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Sample records for infarction risk score

  1. A genetic risk score of 45 coronary artery disease risk variants associates with increased risk of myocardial infarction in 6041 Danish individuals

    DEFF Research Database (Denmark)

    Krarup, N T; Borglykke, A

    2015-01-01

    BACKGROUND: In Europeans, 45 genetic risk variants for coronary artery disease (CAD) have been identified in genome-wide association studies. We constructed a genetic risk score (GRS) of these variants to estimate the effect on incidence and clinical predictability of myocardial infarction (MI) and CAD. METHODS: Genotype was available from 6041 Danes. An unweighted GRS was constructed by making a summated score of the 45 known genetic CAD risk variants. Registries provided information (mean follow-up = 11.6 years) on CAD (n = 374) and MI (n = 124) events. Cox proportional hazard estimates with age as time scale was adjusted for sex, BMI, type 2 diabetes mellitus and smoking status. Analyses were also stratified either by sex or median age (below or above 45 years of age). We estimated GRS contribution to MI prediction by assessing net reclassification index (NRI) and integrated discrimination improvement (IDI) added to the European SCORE for 10-year MI risk prediction. RESULTS: The GRS associated significantly with risk of incident MI (allele-dependent hazard ratio (95%CI): 1.06 (1.02-1.11), p = 0.01) but not with CAD (p = 0.39). Stratification revealed association of GRS with MI in men (1.06 (1.01-1.12), p = 0.02) and in individuals above the median of 45.11 years of age (1.06 (1.00-1.12), p = 0.03). There was no interaction between GRS and gender (p = 0.90) or age (p = 0.83). The GRS improved neither NRI nor IDI. CONCLUSION: The GRS of 45 GWAS identified risk variants increase the risk of MI in a Danish cohort. The GRS did not improve NRI or IDI beyond the performance of conventional European SCORE risk factors.

  2. Coronary artery calcium scoring in myocardial infarction

    International Nuclear Information System (INIS)

    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 patients. (author)

  3. Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico / TIMI risk score for acute myocardial infarction according to prognostic stratification / Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico

    Scientific Electronic Library Online (English)

    Jaqueline Locks, Pereira; Thiago Mamôru, Sakae; Michele Cardoso, Machado; Charles Martins de, Castro.

    2009-08-01

    Full Text Available FUNDAMENTO: O escore de risco TIMI (thrombolysis in myocardial infarction) é derivado de ensaio clínico envolvendo pacientes elegíveis para fibrinólise. Como o perfil de risco desses casos difere do encontrado em populações não selecionadas, é importante que se analise a aplicabilidade do escore em [...] condições clínicas habituais. OBJETIVO: Avaliar o manejo e a evolução hospitalar de pacientes internados com infarto agudo do miocárdio conforme estratificação de risco pelo escore TIMI. MÉTODOS: Foram avaliados, retrospectivamente, 103 casos de infarto agudo do miocárdio com supradesnivelamento do segmento ST, admitidos no Hospital Nossa Senhora da Conceição, em Tubarão, nos anos de 2004 e 2005. Os casos foram analisados em três grupos de risco de acordo com o escore TIMI. RESULTADOS: A mortalidade hospitalar pós-infarto foi de 17,5%. No grupo de baixo risco não houve óbito. A mortalidade foi de 8,1% no grupo de médio risco e de 55,6% no de alto risco. O risco de morte para casos de alto risco foi 14,1 vezes maior em relação aos casos de médio e baixo risco (IC95% = 4,4 a 44,1 e p Abstract in spanish FUNDAMENTO: El score de riesgo TIMI (thrombolysis in myocardial infarction) se derivó de ensayo clínico que implicó a pacientes elegibles para fibrinólisis. Como el perfil de riesgo de esos casos difiere del encontrado en poblaciones no seleccionadas, es importante que se analice la aplicabilidad de [...] l score en condiciones clínicas habituales. OBJETIVO: Evaluar el manejo y la evolución hospitalaria de pacientes internados con infarto agudo de miocardio de acuerdo con la estratificación de riesgo mediante la puntuación TIMI. MÉTODOS: Se evaluaron, retrospectivamente, 103 casos de infarto agudo de miocardio con supradesnivelamiento del segmento ST, ingresados en el Hospital Nossa Senhora da Conceição, en Tubarão, en los años de 2004 y 2005. Se analizaron los casos en tres grupos de riesgo según el score TIMI. RESULTADOS: La mortalidad hospitalaria postinfarto fue de un 17,5%. En el grupo de bajo riesgo no hubo óbito. La mortalidad fue del 8,1% en el grupo de medio riesgo y de un 55,6% en el de alto riesgo. El riesgo de muerte para casos de alto riesgo fue 14,1 veces mayor con relación a los casos de medio y bajo riesgo (IC95% = 4,4 a 44,1 y p Abstract in english BACKGROUND: The TIMI (Thrombolysis in Myocardial Infarction) risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the sco [...] re in usual clinical conditions. OBJECTIVES: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. METHODS: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. RESULTS: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p

  4. Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico TIMI risk score for acute myocardial infarction according to prognostic stratification

    Directory of Open Access Journals (Sweden)

    Jaqueline Locks Pereira

    2009-08-01

    Full Text Available FUNDAMENTO: O escore de risco TIMI (thrombolysis in myocardial infarction é derivado de ensaio clínico envolvendo pacientes elegíveis para fibrinólise. Como o perfil de risco desses casos difere do encontrado em populações não selecionadas, é importante que se analise a aplicabilidade do escore em condições clínicas habituais. OBJETIVO: Avaliar o manejo e a evolução hospitalar de pacientes internados com infarto agudo do miocárdio conforme estratificação de risco pelo escore TIMI. MÉTODOS: Foram avaliados, retrospectivamente, 103 casos de infarto agudo do miocárdio com supradesnivelamento do segmento ST, admitidos no Hospital Nossa Senhora da Conceição, em Tubarão, nos anos de 2004 e 2005. Os casos foram analisados em três grupos de risco de acordo com o escore TIMI. RESULTADOS: A mortalidade hospitalar pós-infarto foi de 17,5%. No grupo de baixo risco não houve óbito. A mortalidade foi de 8,1% no grupo de médio risco e de 55,6% no de alto risco. O risco de morte para casos de alto risco foi 14,1 vezes maior em relação aos casos de médio e baixo risco (IC95% = 4,4 a 44,1 e pFUNDAMENTO: El score de riesgo TIMI (thrombolysis in myocardial infarction se derivó de ensayo clínico que implicó a pacientes elegibles para fibrinólisis. Como el perfil de riesgo de esos casos difiere del encontrado en poblaciones no seleccionadas, es importante que se analice la aplicabilidad del score en condiciones clínicas habituales. OBJETIVO: Evaluar el manejo y la evolución hospitalaria de pacientes internados con infarto agudo de miocardio de acuerdo con la estratificación de riesgo mediante la puntuación TIMI. MÉTODOS: Se evaluaron, retrospectivamente, 103 casos de infarto agudo de miocardio con supradesnivelamiento del segmento ST, ingresados en el Hospital Nossa Senhora da Conceição, en Tubarão, en los años de 2004 y 2005. Se analizaron los casos en tres grupos de riesgo según el score TIMI. RESULTADOS: La mortalidad hospitalaria postinfarto fue de un 17,5%. En el grupo de bajo riesgo no hubo óbito. La mortalidad fue del 8,1% en el grupo de medio riesgo y de un 55,6% en el de alto riesgo. El riesgo de muerte para casos de alto riesgo fue 14,1 veces mayor con relación a los casos de medio y bajo riesgo (IC95% = 4,4 a 44,1 y pBACKGROUND: The TIMI (Thrombolysis in Myocardial Infarction risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions. OBJECTIVES: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. METHODS: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. RESULTS: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p <0.001. The chance of receiving fibrinolytic was 50% lower in the high-risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004. CONCLUSION: There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.

  5. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette; Grove, Erik; Hansen, Peter Riis; Ahlehoff, Ole; Buhl, Christian Selmer; Lindhardsen, Jesper; Madsen, Jan Kyst; Køber, Lars; Torp-Pedersen, Christian; Gislason, Gunnar H; Olesen, Jonas Bjerring; Selmer, Christian Laust Weise

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASUR...

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

    Directory of Open Access Journals (Sweden)

    Luis C. L. Correia

    2014-08-01

    Full Text Available 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.

  7. Association between family risk of stroke and myocardial infarction with prevalent risk factors and coexisting diseases.

    OpenAIRE

    Kennedy, RE; HOWARD, G; Go, RC; Rothwell, PM; Tiwari, HK; Feng, R; McClure, LA; Prineas, RJ; Banerjee, A.(Variable Energy Cyclotron Centre, Kolkata, 700064, India); Arnett, DK

    2012-01-01

    BACKGROUND AND PURPOSE: Familial transmission of stroke and myocardial infarction (MI) is partially mediated by transmission of cerebrovascular and cardiovascular risk factors. We examined relationships between family risk of stroke and MI with risk factors for these phenotypes. METHODS: A cross-sectional association between the stratified log-rank family score for stroke and MI with prevalent risk factors was assessed in the REasons for Geographic And Racial Differences in Stroke (REGARDS) c...

  8. Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico TIMI risk score for acute myocardial infarction according to prognostic stratification

    OpenAIRE

    Jaqueline Locks Pereira; Thiago Mamôru Sakae; Michele Cardoso Machado; Charles Martins de Castro

    2009-01-01

    FUNDAMENTO: O escore de risco TIMI (thrombolysis in myocardial infarction) é derivado de ensaio clínico envolvendo pacientes elegíveis para fibrinólise. Como o perfil de risco desses casos difere do encontrado em populações não selecionadas, é importante que se analise a aplicabilidade do escore em condições clínicas habituais. OBJETIVO: Avaliar o manejo e a evolução hospitalar de pacientes internados com infarto agudo do miocárdio conforme estratificação de risco pelo escore TIMI. MÉTODOS: F...

  9. The correlative analysis between volume measurement by SPECT and the clinical scoring in cerebral infarction

    International Nuclear Information System (INIS)

    The reliability of the clinical scoring system by the volume measurement of cerebral infarction with SPECT was assessed. The volume measurement of left and right brain in 20 healthy subjects was used as control. We studied the correlations between the volume of infarcted lesion measured by SPECT and two kinds of clinical scoring system in 31 patients who suffered from simple unilateral cerebral infarction. The correlation coefficient between volume and score was 0.631?0.795 (P<0.001). The coincidence rate was rather good. SPECT study has objectively showed that these 2 kinds of clinical scoring system are quite reliable

  10. Comparison of Selvester QRS score with magnetic resonance imaging measured infarct size in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Bang, Lia E

    2012-01-01

    Recent studies have shown that the Selvester QRS score is significantly correlated with delayed enhancement-magnetic resonance imaging (DE-MRI) measured myocardial infarct (MI) size in reperfused ST elevation MI (STEMI). This study further tests the hypothesis that Selvester QRS score correlates well with MI size determined by DE-MRI in reperfused STEMI.

  11. Systemic Risk Score: A Suggestion

    OpenAIRE

    Hurlin, Christophe; Pérignon, Christophe

    2013-01-01

    We identify a potential bias in the methodology disclosed in July 2013 by the Basel Committee on Banking Supervision (BCBS) for identifying systemically important financial banks. Contrary to the original objective, the relative importance of the five categories of risk importance (size, cross-jurisdictional activity, interconnectedness, substitutability/financial institution infrastructure, and complexity) may not be equal and the resulting systemic risk scores are mechanically dominated by ...

  12. The SYNTAX score and SYNTAX-based clinical risk scores.

    Science.gov (United States)

    Farooq, Vasim; Brugaletta, Salvatore; Serruys, Patrick W

    2011-01-01

    Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the SYNTAX pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the SYNTAX score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score. PMID:22041038

  13. Plasma HDL cholesterol and risk of myocardial infarction : a mendelian randomisation study

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M

    2012-01-01

    BACKGROUND: High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes, mendelian randomisation can be used to test the hypothesis that the association of a plasma biomarker with disease is causal. METHODS: We performed two mendelian randomisation analyses. First, we used as an instrument a single nucleotide polymorphism (SNP) in the endothelial lipase gene (LIPG Asn396Ser) and tested this SNP in 20 studies (20?913 myocardial infarction cases, 95?407 controls). Second, we used as an instrument a genetic score consisting of 14 common SNPs that exclusively associate with HDL cholesterol and tested this score in up to 12?482 cases of myocardial infarction and 41?331 controls. As a positive control, we also tested a genetic score of 13 common SNPs exclusively associated with LDL cholesterol. FINDINGS: Carriers of the LIPG 396Ser allele (2·6% frequency) had higher HDL cholesterol (0·14 mmol/L higher, p=8×10(-13)) but similar levels of other lipid and non-lipid risk factors for myocardial infarction compared with non-carriers. This difference in HDL cholesterol is expected to decrease risk of myocardial infarction by 13% (odds ratio [OR] 0·87, 95% CI 0·84-0·91). However, we noted that the 396Ser allele was not associated with risk of myocardial infarction (OR 0·99, 95% CI 0·88-1·11, p=0·85). From observational epidemiology, an increase of 1 SD in HDL cholesterol was associated with reduced risk of myocardial infarction (OR 0·62, 95% CI 0·58-0·66). However, a 1 SD increase in HDL cholesterol due to genetic score was not associated with risk of myocardial infarction (OR 0·93, 95% CI 0·68-1·26, p=0·63). For LDL cholesterol, the estimate from observational epidemiology (a 1 SD increase in LDL cholesterol associated with OR 1·54, 95% CI 1·45-1·63) was concordant with that from genetic score (OR 2·13, 95% CI 1·69-2·69, p=2×10(-10)). INTERPRETATION: Some genetic mechanisms that raise plasma HDL cholesterol do not seem to lower risk of myocardial infarction. These data challenge the concept that raising of plasma HDL cholesterol will uniformly translate into reductions in risk of myocardial infarction. FUNDING: US National Institutes of Health, The Wellcome Trust, European Union, British Heart Foundation, and the German Federal Ministry of Education and Research.

  14. Gender and secondary risk assessment following an ST-elevation myocardial infarction

    OpenAIRE

    Scruth E; Worrall-Carter L; Cheng E.

    2013-01-01

    Elizabeth Scruth,1,3 Linda Worrall-Carter,1 Eugene Cheng2 1St Vincent’s/ACU Centre for Nursing Research, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia; 2Kaiser Permanente Medical Group, San Jose, CA, USA; 3Kaiser Permanente Northern California, Oakland, CA, USA Purpose: The Thrombolysis in Myocardial Infarction (TIMI) risk score, Global Register of Acute Coronary Events (GRACE) risk score, and the Controlled Abcixi...

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

    International Nuclear Information System (INIS)

    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)

  16. 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.)

  17. Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    2007-01-01

    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 prospe...

  18. The Role of Unknown Risk Factors in Myocardial Infarction

    OpenAIRE

    Nita A Tanna; Rakesh Siyaram Srivastava; Vilpa Arvindbhai Tanna; Hetal Vithalbhai Vaishnani

    2013-01-01

    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 melli...

  19. Gender and secondary risk assessment following an ST-elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Scruth E

    2013-08-01

    Full Text Available Elizabeth Scruth,1,3 Linda Worrall-Carter,1 Eugene Cheng2 1St Vincent’s/ACU Centre for Nursing Research, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia; 2Kaiser Permanente Medical Group, San Jose, CA, USA; 3Kaiser Permanente Northern California, Oakland, CA, USA Purpose: The Thrombolysis in Myocardial Infarction (TIMI risk score, Global Register of Acute Coronary Events (GRACE risk score, and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC risk score are validated predictors of secondary events and death after an acute coronary syndrome (ACS. In our study, we sought to examine the predictability of the TIMI, GRACE, and the CADILLAC risk scores in women undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI for in-hospital, 1-year major cardiac events, nonmajor cardiac events, and mortality. A limited number of studies examining the secondary risk scores for use after STEMI in women have been conducted. Most studies have been conducted in both men and women without separating out the predictability in women in regard to the various risk scores. Patients and methods: In a subanalysis of women from a larger study of both men and women with STEMI, a 1-year follow up of 77 women with STEMI was undertaken using a retrospective approach and comparing the TIMI, GRACE, and CADILLAC risk scores for in-hospital and 1-year outcomes of major cardiac events, nonmajor cardiac events, and death. The predictive value of the models was assessed with evaluation of the area under the curve in receiver operating-characteristic analysis. Results: The study revealed that risk stratification of female patients with STEMI early after presentation using the TIMI risk score or after angiography using the CADILLAC risk score may provide important prognostic information and enable accurate identification of high-risk patients. Conclusion: Though limited by sample size and retrospective analysis, our study provided evidence into the validity of using existing secondary risk tools in women. Further studies are needed to determine the risk score that is most predictive for women presenting with STEMI and treated with percutaneous coronary intervention. It may be useful to incorporate the risk scores into clinical practice to guide short- and long-term follow-up after STEMI in women as a preventive strategy. Keywords: cardiovascular risk, acute coronary syndromes, nonmajor cardiac events, major cardiac events

  20. Risk profile in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD), aged 20 to 40 years, in our population. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit (CCU) and were managed for Acute myocardial infarction (MI). Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years (SD=3.67). Majority of patients were males. Smoking was the major risk factor (64.2%) followed by family history of IHD (30.7%). Most frequent risk factor for Acute myocardial infarction (MI) at young age is smoking followed by family history. (author)

  1. Evaluation of area at risk by 123I-BMIPP in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate the detection of area at risk of acute myocardial infarction (AMI) by 123I-BMIPP (BMIPP). 99mTc-tetrofosmin (TF) scintigraphy was performed on 13 patients with AMI with total coronary occlusion. BMIPP scintigraphy was done on the same patients within 1 week after successful reperfusion by direct PTCA. Activity of both tracers was scored in 8 basal, 8 midventricular and 2 apical segments, using a four-point grading system as defect score: 3=defect, 2=severely low uptake, 1=slightly low uptake, 0=normal. Extent score (ES) was defined as a total number of segment which deteriorated uptake, and severity score (SS) was defined as a total score of defect score. ES of BMIPP was 6.5±2.4 and that of TF was 7.5±2.4. ES of BMIPP was smaller than that of TF. A ratio of BMIPP/TF was 0.86±0.18. SS of BMIPP was 16.2±6.0 and that of TF was 19.2±5.6. SS of TF was larger than that of BMIPP. A ratio of BMIPP/TF was 0.83±0.18. A correlation of ES and SS between TF and BMIPP was excellent. BMIPP showed ischemic area by culprit lesion and infarct area clearly. We concluded that BMIPP could indicate area at risk. (author)

  2. Perioperative Anaphylactic Risk Score For Risk-Oriented Premedication

    Science.gov (United States)

    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.

    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

  3. Plasma HDL cholesterol and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M; Orho-Melander, Marju; Frikke-Schmidt, Ruth; Barbalic, Maja; Jensen, Majken Karoline; Hindy, George; Hólm, Hilma; Ding, Eric L; Johnson, Toby; Schunkert, Heribert; Samani, Nilesh J; Clarke, Robert; Hopewell, Jemma C; Thompson, John F; Li, Mingyao; Thorleifsson, Gudmar; Newton-Cheh, Christopher; Musunuru, Kiran; Pirruccello, James P; Saleheen, Danish; Chen, Li; Stewart, Alexandre F R; Schillert, Arne; Thorsteinsdottir, Unnur; Thorgeirsson, Gudmundur; Anand, Sonia; Engert, James C; Morgan, Thomas; Spertus, John; Stoll, Monika; Berger, Klaus; Martinelli, Nicola; Girelli, Domenico; McKeown, Pascal P; Patterson, Christopher C; Epstein, Stephen E; Devaney, Joseph; Burnett, Mary-Susan; Mooser, Vincent; Ripatti, Samuli; Surakka, Ida; Nieminen, Markku S; Sinisalo, Juha; Lokki, Marja-Liisa; Perola, Markus; Havulinna, Aki; de Faire, Ulf; Gigante, Bruna; Ingelsson, Erik; Zeller, Tanja; Wild, Philipp; de Bakker, Paul I W; Klungel, Olaf H; Maitland-van der Zee, Anke-Hilse; Peters, Bas J M; de Boer, Anthonius; Grobbee, Diederick E; Kamphuisen, Pieter W; Deneer, Vera H M; Elbers, Clara C; Onland-Moret, N Charlotte; Hofker, Marten H; Wijmenga, Cisca; Verschuren, W M Monique; Boer, Jolanda M A; van der Schouw, Yvonne T; Rasheed, Asif; Frossard, Philippe; Demissie, Serkalem; Willer, Cristen; Do, Ron; Ordovas, Jose M; Abecasis, Gonçalo R; Boehnke, Michael; Mohlke, Karen L; Daly, Mark J; Guiducci, Candace; Burtt, Noël P; Surti, Aarti; Gonzalez, Elena; Purcell, Shaun; Gabriel, Stacey; Marrugat, Jaume; Peden, John; Erdmann, Jeanette; Diemert, Patrick; Willenborg, Christina; König, Inke R; Fischer, Marcus; Hengstenberg, Christian; Ziegler, Andreas; Buysschaert, Ian; Lambrechts, Diether; Van de Werf, Frans; Fox, Keith A; El Mokhtari, Nour Eddine; Rubin, Diana; Schrezenmeir, Jürgen; Schreiber, Stefan; Schäfer, Arne; Danesh, John; Blankenberg, Stefan; Roberts, Robert; McPherson, Ruth; Watkins, Hugh; Hall, Alistair S; Overvad, Kim; Rimm, Eric; Boerwinkle, Eric; Tybjaerg-Hansen, Anne; Cupples, L Adrienne; Reilly, Muredach P; Melander, Olle; Mannucci, Pier M; Ardissino, Diego; Siscovick, David; Elosua, Roberto; Stefansson, Kari; O'Donnell, Christopher J; Salomaa, Veikko; Rader, Daniel J; Peltonen, Leena; Schwartz, Stephen M; Altshuler, David; Kathiresan, Sekar

    2012-01-01

    High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes, mendelian randomisation can be used to test the hypothesis that the association of a plasma biomarker with disease is causal.

  4. Left ventricular asynergy score as an indicator of previous myocardial infarction

    International Nuclear Information System (INIS)

    Sixty-eight patients with coronary heart disease (CHD) i.e. a hisotry of angina of effort and/or previous 'possible infarction' were examined inter alia with ECG and cinecardioangiography. A system of scoring was designed which allowed a semiquantitative estimate of the left ventricular asynergy from cinecardioangiography - the left ventricular motion score (LVMS). The LVMS was associated with the presence of a previous myocardial infarction (MI), as indicated by the history and ECG findings. The ECG changes specific for a previous MI were associated with high LVMS values and unspecific or absent ECG changes with low LVMS values. Decision thresholds for ECG changes and asynergy in diagnosing a previous MI were evaluated by means of a ROC analysis. The accuracy of ECG in detecting a previous MI was slightly higher when asynergy indicated a 'true MI' than when autopsy result did so in a comparable group. Therefore the accuracy of asynergy (LVMS ? 1) in detecting a previous MI or myocardial fibrosis in patients with CHD should be at least comparable with that of autopsy (scar > 1 cm). (orig.)

  5. Heart Rate Turbulence as Risk-Predictor after Myocardial Infarction

    OpenAIRE

    ChristineStefanieZuern; PetraBarthel

    2011-01-01

    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,...

  6. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977 and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early onset of acute myocardial infarct and for female patients. Overall, there do not seem to be major shared environmental or behavioral risk factors for acute myocardial infarct and cancers, except for smoking, and there seems to be no common inherited susceptibility to the development of these diseases.

  7. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977 and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the cat...

  8. Does retirement reduce the risk of myocardial infarction?

    DEFF Research Database (Denmark)

    Olesen, Kasper; Rugulies, Reiner; Rod, Naja Hulvej; Bonde, Jens Peter

    2014-01-01

    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...

  9. Plasma HDL cholesterol and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M; Orho-Melander, Marju; Frikke-Schmidt, Ruth; Barbalic, Maja; Jensen, Majken K; Hindy, George; Hólm, Hilma; Ding, Eric L; Johnson, Toby; Schunkert, Heribert; Samani, Nilesh J; Clarke, Robert; Hopewell, Jemma C; Thompson, John F; Li, Mingyao; Thorleifsson, Gudmar; Newton-Cheh, Christopher; Musunuru, Kiran; Pirruccello, James P; Saleheen, Danish; Chen, Li; Stewart, Alexandre Fr; Schillert, Arne; Thorsteinsdottir, Unnur; Thorgeirsson, Gudmundur; Anand, Sonia; Engert, James C; Morgan, Thomas; Spertus, John; Stoll, Monika; Berger, Klaus; Martinelli, Nicola; Girelli, Domenico; McKeown, Pascal P; Patterson, Christopher C; Epstein, Stephen E; Devaney, Joseph; Burnett, Mary-Susan; Mooser, Vincent; Ripatti, Samuli; Surakka, Ida; Nieminen, Markku S; Sinisalo, Juha; Lokki, Marja-Liisa; Perola, Markus; Havulinna, Aki; de Faire, Ulf; Gigante, Bruna; Ingelsson, Erik; Zeller, Tanja; Wild, Philipp; de Bakker, Paul I W; Klungel, Olaf H; Maitland-van der Zee, Anke-Hilse; Peters, Bas J M; de Boer, Anthonius; Grobbee, Diederick E; Kamphuisen, Pieter W; Deneer, Vera H M; Elbers, Clara C; Onland-Moret, N Charlotte; Hofker, Marten H; Wijmenga, Cisca; Verschuren, Wm Monique; Boer, Jolanda Ma; van der Schouw, Yvonne T; Rasheed, Asif; Frossard, Philippe; Demissie, Serkalem; Willer, Cristen; Do, Ron; Ordovas, Jose M; Abecasis, Gonçalo R; Boehnke, Michael; Mohlke, Karen L; Daly, Mark J; Guiducci, Candace; Burtt, Noël P; Surti, Aarti; Gonzalez, Elena; Purcell, Shaun; Gabriel, Stacey; Marrugat, Jaume; Peden, John; Erdmann, Jeanette; Diemert, Patrick; Willenborg, Christina; König, Inke R; Fischer, Marcus; Hengstenberg, Christian; Ziegler, Andreas; Buysschaert, Ian; Lambrechts, Diether; Van de Werf, Frans; Fox, Keith A; El Mokhtari, Nour Eddine; Rubin, Diana; Schrezenmeir, Jürgen; Schreiber, Stefan; Schäfer, Arne; Danesh, John; Blankenberg, Stefan; Roberts, Robert; McPherson, Ruth; Watkins, Hugh; Hall, Alistair S; Overvad, Kim; Rimm, Eric; Boerwinkle, Eric; Tybjaerg-Hansen, Anne; Cupples, L Adrienne; Reilly, Muredach P; Melander, Olle; Mannucci, Pier M; Ardissino, Diego; Siscovick, David; Elosua, Roberto; Stefansson, Kari; O'Donnell, Christopher J; Salomaa, Veikko; Rader, Daniel J; Peltonen, Leena; Schwartz, Stephen M; Altshuler, David; Kathiresan, Sekar

    2012-01-01

    BACKGROUND: High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes, mendelian randomisation can be used to test the hypothesis that the association of a plasma biomarker with disease is causal. METHODS: We performed two mendelian randomisation analyses. First, we u...

  10. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J

    2014-01-01

    In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich and Selvester score, indicating MaR, is stable until myocardial reperfusion therapy. In a retrospective analysis of a study population of 114 patients, 33 patients were included. The combined Aldrich and Selvester score was determined in ECGs recorded in the ambulance (ECG1) and in the hospital before reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was <4.5-percentage point. Stability of the combined Aldrich and Selvester score was observed in 12/33 patients (36.4%), and in regards to anterior and inferior ST elevation in 4/14 patients (28.6%) and 8/19 patients (42.1%), respectively. The median time between the recording of ECG1 and ECG2 was 75 minutes, however the changes in ECG scores were independent of the time between ECG recordings. Patients not meeting the stability criterion either had a decrease (9 patients) or increase (12 patients) of the combined Aldrich and Selvester score. In conclusion, the ECG estimated MaR was stable between the earliest recording time and initiation of reperfusion treatment only in a subgroup of the patients with STEMI. The findings of this study may suggest heterogeneity in regards to the development of the MaR and could indicate a potential need for differentiation in the acute treatment.

