four biochemical scoring systems  

DEFF Research Database (Denmark)

Risk assessment is an important part of emergency patient care. Risk assessment tools based on biochemical data have the advantage that calculation can be automated and results can be easily provided. However, to be used clinically, existing tools have to be validated by independent researchers. This study involved an independent external validation of four risk stratification systems predicting death that rely primarily on biochemical variables.

Brabrand, Mikkel; Knudsen, Torben

2013-01-01

309

The Relationship of Gensini Score with the Cardiovascular Risk of Patients with Indication of Angiography  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: This study was designed to explore the contribution of risk factors for coronary artery disease (CAD) in patients with indication for coronary angiography. Coronary angiography is defined as the radiographic visualization of the coronary vessels after injection of radio opaque contrast media. Despite the recognition of risk factors for CAD, the association between related risk factors and angiographic findings remains controversial. The aim of the present study was to explore the ...

Abbas Mohagheghi M.D.; Mehrnaz Mohebi M.D.; Daruosh Kamal Hedayat M.D.; Abdulhoseyn Tabatabaee M.D.; Narges Naseri M.D.

2011-01-01

310

Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort  

DEFF Research Database (Denmark)

Background: Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously developed diabetes risk score, PreDxH Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. Methodology/Principal Findings: DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged 30–60) for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity was fixed to match MetS, DRS had a significantly lower false positive rate. Similarly, when the false positive rate was fixed to match MetS, DRS had a significantly higher specificity. In further analyses, subjects were classified by presence of 0–2, 3 or 4–5 risk factors with matching proportions of subjects distributed among three DRS groups. Comparison between the two risk stratification schemes, MetS risk factors and DRS, were evaluated using Net Reclassification Improvement (NRI). Comparing risk stratification by DRS to MetS factors in the total population, the NRI was 0.146 (p = 0.008) demonstrating DRS provides significantly improved stratification. Additionally, the relative risk of T2DM differed by 15 fold between the low and high DRS risk groups, but only 8-fold between the low and high risk MetS groups. Conclusions/Significance: DRS provides a more accurate assessment of risk for diabetes than MetS. This improved performance may allow clinicians to focus preventive strategies on those most in need of urgent intervention.

Shafizadeh, Tracy B; Moler, Edward J

2011-01-01

311

The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke  

Science.gov (United States)

Background We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade. Methods and Findings A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%–34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements. Conclusions Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths. Please see later in the article for the Editors' Summary PMID:23874160

Basu, Sanjay; Glantz, Stanton; Bitton, Asaf; Millett, Christopher

2013-01-01

312

Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).  

Science.gov (United States)

There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2-4.6%) in 962 high-risk vs 0.6% (95% CI 0.2-1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3-5.3%) in 714 high-risk vs 1.1% (95% CI 0.6-2.3%) in 764 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10-0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28-0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis. PMID:24226257

Nendaz, M; Spirk, D; Kucher, N; Aujesky, D; Hayoz, D; Beer, J H; Husmann, M; Frauchiger, B; Korte, W; Wuillemin, W A; Jäger, K; Righini, M; Bounameaux, H

2014-03-01

313

Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction: a case-control study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction. Methods Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM or glutathione-conjugating (glutathione S-transferase P, GSTP1 genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls. The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration. Results There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury were divided into tertiles, individuals with GCLM-588 TT genotype displayed a lower risk relative to the CC genotype in all but one tertile; in most tertiles the odds ratio was around 0.5 for TT. However, there were few TT carriers and the results were not statistically significant. The results were similar when taking plasma eicosapentaenoic+docosahexaenoic acid, erythrocyte-selenium and erythrocyte-mercury into account simultaneously. Conclusions No statistically significant genetic modifying effects were seen for the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction. Still, our results indicate that the relatively rare GCLM-588 TT genotype may have an impact, but a larger study is necessary for confirmation.

Norberg Margareta

2011-04-01

314

Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS study  

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Full Text Available Emily B Levitan,1 Christopher Gamboa,1 Monika M Safford,2 Dana V Rizk,3 Todd M Brown,4 Elsayed Z Soliman,5 Paul Muntner11Department of Epidemiology, 2Division of Preventive Medicine, 3Division of Nephrology, 4Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA; 5Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston Salem, NC, USABackground: Individuals with unrecognized myocardial infarction (UMI have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI. The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.Methods: Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036. Myocardial infarction (MI status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%, and RMI (self-reported history of MI; n = 1574; 7.5%.Results: For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19–1.52. Blood pressure control (<140/90 mmHg was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93–1.13.Conclusion: Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.