  11. A measure of mortality risk for elderly patients with acute myocardial infarction.

    Science.gov (United States)

    Van Ruiswyk, J; Hartz, A; Kuhn, E; Krakauer, H; Young, M; Rimm, A

    1993-01-01

    The objective of this study was to derive and validate a simple scoring system that predicts risk of short-term mortality in elderly patients hospitalized with acute myocardial infarction (AMI) and to compare this derived score with the MedisGroups admission severity score. A myocardial infarction severity score (MISS) was derived from a database of clinical information abstracted using MedisGroups and follow-up information on 30-day mortality status. The MISS was validated and compared with the MedisGroups Admission Severity Groups (ASGs) in a separate database. The derivation set included 2,037 Medicare patients 65 years old or older with confirmed AMI who were randomly selected from patients discharged from hospitals in seven states during 1985. The validation set consisted of 6,323 patients from the 1988 MedisGroups comparative database who were at least 65 years of age and had confirmed AMI. Multivariate logistic regression analysis found a set of nine abnormal patient characteristics that independently predict 30-day mortality. There was good agreement between mortality rates predicted by the logistic model and observed mortality rates in the validation population. This regression model was then simplified to an additive score where eight of the characteristics were weighted as one point and one characteristic was weighted as two points. The MISS is the sum of the points for each patient. In the validation dataset, the 1,373 patients with the lowest MISS scores had a mortality rate of 4.6% and the 400 patients with the highest MISS scores had a mortality rate of 64%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8483400

  12. Recurrent Stroke : The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort

    DEFF Research Database (Denmark)

    Andersen, SØren Due; Gorst-Rasmussen, Anders

    2015-01-01

    BACKGROUND AND PURPOSE: The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. METHODS: We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. RESULTS: 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. CONCLUSIONS: In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application.

  13. Prehypertension, Hypertension, and the Risk of Acute Myocardial Infarction in HIV-Infected and -Uninfected Veterans

    OpenAIRE

    Armah, Kaku A.; Chang, Chung-Chou H; Baker, Jason V.; Ramachandran, Vasan S; Budoff, Matthew J; CRANE, Heidi M.; Gibert, Cynthia L.; Goetz, Matthew B; Leaf, David A; McGinnis, Kathleen A; Oursler, Krisann K; Rimland, David; Rodriguez-Barradas, Maria C.; Sico, Jason J.; Warner, Alberta L.

    2013-01-01

    We found increased acute myocardial infarction risk among hypertensive and prehypertensive HIV-infected veterans compared to normotensive uninfected veterans, independent of confounding comorbidities.

  14. Early cerebral infarction following aneurysmal subarachnoid hemorrhage: frequency, risk factors, patterns, and prognosis.

    Science.gov (United States)

    Fu, Chao; Yu, Weidong; Sun, Libo; Li, Dongyuan; Zhao, Conghai

    2013-11-01

    Early cerebral infarction (ECI) following aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. This study aims to determine the frequency and risk factors of this special episode, as well as to assess the relationship between its patterns and outcome. We retrospectively enrolled 243 patients who underwent aneurysm treatment within 60 hours of SAH. ECI was defined as one or more new hypodense abnormalities on computed tomography within 3 days after SAH, rather than lesions attributable to edema, retraction effect, and ventricular drain placement. Risk factors were tested by multivariate analysis. The infarct was classified by an established grading system (single or multiple, cortical or deep or combined). Poor outcome was defined as the Glasgow Outcome Score of severe disability or worse. Sixty-five patients (26.7%) had early infarction. Acute hydrocephalus (odds ratio [OR] 6.67; 95% confidence interval [CI] 1.59-27.95), admission plasma glucose level (OR 1.42 per mmol/L; 95% CI 1.16-1.73), and treatment modality (OR 16.27; 95% CI 4.05-65.28) were independent predictors of ECI. The pattern was single cortical in 19 patients (29.2%), single deep in 9 (13.8%), multiple cortical in 8 (12.3%), multiple deep in 14 (21.5%), and multiple combined in 15 (23.1%). ECI was associated with delayed cerebral infarction (DCI) (P = 0.002) and poor outcome (P surgical treatment, acute hydrocephalus and high admission plasma glucose, may potentially predict DCI and unfavorable outcome. Further studies are warranted to reveal the underlying mechanisms of this event and thereby minimize it. PMID:24016219

  15. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

    DEFF Research Database (Denmark)

    Juul, Nikolai; Gislason, Gunnar

    2015-01-01

    BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  16. Online risk engines and scoring tools in endocrinology

    OpenAIRE

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

    2013-01-01

    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 vari...

  17. Genetic Risk Score Predicts Late-Life Cognitive Impairment

    Science.gov (United States)

    Wollam, Mariegold E.; Weinstein, Andrea M.; Saxton, Judith A.; Morrow, Lisa; Snitz, Beth; Fowler, Nicole R.; Suever Erickson, Barbara L.; Roecklein, Kathryn A.; Erickson, Kirk I.

    2015-01-01

    Introduction. A family history of Alzheimer's disease is a significant risk factor for its onset, but the genetic risk associated with possessing multiple risk alleles is still poorly understood. Methods. In a sample of 95 older adults (Mean age = 75.1, 64.2% female), we constructed a genetic risk score based on the accumulation of risk alleles in BDNF, COMT, and APOE. A neuropsychological evaluation and consensus determined cognitive status (44 nonimpaired, 51 impaired). Logistic regression was performed to determine whether the genetic risk score predicted cognitive impairment above and beyond that associated with each gene. Results. An increased genetic risk score was associated with a nearly 4-fold increased risk of cognitive impairment (OR = 3.824, P = .013) when including the individual gene polymorphisms as covariates in the model. Discussion. A risk score combining multiple genetic influences may be more useful in predicting late-life cognitive impairment than individual polymorphisms. PMID:26366299

  18. Body Mass Index Genetic Risk Score and Endometrial Cancer Risk

    Science.gov (United States)

    Prescott, Jennifer; Setiawan, Veronica W.; Wentzensen, Nicolas; Schumacher, Fredrick; Yu, Herbert; Delahanty, Ryan; Bernstein, Leslie; Chanock, Stephen J.; Chen, Chu; Cook, Linda S.; Friedenreich, Christine; Garcia-Closas, Monserrat; Haiman, Christopher A.; Le Marchand, Loic; Liang, Xiaolin; Lissowska, Jolanta; Lu, Lingeng; Magliocco, Anthony M.; Olson, Sara H.; Risch, Harvey A.; Shu, Xiao-Ou; Ursin, Giske; Yang, Hannah P.; Kraft, Peter; De Vivo, Immaculata

    2015-01-01

    Genome-wide association studies (GWAS) have identified common variants that predispose individuals to a higher body mass index (BMI), an independent risk factor for endometrial cancer. Composite genotype risk scores (GRS) based on the joint effect of published BMI risk loci were used to explore whether endometrial cancer shares a genetic background with obesity. Genotype and risk factor data were available on 3,376 endometrial cancer case and 3,867 control participants of European ancestry from the Epidemiology of Endometrial Cancer Consortium GWAS. A BMI GRS was calculated by summing the number of BMI risk alleles at 97 independent loci. For exploratory analyses, additional GRSs were based on subsets of risk loci within putative etiologic BMI pathways. The BMI GRS was statistically significantly associated with endometrial cancer risk (P = 0.002). For every 10 BMI risk alleles a woman had a 13% increased endometrial cancer risk (95% CI: 4%, 22%). However, after adjusting for BMI, the BMI GRS was no longer associated with risk (per 10 BMI risk alleles OR = 0.99, 95% CI: 0.91, 1.07; P = 0.78). Heterogeneity by BMI did not reach statistical significance (P = 0.06), and no effect modification was noted by age, GWAS Stage, study design or between studies (P?0.58). In exploratory analyses, the GRS defined by variants at loci containing monogenic obesity syndrome genes was associated with reduced endometrial cancer risk independent of BMI (per BMI risk allele OR = 0.92, 95% CI: 0.88, 0.96; P = 2.1 x 10?5). Possessing a large number of BMI risk alleles does not increase endometrial cancer risk above that conferred by excess body weight among women of European descent. Thus, the GRS based on all current established BMI loci does not provide added value independent of BMI. Future studies are required to validate the unexpected observed relation between monogenic obesity syndrome genetic variants and endometrial cancer risk. PMID:26606540

  19. Risk Stratification and Management of Patients with Acute Myocardial Infarction (AMI).

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Faltus, Václav; Monhart, Z.; Ryšavá, D.; Velimský, T.; Ballek, L.; Huba?, J.; Tome?ková, Marie; Janský, P.

    Timisoara : Cardiology Clinic of the Emergency County Hospital, 2007. s. 28-29. [International Workshop on the Risk Stratification in Patients with Ischemic Heart Disease. 12.04.2007-13.04.2007, Timisoara] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: BB - Applied Statistics, Operational Research

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

    Directory of Open Access Journals (Sweden)

    Lorenzo-Aguiar Dolores

    2011-01-01

    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.

  1. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention

    DEFF Research Database (Denmark)

    Munk, Kim; Andersen, Niels Holmark

    2012-01-01

    Left ventricular systolic function is a key determinant of outcome after ST-segment elevation myocardial infarction (STEMI). The aim of this study was to study speckle-tracking global longitudinal strain (GLS) for early risk evaluation in STEMI and compare it with left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI).

  2. New risk markers may change the HeartScore risk classification significantly in one-fifth of the population

    DEFF Research Database (Denmark)

    Olsen, M H; Hansen, T W

    2008-01-01

    The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population sample of 2460 individuals was divided in three groups: 472 subjects receiving cardiovascular medication or having history of diabetes, prior myocardial infarction or stroke, 559 high-risk subjects with a 10-year risk of cardiovascular death above 5% as estimated by HeartScore, and 1429 low-moderate risk subjects with estimated risk below 5%. During the following 9.5 years the composite end point of cardiovascular death, non-fatal myocardial infarction or stroke (CEP) occurred in 204 subjects. CEP was predicted in all three groups by UACR (HRs: 2.1, 2.1 and 2.3 per 10-fold increase, all P or =0.73/1.06 mg mmol(-1) or hsCRP> or =6.0/7.3 mg l(-1) identified a subgroup of 16% who experienced one-third of the CEPs. In the patient group, combined absence of high UACR and high Nt-proBNP> or =110/164 pg ml(-1) (men/women) identified a subgroup of 52% who experienced only 15% of the CEPs. Additional use of UACR and hsCRP in subjects with low-moderate risk and UACR and Nt-proBNP in subjects with known diabetes of cardiovascular disease changed HeartScore risk classification significantly in 19% of the population.

  3. 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. 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)

  4. Antidiabetic treatments and risk of hospitalisation with myocardial infarction: a nationwide case-control study

    DEFF Research Database (Denmark)

    Horsdal, Henriette Thisted; SØndergaard, Flemming

    2011-01-01

    Data on cardiovascular risk associated with different types of antidiabetic treatments are sparse and conflicting. We examined the risk of hospitalisation with myocardial infarction (MI) among patients treated with sulfonylureas, metformin, insulin, any combination and no antidiabetic pharmacotherapy.

  5. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

    LENUS (Irish Health Repository)

    Rodríguez-Granillo, Gastón A

    2012-01-05

    Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

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

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; GrØnbæk, Morten

    2009-01-01

      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

  7. Contemporary and evolving risk scoring algorithms for percutaneous coronary intervention.

    Science.gov (United States)

    Farooq, Vasim; Brugaletta, Salvatore; Serruys, Patrick W

    2011-12-01

    Risk stratification is an essential part of appropriately informing patients electing to undergo percutaneous coronary intervention (PCI). This process is also an integral part of the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery)-pioneered heart team approach in determining the most appropriate revascularisation modality for patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score to aid in this decision-making process; the lack of clinical variables in this score has, however, been its main limitation. This review examines the important established and evolving contemporary risk models used to aid this risk-stratification process. Risk scores based on clinical and anatomical variables alone and in combination-the latter of which is the subject of continuing research-are all explored. Other areas of discussion include risk scores based on the completeness of revascularisation and emerging concepts such as functional anatomical risk scores and the patient-empowered risk-benefit trade-off between PCI and coronary artery bypass grafting, to help personalise the choice of revascularisation modality. PMID:22058284

  8. Online risk engines and scoring tools in endocrinology

    Directory of Open Access Journals (Sweden)

    Partha Pratim Chakraborty

    2013-01-01

    Full Text Available 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.

  9. Time course of lesion development in patients with acute brain stem infarction and correlation with NIHSS score

    International Nuclear Information System (INIS)

    Background and purpose: diffusion weighted magnetic resonance imaging (MRI) is highly sensitive in detecting acute supratentorial cerebral ischemia and Diffusion Weighted Imaging (DWI) lesion size has been shown to correlate strongly with the neurologic deficit in middle cerebral artery territory stroke. However, data concerning infratentorial strokes are rare. We examined the size and evolution of acute brain stem ischemic lesions and their relationship to neurological outcome. Methods: brain stem infarctions of 11 patients were analyzed. We performed DWI in all patients and in 7/11 patients within 24 h, T2W sequences within the first 2 weeks (10/11 patients) and follow-up MRI (MR2) within 3-9 months (median 4.8 months) later (12/12 patients). Lesion volumes were compared with early and follow-up neurologic deficit as determined by National Institutes of Health Stroke Scale (NIHSS) score. Results: the relative infarct volumes--with MR2 lesion size set to 100%--decreased over the time (P<0.02) with a mean shrinking factor of 3.3 between DWI (MR0) and the follow-up MRT (P<0.02), and 1.6 between early T2W (MR1) and MR2 (P<0.04). The mean DWI volume size (MR0) was larger than the early T2W (P<0.02). Although neurological outcome was good in all patients (mean NIHSS score of 1.3 at follow-up), early NIHSS and follow-up NIHSS scores were strongly correlated (r=0.9, P<0.00). NIHSS score at follow-up was highly correlated with lesion size of DWI (MR0; r=0.71, P<0.04) and T2W of MR1 (r=0.86, P<0.001). Conclusions: in this study, we saw a shrinking of the brain stem infarct volume according to clinical improvement of patients. Great extension of restricted diffusion in the acute stage does not necessarily implicate a large resulting infarction or a bad clinical outcome

  10. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Schoos, Mikkel M

    2014-01-01

    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins estimating the acuteness of myocardial ischemia and Sclarovsky-Birnbaum's grades of ischemia evaluating the severity of ongoing ischemia.

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

    Directory of Open Access Journals (Sweden)

    Gong Jian

    2013-02-01

    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.

  12. 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)

  13. SCORING THE DEFAULT RISK OF LOCAL AUTHORITY

    Directory of Open Access Journals (Sweden)

    GORI Elena

    2014-06-01

    Full Text Available In the Nineties, almost all public administrations were affected by a change that made municipalities more responsible in using public resources. More recently, the global crisis and the gradual cuts in funding from the State led to significant repercussions on the budgets of local authorities with an increasing number of defaults. The Italian government introduced the procedure of “financial default” to rescue local authorities in financial difficulties from 1989. However, to date, a methodology to constantly monitor the local authorities’ "health" and to prevent financial defaults has not yet been formalized. As previous studies highlighted a close link between financial condition and service delivered to citizens, the study aims to construct a set of specific indicators to judge the default risk of Italian LAs in order to prevent defaults. In this research we use a deductive method. The research was carried out in eight different steps according to a logical process of identifying the risk indicators and the consequent risk ranges. The results are significant as they clarify the situation leading potentially to default and they propose a set of specific risk indicators to evaluate and to prevent the risk of default. This logical process could easily be adopted at an international level, with the necessary modifications for specific accounting regimes.

  14. Influence of cardiovascular risk factors on infarct size and interaction with mechanical ischaemic postconditioning in ST-elevation myocardial infarction

    Science.gov (United States)

    Pichot, Sophie; Mewton, Nathan; Bejan-Angoulvant, Theodora; Roubille, Francois; Rioufol, Gilles; Giraud, Céline; Boussaha, Inesse; Lairez, Olivier; Elbaz, Meyer; Piot, Christophe; Angoulvant, Denis; Ovize, Michel

    2015-01-01

    Objective Previous studies have shown that mechanical postconditioning (PostC) significantly reduces infarct size (IS) in patients with acute myocardial infarction. Our objective was to assess the influence of traditional cardiovascular (CV) risk factors on IS and their interaction with ischaemic PostC in patients with acute ST-elevation myocardial infarction (STEMI). Methods The study population was constituted from the clinical database pooling of four previously published PostC prospective, multicentre, randomised, open-label controlled trials with identical inclusion criteria. Patients with STEMI, presenting within 12?h of symptoms onset referred for percutaneous coronary intervention, were included. Mechanical ischaemic PostC was performed by four repeated cycles of inflation–deflation of the angioplasty balloon within 1?min of reflow, while the control group underwent no intervention. IS was assessed by measuring total creatine kinase release over 72?h. Results 173 patients, aged 58±12 years, 76% males, 48% anterior infarct were included (82 in the PostC group, 91 in the control group). IS was significantly reduced in the PostC compared to the control group (71.7±41.6 vs 88.2±54.5×103 arbitrary units; p=0.027). After adjustment for abnormally contracting segments, older patients had smaller IS and smokers had larger IS. Gender, diabetes, hypertension, dyslipidemia and obesity did not have any significant effect on IS. Multivariate regression analysis showed that none of the traditional risk factors had a significant impact on the cardioprotective effect of mechanical ischaemic PostC. Conclusions The present analysis suggests that the cardioprotective effect of mechanical PostC is not influenced by traditional CV risk factors that are prevalent in patients with STEMI. PMID:26288738

  15. 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)

    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

    Full Text Available 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.

  16. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity.

    Science.gov (United States)

    Power, Robert A; Steinberg, Stacy; Bjornsdottir, Gyda; Rietveld, Cornelius A; Abdellaoui, Abdel; Nivard, Michel M; Johannesson, Magnus; Galesloot, Tessel E; Hottenga, Jouke J; Willemsen, Gonneke; Cesarini, David; Benjamin, Daniel J; Magnusson, Patrik K E; Ullén, Fredrik; Tiemeier, Henning; Hofman, Albert; van Rooij, Frank J A; Walters, G Bragi; Sigurdsson, Engilbert; Thorgeirsson, Thorgeir E; Ingason, Andres; Helgason, Agnar; Kong, Augustine; Kiemeney, Lambertus A; Koellinger, Philipp; Boomsma, Dorret I; Gudbjartsson, Daniel; Stefansson, Hreinn; Stefansson, Kari

    2015-07-01

    We tested whether polygenic risk scores for schizophrenia and bipolar disorder would predict creativity. Higher scores were associated with artistic society membership or creative profession in both Icelandic (P = 5.2 × 10(-6) and 3.8 × 10(-6) for schizophrenia and bipolar disorder scores, respectively) and replication cohorts (P = 0.0021 and 0.00086). This could not be accounted for by increased relatedness between creative individuals and those with psychoses, indicating that creativity and psychosis share genetic roots. PMID:26053403

  17. ALDH2*2 Allele is a Negative Risk Factor for Cerebral Infarction in Chinese Women.

    Science.gov (United States)

    Li, Qiao-Yan; Zhao, Ning-Min; Ma, Jian-Jun; Duan, Hong-Fei; Ma, Yong-Cheng; Zhang, Wei; Zhao, Hong-Wei; Qin, Yu-Hua

    2015-10-01

    Unlike its reported role in the cardiovascular diseases, little information is available for mitochondrial aldehyde dehydrogenase 2 (ALDH2) in the cerebrovascular function. We investigated the different effects of ALDH2 genotypes on the risk of cerebral infarction between the genders, because different genders had different smoking and/or dinking status which are also risk factors for cerebral infarction. 247 healthy Chinese Han people (controls, group 1), 287 Chinese Han male patients with cerebral infarction (group 2), and 82 Chinese Han female patients with cerebral infarction (group 3) were involved in this study. The frequencies of the ALDH2*2 allele in group 3 were significantly higher than those in other groups (with P = 0.001 and P = 0.002, respectively). The difference of ALDH2*2 allele frequency between group 1 and group 2 was not significant (P = 0.652). After adjustment for smoking and drinking status, the male patients without smoking or drinking status (group 4) had higher ALDH2*2 allele frequency than group 1, but the difference was still not significant (P = 0.139). Thus, we conclude that ALDH2*2 allele may be a significant negative risk factor for cerebral infarction in Chinese women [odds ratio (OR) = 2.207, 95% CI 1.416-3.439]. But for Chinese male patients, the negative effects of ALDH2*2 allele on cerebral infarction which might be concealed by other risk factors were not significant. PMID:26142243

  18. 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

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh

    2008-01-01

    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

  19. A Soft Intelligent Risk Evaluation Model for Credit Scoring Classification

    Directory of Open Access Journals (Sweden)

    Mehdi Khashei

    2015-09-01

    Full Text Available Risk management is one of the most important branches of business and finance. Classification models are the most popular and widely used analytical group of data mining approaches that can greatly help financial decision makers and managers to tackle credit risk problems. However, the literature clearly indicates that, despite proposing numerous classification models, credit scoring is often a difficult task. On the other hand, there is no universal credit-scoring model in the literature that can be accurately and explanatorily used in all circumstances. Therefore, the research for improving the efficiency of credit-scoring models has never stopped. In this paper, a hybrid soft intelligent classification model is proposed for credit-scoring problems. In the proposed model, the unique advantages of the soft computing techniques are used in order to modify the performance of the traditional artificial neural networks in credit scoring. Empirical results of Australian credit card data classifications indicate that the proposed hybrid model outperforms its components, and also other classification models presented for credit scoring. Therefore, the proposed model can be considered as an appropriate alternative tool for binary decision making in business and finance, especially in high uncertainty conditions.

  20. Assessment of cardiac risk 10 days after uncomplicated myocardial infarction.

    OpenAIRE

    Jelinek, V M; McDonald, I G; Ryan, W F; Ziffer, R W; Clemens, A.; Gerloff, J

    1982-01-01

    A total of 188 patients with uncomplicated acute myocardial infarction (long-term Norris prognostic index 3.2) were rapidly mobilised, underwent a symptom-limited exercise test around the day of discharge from hospital (day 10), and returned to work at a median of six weeks after the acute event. The incidence of cardiac death six months, one year, and three years after infarction was 2.7%, 4.5%, and 7.3% respectively, and the corresponding figures for recurrent heart attacks were 3.4%, 8.2%,...

  1. High Framingham risk score decreases quality of life in adults

    Directory of Open Access Journals (Sweden)

    Christian Yosaputra

    2010-04-01

    Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.

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

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Agerbo, Esben

    2010-01-01

    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.

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

    DEFF Research Database (Denmark)

    Thune, J.J.; Signorovitch, J.; Velazquez, E.J.; McMurray, J.J.; Califf, R.M.; Maggioni, A.P.; Rouleau, J.L.; Howlett, J.; Zelenkofske, S.; Pfeffer, M.A.; Solomon, S.D.; Køber, Lars Valeur

    2007-01-01

    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)...

  4. Multivariate risk assessment and risk score cards in hypertension

    OpenAIRE

    Tocci, Giuliano; Valenti, Valentina; Sciarretta, Sebastiamo; VOLPE, MASSIMO

    2007-01-01

    Cardiovascular disease represents the leading cause of morbidity and mortality in Western countries, and hypertension-related cardiovascular events affect about 37 million people per year, worldwide. In this perspective, hypertensive patients are at increased risk to experience cardiovascular events during life-long period, and treatment of high blood pressure represents one of the most effective strategies to reduce global cardiovascular risk. However, due to its multifactorial pathophysiolo...

  5. Myocardial infarction (heart attack) and its risk factors: a statistical study

    International Nuclear Information System (INIS)

    A Statistical technique of odds ratio analysis was performed to look at the association of Myocardial Infarction with sex, smoking, hypertension, cholesterol, diabetes, family history, number of dependents, household income and residence. For this purpose a total of 506 patients were examined and their personal and medical data were collected. For each patient, the phenomenon of myocardial infarction was studied in relation to different risk factors. The analysis suggests that smoking, hypertension, cholesterol level, diabetes, family history are important risk factors for the occurrence of MI. (author)

  6. Discrepancy between coronary artery calcium score and HeartScore in middle-aged Danes: the DanRisk study

    DEFF Research Database (Denmark)

    Diederichsen, Axel Cosmus Pyndt; Sand, Niels Peter

    2012-01-01

    Background: Coronary artery calcification (CAC) is an independent and incremental risk marker. This marker has previously not been compared to the HeartScore risk model. Design: A random sample of 1825 citizens (men and women, 50 or 60 years of age) was invited for screening. Methods: Using the HeartScore model, the 10-year risk of fatal cardiovascular events based on gender, age, smoking, systolic blood pressure, and total cholesterol was estimated. A low risk was defined as

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

    OpenAIRE

    Wu, Ri-Han; Li, Qiang; TAN, YAN; Liu, Xue-Yuan; HUANG Jing

    2014-01-01

    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 Heal...

  8. Posttraumatic Stress and Myocardial Infarction Risk Perceptions in Hospitalized Acute Coronary Syndrome Patients

    OpenAIRE

    Edmondson, Donald; Shaffer, Jonathan A.; Denton, Ellen-ge; SHIMBO, DAICHI; Clemow, Lynn

    2012-01-01

    Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n?=?420). Participants completed a brief PTSD screen 3–7?days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or...

  9. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients

    OpenAIRE

    DonaldEdmondson

    2012-01-01

    Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n= 420). Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or ...

  10. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar; Madsen, Ole Rintek; Torp-Pedersen, Christian; Hansen, Peter Riis; Olesen, Jonas Bjerring

    2011-01-01

    OBJECTIVES: /st> To examine in a nationwide cohort whether the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) is comparable to the risk in patients with diabetes mellitus (DM). METHODS: /st> The study included the entire Danish population followed from 1 January 1997 until 31 December 2006. Through individual level-linkage of nationwide administrative registers, the authors identified subjects who developed RA and DM. The risk of MI was analysed using multivariable...

  11. Smoking and risk of myocardial infarction in women and men : longitudinal population study

    DEFF Research Database (Denmark)

    Prescott, E; Hippe, M

    1998-01-01

    OBJECTIVE: To compare risk of myocardial infarction associated with smoking in men and women, taking into consideration differences in smoking behaviour and a number of potential confounding variables. DESIGN: Prospective cohort study with follow up of myocardial infarction. SETTING: Pooled data from three population studies conducted in Copenhagen. SUBJECTS: 11,472 women and 13,191 men followed for a mean of 12.3 years. MAIN OUTCOME MEASURES: First admission to hospital or death caused by myocardial infarction. RESULTS: 1251 men and 512 women had a myocardial infarction during follow up. Compared with non-smokers, female current smokers had a relative risk of myocardial infarction of 2.24 (range 1.85-2.71) and male smokers 1.43 (1.26-1.62); ratio 1.57 (1.25-1.97). Relative risk of myocardial infarction increased with tobacco consumption in both men and women and was higher in inhalers than in non-inhalers. The risks associated with smoking, measured by both current and accumulated tobacco exposure, wereconsistently higher in women than in men and did not depend on age. This sex difference was not affected by adjustment for arterial blood pressure, total and high density lipoprotein cholesterol concentrations, triglyceride concentrations, diabetes, body mass index, height, alcohol intake, physical activity, and level of education. CONCLUSION: Women may be more sensitive than men to some of the harmful effects of smoking. Interactions between components of smoke and hormonal factors that may be involved in development of ischaemic heart disease should be examined further.

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

    DEFF Research Database (Denmark)

    Dalager-Pedersen, Michael; SØgaard, Mette

    2014-01-01

    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.

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

    International Nuclear Information System (INIS)

    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. 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. 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%. 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

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

    Directory of Open Access Journals (Sweden)

    Whitcomb Brian W

    2004-04-01

    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.

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

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court; Gerstoft, Jan; Kronborg, Gitte; Obel, Niels; Jensen, Janne

    2010-01-01

    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 r...

  16. Risk of myocardial infarction in parents of HIV-infected individuals: a population-based cohort study

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Omland, Lars H; Pedersen, Court; Gerstoft, Jan; Kronborg, Gitte; Jensen, Janne; Obel, Niels

    2010-01-01

    ABSTRACT: BACKGROUND: 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...

  17. Using health inspection scores to assess risk in food services.

    Science.gov (United States)

    Lee, Ji-Eun; Almanza, Barbara A; Nelson, Douglas C; Ghiselli, Richard F

    2009-03-01

    This study gathered health inspectors' opinions about appropriate weightings of critical, noncritical, and repeat violations under the current food inspection system, and developed a classification of violations for high-, medium-, and low-risk restaurants. Results showed that health inspectors thought that the appropriate weights were five points for a critical violation, one point for a noncritical violation, and double points for a repeat violation. In addition, health inspectors thought that the maximum numbers of critical violations for a high-, medium-, and low-risk category were 2.05, 3.02, and 4.83, respectively, and for noncritical violations, 4.59, 7.30, and 10.37, respectively. A paired t-test was used to compare these values with estimations based on the traditional health inspection scoring system. Results indicate that the maximum number of critical violations for medium risk and maximum numbers of noncritical violations for low-, medium-, or high-risk restaurants were significantly different between health inspectors' opinions and mathematical estimations. Health inspectors appear to be stricter than the traditional health inspection scoring system about violations, particularly repeat violations, and their importance in enforcement of food safety. PMID:19326667

  18. Plasma sodium and mortality risk in patients with myocardial infarction and a low LVEF

    DEFF Research Database (Denmark)

    Schou, Morten; Valeur, Nana

    2011-01-01

    Hyponatremia is a known prognostic factor for mortality in patients with heart failure but has not been extensively studied in patients with myocardial infarction (MI). This study was, therefore, designed to evaluate whether plasma sodium and hyponatremia (<135 mM) are associated with mortality risk in patients with MI.

  19. Risk Stratification and Effects of Pharmacotherapy in Patients with Acute Myocardial Infarction (AMI) based on data from Pilot AMI Registry.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tome?ková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Huba?, J.; Charalampidi, K.; Jánský, P.

    2007-01-01

    Ro?. 30 (2007), s. 367-367. ISSN 1420-4096. [Central European Meeting on Hypertension and Cardiovascular Disease Prevention. 11.10.2007-13.10.2007, Kraków] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

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

    Scientific Electronic Library Online (English)

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

    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.

  1. Acute Myocardial Infarction: A Comparison of the Risk between Physicians and the General Population

    OpenAIRE

    Chen, Yen-Ting; Huang, Chien-Cheng; Weng, Shih-Feng; Hsu, Chien-Chin; Wang, Jhi-joung; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran; Juan, Chi-Wen

    2015-01-01

    Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan's National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk b...

  2. Cardiovascular risk factor profile in subjects with familial predisposition to myocardial infarction in Denmark.

    OpenAIRE

    Hippe, M; VESTBO, J; Bjerg, A M; Borch-Johnsen, K.; Appleyard, M.; Hein, H O; Andersen, P.K; Jensen, G.; Sørensen, T. I.

    1997-01-01

    STUDY OBJECTIVES: To identify possible modifiable mediators of familial predisposition to myocardial infarction (MI) by assessing the risk factor profile in individuals without MI in relation to parental occurrence of MI. DESIGN AND METHODS: Cross sectional survey of the general population. The odds of an adverse cardiovascular risk factor profile in subjects reporting parental occurrence of MI versus subjects not reporting parental occurrence were estimated by logistic regression models. SET...

  3. Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Christensen, Bo; Søndergaard, Jens; Vestergaard, Mogens

    2013-01-01

    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 s...

  4. Modeling Linkage Disequilibrium Increases Accuracy of Polygenic Risk Scores

    DEFF Research Database (Denmark)

    Vilhjálmsson, Bjarni J; Finucane, Hilary K

    2015-01-01

    Polygenic risk scores have shown great promise in predicting complex disease risk and will become more accurate as training sample sizes increase. The standard approach for calculating risk scores involves linkage disequilibrium (LD)-based marker pruning and applying a p value threshold to association statistics, but this discards information and can reduce predictive accuracy. We introduce LDpred, a method that infers the posterior mean effect size of each marker by using a prior on effect sizes and LD information from an external reference panel. Theory and simulations show that LDpred outperforms the approach of pruning followed by thresholding, particularly at large sample sizes. Accordingly, predicted R(2) increased from 20.1% to 25.3% in a large schizophrenia dataset and from 9.8% to 12.0% in a large multiple sclerosis dataset. A similar relative improvement in accuracy was observed for three additional large disease datasets and for non-European schizophrenia samples. The advantage of LDpred over existing methods will grow as sample sizes increase.

  5. Integrating genetics and social science: genetic risk scores.

    Science.gov (United States)

    Belsky, Daniel W; Israel, Salomon

    2014-01-01

    The sequencing of the human genome and the advent of low-cost genome-wide assays that generate millions of observations of individual genomes in a matter of hours constitute a disruptive innovation for social science. Many public use social science datasets have or will soon add genome-wide genetic data. With these new data come technical challenges, but also new possibilities. Among these, the lowest-hanging fruit and the most potentially disruptive to existing research programs is the ability to measure previously invisible contours of health and disease risk within populations. In this article, we outline why now is the time for social scientists to bring genetics into their research programs. We discuss how to select genetic variants to study. We explain how the polygenic architecture of complex traits and the low penetrance of individual genetic loci pose challenges to research integrating genetics and social science. We introduce genetic risk scores as a method of addressing these challenges and provide guidance on how genetic risk scores can be constructed. We conclude by outlining research questions that are ripe for social science inquiry. PMID:25343363

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

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Witte, Daniel Rinse; Almdal, Thomas Peter; Nielsen, Louise; Badawi, Salah; Sheikh, AR; Belhadj, M; Nadir, D; Zinai, Sakina; Vistisen, Dorte

    2013-01-01

    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 measure...

  7. Psoriasis and Cardiovascular Risk: Assessment by CUORE Project Risk Score in Italian Patients

    OpenAIRE

    Doukaki, Spyridoula; Caputo, Valentina; Bongiorno, Maria Rita

    2013-01-01

    Background. Psoriasis is a common inflammatory and immune-mediated skin disease. There is growing controversy as to whether cardiovascular risk is elevated in psoriasis. A number of studies suggest a high prevalence of cardiovascular risk factors as well as cardiovascular diseases in psoriasis patients. Objective. The objective of this study was to estimate cardiovascular risk score in psoriasis patients and the relation between cardiovascular risk and psoriasis features. Cardiovascular r...

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

    DEFF Research Database (Denmark)

    Jorgensen, C. H.; Gislason, G. H.; Bretler, D.; Sorensen, R.; Norgaard, M. L.; Hansen, M. L.; Schramm, T. K.; Abildstrom, S. Z.; Torp-Pedersen, C.; Hansen, P. R.

    2011-01-01

    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....

  9. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction

    DEFF Research Database (Denmark)

    Do, Ron; Stitziel, Nathan O; Won, Hong-Hee; Jørgensen, Anders Berg; Duga, Stefano; Angelica Merlini, Pier; Kiezun, Adam; Farrall, Martin; Goel, Anuj; Zuk, Or; Guella, Illaria; Asselta, Rosanna; Lange, Leslie A; Peloso, Gina M; Auer, Paul L; Girelli, Domenico; Martinelli, Nicola; Farlow, Deborah N; DePristo, Mark A; Roberts, Robert; Stewart, Alexander F R; Saleheen, Danish; Danesh, John; Epstein, Stephen E; Sivapalaratnam, Suthesh; Hovingh, G Kees; Kastelein, John J; Samani, Nilesh J; Schunkert, Heribert; Erdmann, Jeanette; Shah, Svati H; Kraus, William E; Davies, Robert; Nikpay, Majid; Johansen, Christopher T; Wang, Jian; Hegele, Robert A; Hechter, Eliana; Marz, Winfried; Kleber, Marcus E; Huang, Jie; Johnson, Andrew D; Li, Mingyao; Burke, Greg L; Gross, Myron; Liu, Yongmei; Assimes, Themistocles L; Heiss, Gerardo; Lange, Ethan M; Folsom, Aaron R; Taylor, Herman A; Olivieri, Oliviero; Hamsten, Anders; Clarke, Robert; Reilly, Dermot F; Yin, Wu; Rivas, Manuel A; Donnelly, Peter; Rossouw, Jacques E; Psaty, Bruce M; Herrington, David M; Wilson, James G; Rich, Stephen S; Bamshad, Michael J; Tracy, Russell P; Cupples, L Adrienne; Rader, Daniel J; Reilly, Muredach P; Spertus, John A; Cresci, Sharon; Hartiala, Jaana; Tang, W H Wilson; Hazen, Stanley L; Allayee, Hooman; Reiner, Alex P; Carlson, Christopher S; Kooperberg, Charles; Jackson, Rebecca D; Boerwinkle, Eric; Lander, Eric S; Schwartz, Stephen M; Siscovick, David S; McPherson, Ruth; Tybjaerg-Hansen, Anne; Abecasis, Goncalo R; Watkins, Hugh; Nickerson, Deborah A; Ardissino, Diego; Sunyaev, Shamil R; O'Donnell, Christopher J; Altshuler, David; Gabriel, Stacey; Kathiresan, Sekar

    2015-01-01

    Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance. When MI occurs early in life, genetic inheritance is a major component to risk. Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to MI risk in individual families, whereas common variants at more than 45 loci have been associated with MI risk in the population. Here we evaluate how rare mutations contribute to early-onset MI risk in the ...

  10. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction

    DEFF Research Database (Denmark)

    Charlot, Mette Gitz; Grove, Erik L; Hansen, Peter Riis; Olesen, Jonas Bjerring; Ahlehoff, Ole; Selmer, Christian; Lindhardsen, Jesper; Madsen, Jan Kyst; Køber, Lars Valeur; Torp-Pedersen, Christian Tobias; Gislason, Gunnar Hilmar

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASUR...

  11. Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization?

    Science.gov (United States)

    Bhatt, Hemal; Turkistani, Atika; Sanghani, Dharmesh; Julliard, Kell; Fernaine, George

    2015-11-01

    The association of cardiovascular risk factors and complexity and severity of coronary artery disease with contrast volume (CV) remains unknown. We assessed the predictive factors of CV use during elective and emergent cardiac catheterization (CC). Electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 708 patients were eligible. On multivariable regression analysis, the presence of obstructed coronary arteries was associated with CV (P = .01, ? = -14.17), with greater CV used in patients with single or double vessel disease compared to those with triple vessel disease. The presence of lesions with >70% stenosis in major epicardial arteries (P = .019, ? = 24.39) and ST-segment elevation myocardial infarction (P = .001, ? = 36.14) was associated with increased CV use. Elevated B-type natriuretic peptide (P = .036, ? = -17.23) and increase in Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (P = .024, ? = -29.06) were associated with decreased CV use. These aforementioned associations were attenuated after adjusting for percutaneous coronary intervention. Our findings may help predict patient populations who could be exposed to increased CV during CC, thereby possibly increasing their risk of contrast-induced nephropathy. PMID:25712287

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

    International Nuclear Information System (INIS)

    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)

  13. Practical use of the Framingham risk score in primary prevention

    Science.gov (United States)

    Bosomworth, N. John

    2011-01-01

    Abstract Objective To review the 2009 Canadian Cardiovascular Society guidelines and provide practical recommendations for physicians. Sources of information Initial review of the references provided with the guidelines led to a search of the PubMed, ACP Journal Club, and Cochrane databases using the key words primary prevention and statin for English-language clinical trials, randomized controlled trials, meta-analyses, and reviews conducted with human participants. References from appropriate retrieved articles were also reviewed. Main message The guidelines outline low-density lipoprotein cholesterol (LDL-C) thresholds and targets to inform optimal use of statins in the primary prevention of cardiovascular disease (CVD). Family history of CVD and levels of high-sensitivity C-reactive protein (hsCRP) are risk modifiers in calculating the risk score with the new recommendations. An electronic calculator has been developed to facilitate increased uptake of these guidelines. Large numbers of asymptomatic people, particularly the elderly, will become eligible for statin therapy according to these new guidelines. Poor uptake by physicians and patients might result from the need for repeated testing of hsCRP and LDL-C levels in people who do not perceive themselves to be ill. Controversy persists concerning the role of hsCRP in the reclassification of CVD risk, and the concept of treating LDL-C to target has never been tested as an independent variable in a randomized trial. As two-thirds of the LDL-C lowering achieved by a statin occurs at the initial dose, it might be possible to achieve considerable CVD risk reduction for those at risk by treating initially with a mid-dose statin without LDL-C follow-up. Conclusion A simplified approach might appeal to patients or physicians who find current guidelines too complex, cumbersome, or costly. Success in getting high-risk patients to take statins is key to achieving improved CVD mortality reduction. PMID:21626897

  14. Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing

    OpenAIRE

    Lam, Teresa; Burns, Kharis; Dennis, Mark; Cheung, N Wah; Gunton, Jenny E.

    2015-01-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus, who have a risk of cardiovascular mortality two to four times that of people without diabetes. An individualised approach to cardiovascular risk estimation and management is needed. Over the past decades, many risk scores have been developed to predict CVD. However, few have been externally validated in a diabetic population and limited studies have examined the impact of applyi...

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

    DEFF Research Database (Denmark)

    Shah, Amil M; Uno, Hajime

    2010-01-01

    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.

  16. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    Directory of Open Access Journals (Sweden)

    David Corcoran

    2015-09-01

    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  17. A four-year cardiovascular risk score for type 2 diabetic inpatients

    Directory of Open Access Journals (Sweden)

    Dolores Ramírez-Prado

    2015-06-01

    Full Text Available As cardiovascular risk tables currently in use were constructed using data from the general population, the cardiovascular risk of patients admitted via the hospital emergency department may be underestimated. Accordingly, we constructed a predictive model for the appearance of cardiovascular diseases in patients with type 2 diabetes admitted via the emergency department. We undertook a four-year follow-up of a cohort of 112 adult patients with type 2 diabetes admitted via the emergency department for any cause except patients admitted with acute myocardial infarction, stroke, cancer, or a palliative status. The sample was selected randomly between 2010 and 2012. The primary outcome was time to cardiovascular disease. Other variables (at baseline were gender, age, heart failure, renal failure, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidaemia, insulin, smoking, admission for cardiovascular causes, pills per day, walking habit, fasting blood glucose and creatinine. A cardiovascular risk table was constructed based on the score to estimate the likelihood of cardiovascular disease. Risk groups were established and the c-statistic was calculated. Over a mean follow-up of 2.31 years, 39 patients had cardiovascular disease (34.8%, 95% CI [26.0–43.6%]. Predictive factors were gender, age, hypertension, renal failure, insulin, admission due to cardiovascular reasons and walking habit. The c-statistic was 0.734 (standard error: 0.049. After validation, this study will provide a tool for the primary health care services to enable the short-term prediction of cardiovascular disease after hospital discharge in patients with type 2 diabetes admitted via the emergency department.

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

    OpenAIRE

    Keavney Bernard

    2010-01-01

    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 considerabl...

  19. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease.

    Science.gov (United States)

    Endler, Georg; Klimesch, Alexandra; Sunder-Plassmann, Heike; Schillinger, Martin; Exner, Markus; Mannhalter, Christine; Jordanova, Nelli; Christ, Günter; Thalhammer, Renate; Huber, Kurt; Sunder-Plassmann, Raute

    2002-05-01

    After rupture of an arteriosclerotic plaque in a coronary artery, platelets play a crucial role in the subsequent thrombus formation, leading to myocardial infarction. An increased mean platelet volume (MPV), as an indicator of larger, more reactive platelets, may represent a risk factor for myocardial infarction. However, this hypothesis is still controversial and most studies addressing the role of MPV were performed comparing patients suffering from myocardial infarction with healthy controls. We intended to identify patients at high risk of suffering myocardial infarction in a group of patients with known coronary artery disease. One hundred and eighty-five consecutive patients with stable coronary artery disease were compared with 188 individuals who had suffered myocardial infarction. Patients within the highest quintile of MPV (> or = 11.6 fl) had a significantly higher risk of experiencing a myocardial infarction compared with patients within the lowest quintile (OR = 2.6, 95% CI 1.3-5.1) in a multivariate analysis that included sex, age, body mass index, hyperlipidaemia, hypertension, smoking and diabetes mellitus. Our results indicate that patients with pre-existing coronary artery disease and an increased MPV (> or = 11.6 fl) are at higher risk of myocardial infarction. These patients can be easily identified during routine haematological analysis and could possibly benefit from preventive treatment. PMID:11972524

  20. SCORING ASSESSMENT AND FORECASTING MODELS BANKRUPTCY RISK OF COMPANIES

    Directory of Open Access Journals (Sweden)

    SUSU Stefanita

    2014-07-01

    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.

  1. MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT

    OpenAIRE

    FRANCA DUMITRU; MARIA MORARU

    2012-01-01

    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.

  2. Seasonal variation in incidence of acute myocardial infarction and cardiovascular disease risk factors in a subarctic population : the Tromsø Study

    OpenAIRE

    Hopstock, Laila Arnesdatter

    2012-01-01

    SUMMARY A seasonal pattern with winter peak in acute myocardial infarction incidence and cardiovascular disease risk factors is observed in studies worldwide. However, several previous studies have methodical limitations and few are performed in cold climate areas. The aim of this thesis is to assess the effect of season and meteorological factors on first-ever myocardial infarction and the seasonal variation in cardiovascular disease risk factors in a subarctic adult population with long-te...

  3. Genetically elevated lipoprotein(a) and increased risk of myocardial infarction

    DEFF Research Database (Denmark)

    Kamstrup, Pia R; Tybjaerg-Hansen, Anne; Steffensen, Rolf; Nordestgaard, Børge G

    2009-01-01

    CONTEXT: High levels of lipoprotein(a) are associated with increased risk of myocardial infarction (MI). OBJECTIVE: To assess whether genetic data are consistent with this association being causal. DESIGN, SETTING, AND PARTICIPANTS: Three studies of white individuals from Copenhagen, Denmark, were used: the Copenhagen City Heart Study (CCHS), a prospective general population study with 16 years of follow-up (1991-2007, n = 8637, 599 MI events); the Copenhagen General Population Study (CGPS), a c...

  4. von Willebrand factor in plasma: a novel risk factor for recurrent myocardial infarction and death.

    OpenAIRE

    Jansson, J H; Nilsson, T. K.; Johnson, O.

    1991-01-01

    OBJECTIVE--To evaluate as predictors of reinfarction and mortality tissue plasminogen activator antigen and activity before and after venous occlusion, plasminogen activator inhibitor, von Willebrand factor, and established risk factors. DESIGN--Prospective study with a mean observation time of 4.9 years. SETTING--Secondary referral centre, the Department of Internal Medicine, University Hospital of Umeå. PATIENTS--123 consecutive survivors of myocardial infarction under the age of 70 years. ...

  5. Acute Myocardial Infarction in Young Adults: Study of Risk factors, Angiographic Features and Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Rikesh Tamrakar

    2013-11-01

    Full Text Available Background and aims: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. Methods: One hundred and fifteen consecutive patients diagnosed as acute myocardial infarction and were below 45 years over the period of one year were enrolled in the study. Clinical parameters, risk factors, angiographic patterns were analysed. Patients were assessed daily during hospital stay to study in-hospital outcome and complications. Results: Out of total patients studied, 64.3% were smokers, 27.8% were hypertensive, 15.65% were diabetic and 9.6% had history of dyslipidemia. There was history of recreational drug abuse in 4.3% of patients. Most patients present as ST elevation myocardial infarction (87%. Majority of patients were in Killip class I (69.5% at presentation in emergency. Single vessel disease (58.3% was the most common finding in coronary angiography and 7.6% patients have normal or non obstructive coronary lesions. Complications include arrhythmia (6%, cardiogenic shock (5.2% and mortality (1.7%. Conclusions: In young acute myocardial infarction patients, smoking is the single most important modifiable risk factor. Other conventional risk factors are less strongly associated than older patients. Young patients tend to have less extensive coronary artery lesions. In few patients, presence of normal or non obstructive coronary lesions would suggest possibility of different mechanism of myocardial necrosis. Overall, these patients had favourable outcome and better prognosis.

  6. Dietary antioxidants and risk of myocardial infarction in the elderly: the Rotterdam Study

    OpenAIRE

    Klipstein-Grobusch, K; Geleijnse, J.M.; Breeijen, J.H. den; Boeing, H.; Grobbee, D.E.; Witteman, J.C.M.; Hofman, A.

    1999-01-01

    BACKGROUND: Epidemiologic studies have shown dietary antioxidants to be inversely correlated with ischemic heart disease. OBJECTIVE: We investigated whether dietary beta-carotene, vitamin C, and vitamin E were related to the risk of myocardial infarction (MI) in an elderly population. DESIGN: The study sample consisted of 4802 participants of the Rotterdam Study aged 55-95 y who were free of MI at baseline and for whom ...

  7. Post-Myocardial Infarction Anxiety or Depressive Symptoms and Risk of New Cardiovascular Events or Death

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Christensen, Bo; Nielsen, Tine Jepsen; Vestergaard, Mogens

    2014-01-01

    OBJECTIVE: To examine the association between anxiety symptoms 3 months after myocardial infarction (MI) and/or new cardiovascular events and death, taking into account established risk factors, and to compare the results with those of the impact of depressive symptoms. Post-MI anxiety symptoms have been associated with a composite outcome of new cardiovascular events or death, but previous studies have not fully adjusted for potential confounders. It remains unclear whether anxiety symptoms are...

  8. Adipose tissue arachidonic acid content is associated with the risk of myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, Michael René; Schmidt, Erik Berg; Stegger, Jakob; Gorst-Rasmussen, Anders; Tjonneland, Anne; Overvad, Kim

    2013-01-01

    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 tis...

  9. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2008-01-01

    BACKGROUND: Two nucleos(t)ide reverse transcriptase inhibitors (NRTIs)--abacavir and didanosine--may each be associated with excess risk of myocardial infarction. The reproducibility of this finding in an independent dataset was explored and plausible biological mechanisms were sought. METHODS: Biomarkers, ischemic changes on the electrocardiogram, and rates of various predefined types of cardiovascular disease (CVD) events according to NRTIs used were explored in the Strategies for Management o...

  10. Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction

    OpenAIRE

    Björklund, Erik

    2005-01-01

    We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not...

  11. Risk Factors and Markers for Acute Myocardial Infarction With Angiographically Normal Coronary Arteries.

    Science.gov (United States)

    Daniel, Maria; Ekenbäck, Christina; Agewall, Stefan; Brolin, Elin B; Caidahl, Kenneth; Cederlund, Kerstin; Collste, Olov; Eurenius, Lars; Frick, Mats; Younis-Hassan, Shams; Henareh, Loghman; Jernberg, Tomas; Malmqvist, Karin; Spaak, Jonas; Sörensson, Peder; Hofman-Bang, Claes; Tornvall, Per

    2015-09-15

    Myocardial Infarction with normal coronary arteries (MINCA) is common with a prevalence of 1% to 12% of all myocardial infarctions. The pathogenic mechanisms of MINCA are still unknown, but endothelial dysfunction has been suggested as a possible cause. To investigate risk factors and markers for MINCA, we conducted a case-control study. Considering the reported low prevalence of classical risk factors for coronary heart disease (CHD) in some but not all studies, our hypothesis was that endothelial function and intima-media thickness (IMT) were better, respectively lower, than CHD controls. One hundred patients with MINCA fulfilling diagnostic criteria according to the European Society of Cardiology/American Collage of Cardiology/American Heart Association universal definition of myocardial infarction with myocarditis excluded by cardiac magnetic resonance imaging were investigated. Risk factors, endothelial function (EndoPAT), and IMT were compared to gender- and age-matched patients with myocardial infarction and CHD, respectively healthy controls. Smoking, hypertension, impaired glucose tolerance and diabetes mellitus, inflammatory disease, and psychiatric disorders were more common in patients with MINCA than in healthy controls. In contrast to patients with CHD, the lipid profile was antiatherogenic with low low-density lipoprotein and high high-density lipoprotein cholesterol. There were no major differences between the groups regarding endothelial function and IMT that were in the normal range. In conclusion, the present study showed that MINCA was associated with many established cardiovascular risk factors without major differences in atherosclerosis markers. MINCA patients recalled a high prevalence of emotional stress before admission that together with previous psychiatric vulnerability and female gender speaks strongly in favor of Takotsubo syndrome being an important cause of MINCA. PMID:26251000

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

    OpenAIRE

    Alamgir, M.; Salahuddin, M.

    2005-01-01

    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 a...

  13. Bisphosphonate Use Is Associated With Reduced Risk of Myocardial Infarction in Patients With Rheumatoid Arthritis

    OpenAIRE

    Wolfe, Frederick; Bolster, Marcy B; O’Connor, Christopher M.; Michaud, Kaleb; Lyles, Kenneth W; Colón-Emeric, Cathleen S

    2013-01-01

    Bisphosphonates have been shown to reduce mortality in patients with osteoporotic fractures, but the mechanism is unclear. Bisphosphonates have immunomodulatory effects that may influence the development of vascular disease. We sought to determine if bisphosphonate use is associated with a reduced risk of myocardial infarction (MI) in a rheumatoid arthritis (RA) population with high prevalence of bisphosphonate use and vascular disease. Adult patients with RA enrolled in the National Data Ban...

  14. 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

    Scientific Electronic Library Online (English)

    Rodrigo H., Bagur; Fernando M., Urinovsky; Alejandro E., Contreras; Carlos D., Estrada.

    2009-10-01

    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 TIM [...] I (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 Abstract in english 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 (TIM [...] I) 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

  15. 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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    Hulusi Sat?lm??o?lu

    2011-03-01

    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.

  16. Metabolic syndrome and Framingham risk score in obese young adults

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2013-05-01

    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

  17. SCORE underestimates cardiovascular risk (CVR of HIV+ patients

    Directory of Open Access Journals (Sweden)

    R Ramírez

    2012-11-01

    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.

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

    DEFF Research Database (Denmark)

    Bang, Casper N; Gislason, Gunnar H

    2014-01-01

    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.

  19. Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing.

    Science.gov (United States)

    Lam, Teresa; Burns, Kharis; Dennis, Mark; Cheung, N Wah; Gunton, Jenny E

    2015-05-15

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus, who have a risk of cardiovascular mortality two to four times that of people without diabetes. An individualised approach to cardiovascular risk estimation and management is needed. Over the past decades, many risk scores have been developed to predict CVD. However, few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice. Currently, guidelines are focused on testing for CVD in symptomatic patients. Atypical symptoms or silent ischemia are more common in the diabetic population, and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy, these guidelines can be difficult to interpret. We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing. The modalities for investigation of CVD are discussed. PMID:25987961

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

    Directory of Open Access Journals (Sweden)

    Zoran Velickovic

    2006-10-01

    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.

  1. Polygenic Risk Score, Parental Socioeconomic Status, Family History of Psychiatric Disorders, and the Risk for Schizophrenia

    DEFF Research Database (Denmark)

    Agerbo, Esben; Sullivan, Patrick F; Vilhjálmsson, Bjarni J; Pedersen, Carsten B; Mors, Ole; Børglum, Anders D; Hougaard, David M; Hollegaard, Mads V; Meier, Sandra; Mattheisen, Manuel; Ripke, Stephan; Wray, Naomi R; Mortensen, Preben B

    2015-01-01

    Importance: Schizophrenia has a complex etiology influenced both by genetic and nongenetic factors but disentangling these factors is difficult. Objective: To estimate (1) how strongly the risk for schizophrenia relates to the mutual effect of the polygenic risk score, parental socioeconomic status, and family history of psychiatric disorders; (2) the fraction of cases that could be prevented if no one was exposed to these factors; (3) whether family background interacts with an individual's gen...

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

    DEFF Research Database (Denmark)

    Handlos, L N; Witte, Daniel

    2013-01-01

    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.

  3. Genetic polymorphism of CYP1A2 increases the risk of myocardial infarction

    OpenAIRE

    M Cornelis; El-Sohemy, A; Campos, H.

    2004-01-01

    Background: There is growing evidence that DNA damage caused by mutagens found in tobacco smoke may contribute to the development of coronary heart disease (CHD). In order to bind to DNA many mutagens require metabolic activation by cytochrome P450 (CYP) 1A1 or CYP1A2. The objective of this study was to determine the effects of CYP1A1 and CYP1A2 genotypes on risk of myocardial infarction (MI) and whether smoking interacts with genotype to modify risk.

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

    Directory of Open Access Journals (Sweden)

    Keavney Bernard

    2010-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Harris PRE

    2013-08-01

    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

  6. 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

    DEFF Research Database (Denmark)

    Bloch Thomsen, Poul Erik; Jons, Christian

    2010-01-01

    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.

  7. Risk Stratification and Effects of the First 24-Hour Pharmacotherapy in Predominantly Hypertensive Patients with Acute Myocardial Infarction.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tome?ková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Huba?, J.; Charalampidi, K.

    2009-01-01

    Ro?. 27, Suppl. 4 (2009), S421-S422. ISSN 0263-6352. [European Meeting on Hypertension /19./. 12.06.2009-16.06.2009, Milan] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * hypertension and other cardiovascular risk factors * first 24-hour pharmacotherapy of myocardial infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  8. Analysis on risk factors of short-term poor outcome among different subtypes of acute cerebral infarction

    International Nuclear Information System (INIS)

    Objective: to investigate the risk factors of short-term poor outcome among patients suffering from acute cerebral infarction who had different subtypes of cerebral infarction. Methods: A total of 3231 acute cerebral infarction patients were included in the present study. Data on demographic characteristics, life style, risk factors, history of cardiovascular disease, admission blood pressure, and clinical outcome at discharge were collected for all participants. Poor outcome was defined as NIHSS ?10 at discharge or death occurring during hospitalization. The association between poor outcome of cerebral infarction and risk factors was analyzed by using multiple logistic models. Results: Incidence rate of poor outcome is the highest in the patients with cerebral embolism, next in patients with cerebral thrombosis and the lowest in patients with lacunar infarction. Cerebral thrombosis was positively associated with smoking (OR: 1.228; 95% CI: 1.013?1.637), dyslipidemia (OR: 1.264; 95% CI: 1.081?1.478), and a history of diabetes mellitus (OR: 1.371; 95% CI: 1.075?1.747); cerebral embolism was positively associated with a history of atrial fibrillation (OR: 3.131; 95% CI: 1.206?8.128) and a history of rheumatic heart disease (OR: 5.601; 95% CI: 1.561?20.091); lacunar infarction is positively associated with alcohol consumption, (OR: 1.428; 95% CI: 1.063?1.919). Conclusion: The incidence rate of poor outcome is the highest in the patients with cerebral embolism among three subtypes of cerebral infarction, there are different risk factors of poor outcome for three subtypes of cerebral infarction. (authors)

  9. Reduced risk of death at 28 days in patients taking a beta blocker before admission to hospital with myocardial infarction.

    OpenAIRE

    Nidorf, S M; Parsons, R W; Thompson, P L; Jamrozik, K D; Hobbs, M. S.

    1990-01-01

    OBJECTIVE--To see whether patients taking an oral beta blocker at the time of admission to hospital with myocardial infarction have a reduced risk of death at 28 days. DESIGN--Retrospective analysis of data collected on patients admitted over four years. SETTING--Community based study. PATIENTS--2430 Consecutive patients living in the Perth statistical division admitted to hospital with myocardial infarction during 1984-7. MAIN OUTCOME MEASURE--Survival at 28 days among patients taking a beta...

  10. Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? Study from the Copenhagen Centre for Prospective Population Studies

    OpenAIRE

    Andersen, I; Burr, H; Kristensen, T.; Gamborg, M; Osler, M.; Prescott, E.; Diderichsen, F

    2004-01-01

    Aim: To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment.

  11. 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

    DEFF Research Database (Denmark)

    2010-01-01

    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...

  12. Evaluation of risk for type 2 diabetes mellitus in medical students using Indian diabetes risk score

    Directory of Open Access Journals (Sweden)

    Pranita Ashok

    2011-01-01

    Full Text Available Background: According to World Health Organisation, type 2 diabetes mellitus [type 2 D. M] has recently escalated in all age groups and is now being identified in younger age groups. This underscores the need for mass awareness and screening programs to detect diabetes at an early stage. For this purpose we have used a simplified Indian Diabetes Risk Score (IDRS for prediction of diabetes in undergraduate medical students. Objectives: To screen and to identify 1st MBBS students at risk for developing type 2 D. M using IDRS. Materials and Methods : 261 undergraduates (1st MBBS students were scored using IDRS which includes age, family history of diabetes, exercise status, and waist circumference. After scoring them, we assessed random capillary blood glucose (RCBG in students with high IDRS score. Students with RCBG ? 113 mg/dl are followed for definitive tests for diagnosis of prediabetes and diabetes. Results and Conclusion: We have assessed 261 students till now. It was observed that 5%, 55%, and 38% students in High, Moderate, and Low risk group, respectively, for developing type 2 D. M. The mean abdominal obesity in high risk students was 101.95 ± 5.76 as compared to 79.17 ± 11.08 in moderate and low risk students (P 113 mg/dl in which one student found to have prediabetic. Conclusion: This underscores the need for further investigations to detect diabetes at an early stage and to overcome the disease burden of diabetes in future. Prevention of obesity and promotion of physical activity have to be the future plan of action which can be suggested in the form of regular exercise and diet planning for the students as part of an integrated approach.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.

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

    International Nuclear Information System (INIS)

    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.

  15. Beyond the SYNTAX score--advantages and limitations of other risk assessment systems in left main percutaneous coronary intervention.

    Science.gov (United States)

    Capodanno, Davide

    2013-01-01

    Risk stratification is an emerging topic in the modern management of patients with left main disease referred for percutaneous coronary intervention (PCI). Recent years have witnessed an explosive multiplication of risk models for prognostic stratification in complex PCI. Many of this models deal with modification of the angiographic SYNTAX score, or seek to overcome its known pitfalls and limitations, including lack of clinical and functional information, inter- and intra-observer variabilities, and poor calibration. Risk scoring systems beyond the SYNTAX score may be classified into angiographic (residual SYNTAX score, coronary artery bypass grafting SYNTAX score), clinical (EuroSCORE I and II, ACEF score and modified ACEF scores), combined clinical and angiographic (Global Risk Classification, Clinical SYNTAX score, logistic Clinical SYNTAX score, SYNTAX score II) and functional (Functional SYNTAX score). This article reviews current concepts in risk modeling and explores the advantages and limitations of the alternatives to the SYNTAX score in patients undergoing left main PCI.? PMID:23546417

  16. 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)

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

    DEFF Research Database (Denmark)

    Saidj, Madina; JØrgensen, Torben

    2013-01-01

    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.

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

    OpenAIRE

    Liew, SM; Doust, J; Glasziou, P

    2011-01-01

    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...

  19. A Clinical Risk Score for Atrial Fibrillation in a Biracial Prospective Cohort (From the Atherosclerosis Risk in Communities (ARIC) Study)

    OpenAIRE

    Chamberlain, Alanna M; Agarwal, Sunil K; Folsom, Aaron R.; Soliman, Elsayed Z; Chambless, Lloyd E.; Crow, Richard; Ambrose, Marietta; Alonso, Alvaro

    2011-01-01

    A risk score for AF has been developed by the Framingham Heart Study; however the applicability of this risk score, derived from whites, to predict new-onset AF in non-whites is uncertain. Therefore, we developed a 10-year risk score for new-onset AF using risk factors commonly measured in clinical practice using 14,546 individuals from the Atherosclerosis Risk in Communities study, a prospective community-based cohort of blacks and whites in the United States. During 10 years of follow-up, 5...

  20. MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT

    Directory of Open Access Journals (Sweden)

    FRANCA DUMITRU

    2012-11-01

    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.

  1. Risk of acute myocardial infarction with nonselective non-steroidal anti-inflammatory drugs: a meta-analysis

    OpenAIRE

    Singh, G.(INFN Sezione di Bari, Università di Bari, Politecnico di Bari, Bari, Italy); Wu, O.; Langhorne, P.; Madhok, R.

    2006-01-01

    The use of cyclo-oxygenase 2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased risk of acute myocardial infarction (AMI). The association between the risks of AMI with nonselective NSAIDs is less clear. We reviewed the published evidence and assessed the risk of AMI with nonselective NSAIDs. We performed a meta-analysis of all studies containing data from population databases that compared the risk of AMI in NSAID users with that in non-users or remote NSAID...

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

    Directory of Open Access Journals (Sweden)

    Seyed Ali Mousavi

    2007-07-01

    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.

  3. Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude?

    DEFF Research Database (Denmark)

    Hallqvist, J; Diderichsen, Finn; Theorell, T; Reuterwall, C; Ahlbom, A

    1998-01-01

    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 w...

  4. Assessment of the value of a genetic risk score in improving the estimation of coronary risk

    Science.gov (United States)

    Lluis-Ganella, Carla; Subirana, Isaac; Lucas, Gavin; Tomás, Marta; Muñoz, Daniel; Sentí, Mariano; Salas, Eduardo; Sala, Joan; Ramos, Rafel; Ordovas, Jose M; Marrugat, Jaume; Elosua, Roberto

    2013-01-01

    Background The American Heart Association has established criteria for the evaluation of novel markers of cardiovascular risk. In accordance with these criteria, we assessed the association between a multi-locus genetic risk score (GRS) and incident coronary heart disease (CHD), and evaluated whether this GRS improves the predictive capacity of the Framingham risk function. Methods and results Using eight genetic variants associated with CHD but not with classical cardiovascular risk factors (CVRFs), we generated a multi-locus GRS, and found it to be linearly associated with CHD in two population based cohorts: The REGICOR Study (n=2,351) and The Framingham Heart Study (n=3,537) (meta-analyzed HR [95%CI]: ~1.13 [1.01–1.27], per unit). Inclusion of the GRS in the Framingham risk function improved its discriminative capacity in the Framingham sample (c-statistic: 72.81 vs.72.37, p=0.042) but not in the REGICOR sample. According to both the net reclassification improvement (NRI) index and the integrated discrimination index (IDI), the GRS improved re-classification among individuals with intermediate coronary risk (meta-analysis NRI [95%CI]: 17.44 [8.04; 26.83]), but not overall. Conclusions A multi-locus GRS based on genetic variants unrelated to CVRFs was associated with a linear increase in risk of CHD events in two distinct populations. This GRS improves risk reclassification particularly in the population at intermediate coronary risk. These results indicate the potential value of the inclusion of genetic information in classical functions for risk assessment in the intermediate risk population group. PMID:22521901

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

    Directory of Open Access Journals (Sweden)

    M. Alamgir

    2005-07-01

    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.

  6. High risk for obstructive sleep apnea in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Carla Renata Silva Andrechuk

    2015-10-01

    Full Text Available Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male. A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

  7. Acute myocardial infarction: a comparison of the risk between physicians and the general population.

    Science.gov (United States)

    Chen, Yen-ting; Huang, Chien-Cheng; Weng, Shih-Feng; Hsu, Chien-Chin; Wang, Jhi-Joung; Lin, Hung-Jung; Su, Shih-Bin; Guo, How-Ran; Juan, Chi-Wen

    2015-01-01

    Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan's National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P differences in the risk for having an AMI were nonsignificant. Medical center physicians had a lower risk (AOR: 0.42; 95% CI: 0.20-0.85) than did local clinic physicians. Taiwan's physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment. PMID:25802869

  8. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index

    DEFF Research Database (Denmark)

    Jakobsen, Marianne Uhre; Dethlefsen, Claus; Joensen, Albert M; Stegger, Jakob; Tjønneland, Anne; Schmidt, Erik B; Overvad, Kim

    2010-01-01

    BACKGROUND: Studies have suggested that replacing saturated fatty acids (SFAs) with carbohydrates is modestly associated with a higher risk of ischemic heart disease, whereas replacing SFAs with polyunsaturated fatty acids is associated with a lower risk of ischemic heart disease. The effect of carbohydrates, however, may depend on the type consumed. OBJECTIVES: By using substitution models, we aimed to investigate the risk of myocardial infarction (MI) associated with a higher energy intake fro...

  9. The high-density lipoprotein-adjusted SCORE model worsens SCORE-based risk classification in a contemporary population of 30 824 Europeans : the Copenhagen General Population Study

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib

    2015-01-01

    AIMS: Recent European guidelines recommend to include high-density lipoprotein (HDL) cholesterol in risk assessment for primary prevention of cardiovascular disease (CVD), using a SCORE-based risk model (SCORE-HDL). We compared the predictive performance of SCORE-HDL with SCORE in an independent, contemporary, 'low-risk' European population, focusing on ability to identify those in need of intensified CVD prevention. METHODS AND RESULTS: Between 2003 and 2008, 46 092 individuals without CVD, diabetes, or statin use were enrolled in the Copenhagen General Population Study (CGPS). During a mean of 6.8 years of follow-up, 339 individuals died of CVD. In the SCORE target population (age 40-65; n = 30 824), fewer individuals were at baseline categorized as high risk (?5% 10-year risk of fatal CVD) using SCORE-HDL compared with SCORE (10 vs. 17% in men, 1 vs. 3% in women). SCORE-HDL did not improve discrimination of future fatal CVD, compared with SCORE, but decreased the detection rate (sensitivity) of the 5% high-risk threshold from 42 to 26%, yielding a negative net reclassification index (NRI) of -12%. Importantly, using SCORE-HDL, the sensitivity was zero among women. Both SCORE and SCORE-HDL overestimated risk of fatal CVD. In well-calibrated models developed from the CGPS, HDL did not improve discrimination or NRI. Lowering the decision threshold from 5 to 1% led to progressive gain in NRI for both CVD mortality and morbidity. CONCLUSION: SCORE-HDL did not improve discrimination compared with SCORE, but deteriorated risk classification based on NRI. Future guidelines should consider lower decision thresholds and prioritize CVD morbidity and people above age 65.

  10. Low Apgar Scores and Risk of Childhood Attention Deficit Hyperactivity Disorder

    DEFF Research Database (Denmark)

    Li, Jiong; Olsen, JØrn

    2011-01-01

    OBJECTIVE: To examine whether low Apgar scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: We conducted a nationwide population-based cohort study of all 980 902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first. We used Cox regression models to examine the association between Apgar scores at 5 minutes and ADHD. RESULTS: Apgar scores were inversely associated with risk of ADHD (hazard ratio 0.92; 95% confidence interval [CI]: 0.88-0.96, P trend <.001). Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children with Apgar scores of 1 to 4 (hazard ratio 1.75; 95% CI: 1.15-2.11) and 63% higher for those with Apgar scores of 5 to 6 (95% CI: 1.25-2.11). CONCLUSIONS: A low Apgar score was associated with an increased risk of ADHD in childhood. Low Apgar scores and ADHD may share common causes or a low Apgar score reflects at least one causal pathway leading to ADHD.

  11. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction

    DEFF Research Database (Denmark)

    Do, Ron; Stitziel, Nathan O

    2015-01-01

    Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance. When MI occurs early in life, genetic inheritance is a major component to risk. Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to MI risk in individual families, whereas common variants at more than 45 loci have been associated with MI risk in the population. Here we evaluate how rare mutations contribute to early-onset MI risk in the population. We sequenced the protein-coding regions of 9,793 genomes from patients with MI at an early age (?50 years in males and ?60 years in females) along with MI-free controls. We identified two genes in which rare coding-sequence mutations were more frequent in MI cases versus controls at exome-wide significance. At low-density lipoprotein receptor (LDLR), carriers of rare non-synonymous mutations were at 4.2-fold increased risk for MI; carriers of null alleles at LDLR were at even higher risk (13-fold difference). Approximately 2% of early MI cases harbour a rare, damaging mutation in LDLR; this estimate is similar to one made more than 40 years ago using an analysis of total cholesterol. Among controls, about 1 in 217 carried an LDLR coding-sequence mutation and had plasma LDL cholesterol > 190 mg dl(-1). At apolipoprotein A-V (APOA5), carriers of rare non-synonymous mutations were at 2.2-fold increased risk for MI. When compared with non-carriers, LDLR mutation carriers had higher plasma LDL cholesterol, whereas APOA5 mutation carriers had higher plasma triglycerides. Recent evidence has connected MI risk with coding-sequence mutations at two genes functionally related to APOA5, namely lipoprotein lipase and apolipoprotein C-III (refs 18, 19). Combined, these observations suggest that, as well as LDL cholesterol, disordered metabolism of triglyceride-rich lipoproteins contributes to MI risk.

  12. Periodontitis as risk factor for acute myocardial infarction: A case control study

    Directory of Open Access Journals (Sweden)

    Sujal M Parkar

    2013-01-01

    Conclusion: The results of the present study show evidence that those patients who have experienced myocardial infarction exhibit poor periodontal conditions in comparison to healthy subjects and suggest an association between chronic oral infections and myocardial infarction.

  13. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients.

    Science.gov (United States)

    Edmondson, Donald; Shaffer, Jonathan A; Denton, Ellen-Ge; Shimbo, Daichi; Clemow, Lynn

    2012-01-01

    Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n?=?420). Participants completed a brief PTSD screen 3-7?days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between "average" and "below average"). Further, participants who screened positive for current PTSD (n?=?15) showed significantly greater optimistic bias than those who screened negative (p?depression, and self-confidence in their ability to control their heart disease. Clinicians should be aware that psychosocial factors, and PTSD in particular, may be associated with poor adherence to medical advice due to exaggerated optimistic bias in recurrence risk perceptions. PMID:22593749

  14. Association between Apolipoprotein E polymorphism and myocardial infarction risk: A systematic review and meta-analysis

    Science.gov (United States)

    Wang, Yi-Lian; Sun, Li-Ming; Zhang, Li; Xu, Hai-Tao; Dong, Zheng; Wang, Luo-Qing; Wang, Ming-Lang

    2015-01-01

    Published data regarding the association between Apolipoprotein E (ApoE) genetic variation and myocardial infarction (MI) risk were not always consistent. Therefore, the current meta-analysis was conducted to derive a more precise estimation of the association between ApoE polymorphism and MI risk. PubMed and Web of Science were searched to identify relevant studies. Summary odds ratio (ORs) and 95% confidence intervals (CIs) were calculated using random-effect or fixed-effect models based on the heterogeneity of included studies. All the tests were performed using Stata 11.0. A total of 22 eligible studies were identified in this meta-analysis. The results show that ApoE ?2 and ?4 alleles were associated with MI risk. The study suggests that there is close association between ApoE polymorphism and MI risk. It shows that ApoE ?2 allele is a protective factor of MI, while ?4 allele is a risk factor of MI, especially in Caucasian and Asian population. Nevertheless, well-designed, unbiased and larger sample size studies are required to confirm the results.

  15. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients

    Directory of Open Access Journals (Sweden)

    DonaldEdmondson

    2012-05-01

    Full Text Available Posttraumatic stress disorder (PTSD is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n= 420. Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between “average” and “below average”. Further, participants who screened positive for current PTSD (n=15 showed significantly greater optimistic bias than those who screened negative (p< .05, after adjustment for demographics, ACS severity, medical comorbidities, depression, and self-confidence in their ability to control their heart disease. Clinicians should be aware that psychosocial factors, and PTSD in particular, may be associated with poor adherence to medical advice due to exaggerated optimistic bias in recurrence risk perceptions.

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

    Directory of Open Access Journals (Sweden)

    Tomaiuolo Rossella

    2012-11-01

    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.

  17. 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

  18. A Clinical Study on Blood Lipids as a Risk Factor of Cerebral Infarction

    OpenAIRE

    Yeon-hui Son; Sang-hee Lee; Jae-kyu Kim; Hyun-yun Jeong; Young-kyun Kim; Jung-nam Kwon

    2008-01-01

    Objective : The purpose of this case-control study was done to examine the relationship among the acute brain infarction, silent brain infarction and blood lipids. Methods : We compared the components of blood lipids among acute brain infarction patients group (n=99), silent brain infarction patients group(n=101) and controls group (n=153). The analysis of the data was done by Frequency Analysis, one-way ANOVA, Post Hoc Test(Duncan), Pearson’s Correlation. Results : The results were as ...

  19. Psoriasis and the Framingham risk score in a Danish hospital cohort

    DEFF Research Database (Denmark)

    GyldenlØve, Mette; Jensen, Peter

    2014-01-01

    Psoriasis is a chronic inflammatory skin disease, which is associated with an increased risk of cardiovascular morbidity and mortality. Our aim was to compare the Framingham risk score, a method to estimate coronary heart disease and prevalences of cardiovascular risk factors in patients with psoriasis and the general population.

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

    DEFF Research Database (Denmark)

    Lindberg, SØren; Jensen, Jan S

    2014-01-01

    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.

  1. A circulating biomarker risk-prediction model correlates with CHADS-2 risk score in chronic atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Smita I. Negi

    2015-03-01

    Conclusions: A biomarker risk-model using a combination of hs-CRP and DROMs correlates well with CHADS-2 risk scores in chronic AF. Either or both of these markers may add predictive power to future stroke risk prediction models.

  2. A Simple Risk Score for Identifying Individuals with Impaired Fasting Glucose in the Southern Chinese Population

    Directory of Open Access Journals (Sweden)

    Hui Wang

    2015-01-01

    Full Text Available This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG among the Southern Chinese population. A sample of participants aged ?20 years and without known diabetes from the 2006–2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008–2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ?28 for men and ?18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008–2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice.

  3. Does childhood misfortune raise the risk of acute myocardial infarction in adulthood?

    Science.gov (United States)

    Morton, Patricia M; Mustillo, Sarah A; Ferraro, Kenneth F

    2014-03-01

    Whereas most research on acute myocardial infarction (AMI) has focused on more proximal influences, such as adult health behaviors, the present study examines the early origins of AMI. Longitudinal data were drawn from the National Survey of Midlife Development in the United States (N = 3032), a nationally representative survey of men and women aged 25-74, which spans from 1995 to 2005. A series of event history analyses modeling age of first AMI investigated the direct effects of accumulated and separate domains of childhood misfortune as well as the mediating effects of adult health lifestyle and psychosocial factors. Findings reveal that accumulated childhood misfortune and child maltreatment increased AMI risk, net of several adult covariates, including family history of AMI. Smoking fully mediated the effects of both accumulated childhood misfortune and child maltreatment. These findings reveal the importance of the early origins of AMI and health behaviors as mediating factors. PMID:24581071

  4. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS)

    Science.gov (United States)

    Dominguez, Ligia J.; Bes-Rastrollo, Maira; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Martínez-González, Miguel A.

    2015-01-01

    Background Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN (“Seguimiento Universidad de Navarra”) longitudinal study. Methods We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. Results We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25–39 points) vs. low (11–24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40–60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). Conclusions The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM and also as an educational tool for laypeople to help them in self-assessing their future risk for developing diabetes. PMID:26544985

  5. Genetic Variants Of Cytochrome b-245, Alpha Polypeptide Gene And Premature Acute Myocardial Infarction Risk In An Iranian Population

    Directory of Open Access Journals (Sweden)

    Amin Fatemeh

    2015-10-01

    Full Text Available Background: Oxidative stress induced by superoxide anion plays critical roles in the pathogenesis of coronary artery disease (CAD and hence acute myocardial infarction (AMI. The major source of superoxide production in vascular smooth muscle and endothelial cells is the NADPH oxidase complex. An essential component of this complex is p22phox, that is encoded by the cytochrome b-245, alpha polypeptide (CYBA gene. The aim of this study was to investigate the association of CYBA variants (rs1049255 and rs4673 and premature acute myocardial infarction risk in an Iranian population.

  6. Baldness and myocardial infarction in men: the atherosclerosis risk in communities study.

    Science.gov (United States)

    Shahar, Eyal; Heiss, Gerardo; Rosamond, Wayne D; Szklo, Moyses

    2008-03-15

    Because hair loss may be a surrogate measure of androgenic activity-possibly a determinant of coronary atherosclerosis-several studies have explored the presence and magnitude of an association between male pattern baldness and myocardial infarction (MI). In particular, vertex baldness, but not frontal baldness alone, was strongly associated with incident MI in a large, hospital-based, case-control study. The authors examined these associations in a cross-sectional sample of 5,056 men aged 52-75 years, of whom 767 had a history of MI. The sample was derived from the Atherosclerosis Risk in Communities (ARIC) Study (1987-1998). As compared with a baldness-free reference group, the estimated odds ratios for prevalent MI from a multivariable model were 1.28 (frontal baldness), 1.02 (mild vertex baldness), 1.40 (moderate vertex baldness), and 1.18 (severe vertex baldness). Other regression models have yielded similar results, including the absence of a monotonic "dose-response relation" between the extent of vertex baldness and prevalent MI. The authors also examined the relation of baldness pattern to carotid intimal-medial thickness, a measure of atherosclerosis, among those who were free of clinical cardiovascular disease. The estimated mean differences in carotid intimal-medial thickness between groups of men with various types of baldness and their baldness-free counterparts were all close to zero. The results of this study suggest that male pattern baldness is not a surrogate measure of an important risk factor for myocardial infarction or asymptomatic atherosclerosis. PMID:18208984

  7. Genetic risk score analysis indicates migraine with and without comorbid depression are genetically different disorders

    OpenAIRE

    Ligthart L; Hottenga JJ; Lewis CM; Farmer AE; Craig IW; Breen G; Willemsen G; Vink JM; Middeldorp CM; EM Byrne; Heath AC; Madden PA; Pergadia ML; GW Montgomery; Ng, Martin

    2013-01-01

    Migraine and major depressive disorder (MDD) are comorbid, moderately heritable and to some extent influenced by the same genes. In a previous paper, we suggested the possibility of causality (one trait causing the other) underlying this comorbidity. We present a new application of polygenic (genetic risk) score analysis to investigate the mechanisms underlying the genetic overlap of migraine and MDD. Genetic risk scores were constructed based on data from two discovery samples in which genom...

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

    DEFF Research Database (Denmark)

    Holme, Ingar; Pedersen, Terje R

    2012-01-01

    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

  9. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Deepali R Damkondwar

    2012-01-01

    Full Text Available Aim: To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. Materials and Methods: In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ?40 years. The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%, and low risk (<10%. Results: Out of the 1248 subjects, 830 (66.5% patients had a low risk of developing cardiovascular disease (CVD in 10 years and 418 (33.5% had a high risk of developing CVD in 10 years. The risk of developing CVD was more in males than females (56.8% vs. 7% The prevalence of both diabetic retinopathy and sight-threatening retinopathy was more in the high-risk group (21% and 4.5%, respectively. The risk factors for developing diabetic retinopathy were similar in both the groups (low vs. high - duration of diabetes (OR 1.14 vs. 1.08, higher HbA1c (OR 1.24 vs. 1.22, presence of macro- and microalbuminuria (OR 10.17 vs. 6.12 for macro-albuminuria and use of insulin (OR 2.06 vs. 4.38. The additional risk factors in the high-risk group were presence of anemia (OR 2.65 and higher serum high density lipoprotein (HDL cholesterol (OR 1.05. Conclusion: Framingham risk scoring, a global risk assessment tool to predict the 10-year risk of developing CVD, can also predict the occurrence and type of diabetic retinopathy. Those patients with high CVD scores should be followed up more frequently and treated adequately. This also warrants good interaction between the treating physician/cardiologist and the ophthalmologist.

  10. Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

    Science.gov (United States)

    Silva, Leonardo Sinnott; Caramori, Paulo Ricardo Avancini; Nunes Filho, Antonio Carlos Bacelar; Katz, Marcelo; Guaragna, João Carlos Vieira da Costa; Lemos, Pedro; Lima, Valter; Abizaid, Alexandre; Tarasoutchi, Flavio; de Brito Jr, Fabio S.

    2015-01-01

    Background Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. Objectives To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. Methods The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)]. Results The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05). Conclusions In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required. PMID:26247244

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

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-06-01

    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.

  12. ADRB2 polymorphisms predict the risk of myocardial infarction and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Dong-Wei Wang

    2015-01-01

    Full Text Available Abstract Recently, the rs1042713 G > A and rs1042714 C > G polymorphisms in the beta-2 adrenergic receptor (ADRB2 gene were shown to be related to atherosclerosis diseases. Therefore, we performed a systemic meta-analysis to determine whether the two functional polymorphisms are related to the risk of myocardial infarction (MI and coronary artery disease (CAD. We identified published studies that are relevant to our topic of interest. Seven case-control studies, with a total of 6,843 subjects, were incorporated into the current meta-analysis. Our analysis showed a higher frequency of rs1042713 G > A variant in patients with MI or CAD compared to healthy controls. A similar result was also obtained with the rs1042714 C > G variant under both the allele and dominant models. Ethnicity-stratified subgroup analysis suggested that the rs1042714 C > G variant correlated with an increased risk of the two diseases in both Asians and Caucasians, while rs1042713 G > A only contributes to the risk of two diseases in Asians. In the disease type-stratified subgroups, the frequencies of both the rs1042713 G > A and rs1042714 C > G variants were higher in the cases than in the controls in both the MI and CAD subgroups. Collectively, our data contribute towards understanding the correlation between the rs1042713 G > A and rs1042714 C > G polymorphisms in ADRB2 and the susceptibility to MI and CAD.

  13. Early Risk stratification for Arrhythmic death in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sadr-Ameli

    2007-01-01

    Full Text Available Background: Sudden cardiac death is a leading cause of death in patients with ST-elevation myocardial infarction (MI. According to high cost of modern therapeutic modalities it is of paramount importance to define protocols for risk stratification of post-MI patients before considering expensive devices such as implantable cardioverter-defibrillator.Methods: One hundred and thirty seven patients with acute ST-elevation MI were selected and underwent echocardiographic study, holter monitoring and signal-averaged electrocardiography (SAECG. Then, the patients were followed for 12 ±3 months.Results: During follow-up, 13 deaths (9.5% occurred; nine cases happened as sudden cardiac death (6.6%. The effect of ejection fraction (EF less than 40% on occurrence of arrhythmic events was significant (P<0.001. Sensitivity and positive predictive value of EF<40% was 100% and 76.95% respectively. Although with lesser sensitivity and predictive power than EF<40%, abnormal heart rate variability (HRV and SAECG had also significant effects on occurrence of sudden death (P=0.02 and P=0.003 respectively. Nonsustained ventricular tachycardia was not significantly related to risk of sudden death in this study (P=0.20.Conclusions: This study indicated that EF less than 40% is the most powerful predictor of sudden cardiac death in post MI patients. Abnormal HRV and SAECG are also important predictors and can be added to EF for better risk stratification.

  14. High-risk myocardial infarction patients appear to derive more mortality benefit from short door-to-balloon time than low-risk patients

    OpenAIRE

    Kong, Poi Keong; Connolly, Derek; Varma, Chetan; Lip, Gregory; Millane, Teri; Davis, Russell; Ahmad, Rajai

    2009-01-01

    Abstract Objectives: To evaluate reduction of door-to-balloon (DTB) time and its impact on in-hospital mortality of high-risk infarct patients in a collaboration of district general hospitals (DGH) with a physician-to-patient model. Methods: Primary percutaneous coronary interventions (PPCI) with short DTB time offer mortality benefit for STEMI but literatures are conflicting on this benefit for high-risk versus low-risk patients. In a unique model at Sandwell and West Bi...

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

    DEFF Research Database (Denmark)

    JØrgensen, C H; Gislason, G H

    2011-01-01

    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.

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

    OpenAIRE

    Bigi, Riccardo; FIORENTINI, CESARE

    1997-01-01

    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.

  17. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score

    Directory of Open Access Journals (Sweden)

    I Ramsay

    2012-11-01

    Full Text Available HIV-1-infected patients are thought to be at higher risk of cardiovascular events. Measures of arterial stiffness are independently associated with cardiovascular risk [1]. The aim of our study was to determine if higher Framingham risk is associated with higher carotid femoral pulse wave velocity (cfPWV in HIV-infected volunteers (HIV cohort and to establish whether there is a difference in cfPWV between the HIV cohort and age- and gender-matched controls. We recruited 47 males (HIV cohort on antiretroviral treatment, from a UK HIV clinic between October 2010 and March 2012 (31 low Framingham risk <10% and 16 high risk >20%. This group was matched with 46 healthy subjects from a contemporaneous study performed by our group. The inclusion criteria were: age 35–75 years with Framingham risk >20% or <10%, on antiretroviral treatment with undetectable viral load, no previous coronary heart disease, stroke or insulin therapy. Subjects underwent cfPWV measurement using Complior® (Artech, France. Student's t-test was used to evaluate differences between high- and low-risk groups and also between cases and controls. The mean age of the HIV cohort was 49.43±9.35 years (mean±SD and in the control group 52.20±8.80 years (p=0.15. Mean duration of HIV infection was 13.83±7.25 years, mean CD4 count was 728.81±312.62×106/L and all viral loads were undetectable. In the HIV cohort, cfPWV was 8.39±1.09 m/s in the low-risk group and 10.43±2.93 m/s in the high-risk group (p=0.02. Multivariate analysis with cfPWV as dependent variable, and age, systolic blood pressure, cholesterol, smoking history, duration of HIV infection and antiretroviral therapy, zenith viral loads and nadir CD4 counts as independent variables was performed in the high- and low-risk groups. This showed age alone to be a significant predictive factor (p=0.002. With Framingham risk as dependent variable and using the above factors as independent variables, no HIV-related factors were significant predictors. The overall mean cfPWV for the HIV cohort (n=47 was 9.09±2.13 m/s compared to 11.95±2.37 m/s in the control group (n=46(p<0.01. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score or carotid-femoral pulse wave velocity. This may be due to good control of traditional cardiovascular risk factors and a healthy lifestyle in this cohort.

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

    Directory of Open Access Journals (Sweden)

    Goh LGH

    2014-03-01

    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

  19. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI : a correlation with histopathology

    DEFF Research Database (Denmark)

    Boesen, Lars; Chabanova, Elizaveta

    2015-01-01

    OBJECTIVES: To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. MATERIALS AND METHODS: Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cTMRI), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. RESULTS: Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p?risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. CONCLUSIONS: Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. KEY POINTS: • Multiparametric MRI is an accurate diagnostic technique for preoperative prostate cancer staging • ECE risk scoring predicts extracapsular tumour extension at final pathology • ECE risk scoring shows an AUC of 0.86 on the ROC-curve • ECE risk scoring shows a moderate inter-reader agreement (K?=?0.45) • Multiparametric MRI provides essential knowledge for optimal clinical management.

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

    International Nuclear Information System (INIS)

    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 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)

  1. Metabolic risk score indexes validation in overweight healthy people

    OpenAIRE

    Morencos Martínez, Esther; Benito Peinado, Pedro José; Gonzalez Gross, Maria Marcela; Romero Moraleda, Blanca; Gomez Candela, C.; FERNANDEZ, C; Calderón Montero, Francisco Javier

    2011-01-01

    The constellation of adverse cardiovascular disease (CVD) and metabolic risk factors, including elevated abdominal obesity, blood pressure (BP), glucose, and triglycerides (TG) and lowered high-density lipoprotein-cholesterol (HDL-C), has been termed the metabolic syndrome (MetSyn) [1]. A number of different definitions have been developed by the World Health Organization (WHO) [2], the National Cholesterol Education Program Adult Treatment Panel III (ATP III) [3], the European Group for the ...

  2. Association of the heart rate turbulence with classic risk stratification parameters in postmyocardial infarction patients.

    Science.gov (United States)

    Jeron, Andreas; Kaiser, Tanja; Hengstenberg, Christian; Löwel, Hannelore; Riegger, Günter A J; Holmer, Stephan

    2003-10-01

    The heart rate turbulence (HRT) parameters were introduced for risk stratification of ventricular arrhythmias in postmyocardial infarction patients. However, the relationship of these parameters with other risk stratificators such as heart rate variability (HRV), repolarization parameters or left ventricular function is unknown. Furthermore, the influence of age and medication on HRT remains to be evaluated. Holter ECG's of 509 post-MI patients (1-10 years after MI) were screened for single ventricular extrasystole. In 196 patients the parameters' turbulence onset (TO) and turbulence slope (TS) could be computed. A pathological TO (>0%) and TS (left ventricular dysfunction (EF 45%. In contrast, the percentage of pathological HRT was not different between patients with left ventricular hypertrophy (16 out of 59, 27%) compared to patients without LVH (38 out of 133, 28%). The HRT was pathological in 14 out of 24 patients with diabetes mellitus (58%) compared to 40 out of 172 (23%) normoglycemic patients (TO: -0.6 +/- 3.1 vs. -2.5 +/- 5.5, P left ventricular function and correlates with heart rate variability. Therapy with ss-blockers has no influence on HRT, while diabetic patients may have an increased likelihood of pathological HRT. PMID:14516285

  3. Genetic Variation in ABCG1 and Risk of Myocardial Infarction and Ischemic Heart Disease

    DEFF Research Database (Denmark)

    Schou, Jesper; Frikke-Schmidt, Ruth

    2012-01-01

    OBJECTIVE: ATP binding cassette transporter G1 (ABCG1) facilitates cholesterol efflux from macrophages to mature high-density lipoprotein particles. Whether genetic variation in ABCG1 affects risk of atherosclerosis in humans remains to be determined. METHODS AND RESULTS: We resequenced the core promoter and coding regions of ABCG1 in 380 individuals from the general population. Next, we genotyped 10 237 individuals from the Copenhagen City Heart Study for the identified variants and determined the effect on lipid and lipoprotein levels and on risk of myocardial infarction (MI) and ischemic heart disease (IHD). g.-376C>T, g.-311T>A, and Ser630Leu predicted risk of MI in the Copenhagen City Heart Study, with hazard ratios of 2.2 (95% confidence interval: 1.2-4.3), 1.7 (1.0-2.9), and 7.5 (1.9-30), respectively. These results were confirmed for g.-376C>T in a case-control study comprising 4983 independently ascertained IHD cases and 7489 controls. Expression levels of ABCG1 mRNA were decreased by approximately 40% in g.-376C>T heterozygotes versus noncarriers (probability values: 0.005-0.009). Finally, in vitro specificity protein 1 (Sp1) bound specifically to a putative Sp1 binding site at position -382 to -373 in the ABCG1 promoter, and the presence of the -376 T allele reduced binding and transactivation of the promoter by Sp1. CONCLUSIONS: This is the first report of a functional variant in ABCG1 that associates with increased risk of MI and IHD in the general population.

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

    Scientific Electronic Library Online (English)

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

    2011-02-01

    Full Text Available 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.

  5. A Retrospective Analysis of Pressure Ulcer Incidence and Modified Braden Scale Score Risk Classifications.

    Science.gov (United States)

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha

    2015-09-01

    The Braden Scale is the most widely used pressure ulcer risk assessment in the world, but the currently used 5 risk classification groups do not accurately discriminate among their risk categories. To optimize risk classification based on Braden Scale scores, a retrospective analysis of all consecutively admitted patients in an acute care facility who were at risk for pressure ulcer development was performed between January 2013 and December 2013. Predicted pressure ulcer incidence first was calculated by logistic regression model based on original Braden score. Risk classification then was modified based on the predicted pressure ulcer incidence and compared between different risk categories in the modified (3-group) classification and the traditional (5-group) classification using chi-square test. Two thousand, six hundred, twenty-five (2,625) patients (mean age 59.8 ± 16.5, range 1 month to 98 years, 1,601 of whom were men) were included in the study; 81 patients (3.1%) developed a pressure ulcer. The predicted pressure ulcer incidence ranged from 0.1% to 49.7%. When the predicted pressure ulcer incidence was greater than 10.0% (high risk), the corresponding Braden scores were less than 11; when the predicted incidence ranged from 1.0% to 10.0% (moderate risk), the corresponding Braden scores ranged from 12 to 16; and when the predicted incidence was less than 1.0% (mild risk), the corresponding Braden scores were greater than 17. In the modified classification, observed pressure ulcer incidence was significantly different between each of the 3 risk categories (P less than 0.05). However, in the traditional classification, the observed incidence was not significantly different between the high-risk category and moderate-risk category (P less than 0.05) and between the mild-risk category and no-risk category (P less than 0.05). If future studies confirm the validity of these findings, pressure ulcer prevention protocols of care based on Braden Scale scores can be simplified. PMID:26367479

  6. Serum Gamma-Glutamyltransferase Concentration Correlates with Framingham Risk Score in Koreans

    OpenAIRE

    Kim, Kyu-Nam; Kim, Kwang-Min; Lee, Duck-Joo; Joo, Nam-Seok

    2011-01-01

    Gamma-glutamyltransferase (GGT) is a novel coronary artery disease (CAD) risk factor, but its use as an independent factor for CAD risk prediction remains unclear in Asian population. This study examined the association between serum GGT concentration and Framingham risk score (FRS) in the Korean population. This cross-sectional study was performed on 30,710 Koreans. Besides FRS, body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid and high sensitive C-reactive prot...

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

    OpenAIRE

    Lorenzo-Aguiar Dolores; Alonso-Hernández Angel; Fernández-Rivera Constantino; Seoane-Pillado Teresa; Seijo-Bestilleiro Rocío; Valdés-Cañedo Francisco; Pértega-Díaz Sonia; Pita-Fernández Salvador; López-Calviño Beatriz; López-Muñiz Andres

    2011-01-01

    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 (Framin...

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

    DEFF Research Database (Denmark)

    Nossent, Anne Yaël; Hansen, Jakob Liebe; Doggen, Carine; Quax, Paul H A; Sheikh, Søren P; Rosendaal, Frits R

    2011-01-01

    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.

  9. Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients

    DEFF Research Database (Denmark)

    Hansen, Malene Kærslund; Gammelager, Henrik; Mikkelsen, Martin Majlund; Hjortdal, Vibeke Elisabeth; Layton, J Bradley; Johnsen, Søren Paaske; Christiansen, Christian Fynbo

    2013-01-01

    The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI.

  10. Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients : a cohort study

    DEFF Research Database (Denmark)

    Hansen, Malene Kærslund; Gammelager, Henrik

    2013-01-01

    The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI.

  11. Aggregate risk score for predicting mortality after surgical biopsy for interstitial lung disease†

    OpenAIRE

    Fibla, Juan J.; Brunelli, Alessandro; Cassivi, Stephen D.; Deschamps, Claude

    2012-01-01

    In order to develop a practical risk score for 90-day mortality following surgical lung biopsy (SLB) for interstitial lung disease (ILD) we reviewed 311 consecutive patients undergoing SLB for ILD between 2002 and 2009. Postoperative complication, 30-day and 90-day mortality rates were 11.5%, 9% and 10.6% respectively. Univariable and multivariable analyses, validated by bootstrap statistics, were used to identify factors associated with 90-day mortality. A scoring system was developed by pro...

  12. Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England

    OpenAIRE

    Wynne-Jones, K; M. Jackson; Grotte, G; Bridgewater, B; North, W

    2000-01-01

    OBJECTIVE—To study the use of the Parsonnet score to predict mortality following adult cardiac surgery.?DESIGN—Prospective study.?SETTING—All centres performing adult cardiac surgery in the north west of England.?SUBJECTS—8210 patients undergoing surgery between April 1997 and March 1999.?MAIN OUTCOME MEASURES—Risk factors and in-hospital mortality were recorded according to agreed definitions. Ten per cent of cases from each centre were selected at random for validation. A Parsonnet score wa...

  13. Analysis on the risk of contralateral proximal femoral epiphyseal slippage using the modified Oxford score?

    Science.gov (United States)

    Soni, Jamil Faissal; Valenza, Weverley Rubele; Ueda, Wellington Keity; Schelle, Gisele Cristine; Costa, Anna Carolina Pavelec; Ferraz Faria, Fernando

    2015-01-01

    Objective To determine the application of the modified Oxford score among patients with proximal femoral epiphyseal slippage (PFES) as an aid to indicating prophylactic surgical treatment on the contralateral hip. Methods Retrospective analysis on the medical files of patients attended at the institution where the authors work. From these, patients attended between 2008 and 2011 who presented unilateral PFES and were followed up for a minimum of two years were selected. Patients were excluded if they presented endocrine disease, metabolic disease, Down syndrome or radiographs that were inadequate for determining the modified Oxford score. The initial radiographs received scores ranging from 16 to 26. Statistical analysis was used to determine whether the scoring was predictive of future development of contralateral slippage. Results Among the 15 patients with unilateral PFES that were selected, five (33.3%) evolved with contralateral slippage. The patients were divided into two groups. Four patients were considered to present risk and three of them developed contralateral slippage. In the group that was considered not to present risk, there were 11 patients and two of these evolved with contralateral slippage. Thus, there was a tendency for the patients in the group that developed the disease to differ from the group that did not develop it, in relation to the risk classification. Conclusion Although application of the modified Oxford score was not statistically significant in our sample, we noted a tendency toward contralateral slippage among hips with low scores. PMID:26535204

  14. Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Olsen, Anne-Marie Schjerning; Gislason, Gunnar H.; McGettigan, Patricia; Fosbøl, Emil; Sørensen, Rikke; Hansen, Morten Lock; Køber, Lars; Torp-Pedersen, Christian; Lamberts, Morten

    2015-01-01

    IMPORTANCE: Antithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns. OBJECTIVE: To examine the risk of bleeding and cardiovascular events among patients with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed. DESIGN, SETTING, AND PARTICIPANTS: Using nationwide administrative registries in Denmark (2002-2011), we studied patient...

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

    OpenAIRE

    Paszat, LF; Vallis, KA; Benk, VM; Groome, PA; Mackillop, WJ; Wielgosz, A

    2007-01-01

    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...

  16. Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Engstrøm, Thomas; Glinge, Charlotte; Risgaard, Bjarke; Jabbari, Javad; Winkel, Bo Gregers; Terkelsen, Christian Juhl; Tilsted, Hans-Henrik; Jensen, Lisette Okkels; Hougaard, Mikkel; Chiuve, Stephanie E; Pedersen, Frants; Svendsen, Jesper Hastrup; Haunsø, Stig; Albert, Christine M; Tfelt-Hansen, Jacob

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPC...

  17. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Jabbari, Reza; Engstrøm, Thomas; Glinge, Charlotte; Risgaard, Bjarke; Jabbari, Javad; Winkel, Bo Gregers; Terkelsen, Christian Juhl; Tilsted, Hans-Henrik; Jensen, Lisette Okkels; Hougaard, Mikkel; Chiuve, Stephanie E; Pedersen, Frants; Svendsen, Jesper Hastrup; Haunsø, Stig; Albert, Christine M; Tfelt-Hansen, Jacob

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPC...

  18. Income as mediator of the effect of occupation on the risk of myocardial infarction: does the income measurement matter?

    DEFF Research Database (Denmark)

    Andersen, Ingelise; Gamborg, Michael; Osler, Merete; Prescott, Eva; Diderichsen, Finn

    2005-01-01

    AIM: To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account. METHODS: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 665 employees, 43% women, aged 20-75 years, with an initial examination between 1974 and 1992 were followed up until 1999 for incident (hospital admission or fatal) MI. Register based information on job categories and...

  19. Comparison of renal function and cardiovascular risk following acute myocardial infarction in patients with and without diabetes mellitus

    DEFF Research Database (Denmark)

    Anavekar, Nagesh S; Solomon, Scott D; McMurray, John J V; Maggioni, Aldo; Rouleau, Jean Lucien; Califf, Robert; White, Harvey; Køber, Lars Valeur; Velazquez, Eric; Pfeffer, Marc A

    2008-01-01

    Renal dysfunction is an independent risk factor for cardiovascular (cv) disease and its associated complications. Diabetes mellitus (dm) is a common cause of renal dysfunction. Whether the presence or absence of dm modifies the relation between renal dysfunction and cv disease is unclear. The valiant trial identified 14,527 patients with acute myocardial infarction complicated by either clinical or radiologic signs of heart failure and/or left ventricular dysfunction for whom baseline creatinine...

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

    OpenAIRE

    Arshad Hussain Laghari; Allah Nawaz Memon; Afsheen Mushtaque shah; Syed Fasih Ahmed; Muhammad Saleh Memon

    2009-01-01

    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 patien...

  1. Long-term prognosis and risk heterogeneity of heart failure complicating acute myocardial infarction.

    Science.gov (United States)

    de Carvalho, Leonardo P; Gao, Fei; Chen, Qifeng; Sim, Ling-Ling; Koh, Tian-Hai; Foo, David; Ong, Hean-Yee; Tong, Khim-Leng; Tan, Huay-Cheem; Yeo, Tiong-Cheng; Chow, Khuan-Yew; Richards, A Mark; Peterson, Eric D; Chua, Terrance; Chan, Mark Y

    2015-04-01

    The Killip classification of acute heart failure was developed decades ago to predict short-term mortality in patients with acute myocardial infarction (AMI). The aim of this study was to determine the long-term prognosis of acute heart failure graded according to the Killip classification in 15,235 unselected patients hospitalized for AMI from 2000 to 2005. Vital status for each patient was ascertained, through to March 1, 2012, from linkage with national death records. A stepwise gradient in the adjusted hazard ratio (HR) for 12-year mortality was observed with increasing Killip class: class I (n = 10,123), HR 1.00 (reference group); class II (n = 2,913), HR 1.13 (95% confidence interval [CI] 1.06 to 1.21); class III (n = 1,217) HR 1.49 (95% CI 1.37 to 1.62); and class IV (n = 898), HR 2.80 (95% CI 2.53 to 3.10). Unexpectedly, in a landmark analysis excluding deaths CI 1.33 to 2.19, p 60 years of age was 2.30 (95% CI 2.07 to 2.56, p <0.001). In conclusion, on the basis of simple clinical features, the Killip classification robustly predicted 12-year mortality after AMI. The heterogeneity in early versus late risk in patients with Killip class IV heart failure underscores the importance of appropriate early treatment in cardiogenic shock. PMID:25682439

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

    Directory of Open Access Journals (Sweden)

    Seyed Ali Moezy

    2011-07-01

    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.<

  3. Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study

    Science.gov (United States)

    Weng, Shih-Feng; Hsu, Chien-Chin; Wang, Jhi-Joung; Su, Shih-Bin; Huang, Chien-Cheng; Guo, How-Ran

    2015-01-01

    Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan’s National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+]) between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[?]) as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[?] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72–2.50). In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03–3.57) and patients AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[?] AMI[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients AMI in CAD patients. PMID:26529110

  4. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

    DEFF Research Database (Denmark)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning

    2015-01-01

    BACKGROUND: Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. METHODS AND RESULTS: Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI's and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). CONCLUSION: Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  5. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

    Science.gov (United States)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning; Madsen, Jesper Clausager; Faber, Jens; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar; Selmer, Christian

    2015-01-01

    Background Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. Methods and Results Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI’s and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). Conclusion Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI. PMID:26069971

  6. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

    Directory of Open Access Journals (Sweden)

    Priscila Costa

    2015-06-01

    Full Text Available OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points, moderate (4 to 8 points, and high (? 9 points. Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

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

    International Nuclear Information System (INIS)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

    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.)

  9. Was there really any evidence that rosiglitazone increased the risk of myocardial infarction or death from cardiovascular causes?

    Science.gov (United States)

    Stone, Jennifer C; Furuya-Kanamori, Luis; Barendregt, Jan J; Doi, Suhail A R

    2015-03-01

    Rosiglitazone has previously been widely used to treat patients with type 2 diabetes mellitus, but its safety in terms of cardiovascular morbidity and mortality had been called into question. Recently, there have been doubts raised about the meta-analytic evidence with the regulatory authorities relaxing its restrictions. We hypothesized that the original analyses may have produced exaggerated results because of the small baseline risks involved. To demonstrate this, we replicated the meta-analysis of four randomized trials of greater than 12-month follow-up that made use of a randomized control group not receiving rosiglitazone and reported outcome data for all occurrences of the complementary outcomes (no myocardial infarction, no death from cardiovascular causes, and no heart failure). Data were combined by means of a fixed-effects model. In the rosiglitazone group, as compared with the control group, the relative risk for no myocardial infarction was 0.997 (95% confidence interval [CI], 0.994 to 1.000), and the relative risk for no death from cardiovascular causes was 1.001 (95%CI, 0.999 to 1.003). Finally, no heart failure had a relative risk of 0.995 (95%CI, 0.993 to 0.998). Rosiglitazone does not seem to have any significant increase in the risk of myocardial infarction or of death from cardiovascular causes associated with its use. Regulatory authorities should revisit this issue of the appropriate measure for reporting of adverse events with low baseline risks as this has implications well beyond rosiglitazone. PMID:25515780

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

    Science.gov (United States)

    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

    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.

  11. An Inflammatory Polymorphisms Risk Scoring System for the Differentiation of Ischemic Stroke Subtypes

    Science.gov (United States)

    Muiño, Elena; Krupinski, Jurek; Carrera, Caty; Gallego-Fabrega, Cristina; Montaner, Joan; Fernández-Cadenas, Israel

    2015-01-01

    Inflammation has been associated with atherothrombotic stroke and recently with cardioembolic stroke. Different genetic risk factors have been specifically associated with the subtypes of ischemic stroke (cardioembolic, atherothrombotic, and lacunar). However, there are no studies that have generated genetic risk scores for the different subtypes of ischemic stroke using polymorphisms associated with inflammation. Methods. We have analyzed 68 polymorphisms of 30 inflammatory mediator genes in 2,685 subjects: 1,987 stroke cases and 698 controls. We generated a genetic scoring system with the most significant polymorphisms weighted by the odds ratio of every polymorphism and taken into consideration the stroke subtype. Results. Three polymorphisms, rs1205 (CRP gene), rs1800779, and rs2257073 (NOS3 gene), were associated with cardioembolic stroke (p value <0.05). The score generated was only associated with the cardioembolic stroke subtype (p value: 0.001) and was replicated in an independent cohort (p value: 0.017). The subjects with the highest score presented a cardioembolic stroke in 92.2% of the cases (p value: 0.002). Conclusion. The genetics of inflammatory markers is more closely associated with cardioembolic strokes than with atherothrombotic or lacunar strokes. The genetic risk scoring system could be useful in the prediction and differentiation of ischemic stroke; however, it might be specific to particular ischemic stroke subtypes. PMID:26355258

  12. Interactions of Lipid Genetic Risk Scores with Estimates of Metabolic Health in a Danish Population

    DEFF Research Database (Denmark)

    Justesen, Johanne M; Allin, Kristine H; Sandholt, Camilla H; Borglykke, Anders; Krarup, Nikolaj T; Grarup, Niels; Linneberg, Allan; Jørgensen, Torben; Hansen, Torben; Pedersen, Oluf

    2015-01-01

    BACKGROUND: -There are several well-established lifestyle factors influencing dyslipidemia and currently, 157 genetic susceptibility loci have been reported to be associated with serum lipid levels at genome-wide statistical significance. However, the interplay between lifestyle risk factors and these susceptibility loci has not been fully elucidated. We tested if genetic risk scores (GRS) of lipid-associated SNPs associate with fasting serum lipid traits and if the effects are modulated by life...

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

    DEFF Research Database (Denmark)

    Petersen, Christina BjØrk; Bauman, Adrian

    2014-01-01

    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.

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

    Scientific Electronic Library Online (English)

    Ricardo, Casalino; Flávio, Tarassoutchi.

    2012-05-01

    Full Text Available 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.

  15. The Impact of SIM on FCAT Reading Scores of Special Education and At-Risk Students

    Science.gov (United States)

    Matyo-Cepero, Jude

    2013-01-01

    The purpose of this study was to determine if special education and at-risk students educated exclusively in a school-within-a-school setting showed improved high-stakes standardized reading test scores after learning the strategic instruction model (SIM) inference strategy. This study was focused on four groups of eighth-grade students attending…

  16. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

    International Nuclear Information System (INIS)

    To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cTMRI), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. (orig.)

  17. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Boesen, Lars; Mikines, Kari [Herlev University Hospital, Department of Urology, Herlev (Denmark); Chabanova, Elizaveta; Loegager, Vibeke; Thomsen, Henrik S. [Herlev University Hospital, Department of Radiology, Herlev (Denmark); Balslev, Ingegerd [Herlev University Hospital, Department of Pathology, Herlev (Denmark)

    2015-06-01

    To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cT{sub MRI}), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. Histopathology and cT{sub MRI} showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. (orig.)

  18. Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Verma

    2014-06-01

    Conclusion: Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis. [Int J Res Med Sci 2014; 2(3.000: 1101-1106

  19. Autism risk assessment in siblings of affected children using sex-specific genetic scores

    Directory of Open Access Journals (Sweden)

    Carayol Jerome

    2011-10-01

    Full Text Available Abstract Background The inheritance pattern in most cases of autism is complex. The risk of autism is increased in siblings of children with autism and previous studies have indicated that the level of risk can be further identified by the accumulation of multiple susceptibility single nucleotide polymorphisms (SNPs allowing for the identification of a higher-risk subgroup among siblings. As a result of the sex difference in the prevalence of autism, we explored the potential for identifying sex-specific autism susceptibility SNPs in siblings of children with autism and the ability to develop a sex-specific risk assessment genetic scoring system. Methods SNPs were chosen from genes known to be associated with autism. These markers were evaluated using an exploratory sample of 480 families from the Autism Genetic Resource Exchange (AGRE repository. A reproducibility index (RI was proposed and calculated in all children with autism and in males and females separately. Differing genetic scoring models were then constructed to develop a sex-specific genetic score model designed to identify individuals with a higher risk of autism. The ability of the genetic scores to identify high-risk children was then evaluated and replicated in an independent sample of 351 affected and 90 unaffected siblings from families with at least 1 child with autism. Results We identified three risk SNPs that had a high RI in males, two SNPs with a high RI in females, and three SNPs with a high RI in both sexes. Using these results, genetic scoring models for males and females were developed which demonstrated a significant association with autism (P = 2.2 × 10-6 and 1.9 × 10-5, respectively. Conclusions Our results demonstrate that individual susceptibility associated SNPs for autism may have important differential sex effects. We also show that a sex-specific risk score based on the presence of multiple susceptibility associated SNPs allow for the identification of subgroups of siblings of children with autism who have a significantly higher risk of autism.

  20. 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)

    Mortensen, Martin B; Falk, Erling

    2014-01-01

    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.

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Cook Stephen

    2013-02-01

    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.

  3. SYNTAX, STS and EuroSCORE - how good are they for risk estimation in atherosclerotic heart disease?

    Science.gov (United States)

    Metzler, Bernhard; Winkler, Bernhard

    2012-12-01

    Tests that enable prediction of adverse outcome after surgical or nonsurgical intervention in cardiac patients are of great importance since they can help guide clinical decision making. The new evolving percutaneous therapeutic techniques combined with the currently available risk scoring systems require improved prediction models. In the context of steadily improving surgical techniques and perioperative care, on the one hand, and the inadequacy of regional patient data sets to provide generally applicable risk prediction base, on the other, there is need for adaption and recalibration of scoring systems some of which are partly outdated but still widely in use. The accuracy of predictive models depends on their proper application as well as the knowledge of their individual strengths and weaknesses. The EuroSCORE and the STS score take into consideration some risk factors associated with mortality, whereas the SYNTAX score relies solely on coronary anatomy and lesion characteristics. A combination of selected score components from the EuroSCORE, assessing the mortality risk, and those from the SYNTAX score, reflecting the coronary artery disease complexity, can be expected to yield more accurate results in estimating risk in individual patients. In this review, the predictive ability of the SYNTAX score, the STS score and the EuroSCORE will be discussed. PMID:22187025

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

    Directory of Open Access Journals (Sweden)

    Knudsen Torben

    2010-02-01

    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.

  5. Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy

    OpenAIRE

    Mahmood Hajiahmadi; Maryam Javadian; Nesa Asnafi1; Mousa Ahmadpour-Kacho; Nazila Hosseini Taleghani

    2010-01-01

    Objective:The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. Methods:This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad hospital, which is affiliated to Babol University of Medical Scienc...

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

    Scientific Electronic Library Online (English)

    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.

    2003-12-01

    Full Text Available 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.

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

    Directory of Open Access Journals (Sweden)

    M. Ciruzzi

    2003-12-01

    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.

  8. Distinction of salvaged and infarcted myocardium within the ischaemic area-at-risk with T2 mapping

    DEFF Research Database (Denmark)

    Hammer-Hansen, Sophia; Ugander, Martin

    2014-01-01

    AIM: Area-at-risk (AAR) measurements often rely on T2-weighted images, but subtle differences in T2 may be overlooked with this method. To determine the differences in oedema between salvaged and infarcted myocardium, we performed quantitative T2 mapping of the AAR. We also aimed to determine the impact of reperfusion time on T2 in the AAR. METHODS: Twenty-two dogs underwent 2 h of coronary occlusion followed by 4 or 48 h of reperfusion before cardiac magnetic resonance imaging at 1.5 T. Late gadolinium enhancement images were used to define the infarcted, salvaged, and remote myocardium. T2 values from T2 maps and signal intensities on T2-weighted images were measured in the corresponding areas. RESULTS: At both imaging time points, the T2 of the salvaged myocardium was longer than of remote (66.0 ± 6.9 vs. 51.4 ± 3.5 ms, P < 0.001 at 4 h, and 56.7 ± 7.3 vs. 48.1 ± 3.5 ms, P < 0.001 at 48 h). The T2 was also longer in the infarcted myocardium compared with remote at both 4 and 48 h (71.4 ± 7.6 ms, P < 0.01vs. salvage and 64.0 ± 6.9 ms, P = 0.03 vs. salvage, both P < 0.001 vs. remote). The increase in T2 in the salvaged myocardium compared with remote was greater after 4 h than after 48 h (14.7 ± 5.6 vs. 8.7 ± 5.1 ms, P = 0.02). CONCLUSIONS: T2 relaxation parameters are different in the infarcted and salvaged myocardium, and both are significantly longer than remote. Furthermore, the magnitude of increase in T2 was less in the salvaged myocardium after longer reperfusion, indicating partial resolution of oedema in the first 48 h after reperfusion.

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

    Directory of Open Access Journals (Sweden)

    Amanda Mocroft

    2014-11-01

    Full Text Available 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.

  10. 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)

    Køber Lars

    2010-01-01

    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.

  11. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan; Woodward, Mark; Ahmadvand, Alireza; Aguilar-Salinas, Carlos A; Azizi, Fereidoun; Cifkova, Renata; Di Cesare, Mariachiara; Eriksen, Louise; Farzadfar, Farshad; Ikeda, Nayu; Khalili, Davood; Khang, Young-Ho; Lanska, Vera; León-Muñoz, Luz; Magliano, Dianna; Msyamboza, Kelias P; Oh, Kyungwon; Rodríguez-Artalejo, Fernando; Rojas-Martinez, Rosalba; Shaw, Jonathan E; Stevens, Gretchen A; Tolstrup, Janne; Zhou, Bin; Salomon, Joshua A; Ezzati, Majid; Danaei, Goodarz

    2015-01-01

    BACKGROUND: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. METHODS: We used data from eight prospective cohort studies to estimate coefficients of the risk equation...

  12. Framingham coronary heart disease risk score can be predicted from structural brain images in elderly subjects.

    Directory of Open Access Journals (Sweden)

    Jane Maryam Rondina

    2014-12-01

    Full Text Available Recent literature has presented evidence that cardiovascular risk factors (CVRF play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer’s disease (AD and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies in a sample of healthy elderly individuals. We aim to answer the following questions: Is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: i we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease. ii When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. iii We found important gender differences, and the possible causes of that finding are discussed.

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

    International Nuclear Information System (INIS)

    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. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. 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. 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%). 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo, E-mail: anamariafeoli@hotmail.com [Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil)

    2014-04-15

    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. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. 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. 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%). 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.

  15. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction

    Directory of Open Access Journals (Sweden)

    Dai Hongying

    2013-01-01

    Full Text Available Abstract Background Multifactor Dimensionality Reduction (MDR has been widely applied to detect gene-gene (GxG interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. Results We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. Conclusions The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi are proposed to detect multiple GxG interactions.

  16. 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 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.

  17. [Outpatient coronary groups. 1st experiences with high-risk infarct patients after a year's model experiment].

    Science.gov (United States)

    Buchbinder, W; Gocke, H; Ilker, H G; Stein, G

    1981-04-01

    One year's experience with patients after myocardial infarction with low physical capacity (high risk-patients) and their participation in coronary clubs. After satisfactory results have been recorded with coronary training-groups at Hamburg first results can be reported from a trial with a coronary exercising-group at the patient's community. Patients after myocardial infarction with low physical capacity (high risk-patients) have participated regularly in coronary club meetings. One year's observation with medical controls showed no hazards from special adapted exercises combined with health education. Cardiac complications did not occur. The exercise program aims on increasing coordination and flexibility; general aerobic endurance is not to be improved. Thus a better and more economical functioning of the cardiovascular system is reached; life quality is improved. Further propagation of the coronary exercising-program is recommended if the described precautions are observed. This way many coronary patients could benefit also from long-time participation in comprehensive care in coronary clubs, which were up to now excluded from coronary training groups because of high risk. PMID:7227944

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

    Directory of Open Access Journals (Sweden)

    Boscarino JA

    2013-04-01

    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

  19. Risk prediction scores for recurrence and progression of non-muscle invasive bladder cancer

    DEFF Research Database (Denmark)

    Vedder, Moniek M; Márquez, Mirari; de Bekker-Grob, Esther W; Calle, Malu L; Dyrskjøt, Lars; Kogevinas, Manoils; Segersten, Ulrika; Malmström, Per-Uno; Algaba, Ferran; Beukers, Willemien; Ørntoft, Torben F; Zwarthoff, Ellen; Real, Francisco X; Malats, Nuria; Steyerberg, Ewout W

    2014-01-01

    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 f...

  20. Low Apgar Scores and Risk of Childhood Attention Deficit Hyperactivity Disorder

    DEFF Research Database (Denmark)

    Li, Jiong; Olsen, Jørn; Vestergaard, Mogens; Obel, Carsten

    2011-01-01

    OBJECTIVE: To examine whether low Apgar scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: We conducted a nationwide population-based cohort study of all 980 902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came ...

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

    OpenAIRE

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

    2012-01-01

    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...

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

    DEFF Research Database (Denmark)

    Pocock, Stuart J; Ariti, Cono A

    2012-01-01

    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.

  3. Evaluation of a risk factor scoring model in screening for undiagnosed diabetes in China population*

    OpenAIRE

    Dong, Jian-jun; Lou, Neng-jun; Zhao, Jia-Jun; Zhang, Zhong-wen; Qiu, Lu-lu; Zhou, Ying; Liao, Lin

    2011-01-01

    Objective: To develop a risk scoring model for screening for undiagnosed type 2 diabetes in Chinese population. Methods: A total of 5348 subjects from two districts of Jinan City, Shandong Province, China were enrolled. Group A (2985) included individuals from east of the city and Group B (2363) from west of the city. Screening questionnaires and a standard oral glucose tolerance test (OGTT) were completed by all subjects. Based on the stepwise logistic regression analysis of Group A, variabl...

  4. 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....

  5. Determinants of Excess Genetic Risk of Acute Myocardial Infarction - A Matched Case-Control Study.

    Czech Academy of Sciences Publication Activity Database

    Valenta, Zden?k; Mazura, Ivan; Kolá?, M.; Feglarová, Petra; Peleška, Jan; Tome?ková, Marie; Kalina, Jan; Slovák, Dalibor; Zvárová, Jana

    2012-01-01

    Ro?. 8, ?. 1 (2012), s. 34-43. ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional support: RVO:67985807 Keywords : genome-wide association study * gene expression * myocardial infarction * genetic predisposition * predictive modeling Subject RIV: BB - Applied Statistics, Operational Research http://www.ejbi.org/img/ejbi/2012/1/Valenta_en.pdf

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

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    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.

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

    DEFF Research Database (Denmark)

    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

    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 unb...

  8. High-risk subgroup of inferior myocardial infarction. Importance of anterior wall motion and right ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tsunehiko; Yasuda, Tsunehiro; Gold, H.K.; Leinbach, R.C.; Boucher, C.A.; McKusick, K.A.; Strauss, H.W.

    1986-12-01

    To identify high-risk subgroups of inferior myocardial infarction, 75 patients presenting with their first inferior infarction were investigated by sequential gated blood pool scans. The patients were divided into four groups based on the right ventricular function (RVF) and anterior wall motion (AWM) of the left ventricle by scan at the time of admission. A second blood pool scan was performed at ten days to evaluate RV and LV function. Thirty-eight patients had cardiac catheterization before discharge and all patients were followed up for one year to determine their clinical outcome. Depressed RVF and reduced AWM were observed in 26 (35%) (Group A); depressed RVF and normal AWM were found in 20 (27%) (Group B); reduced AWM and normal RVE in 10 (13%) (Group C); and normal RVF and AWM in 19 (25%) (Group D). The mean values of biventricular function (LVEF, RVEF) in groups A, B, C, and D were (44.9 +- 8.4%, 32.5 +- 9.9%), (59.9 +- 8.6%, 34.5 +- 8.0%), (44.9 +- 15.7%, 48.2 +- 3.3%), and (60.4 +- 9.1%, 51.6 +- 10.6%), respectively, at admission. In serial measurements, LVEF did not change significantly in any group, however, RVEF improved nearly 10 points in groups A and B at 10 days. Group A also had the highest incidence (82 %) of left anterior descending coronary artery involvement, and the highest mean creatine phosphokinase levels (762 +- 318 U/1): Furthermore, group A had a high incidence of major complications during their hospital course and high mortality during the one-year follow-up. These data clearly identified group A as a high-risk subgroup of patients with inferior infarction.

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

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Marott, Jacob L; Sehestedt, Thomas; Hansen, Tine W; Olsen, Michael H; Andersen, Ove; Linneberg, Allan; Haugaard, Steen B; Eugen-Olsen, Jesper; Hansen, Peter R; Jeppesen, Jørgen

    2013-01-01

    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 ische...

  10. A Risk-Scoring Model for the Prediction of Endometrial Cancer among Symptomatic Postmenopausal Women with Endometrial Thickness > 4?mm

    OpenAIRE

    Luca Giannella; Kabala Mfuta; Tiziano Setti; Lillo Bruno Cerami; Ezio Bergamini; Fausto Boselli

    2014-01-01

    Objective. To develop and test a risk-scoring model for the prediction of endometrial cancer among symptomatic postmenopausal women at risk of intrauterine malignancy. Methods. We prospectively studied 624 postmenopausal women with vaginal bleeding and endometrial thickness > 4?mm undergoing diagnostic hysteroscopy. Patient characteristics and endometrial assessment of women with or without endometrial cancer were compared. Then, a risk-scoring model, including the best predictors of endometr...

  11. Impact of Primary Gleason Grade on Risk Stratification for Gleason Score 7 Prostate Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Koontz, Bridget F., E-mail: bridget.koontz@duke.edu [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Tsivian, Matvey [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Mouraviev, Vladimir [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Sun, Leon [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Vujaskovic, Zeljko [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Moul, Judd [Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States); Lee, W. Robert [Department of Radiation Oncology, Duke Prostate Center, Duke University Medical Center, Durham, NC (United States)

    2012-01-01

    Purpose: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. Methods: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D'Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. Results: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). Conclusions: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

  12. Impact of Primary Gleason Grade on Risk Stratification for Gleason Score 7 Prostate Cancers

    International Nuclear Information System (INIS)

    Purpose: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. Methods: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D’Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. Results: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). Conclusions: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

  13. MORTALITY RISK ASSESSMENT IN PICU USING PRISM-III-24 SCORE

    Directory of Open Access Journals (Sweden)

    Harilal Naik

    2014-11-01

    Full Text Available OBJECTIVE: Assessment of risk of mortality using PRISM III-24 score in children admitted to PICU of Basaweshwara Teaching and General Hospital, attached to Mahadevappa Rampure Medical College, Gulbarga. DESIGN: Prospective cohort study. Setting: PICU of BTGH, Gulbarga. METHODS: 404 patients who had been admitted consecutively to the PICU during a period of 12 months (July 2011 to June 2012 were studied. PRISM III-24 score was calculated. Hospital outcome was recorded as survived/expired. Calibration and discrimination of the model was calculated by Hosmer-Lemeshow goodness-of-fit test and Area under the ROC Curve. The association between r (empirical function and PRISM III-24 score was assessed by Binary Logistic Regression method. RESULTS: Out of 404 patients, 363 (89.85% survived and 41 (10.15% expired. Males formed the majority (227/404. CNS cases (n=118, 29.2% constituted the majority. Mean age, length of hospitalization, and mean PRISM III-24 score were 59.22±51.12 months, 99.84±91.61 hours, and 4.92±7.74 (range 0-36. The test was well designed for the study (goodness-of-fit value P-value 0.186. ROC analysis indicated a strong predictive power for the PRISM III-24 (AUC 0.936. The observed (O mortality rate was 10.15% and the expected (E mortality rate was 10.12% with an O/E ratio of 1.003. CONCLUSION: PRISM III-24 score is a good predictor of mortality in PICU patients under Indian circumstances. The PRISM III-24 scoring system was highly calibrated in our institute.

  14. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    International Nuclear Information System (INIS)

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery

  15. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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

  17. Predicted 10-year risk of cardiovascular disease among Canadian adults using modified Framingham Risk Score in association with dietary intake.

    Science.gov (United States)

    Setayeshgar, Solmaz; Whiting, Susan J; Pahwa, Punam; Vatanparast, Hassanali

    2015-10-01

    Initial risk assessment to estimate 10-year risk of cardiovascular disease (CVD) is completed by Framingham Risk Score (FRS). In 2012 2 modifications were added to FRS by the Canadian Cardiovascular Society: FRS is doubled in subjects aged 30-59 years who have CVD present in a first-degree relative before 55 years of age for men and 65 years of age for women; and cardiovascular age is calculated for each individual. Our aim was to implement these modifications and evaluate differences compared with traditional FRS. Further, we evaluated the association between dietary intake and 10-year risk. The Canadian Health Measures Survey data cycle 1 was used among participants aged 30-74 years (n = 2730). Descriptive and logistic regression analyses were conducted using STATA SE 11. Using modified FRS for predicting 10-year risk of CVD significantly increased the estimated risk compared with the traditional approach, 8.66% ± 0.35% versus 6.06% ± 0.18%, respectively. Greater impact was observed with the "cardiovascular age" modification in men versus women. The distribution of Canadians in low- (breakfast cereal and fruit and vegetable and greater potato and potato products consumption. In conclusion, the traditional FRS method significantly underestimates CVD risk in Canadians; thus, applying modified FRS is beneficial for screening. Additionally, fibre consumption from fruit and vegetable or breakfast cereals might be beneficial in reducing CVD risks. PMID:26417841

  18. THE IMPACT OF SEVERITY OF DIABETIC RETINOPATHY IN CARDIOVASCULAR DISEASE RISK ASSESSMENT USING FRAMINGHAM RISK SCORE - A PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Nidhi

    2015-08-01

    Full Text Available Diabetic retinopathy (DR is the most common micro vascular complications of diabetes, estimated to affect approximately 100 million people worldwide, while cardiovascular disease (CVD is the leading cause of death in individuals with type II diabetes. There is limited Indian data reporting the association of Diabetic retinopathy and its severity with CVD. AIM : To study the relation between the severity of DR and risk of CVD in cen tral Indian subjects. MATERIALS AND METHODS : The subjects consisted of 50 patients with Diabetes mellitus type II having varying grades of diabetic retinopathy attending eye OPD of a tertiary care hospital in central India. 10 year risk of developing CVD was estimated using the Framingham Risk Score. RESULTS : The number of subjects with an increased risk of developing CVD increased with advancing age (28.57% in 40 - 49 years to 61 .53% in > 60 years age group. The risk of CVD was slightly more in males (55. 55% compared to females (43.47%. Out of the 30 patients having sight threatening diabetic retinopathy, 13 had low risk of developing CVD while 17 had high risk of developing CVD. The prevalence of sight threatening retinopathy was more in the high risk group (56.67% when compared to the low - risk group (40%. DISCUSSION : We found that more subjects having high risk of developing CVD had sight - threatening DR compared to those having low risk. CONCLUSION : Diabetic retinopathy may contribute to CVD risk in Indian population too. A careful cardiovascular assessment and follow - up may be required in individuals with diabetic retinopathy, using a larger sample size

  19. Validation of a clinical risk-scoring algorithm for severe scrub typhus

    Directory of Open Access Journals (Sweden)

    Sriwongpan P

    2014-02-01

    Full Text Available Pamornsri Sriwongpan,1,2 Jayanton Patumanond,3 Pornsuda Krittigamas,4 Hutsaya Tantipong,5 Chamaiporn Tawichasri,6 Sirianong Namwongprom1,7 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, 2Department of Social Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, 4Department of General Pediatrics, Nakornping Hospital, Chiang Mai, 5Department of Medicine, Chonburi Hospital, Chonburi, 6Clinical Epidemiology Society at Chiang Mai, Chiang Mai, 7Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: The aim of the study reported here was to validate the risk-scoring algorithm for prognostication of scrub typhus severity. Methods: The risk-scoring algorithm for prognostication of scrub typhus severity developed earlier from two general hospitals in Thailand was validated using an independent dataset of scrub typhus patients in one of the hospitals from a few years later. The predictive performances of the two datasets were compared by analysis of the area under the receiver-operating characteristic curve (AuROC. Classification of patients into non-severe, severe, and fatal cases was also compared. Results: The proportions of non-severe, severe, and fatal patients by operational definition were similar between the development and validation datasets. Patient, clinical, and laboratory profiles were also similar. Scores were similar in both datasets, both in terms of discriminating non-severe from severe and fatal patients (AuROC =88.74% versus 91.48%, P=0.324, and in discriminating fatal from severe and non-severe patients (AuROC =88.66% versus 91.22%, P=0.407. Over- and under-estimations were similar and were clinically acceptable. Conclusion: The previously developed risk-scoring algorithm for prognostication of scrub typhus severity performed similarly with the validation data and the first dataset. The scoring algorithm may help in the prognostication of patients according to their severity in routine clinical practice. Clinicians may use this scoring system to help make decisions about more intensive investigations and appropriate treatments. Keywords: severity, clinical prediction rule, algorithm, prognosis, Thailand

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

    OpenAIRE

    Bates Tom; Rix Thomas E

    2007-01-01

    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 whi...

  1. Framingham risk score can predict cognitive decline progression in Alzheimer's disease.

    Science.gov (United States)

    Viticchi, Giovanna; Falsetti, Lorenzo; Buratti, Laura; Boria, Cristiano; Luzzi, Simona; Bartolini, Marco; Provinciali, Leandro; Silvestrini, Mauro

    2015-11-01

    The role of vascular factors in influencing cognitive decline has been extensively investigated, and some difficulties in defining their weight in dementia pathogenesis have emerged. The aim of the study was to investigate the relevance of the Framingham cardiovascular risk profile (FCRP) in influencing cognitive deterioration in a population of Alzheimer's disease (AD) patients. Two hundred eighty-four consecutive AD patients were enrolled. For each patient, FCRP score was calculated. We did a 1-year follow-up to quantify the cognitive decline by recording changes in the Clinical Dementia Rating score. The FCRP score predicted cognitive deterioration with an area under the curve of 0.63 (95% confidence interval: 0.57-0.69; p vascular impairment, the FCRP predictive value significantly increased with an area under the curve of 0.77 (95% confidence interval: 0.52-0.93; p < 0.05). Our findings show that FCRP can predict the progression of deterioration in AD patients. This was particularly evident in patients with major genetic and atherosclerotic risk factors. PMID:26279114

  2. Does childhood misfortune raise the risk of acute myocardial infarction in adulthood?

    OpenAIRE

    Morton, Patricia M.; Mustillo, Sarah A.; Ferraro, Kenneth F

    2013-01-01

    Whereas most research on acute myocardial infarction (AMI) has focused on more proximal influences, such as adult health behaviors, the present study examines the early origins of AMI. Longitudinal data were drawn from the National Survey of Midlife Development in the United States (N=3,032), a nationally representative survey of men and women aged 25–74, which spans from 1995 to 2005. A series of event history analyses modeling age of first AMI investigated the direct effects of accumulated ...

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

    Directory of Open Access Journals (Sweden)

    Patumanond J

    2012-04-01

    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

  4. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    Fosbøl, E L; Gislason, G H; Jacobsen, S; Folke, F; Hansen, M L; Schramm, T K; Sørensen, R; Rasmussen, J N; Andersen, S S; Abildstrom, S Z; Traerup, J; Poulsen, H E; Rasmussen, S; Køber, L; Torp-Pedersen, C

    2008-01-01

    Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions an...

  5. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Jacobsen, Søren; Rasmussen, Jeppe N; Rasmussen, Søren; Buch, Pernille; Friberg, Jens; Schramm, Tina Ken; Abildstrom, Steen Z; Køber, Lars; Madsen, Mette; Torp-Pedersen, Christian

    2006-01-01

    BACKGROUND: 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. We analyzed the risk of rehospitalization for acute myocardial infarction (MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with prior MI. METHODS AND RESULTS: All patients with first-time MI b...

  6. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    Fosbøl, E L; Gislason, G H; Jacobsen, S; Folke, F; Hansen, M L; Schramm, T K; Sørensen, R; Rasmussen, Jeppe Nørgaard; Andersen, S S; Abildstrøm, Steen; Traerup, J; Poulsen, H E; Rasmussen, S; Køber, L; Torp-Pedersen, C

    2009-01-01

    Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions an...

  7. Necrotizing Fasciitis in Hematological Patients: Enterobacteriaceae Predominance and Limited Utility of Laboratory Risk Indicator for Necrotizing Fasciitis Score.

    Science.gov (United States)

    Foo, Rui Min; Tung, Moon Ley; Poon, Li Mei; Chan, Douglas; Smitasin, Nares; Koh, Liang Piu; Chng, Wee Joo; Chai, Louis Yi Ann

    2015-04-01

    Immune suppression is a recognized risk factor for necrotizing fasciitis. In patients with hematological malignancies, a profoundly immunocompromised group, the predominant causative organisms are Gram negative. Clinical presentation and outcomes in these patients are similar to the immunocompetent. The Laboratory Risk Indicator for Necrotizing Fasciitis score is not reliable for risk stratification of the disease. PMID:26180830

  8. Predictive and Incremental Validity of the Violence Risk Appraisal Guide Scores with Male and Female Jail Inmates

    OpenAIRE

    Hastings, Mark E.; Krishnan, Shilpa; Tangney, June P.; Stuewig, Jeffrey

    2011-01-01

    The present study examines the predictive and incremental validity of Violence Risk Appraisal Guide scores in a sample of 328 male and 145 female jail inmates held on felony charges. Significant gender differences were observed in VRAG item and total score means, as well as in correlations between the VRAG and concurrent measures of aggression. VRAG scores significantly predicted institutional misconduct during incarceration and recidivism in the first year post-release for male inmates, but ...

  9. The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on Body Mass Index: a population-based case-control study

    Directory of Open Access Journals (Sweden)

    Reuterwall Christina

    2006-12-01

    Full Text Available Abstract Background High body mass index (BMI and lack of physical activity have been recognized as important risk factors for coronary heart disease. The aim of the present study was to evaluate whether leisure-time physical activity compensates for the increased risk of acute myocardial infarction associated with overweight and obesity. Methods Data from the SHEEP (Stockholm Heart Epidemiology Program study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992–1994. Odds ratios (OR, together with 95 % confidence intervals (95% CI, were calculated using unconditional logistic regression, as estimates of the relative risks. Results Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI ? 30 and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07–3.18. The results were similar for men and women. Conclusion While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects.

  10. Validation of the Lower-Risk MD Anderson Prognostic Scoring System for Patients With Myelodysplastic Syndrome.

    Science.gov (United States)

    Komrokji, Rami; Ramadan, Hanadi; Al Ali, Najla; Corrales-Yepez, Maria; Zhang, Ling; Padron, Eric; Lancet, Jeffrey; List, Alan

    2015-06-01

    The International Prognostic Scoring System (IPSS) is the most widely used tool for risk assessment and treatment decisions for myelodysplastic syndrome (MDS). Several new models have been proposed to identify a subset of lower-risk patients with MDS who are experiencing inferior than expected outcomes. We validated the Lower-Risk MD Anderson Risk Model (LR-MDAS) in 1288 lower-risk patients with MDS by the IPSS. On the basis of the LR-MDAS, 228 patients (17%) were in category 1, 730 patients (57%) were in category 2, 315 patients (25%) were in category 3, and 15 patients (1%) were in an unknown category. The median overall survival for the corresponding LR-MDAS categories was (1) 109 months (95% confidence interval [CI], 82-137), (2) 56 months (95% CI, 58-73), and (3) 29 months (95% CI, 24-35) (P < .005). Overall, 25% of patients were upstaged to category 3. LR-MDAS refined prognostic value among very low-, low-, and intermediate-risk Revised IPSS. The rate of acute myeloid leukemia transformation according to LR-MDAS was 15%, 18%, and 29% for categories 1, 2, and 3, respectively (P < .005). Our data validate the prognostic value of the LR-MDAS model, but the utility of it as a treatment decision tool should be studied prospectively. PMID:26297280

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

    Science.gov (United States)

    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

    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

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

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2012-04-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Kenneth Blum et al

    2010-07-01

    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.

  14. Can Saliva Proteins Be Used to Predict the Onset of Acute Myocardial Infarction among High-Risk Patients?

    Science.gov (United States)

    Rahim, Mohd Aizat Abdul; Rahim, Zubaidah Haji Abdul; Ahmad, Wan Azman Wan; Hashim, Onn Haji

    2015-01-01

    Human saliva plays a pivotal role in digesting food and maintaining oral hygiene. The presence of electrolytes, mucus, glycoproteins, enzymes, antibacterial compounds, and gingival crevicular fluid in saliva ensures the optimum condition of oral cavity and general health condition. Saliva collection has been proven non-invasive, convenient, and inexpensive compared to conventional venipuncture procedure. These distinctive advantages provide a promising potential of saliva as a diagnostic fluid. Through comprehensive analysis, an array of salivary proteins and peptides may be beneficial as biomarkers in oral and systemic diseases. In this review, we discuss the utility of human salivary proteomes and tabulate the recent salivary biomarkers found in subjects with acute myocardial infarction as well as respective methods employed. In a clinical setting, since acute myocardial infarction contributes to large cases of mortality worldwide, an early intervention using these biomarkers will provide an effective solution to reduce global heart attack incidence particularly among its high-risk group of type-2 diabetes mellitus patients. The utility of salivary biomarkers will make the prediction of this cardiac event possible due to its reliability hence improve the quality of life of the patients. Current challenges in saliva collection are also addressed to improve the quality of saliva samples and produce robust biomarkers for future use in clinical applications. PMID:25897294

  15. Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age >or=55 years.

    DEFF Research Database (Denmark)

    Sajadieh, A; Nielsen, OW

    2006-01-01

    Increased ventricular ectopic activity and even more complex arrhythmias are not uncommon in subjects without apparent heart disease. However, their prognostic significance has been controversial and not updated in recent years. The prevalence and prognostic significance of different ventricular arrhythmias were studied in a cohort of middle-aged and elderly subjects without apparent heart disease. Six hundred seventy-eight men and women aged 55 to 75 years without a history of heart disease or stroke were included. Baseline examinations included physical examinations, fasting laboratory testing, and 48-hour ambulatory electrocardiographic monitoring. All patients were followed for up to 5 years. Combined events were defined as all-cause mortality or acute myocardial infarction. A cardiovascular event was defined as cardiovascular death or acute myocardial infarction. In total, 84% had 0 to 10 ventricular premature complexes (VPCs)/hour, 8% had 11 to 30 VPCs/hour, and 8% had >30 VPCs/hour; 10.8% had >or=1 runof >or=3 VPCs. Frequent VPCs (>or=30/hour) was a significant predictor of combined (hazard ratio 2.47, 95% confidence interval 1.29 to 4.68, p = 0.006) and cardiovascular (hazard ratio 2.85, 95% confidence interval 1.16 to 7.0, p = 0.023) event rates, after adjustment for conventional risk factors. Runs of >or=4 VPCs/day or >or=2 doublets/day were also associated with a poor prognosis, but only in the presence of frequent VPCs. The detection of a single VPC on standard electrocardiography was a significant predictor of frequent VPCs and an independent predictor of events (hazard ratio 2.6, 95% confidence interval 1.02 to 6.66, p = 0.045). In conclusion, apparently healthy, middle-aged and elderly subjects with frequent VPCs (>or=30/hour) have a poor prognosis. According to current guidelines, strict risk-factor modification and primary prevention are justified in these high-risk subjects.

  16. A score to predict short-term risk of COPD exacerbations (SCOPEX

    Directory of Open Access Journals (Sweden)

    Make BJ

    2015-01-01

    Full Text Available Barry J Make,1 Göran Eriksson,2 Peter M Calverley,3 Christine R Jenkins,4 Dirkje S Postma,5 Stefan Peterson,6 Ollie Östlund,7 Antonio Anzueto8 1Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden; 3Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK; 4George Institute for Global Health, The University of Sydney and Concord Clinical School, Woolcock Institute of Medical Research, Sydney, NSW, Australia; 5Department of Pulmonology, University of Groningen and GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; 6StatMind AB, Lund, Sweden; 7Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; 8Department of Pulmonary/Critical Care, University of Texas Health Sciences Center and South Texas Veterans Healthcare System, San Antonio, TX, USA Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month risk of COPD exacerbations (SCOPEX. Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting ß2-agonist (salbutamol. Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk. Keywords: chronic obstructive pulmonary disease, exacerbation, model, predictor, inhaled corticosteroids, bronchodilators 

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

    OpenAIRE

    Hodas, Natasha; Turpin, Barbara; Lunden, Melissa; Baxter, Lisa; Özkaynak, Halûk; Burke, Janet; Ohman-Strickland, Pamela; Thevenet-Morrison, Kelly; Rich, David Q.

    2013-01-01

    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 PM2.5 with those calculated using central-site PM2.5 concentrations to estimate exposure to PM2.5 of outdoor origin (exposure to ambient PM2.5). Because variability in human activity and indoor PM2.5 transport contributes expos...

  18. Work related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP)

    OpenAIRE

    Möller, Jette; Theorell, Töres; Faire, Ulf de; Ahlbom, Anders; Hallqvist, Johan

    2005-01-01

    Study objectives: Recent changes in labour market conditions and in the organisation of work in developed societies have increased exposure to work related stress. The question is whether this also implies an increased risk of myocardial infarction, either through the triggering effect of acute stress, or through accumulation of stress over several months.

  19. 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)

    Hallqvist, J; Diderichsen, Finn

    1998-01-01

    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.

  20. An exposure-weighted score test for genetic associations integrating environmental risk factors.

    Science.gov (United States)

    Han, Summer S; Rosenberg, Philip S; Ghosh, Arpita; Landi, Maria Teresa; Caporaso, Neil E; Chatterjee, Nilanjan

    2015-09-01

    Current methods for detecting genetic associations lack full consideration of the background effects of environmental exposures. Recently proposed methods to account for environmental exposures have focused on logistic regressions with gene-environment interactions. In this report, we developed a test for genetic association, encompassing a broad range of risk models, including linear, logistic and probit, for specifying joint effects of genetic and environmental exposures. We obtained the test statistics by maximizing over a class of score tests, each of which involves modified standard tests of genetic association through a weight function. This weight function reflects the potential heterogeneity of the genetic effects by levels of environmental exposures under a particular model. Simulation studies demonstrate the robust power of these methods for detecting genetic associations under a wide range of scenarios. Applications of these methods are further illustrated using data from genome-wide association studies of type 2 diabetes with body mass index and of lung cancer risk with smoking. PMID:26134142

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

    DEFF Research Database (Denmark)

    Olesen, Kasper; Rugulies, Reiner

    2014-01-01

    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.

  2. Prediction of coronary risk by SYNTAX and derived scores: synergy between percutaneous coronary intervention with taxus and cardiac surgery.

    Science.gov (United States)

    Yadav, Mayank; Palmerini, Tullio; Caixeta, Adriano; Madhavan, Mahesh V; Sanidas, Elias; Kirtane, Ajay J; Stone, Gregg W; Généreux, Philippe

    2013-10-01

    The introduction of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score has prompted a renewed interest for angiographic risk stratification in patients undergoing percutaneous coronary intervention. Syntax score is based on qualitative and quantitative characterization of coronary artery disease by including 11 angiographic variables that take into consideration lesion location and characteristics. Thus far, this score has been shown to be an effective tool to risk-stratify patients with complex coronary artery disease undergoing percutaneous coronary intervention in the landmark SYNTAX trial, as well as in other clinical settings. This review provides an overview of its current applications, including its integration with other nonangiographic clinical scores, and explores future applications of the SYNTAX and derived scores. PMID:23933535

  3. A high anthocyanin intake is associated with a reduced risk of myocardial infarction in young and middle-aged women

    Science.gov (United States)

    Cassidy, Aedín; Mukamal, Kenneth J.; Liu, Lydia; Franz, Mary; Eliassen, A. Heather; Rimm, Eric B

    2013-01-01

    Background Our current knowledge of modifiable risk factors to prevent myocardial infarction (MI) in young and middle-aged women is limited, and the impact of diet is largely unknown. Dietary flavonoids exert potential beneficial effects on endothelial function in short-term trials; however the relationship between habitual intake and risk of MI in women in unknown. Methods and Results We followed 93,600 women aged 25–42 years from the Nurses’ Health Study (NHS) II who were healthy at baseline (1989) to examine the relationship between anthocyanins and other flavonoids and risk of MI. Intake of flavonoid sub-classes were calculated from validated food-frequency questionnaires collected every 4 years using an updated and extended USDA database. During 18 years of follow-up, 405 cases of MI were reported. An inverse association between higher intake of anthocyanins and risk of MI was observed (Hazard Ratio [HR]: 0.68; 95% confidence interval [CI] 0.49–0.96; p=0.03 comparing highest versus lowest quintiles) after multivariate adjustment. The addition of intermediate conditions, including history of hypertension, did not significantly attenuate the relationship (HR 0.70; 0.50–0.97; p=0.03). Combined intake of two anthocyanin-rich foods, blueberries and strawberries, tended to be associated with a decreased risk of MI (HR 0.66; 0.40–1.08) comparing those consuming >3 servings/week to those with lower intake. Intakes of other flavonoid sub-classes were not significantly associated with MI risk. Conclusions A high intake of anthocyanins may reduce MI risk in predominately young women. Intervention trials are needed to further examine the health impact of increasing intakes of commonly consumed anthocyanin-rich foods. PMID:23319811

  4. 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)

    Schelde, Astrid Blicher; Schmidt, Morten

    2014-01-01

    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.

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

    DEFF Research Database (Denmark)

    Derks, Eske M; Vorstman, Jacob A S

    2012-01-01

    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

  6. Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study.

    Science.gov (United States)

    Sansone, Roberto; Rodriguez-Mateos, Ana; Heuel, Jan; Falk, David; Schuler, Dominik; Wagstaff, Rabea; Kuhnle, Gunter G C; Spencer, Jeremy P E; Schroeter, Hagen; Merx, Marc W; Kelm, Malte; Heiss, Christian

    2015-10-01

    Cocoa flavanol (CF) intake improves endothelial function in patients with cardiovascular risk factors and disease. We investigated the effects of CF on surrogate markers of cardiovascular health in low risk, healthy, middle-aged individuals without history, signs or symptoms of CVD. In a 1-month, open-label, one-armed pilot study, bi-daily ingestion of 450 mg of CF led to a time-dependent increase in endothelial function (measured as flow-mediated vasodilation (FMD)) that plateaued after 2 weeks. Subsequently, in a randomised, controlled, double-masked, parallel-group dietary intervention trial (Clinicaltrials.gov: NCT01799005), 100 healthy, middle-aged (35-60 years) men and women consumed either the CF-containing drink (450 mg) or a nutrient-matched CF-free control bi-daily for 1 month. The primary end point was FMD. Secondary end points included plasma lipids and blood pressure, thus enabling the calculation of Framingham Risk Scores and pulse wave velocity. At 1 month, CF increased FMD over control by 1·2 % (95 % CI 1·0, 1·4 %). CF decreased systolic and diastolic blood pressure by 4·4 mmHg (95 % CI 7·9, 0·9 mmHg) and 3·9 mmHg (95 % CI 6·7, 0·9 mmHg), pulse wave velocity by 0·4 m/s (95 % CI 0·8, 0·04 m/s), total cholesterol by 0·20 mmol/l (95 % CI 0·39, 0·01 mmol/l) and LDL-cholesterol by 0·17 mmol/l (95 % CI 0·32, 0·02 mmol/l), whereas HDL-cholesterol increased by 0·10 mmol/l (95 % CI 0·04, 0·17 mmol/l). By applying the Framingham Risk Score, CF predicted a significant lowering of 10-year risk for CHD, myocardial infarction, CVD, death from CHD and CVD. In healthy individuals, regular CF intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects. PMID:26348767

  7. Usefulness of Desirable Lifestyle Factors to Attenuate the Risk of Heart Failure Among Offspring whose Parents had Myocardial Infarction before Age 55 Years

    OpenAIRE

    KHAWAJA, Owais; Kotler, Gregory; Gaziano, John Michael; Djoussé, Luc

    2012-01-01

    Heart failure (HF) is one of the leading causes of hospitalization and death in United States and throughout Europe. While a higher risk of HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MI before age 55, it is unclear whether adherence to healthful behaviors could mitigate that risk. The aim of the current study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence ...

  8. Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: a cross sectional study

    OpenAIRE

    Rasool Syed I; Faruqui Azhar M; Jafar Tazeen H; Jafary Fahim H; Khan Muhammad S; Hatcher Juanita; Chaturvedi Nish

    2006-01-01

    Abstract Background Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD). There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI) in a tertiary care h...

  9. A composite scoring of genotypes discriminates coronary heart disease risk beyond conventional risk factors in the Boston Puerto Rican Health Study

    Science.gov (United States)

    Background: Few studies have examined the usefulness of genetic scores to identify subjects at increased risk for coronary heart disease (CHD). Using a genetic predisposition score (GPS), integrating the additive associations of a set of single nucleotide polymorphisms (SNPs) with CHD, we examined t...

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

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Marott, Jacob L

    2013-01-01

    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.

  11. 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

  12. Dietary compound score and risk of age-related macular degeneration in the Age-Related Eye Disease Study

    Science.gov (United States)

    Purpose: Because foods provide many nutrients, which may interact with each other to modify risk for multifactorial diseases such as age-related macular degeneration (AMD), we sought to develop a composite scoring system to summarize the combined effect of multiple dietary nutrients on AMD risk. Th...

  13. Quantifying the impact of using Coronary Artery Calcium Score for risk categorization instead of Framingham Score or European Heart SCORE in lipid lowering algorithms in a Middle Eastern population

    Science.gov (United States)

    Isma’eel, Hussain A.; Almedawar, Mohamad M.; Harbieh, Bernard; Alajaji, Wissam; Al-Shaar, Laila; Hourani, Mukbil; El-Merhi, Fadi; Alam, Samir; Abchee, Antoine

    2015-01-01

    Background The use of the Coronary Artery Calcium Score (CACS) for risk categorization instead of the Framingham Risk Score (FRS) or European Heart SCORE (EHS) to improve classification of individuals is well documented. However, the impact of reclassifying individuals using CACS on initiating lipid lowering therapy is not well understood. We aimed to determine the percentage of individuals not requiring lipid lowering therapy as per the FRS and EHS models but are found to require it using CACS and vice versa; and to determine the level of agreement between CACS, FRS and EHS based models. Methods Data was collected for 500 consecutive patients who had already undergone CACS. However, only 242 patients met the inclusion criteria and were included in the analysis. Risk stratification comparisons were conducted according to CACS, FRS, and EHS, and the agreement (Kappa) between them was calculated. Results In accordance with the models, 79.7% to 81.5% of high-risk individuals were down-classified by CACS, while 6.8% to 7.6% of individuals at intermediate risk were up-classified to high risk by CACS, with slight to moderate agreement. Moreover, CACS recommended treatment to 5.7% and 5.8% of subjects untreated according to European and Canadian guidelines, respectively; whereas 75.2% to 81.2% of those treated in line with the guidelines would not be treated based on CACS. Conclusion In this simulation, using CACS for risk categorization warrants lipid lowering treatment for 5–6% and spares 70–80% from treatment in accordance with the guidelines. Current strong evidence from double randomized clinical trials is in support of guideline recommendations. Our results call for a prospective trial to explore the benefits/risks of a CACS-based approach before any recommendations can be made. PMID:26557741

  14. 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 cause and initiate treatment. (author)

  15. Composite risk scores and depression as predictors of competing waiting-list outcomes: the Waiting for a New Heart Study.

    Science.gov (United States)

    Zahn, Daniela; Weidner, Gerdi; Beyersmann, Jan; Smits, Jacqueline M A; Deng, Mario C; Kaczmarek, Ingo; Meyer, Sven; Reichenspurner, Hermann; Mehlhorn, Uwe; Wagner, Florian M; Spaderna, Heike

    2010-12-01

    We evaluated two composite risk scores, (Heart Failure Survival Score, HFSS; German Transplant Society Score, GTSS), and depression as predictors of mortality and competing waiting-list outcomes [high-urgency transplantation (HU-HTx), elective transplantation, delisting because of clinical improvement] in 318 heart transplant (HTx) candidates (18% women; aged 53 ± 11 years) from 17 hospitals and newly registered with Eurotransplant. Demographic variables and depression (Hospital Anxiety and Depression Scale, HADS) were assessed using questionnaires. Variables to compute HFSS and GTSS, age, medications, and outcomes were provided by Eurotransplant. At 12 months, 33 patients died, 83 received urgent HTx, 30 elective HTx, and 17 were delisted because of improvement. Applying cause-specific Cox regressions, only the HFSS was significantly associated with 1-year mortality [HR = 0.64 (95% CI = 0.43-0.95), P = 0.029]. The GTSS was the strongest predictor of HU-HTx [HR= 1.02 (95% CI = 1.01-1.02), P < 0.001]. Low depression scores contributed significantly to clinical improvement, even after adjusting for age and risk scores [HADS: HR = 0.12 (95% CI = 0.02-0.89), P = 0.039]. These findings confirm the usefulness of composite risk scores for the prediction of mortality and HU-HTx, validating both scores for their intended use. The finding that depression was an independent predictor of the waiting-list outcome clinical improvement suggests that considering patients' psychological attributes in addition to their medical characteristics is advisable. PMID:20630044

  16. Using “Big Data” to Capture Overall Health Status: Properties and Predictive Value of a Claims-Based Health Risk Score

    Science.gov (United States)

    Hamad, Rita; Modrek, Sepideh; Kubo, Jessica; Goldstein, Benjamin A.; Cullen, Mark R.

    2015-01-01

    Background Investigators across many fields often struggle with how best to capture an individual’s overall health status, with options including both subjective and objective measures. With the increasing availability of “big data,” researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such “health risk score,” the DxCG Intelligence tool. Methods We link claims and administrative datasets on a cohort of U.S. workers during the period 1996–2011 (N = 14,161). We examine the risk score’s association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score’s association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury. Results and Conclusions We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers. PMID:25951622

  17. Respiratory risk score for the prediction of 3-month mortality and prolonged ventilation after liver transplantation.

    Science.gov (United States)

    Kleine, Moritz; Vondran, Florian W R; Johanning, Kai; Timrott, Kai; Bektas, Hüseyin; Lehner, Frank; Klempnauer, Juergen; Schrem, Harald

    2013-08-01

    Survival of critically ill patients is significantly affected by prolonged ventilation. The goal of this study was the development of a respiratory risk score (RRS) for the prediction of 3-month mortality and prolonged ventilation after liver transplantation (LT). Two hundred fifty-four consecutive LT patients from a single center were retrospectively randomized into a training group for model design and a validation group. A receiver operating characteristic (ROC) curve analysis was used to test sensitivity and specificity. The accuracy of the predictions was assessed with the Brier score, and the model calibration was assessed with the Hosmer-Lemeshow test. Cutoff values were determined with the best Youden index. The RRS was calculated in the first 24 hours as follows: (laboratory Model for End-Stage Liver Disease score?>?30?=?2.36 points)?+?(fresh frozen plasma?>?13.5 U?=?2.70 points)?+?(partial pressure of arterial oxygen/fraction of inspired oxygen ratio??10.5 U?=?3.50 points)?+?(preoperative mechanical ventilation?=?3.87 points)?+? (preoperative dialysis?=?2.83 points)?+?(donor steatosis hepatis?>?40%?=?2.95 points). The RSS demonstrated high predictive accuracy, good model calibration, and c statistics?>?0.7 in the training and validation groups. The RSS was able to predict 3-month mortality [cutoff?=?6.64, area under the (ROC) curve (AUROC)?=?0.794] and prolonged ventilation (cutoff?=?3.69, AUROC?=?0.798) with sensitivities of 69% and 81%, specificities of 83% and 73%, and overall model correctness of 76% and 77%, respectively. In conclusion, this study provides the first prognostic model for the prediction of 3-month mortality and prolonged ventilation after LT with high sensitivity and specificity and good model accuracy. The application of the RRS to an external cohort would be desirable for its further validation and introduction as a clinical tool for intensive care resource planning and prognostic decision making. PMID:23696476

  18. Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

    Directory of Open Access Journals (Sweden)

    Salameh P

    2012-09-01

    Full Text Available Pascale Salameh,1 Georges Khayat,2 Mirna Waked31Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, 2Faculty of Medicine, Hôtel Dieu de France Hospital, Beirut and Saint Joseph University, Beirut, 3Faculty of Medicine, Saint George Hospital, Beirut and Balamand University, Beirut, LebanonBackground: Diagnosing chronic obstructive pulmonary disease (COPD without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD, which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%. The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.Keywords: diagnosis, scale, development, spirometry

  19. Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia

    Directory of Open Access Journals (Sweden)

    Hüseyin U?ur Yaz?c?

    2009-02-01

    Full Text Available Objective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI, which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD. Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri. Demographic characteristics (age, gender and risk factors known to be traditional risk factors for CHD (history of hypertension (HT, diabetes mellitus (DM, smoking, and family history were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age ?44 years; Group B - age 45-64 years; and Group C - age?65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated.Results: The mean age was 58±11 years (range 24-96 years. Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DM (p<0.001. Prevalence of smoking was the highest in young patients and males (p<0.001. Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001. Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average.Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors.

  20. Antiepileptic drugs and the risk of ischaemic stroke and myocardial infarction: a population-based cohort study

    Science.gov (United States)

    Renoux, Christel; Dell'Aniello, Sophie; Saarela, Olli; Filion, Kristian B; Boivin, Jean-François

    2015-01-01

    Objectives Hepatic enzyme-inducing antiepileptic drugs (AEDs) increase serum lipid levels and other atherogenic markers via the induction of cytochrome P450 and may therefore increase the risk of vascular events. We sought to assess the risk of ischaemic stroke and myocardial infarction (MI) according to AED enzymatic properties. Design Population-based cohort study with nested case–control analysis. Setting 650 general practices in the UK contributing to the Clinical Practice Research Datalink. Participants A cohort of 252?407 incident AED users aged 18 or older between January 1990 and April 2013. For each case of ischaemic stroke or MI, up to 10 controls were randomly selected among the cohort members in the risk sets defined by the case and matched on age, sex, indication for AED, calendar time and duration of follow-up. Interventions Current use of enzyme-inducing and enzyme-inhibiting AEDs compared with non-inducing AEDs. Primary outcome measures Incidence rate ratios (RRs) of ischaemic stroke and MI. Results 5069 strokes and 3636 MIs were identified during follow-up. Inducing AEDs use was associated with a small increased risk of ischaemic stroke (RR=1.16, 95% CI 1.02 to 1.33) relative to non-inducing AEDs, most likely due to residual confounding. However, current use of inducing AEDs for ?24?months was associated with a 46% increased risk of MI (RR=1.46, 95% CI 1.15 to 1.85) compared with the same duration of non-inducing AED, corresponding to a risk difference of 1.39/1000 (95% CI 0.33 to 2.45) persons per year. Current use of inhibiting AED was associated with a decreased risk of MI (RR=0.81, 95% CI 0.66 to 1.00). Conclusions The use of enzyme-inducing AEDs was not associated with an increased risk of ischaemic stroke; a small increase of MI with prolonged use was observed. In contrast, use of inhibiting AEDs was associated with a decreased risk of MI. PMID:26270948

  1. Do family dinners reduce the risk for early adolescent substance use? A propensity score analysis.

    Science.gov (United States)

    Hoffmann, John P; Warnick, Elizabeth

    2013-01-01

    The risks of early adolescent substance use on health and well-being are well documented. In recent years, several experts have claimed that a simple preventive measure for these behaviors is for families to share evening meals. In this study, we use data from the 1997 National Longitudinal Study of Youth (n = 5,419) to estimate propensity score models designed to match on a set of covariates and predict early adolescent substance use frequency and initiation. The results indicate that family dinners are not generally associated with alcohol or cigarette use or with drug use initiation. However, a continuous measure of family dinners is modestly associated with marijuana frequency, thus suggesting a potential causal impact. These results show that family dinners may help prevent one form of substance use in the short term but do not generally affect substance use initiation or alcohol and cigarette use. PMID:23956358

  2. 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 hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

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

    OpenAIRE

    Wennberg, Patrik

    2009-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Pelle G Lindqvist

    2008-08-01

    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

  5. Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors

    DEFF Research Database (Denmark)

    Artang, Ramin; Rome, Eric

    2013-01-01

    Dabigatran has been associated with greater risk of myocardial infarction (MI) than warfarin. It is unknown whether the increased risk is unique to dabigatran, an adverse effect shared by other oral direct thrombin inhibitors (DTIs), or the result of a protective effect of warfarin against MI. To address these questions, we systematically searched MEDLINE and performed a meta-analysis on randomized trials that compared oral DTIs with warfarin for any indication with end point of MIs after randomization. We furthermore performed a secondary meta-analysis on atrial fibrillation stroke prevention trials with alternative anticoagulants compared with warfarin with end point of MIs after randomization. A total of 11 trials (39,357 patients) that compared warfarin to DTIs (dabigatran, ximelagatran, and AZD0837) were identified. In these trials, patients treated with oral DTIs were more likely to experience an MI than their counterparts treated with warfarin (285 of 23,333 vs 133 of 16,024, odds ratio 1.35, 95% confidence interval 1.10 to 1.66, p = 0.005). For secondary analysis, 8 studies (69,615 patients) were identified that compared warfarin with alternative anticoagulant including factor Xa inhibitors, DTIs, aspirin, and clopidogrel. There was no significant advantage in the rate of MIs with the use of warfarin versus comparators (odds ratio 1.06, 95% confidence interval 0.85 to 1.34, p = 0.59). In conclusion, our data suggest that oral DTIs were associated with increased risk of MI. This increased risk appears to be a class effect of these agents, not a specific phenomenon unique to dabigatran or protective effect of warfarin. These findings support the need for enhanced postmarket surveillance of oral DTIs and other novel agents.

  6. 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)

  7. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Brkovi? E

    2015-02-01

    Full Text Available Eliana Brkovi?,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

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

    DEFF Research Database (Denmark)

    Kasch, Helge; Qerama, Erisela

    2011-01-01

    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.

  9. 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)

    Olesen, Jonas Bjerring; Torp-Pedersen, Christian

    2012-01-01

    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.

  10. Polygenic Risk Score, Parental Socioeconomic Status, Family History of Psychiatric Disorders, and the Risk for Schizophrenia : A Danish Population-Based Study and Meta-analysis

    DEFF Research Database (Denmark)

    Agerbo, Esben; Sullivan, Patrick F

    2015-01-01

    Importance: Schizophrenia has a complex etiology influenced both by genetic and nongenetic factors but disentangling these factors is difficult. Objective: To estimate (1) how strongly the risk for schizophrenia relates to the mutual effect of the polygenic risk score, parental socioeconomic status, and family history of psychiatric disorders; (2) the fraction of cases that could be prevented if no one was exposed to these factors; (3) whether family background interacts with an individual's genetic liability so that specific subgroups are particularly risk prone; and (4) to what extent a proband's genetic makeup mediates the risk associated with familial background. Design, Settings, and Participants: We conducted a nested case-control study based on Danish population-based registers. The study consisted of 866 patients diagnosed as having schizophrenia between January 1, 1994, and December 31, 2006, and 871 matched control individuals. Genome-wide data and family psychiatric and socioeconomic background information were obtained from neonatal biobanks and national registers. Results from a separate meta-analysis (34?600 cases and 45?968 control individuals) were applied to calculate polygenic risk scores. Exposures: Polygenic risk scores, parental socioeconomic status, and family psychiatric history. Main Outcomes and Measures: Odds ratios (ORs), attributable risks, liability R2 values, and proportions mediated. Results: Schizophrenia was associated with the polygenic risk score (OR, 8.01; 95% CI, 4.53-14.16 for highest vs lowest decile), socioeconomic status (OR, 8.10; 95% CI, 3.24-20.3 for 6 vs no exposures), and a history of schizophrenia/psychoses (OR, 4.18; 95% CI, 2.57-6.79). The R2 values were 3.4% (95% CI, 2.1-4.6) for the polygenic risk score, 3.1% (95% CI, 1.9-4.3) for parental socioeconomic status, and 3.4% (95% CI, 2.1-4.6) for family history. Socioeconomic status and psychiatric history accounted for 45.8% (95% CI, 36.1-55.5) and 25.8% (95% CI, 21.2-30.5) of cases, respectively. There was an interaction between the polygenic risk score and family history (P?=?.03). A total of 17.4% (95% CI, 9.1-26.6) of the effect associated with family history of schizophrenia/psychoses was mediated through the polygenic risk score. Conclusions and Relevance: Schizophrenia was associated with the polygenic risk score, family psychiatric history, and socioeconomic status. Our study demonstrated that family history of schizophrenia/psychoses is partly mediated through the individual's genetic liability.

  11. Implementing the number needed to harm in clinical practice: risk of myocardial infarction in HIV-1-infected patients treated with abacavir

    DEFF Research Database (Denmark)

    Kowalska, J D; Kirk, O; Mocroft, A; Høj, L; Friis-Møller, N; Reiss, P; Weller, I; Lundgren, J D

    2010-01-01

    OBJECTIVES: The D:A:D study group reported a 1.9-fold increased relative risk (RR) of myocardial infarction (MI) associated with current or recent use of abacavir. The number needed to harm (NNH) incorporates information about the underlying risk of MI and the increased RR of MI in patients taking abacavir. METHODS: NNH was calculated as the reciprocal of the difference between the underlying risks of MI with and without abacavir use. A parametric statistical model was used to calculate the unde...

  12. Early Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Wong, George Kwok Chu; Leung, Joyce Hoi Ying; Yu, Janice Wong Li; Lam, Sandy Wai; Chan, Emily Kit Ying; Poon, Wai Sang; Abrigo, Jill; Siu, Deyond Yun Woon

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a serious disease with high case fatality and morbidity. Early cerebral infarction has been suggested as a risk factor for poor outcome. We aimed to assess the pattern of early and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. We prospectively enrolled consecutive aneurysmal subarachnoid hemorrhage (SAH) patients presenting to an academic neurosurgical referral center (Prince of Wales Hospital, the Chinese University of Hong Kong) in Hong Kong. Cerebral infarction occurred in 24 (48 %) patients, in which 14 (28 %) had early cerebral infarction and 14 (28 %) had delayed cerebral infarction. Early anterior cerebral infarction occurred in a similar proportion of anterior and posterior circulation aneurysms (24 % vs. 21 %), whereas posterior circulation aneurysm patients had a higher proportion of early posterior cerebral infarction compared with anterior circulation aneurysm patients (18 % vs. 2 %). In conclusion, early cerebral infarction was common and different from delayed cerebral infarction. PMID:26463941

  13. Olson method for locating and calculating the extent of transmural ischemic areas at risk of infarction

    DEFF Research Database (Denmark)

    Olson, Charles W; Wagner, Galen S

    2014-01-01

    OBJECTIVES: The purpose of this study is to present a new and improved method for translating the electrocardiographic changes of acute myocardial ischemia into a display which reflects the location and extent of the ischemic area and the associated culprit coronary artery. This method could be automated to present a graphic image of the ischemic area in a manner understandable by all levels of caregivers; from emergency transport personnel to the consulting cardiologist. BACKGROUND: Current methods for the ECG diagnosis of ST elevated myocardial infarction (STEMI) are criteria driven, and complex, and beyond the interpretive capability of many caregivers. New methods are needed to accurately diagnose the presence of acute transmural myocardial ischemia in order to accelerate a patient's clinical "door to balloon time." The proposed new method could potentially provide the information needed to accomplish this objective. METHODS: The new method improves the precision of diagnosis and quantification of ischemia by normalizing the ST segment inputs from the standard 12 lead ECG, transforming these into a three dimensional vector representation of the ischemia at the electrical center of the heart. The myocardial areas likely to be involved in this ischemia are separately analyzed to assess the probability that they contributed to this event. The source of the ischemia is revealed as a specific region of the heart, and the likely location of the associated culprit coronary artery. Seventy 12 lead ECGs from subjects with known single artery occlusion in one of the three main coronary arteries were selected to test this new method. Graphic plots of the distribution of ischemia as indicated by the method are consistent with the known occlusion. The analysis of the distribution of ischemic areas in the myocardium reveals that the relationships between leads with either ST elevation or ST depression, provide critical information improving the current method.

  14. Microbial Translocation in HIV Infection is Associated with Dyslipidemia, Insulin Resistance, and Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Pedersen, Karin Kaereby; Pedersen, Maria; Trøseid, Marius; Gaardbo, Julie Christine; Lund, Tamara Theresia; Thomsen, Carsten; Gerstoft, Jan; Kvale, Dag; Nielsen, Susanne Dam

    2013-01-01

    Microbial translocation has been suggested to be a driver of immune activation and inflammation. We hypothesized that microbial translocation may be related to dyslipidemia, insulin resistance, and the risk of coronary heart disease in HIV-infected individuals.

  15. Combining the ASA Physical Classification System and Continuous Intraoperative Surgical Apgar Score Measurement in Predicting Postoperative Risk.

    Science.gov (United States)

    Jering, Monika Zdenka; Marolen, Khensani N; Shotwell, Matthew S; Denton, Jason N; Sandberg, Warren S; Ehrenfeld, Jesse Menachem

    2015-11-01

    The surgical Apgar score predicts major 30-day postoperative complications using data assessed at the end of surgery. We hypothesized that evaluating the surgical Apgar score continuously during surgery may identify patients at high risk for postoperative complications. We retrospectively identified general, vascular, and general oncology patients at Vanderbilt University Medical Center. Logistic regression methods were used to construct a series of predictive models in order to continuously estimate the risk of major postoperative complications, and to alert care providers during surgery should the risk exceed a given threshold. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminative ability of a model utilizing a continuously measured surgical Apgar score relative to models that use only preoperative clinical factors or continuously monitored individual constituents of the surgical Apgar score (i.e. heart rate, blood pressure, and blood loss). AUROC estimates were validated internally using a bootstrap method. 4,728 patients were included. Combining the ASA PS classification with continuously measured surgical Apgar score demonstrated improved discriminative ability (AUROC 0.80) in the pooled cohort compared to ASA (0.73) and the surgical Apgar score alone (0.74). To optimize the tradeoff between inadequate and excessive alerting with future real-time notifications, we recommend a threshold probability of 0.24. Continuous assessment of the surgical Apgar score is predictive for major postoperative complications. In the future, real-time notifications might allow for detection and mitigation of changes in a patient's accumulating risk of complications during a surgical procedure. PMID:26359018

  16. Interactions of Lipid Genetic Risk Scores with Estimates of Metabolic Health in a Danish Population

    DEFF Research Database (Denmark)

    Justesen, Johanne M; Allin, Kristine H

    2015-01-01

    BACKGROUND: -There are several well-established lifestyle factors influencing dyslipidemia and currently, 157 genetic susceptibility loci have been reported to be associated with serum lipid levels at genome-wide statistical significance. However, the interplay between lifestyle risk factors and these susceptibility loci has not been fully elucidated. We tested if genetic risk scores (GRS) of lipid-associated SNPs associate with fasting serum lipid traits and if the effects are modulated by lifestyle factors or estimates of metabolic health. METHODS AND RESULTS: -The SNPs were genotyped in two Danish cohorts: Inter99 (n=5,961) for discovery analyses and Health2006 (n=2,565) for replication. Based on published effect sizes of SNPs associated with circulating fasting levels of total cholesterol, LDL-cholesterol, HDL-cholesterol or triglyceride, four weighted GRS (wGRS) were constructed. In a cross-sectional design, we investigated if the effect of these wGRSs on lipid levels were modulated by diet, alcohol consumption, physical activity and smoking or the individual metabolic health status as estimated from BMI, waist circumference and insulin resistance assessed using HOMA-IR. All four lipid wGRSs associated strongly with their respective trait (from P=3.3×10(-69) to P=1.1×10(-123)). We found interactions between the triglyceride wGRS and BMI and waist circumference on fasting triglyceride levels in Inter99 and replicated these findings in Health2006 (Pinteraction=9.8×10(-5) and 2.0×10(-5), respectively in combined analysis). CONCLUSIONS: -Our findings suggest that individuals who are obese may be more susceptible to the cumulative genetic burden of triglyceride SNPs. Therefore, it is suggested that especially these genetically at-risk individuals may benefit more from targeted interventions aiming at obesity prevention.

  17. Stroke Risk Factors Beyond the CHA2DS2-VASc Score: Can We Improve Our Identification of "High Stroke Risk" Patients With Atrial Fibrillation?

    Science.gov (United States)

    Szymanski, Filip M; Lip, Gregory Y H; Filipiak, Krzysztof J; Platek, Anna E; Hrynkiewicz-Szymanska, Anna; Opolski, Grzegorz

    2015-12-01

    The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS2 or CHA2DS2-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA2DS2-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ?1 additional stroke risk factors. PMID:26434516

  18. Stroke Risk Factors Beyond the CHA2DS2-VASc Score : Can We Improve Our Identification of "High Stroke Risk" Patients With Atrial Fibrillation?

    DEFF Research Database (Denmark)

    Szymanski, Filip M; Lip, Gregory Y H

    2015-01-01

    The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS2 or CHA2DS2-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA2DS2-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ?1 additional stroke risk factors.

  19. Genetic variability on adiponectin gene affects myocardial infarction risk: The role of endothelial dysfunction

    OpenAIRE

    Antonopoulos, AS; Tousoulis, D; Antoniades, C; Miliou, A; Hatzis, G; Papageorgiou, N.; Demosthenous, M; Tentolouris, C; Stefanadis, C

    2013-01-01

    Background: Adiponectin is an adipokine with an important role in cardiovascular system conferring anti-inflammatory and anti-atherogenic effects. Two common single nucleotide polymorphisms (SNP) on adiponectin gene, rs2241766 and rs1501299, have been associated with insulin resistance and diabetes mellitus risk however their effects on cardiovascular risk remain unclear. We examined the impact of rs2241766 and rs1501299 on circulating adiponectin levels, endothelial function and cardiovascul...

  20. Genetic variability on adiponectin gene affects myocardial infarction risk: the role of endothelial dysfunction.

    OpenAIRE

    Antonopoulos, AS; Tousoulis, D; Antoniades, C; Miliou, A; Hatzis, G; Papageorgiou, N.; Demosthenous, M; Tentolouris, C; Stefanadis, C

    2013-01-01

    BACKGROUND: Adiponectin is an adipokine with an important role in cardiovascular system conferring anti-inflammatory and anti-atherogenic effects. Two common single nucleotide polymorphisms (SNP) on adiponectin gene, rs2241766 and rs1501299, have been associated with insulin resistance and diabetes mellitus risk however their effects on cardiovascular risk remain unclear. We examined the impact of rs2241766 and rs1501299 on circulating adiponectin levels, endothelial function and cardiovascul...

  1. 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)

    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

    Full Text Available 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.

  2. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration

    DEFF Research Database (Denmark)

    Sabin, Caroline A; Worm, Signe W; Weber, Rainer; Reiss, Peter; El-Sadr, Wafaa; Dabis, Francois; De Wit, Stephane; Law, Matthew; D'Arminio Monforte, Antonella; Friis-Møller, Nina; Kirk, Ole; Pradier, Christian; Weller, Ian; Phillips, Andrew N; Lundgren, Jens

    2008-01-01

    BACKGROUND: Whether nucleoside reverse transcriptase inhibitors increase the risk of myocardial infarction in HIV-infected individuals is unclear. Our aim was to explore whether exposure to such drugs was associated with an excess risk of myocardial infarction in a large, prospective observational cohort of HIV-infected patients. METHODS: We used Poisson regression models to quantify the relation between cumulative, recent (currently or within the preceding 6 months), and past use of zidovudine,...

  3. Plasma Vitamin E and Coenzyme Q10 Are Not Associated with a Lower Risk of Acute Myocardial Infarction in Singapore Chinese Adults12

    OpenAIRE

    NAIDOO, NASHEEN; van Dam, Rob M; Koh, Woon-Puay; Chen, Cynthia; Lee, Yian-Ping; Yuan, Jian-Min; Ong, Choon-Nam

    2012-01-01

    Vitamin E and coenzyme Q10 (CoQ10) have antioxidant effects that may benefit cardiovascular health. Meta-analyses of randomized controlled trials have not shown a protective effect of supplementation with the vitamin E isomer ?-tocopherol on the risk of acute myocardial infarction (AMI), but data on other isomers and CoQ10 are limited. Our objective was to examine the association of the plasma concentrations of vitamin E isomers (?-, ?-, and ?-tocopherol and ?-, ?-, and ?-tocotrienol) and CoQ...

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

    DEFF Research Database (Denmark)

    Obel, Niels; Farkas, D K; Kronborg, G; Larsen, C S; Pedersen, G; Riis, A; Pedersen, Court; Gerstoft, J; Sørensen, H T

    2010-01-01

    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 patien...

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

    DEFF Research Database (Denmark)

    Obel, N; Farkas, Dk; Kronborg, G; Larsen, Cs; Pedersen, G; Riis, A; Pedersen, C; Gerstoft, J; Sørensen, Ht

    2009-01-01

    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 patien...

  6. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

    OpenAIRE

    Gorgels Anton PM; Verschuren WM Monique; Feskens Edith JM; Schouten Leo J; Boer Jolanda MA; Merry Audrey HH; van den Brandt Piet A

    2011-01-01

    Abstract Background Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP), while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI). Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects wi...

  7. Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction

    DEFF Research Database (Denmark)

    Køber, Lars; Swedberg, Karl; McMurray, John J V; Pfeffer, Marc A; Velazquez, Eric J; Diaz, Rafael; Maggioni, Aldo P; Mareev, Viatcheslav; Opolski, Grzegorz; Van de Werf, Frans; Zannad, Faiez; Ertl, Georg; Solomon, Scott D; Zelenkofske, Steven; Rouleau, Jean-Lucien; Leimberger, Jeffrey D; Califf, Robert M

    2006-01-01

    AIMS: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). METHODS: The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcom...

  8. Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Gislason, Gunnar H

    2015-01-01

    IMPORTANCE: Antithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns. OBJECTIVE: To examine the risk of bleeding and cardiovascular events among patients with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed. DESIGN, SETTING, AND PARTICIPANTS: Using nationwide administrative registries in Denmark (2002-2011), we studied patients 30 years or older admitted with first-time MI and alive 30 days after discharge. Subsequent treatment with aspirin, clopidogrel, or oral anticoagulants and their combinations, as well as ongoing concomitant NSAID use, was determined. EXPOSURES: Use of NSAIDs with ongoing antithrombotic treatment after first-time MI. MAIN OUTCOMES AND MEASURES: Risk of bleeding (requiring hospitalization) or a composite cardiovascular outcome (cardiovascular death, nonfatal recurrent MI, and stroke) according to ongoing NSAID and antithrombotic therapy, calculated using adjusted time-dependent Cox regression models. RESULTS: We included 61,971 patients (mean age, 67.7 [SD, 13.6] years; 63% men); of these, 34% filled at least 1 NSAID prescription. The number of deaths during a median follow-up of 3.5 years was 18,105 (29.2%). A total of 5288 bleeding events (8.5%) and 18,568 cardiovascular events (30.0%) occurred. The crude incidence rates of bleeding (events per 100 person-years) were 4.2 (95% CI, 3.8-4.6) with concomitant NSAID treatment and 2.2 (95% CI, 2.1-2.3) without NSAID treatment, whereas the rates of cardiovascular events were 11.2 (95% CI, 10.5-11.9) and 8.3 (95% CI, 8.2-8.4). The multivariate-adjusted Cox regression analysis found increased risk of bleeding with NSAID treatment compared with no NSAID treatment (hazard ratio, 2.02 [95% CI, 1.81-2.26]), and the cardiovascular risk was also increased (hazard ratio, 1.40 [95% CI, 1.30-1.49]). An increased risk of bleeding and cardiovascular events was evident with concomitant use of NSAIDs, regardless of antithrombotic treatment, types of NSAIDs, or duration of use. CONCLUSIONS AND RELEVANCE: Among patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI.

  9. CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Nielsen, Jens Cosedis

    2013-01-01

    The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.

  10. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns1

    Science.gov (United States)

    Costa, Priscila; Kimura, Amélia Fumiko; Brandon, Debra Huffman; Paiva, Eny Dorea; de Camargo, Patricia Ponce

    2015-01-01

    OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (? 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals. PMID:26155011

  11. 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)

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

    2007-12-01

    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 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 that allows the physician to realize if the coronary calciu

  12. Apolipoprotein B is Highly Associated with the Risk of Coronary Heart Disease as Estimated by the Framingham Risk Score in Healthy Korean Men

    OpenAIRE

    Ryoo, Jae-Hong; Ha, Eun-Hee; Kim, Soo-Geun; Ryu, Seungho; Lee, Da-Woon

    2011-01-01

    The aim of this study was to examine the association between serum apolipoprotein B (apoB) and the risk of coronary heart disease (CHD) using Framingham risk score (FRS) in healthy Korean men. A total of 13,523 men without medication history of diabetes and hypertension were enrolled in this study. The FRS is based on six coronary risk factors. FRS ? 10% was defined as more-than-a-moderate risk group and FRS ? 20% as high risk group, respectively. The logistic regression analyses were conduct...

  13. Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents

    OpenAIRE

    Côrtes Rejane LM; Daud Lyana ES; Garcia Mônica SD; Seixas Mirian SS; Vieira Maria; Bontempo Nádia M; Guimarães Mark DC; Guimarães Eleuse MB; Alves Maria

    2009-01-01

    Abstract Background Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecologic...

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

    DEFF Research Database (Denmark)

    Stovring, H.; Harmsen, C. G.

    2013-01-01

    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.

  15. A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids.

    OpenAIRE

    Van Staa, TP; Geusens, P.; Pols, HA; De Laet, C; Leufkens, HG; Cooper, C.

    2005-01-01

    BACKGROUND: Previous analyses of risk factors for glucocorticoid (GC)-induced osteoporosis have focused on the estimation of relative rather than absolute fracture probability. AIM: To estimate risk scores for the individual probability of fracture in GC users. DESIGN: Retrospective data analysis. METHODS: We evaluated all patients aged 40 years or older with a prescription for oral GCs in the General Practice Research Database (GPRD), which comprises the computerized medical records of aroun...

  16. Do the malnutrition universal screening tool (MUST and Birmingham nutrition risk (BNR score predict mortality in older hospitalised patients?

    Directory of Open Access Journals (Sweden)

    Lee Emma

    2008-10-01

    Full Text Available Abstract Background Undernutrition is common in older hospitalised patients, and routine screening is advocated. It is unclear whether screening tools such as the Birmingham Nutrition Risk (BNR score and the Malnutrition Universal Screening Tool (MUST can successfully predict outcome in this patient group. Methods Consecutive admissions to Medicine for the Elderly assessment wards in Dundee were assessed between mid-October 2003 and mid-January 2004. Body Mass Index (BMI, MUST and BNR scores were prospectively collected. Time to death was obtained from the Scottish Death Register and compared across strata of risk. Results 115 patients were analysed, mean age 82.1 years. 39/115 (34% were male. 20 patients were identified as high risk by both methods of screening. A further 10 were categorised high risk only with the Birmingham classification and 12 only with MUST. 80/115 (67% patients had died at the time of accessing death records. MUST category significantly predicted death (log rank test, p = 0.022. Neither BMI (log rank p = 0.37 or Birmingham nutrition score (log rank p = 0.35 predicted death. Conclusion The MUST score, but not the BNR, is able to predict increased mortality in older hospitalised patients.

  17. Clinical discriminators between acute brain hemorrhage and infarction: a practical score for early patient identification Características clínicas diferenciais entre hemorragia e infarto cerebral: uma escala prática para identificação precoce do paciente

    Directory of Open Access Journals (Sweden)

    Ayrton R. Massaro

    2002-06-01

    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 Novas perspectivas no tratamento do acidente vascular cerebral (AVC requerem um método de triagem rápido para seleção dos pacientes. Nosso objetivo foi criar uma escala com informações clínicas simples para diferenciar hematoma intra-parenquimatoso (HEM entre os pacientes com AVC. Estudamos 1.273 pacientes com AVC isquêmico (INF e 237 com HEM do Stroke Data Bank. Variáveis independentes para o diagnóstico de INF e HEM foram determinadas pela análise de regressão logística e utilizadas para criar uma escala. Através da curva ROC foi escolhido o nível de corte para discriminar HEM (<= 2 , com sensibilidade de 76%, especificidade de 83%. Foi realizada validação externa utilizando os pacientes do estudo NOMASS. Embora o uso de uma escala de fácil aplicação pelas equipes de emergência não possa substituir os métodos de imagem na diferenciação entre INF e HEM para a indicação de trombolítico, a escala proposta pode ser útil para selecionar pacientes para estudos clínicos e tratamento pré-hospitalar, alertar técnicos de tomografia e as equipes médicas sobre a chegada de pacientes, contribuindo para reduzir atrasos cruciais no tratamento.

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

    Directory of Open Access Journals (Sweden)

    Güçlü Beriat

    2012-07-01

    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.

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

    OpenAIRE

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

    1985-01-01

    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...

  20. Changes in physical activity in leisure time and the risk of myocardial infarction, ischemic heart disease, and all-cause mortality

    DEFF Research Database (Denmark)

    Petersen, Christina Bjørk; Grønbæk, Morten; Helge, Jørn Wulff; Thygesen, Lau Caspar; Schnohr, Peter; Tolstrup, Janne Schurmann

    2012-01-01

    Physical activity is associated to a lower risk of mortality from all-causes and from coronary heart disease. The long-term effects of changes in physical activity on coronary heart disease are, however, less known. We examined the association between changes in leisure time physical activity and the risk of myocardial infarction (MI), ischemic heart disease (IHD), and all-cause mortality as well as changes in blood pressure in 4,487 men and 5,956 women in the Copenhagen City Heart Study. Physic...

  1. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n?=?16?827). In total, 1787 (10.6%) died within 30?days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65?years (2), age 66-75?years (4), age 76-85?years (5), or age >85?years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from 50% for a score ?20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P?risk for perioperative mortality.

  2. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n?=?16?827). In total, 1787 (10.6%) died within 30?days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65?years (2), age 66-75?years (4), age 76-85?years (5), or age >85?years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from 50% for a score ?20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P?risk for perioperative mortality.

  3. Consideration of QRS complex in addition to ST segment abnormalities in the estimation of the 'risk region' during acute inferior myocardial infarction

    DEFF Research Database (Denmark)

    van Hellemond, Irene E. G.; Bouwmeester, Sjoerd

    2013-01-01

    The myocardial area at risk (MaR) has been estimated in patients with acute myocardial infarction (AMI) by using ST segment based ECG methods. However, as the process from ischemia to infarction progresses, the ST segment deviation is typically replaced by QRS abnormalities, causing a falsely low estimation of the total MaR if determined by using ST segment based methods. A previous study showed the value of the consideration of the abnormalities in the QRS complex, in addition to those in the ST segment estimating the total MaR for patients with anterior AMI. The purpose of this study was to investigate the same method for patients with inferior AMI.

  4. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens D; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A; Ryom, Lene; Ostergaard, L; Pedersen, C; Hergens, L.; Loftheim, I R; Jensen, K B; Raukas, M; Zilmer, K; Justinen, J; Ristola, M; Andersen, Aase Bengaard; Boedker, K; Collins, P; Gerstoft, J; Jensen, L; Moller, H; Andersen, Paul Lehm; Loftheim, I; Mathiesen, L; Nielsen, Henrik Ib

    2015-01-01

    BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model f...

  5. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The dev...

  6. Migrainous infarction

    DEFF Research Database (Denmark)

    Laurell, K; Artto, V; Bendtsen, L; Hagen, K; Kallela, M; Meyer, E Laudon; Putaala, J; Tronvik, E; Zwart, J-A; Linde, Marianne

    2011-01-01

    Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included

  7. Replacement tunnelled dialysis catheters for haemodialysis access: Same site, new site, or exchange — A multivariate analysis and risk score

    International Nuclear Information System (INIS)

    Aim: To identify variables related to complications following tunnelled dialysis catheter (TDC) replacement and stratifying the risk to reduce morbidity in patients with end-stage renal disease. Materials and methods: One hundred and forty TDCs (Split Cath, medCOMP) were replaced in 140 patients over a 5 year period. Multiple variables were retrospectively collected and analysed to stratify the risk and to predict patients who were more likely to suffer from complications. Multivariate regression analysis was used to identify variables predictive of complications. Results: There were six immediate complications, 42 early complications, and 37 late complications. Multivariate analysis revealed that variables significantly associated to complications were: female sex (p = 0.003; OR 2.9); previous TDC in the same anatomical position in the past (p = 0.014; OR 4.1); catheter exchange (p = 0.038; OR 3.8); haemoglobin 15 s (p = 0.002; OR 4.1); and C-reactive protein >50 mg/l (p = 0.007; OR 4.6). A high-risk score, which used the values from the multivariate analysis, predicted 100% of the immediate complications, 95% of the early complications, and 68% of the late complications. Conclusion: Patients can now be scored prior to TDC replacement. A patient with a high-risk score can be optimized to reduce the chance of complications. Further prospective studies to confirm that rotating the site of TDC reduces complications are warranted as this has implications for current guidelines.

  8. A composite scoring of genotypes discriminates coronary heart disesase risk beyond conventional risk factors in the Boston Puerto Rican Health Study

    Science.gov (United States)

    Background and aims: Using a genetic predisposition score (GPS), integrating the additive associations of a set of single nucleotide polymorphisms (SNPs) with CHD, we examined the consequences of the joint presence of a high GPS and conventional risk factors (CRFs). Methods and results: We studied...

  9. Agreement between the SCORE and D’Agostino Scales for the Classification of High Cardiovascular Risk in Sedentary Spanish Patients

    Directory of Open Access Journals (Sweden)

    Luis García-Ortiz

    2009-11-01

    Full Text Available Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40–65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (?20% according to the Framingham-D’Agostino scale, and ?5% according to SCORE. Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. Results: The mean risk in males (35% was 19.5% ± 13% with D’Agostino scale, and 3.2% ± 3.3% with SCORE. Among females, they were 8.1% ± 6.8% and 1.2% ± 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857–0.889 and 0.818 in females (95% CI: 0.800–0.834, while the kappa index was 0.50 in males (95% CI: 0.44%–0.56% and 0.61 in females (95% CI: 0.52%–0.71%. The most frequent disagreement, characterized by high risk according to D’Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. Conclusions: The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate.

  10. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    FosbØl, E L; Gislason, G H

    2009-01-01

    Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals, of whom 1,028,437 were included in the study after applying selection criteria. Compared to no NSAID use, hazard ratios (95% confidence limits) for death/myocardial infarction were 1.01 (0.96-1.07) for ibuprofen, 1.63 (1.52-1.76) for diclofenac, 0.97 (0.83-1.12) for naproxen, 2.13 (1.89-2.41) for rofecoxib, and 2.01 (1.78-2.27) for celecoxib. A dose-dependent increase in cardiovascular risk was seen for selective COX-2 inhibitors and diclofenac. Caution should be exercised in NSAID use in all individuals, and particularly high doses should be avoided if possible.

  11. Does present use of cardiovascular medication reflect elevated cardiovascular risk scores estimated ten years ago? A population based longitudinal observational study

    Directory of Open Access Journals (Sweden)

    Straand Jørund

    2011-03-01

    Full Text Available Abstract Background It is desirable that those at highest risk of cardiovascular disease should have priority for preventive measures, eg. treatment with prescription drugs to modify their risk. We wanted to investigate to what extent present use of cardiovascular medication (CVM correlates with cardiovascular risk estimated by three different risk scores (Framingham, SCORE and NORRISK ten years ago. Methods Prospective logitudinal observational study of 20 252 participants in The Hordaland Health Study born 1950-57, not using CVM in 1997-99. Prescription data obtained from The Norwegian Prescription Database in 2008. Results 26% of men and 22% of women aged 51-58 years had started to use some CVM during the previous decade. As a group, persons using CVM scored significantly higher on the risk algorithms Framingham, SCORE and NORRISK compared to those not treated. 16-20% of men and 20-22% of women with risk scores below the high-risk thresholds for the three risk scores were treated with CVM, while 60-65% of men and 25-45% of women with scores above the high-risk thresholds received no treatment. Among women using CVM, only 2.2% (NORRISK, 4.4% (SCORE and 14.5% (Framingham had risk scores above the high-risk values. Low education, poor self-reported general health, muscular pains, mental distress (in females only and a family history of premature cardiovascular disease correlated with use of CVM. Elevated blood pressure was the single factor most strongly predictive of CVM treatment. Conclusion Prescription of CVM to middle-aged individuals by large seems to occur independently of estimated total cardiovascular risk, and this applies especially to females.

  12. Follicular lymphoma patients with a high FLIPI score and a high tumor burden: A risk stratification model

    Directory of Open Access Journals (Sweden)

    An?eli? Boško

    2015-01-01

    Full Text Available Background/Aim. The widely accepted Follicular Lymphoma International Prognostic Index (FLIPI divides patients into three risk groups based on the score of adverse prognostic factors. The estimated 5-year survival in patients with a high FLIPI score is around 50%. The aim of this study was to analyse the prognostic value of clinical and laboratory parameters that are not included in the FLIPI and the New Prognostic Index for Follicular Lymphoma developed by the International Follicular Lymphoma Prognostic Factor Project (FLIPI2 indices, in follicular lymphoma (FL patients with a high FLIPI score and high tumor burden. Methods. The retrospective analysis included 57 newly diagnosed patients with FL, a high FLIPI score and a high tumor burden. All the patients were diagnosed and treated between April 2000 and June 2007 at the Clinic for Hematology, Clinical Center of Serbia, Belgrade. Results. The patients with a histological grade > 1, erythrocyte sedimentation rate (ESR ± 45 mm/h and hypoalbuminemia had a significantly worse overall survival (p = 0.015; p = 0.001; p = 0.008, respectively, while there was a tendency toward worse overall survival in the patients with an Eastern Cooperative Oncology Group (ECOG > 1 (p = 0.075. Multivariate Cox regression analysis identified a histological grade > 1, ESR ± 45 mm/h and hypoalbuminemia as independent risk factors for a poor outcome. Based on a cumulative score of unfavourable prognostic factors, patients who had 0 or 1 unfavourable factors had a significantly better 5-year overall survival compared to patients with 2 or 3 risk factors (75% vs 24.1%, p = 0.000. Conclusion. The obtained results suggest that from the examined prognostic parameters histological grade > 1, ESR ± 45 mm/h and hypoalbuminemia can contribute in defining patients who need more aggressive initial treatment approach, if two or three of these parameters are present on presentation.

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

    Scientific Electronic Library Online (English)

    M. A., Ciruzzi; H., Schargrozky; P., Pramparo; J., Rosloznyk; H., Zylberstejn; M., Haquim; V., Rudich; A., Caccavo; D., Pizkorz.

    2002-12-01

    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 co [...] ntroles, 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 IAM Abstract in english This 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 f [...] rom 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.

  14. 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)

    M. A. Ciruzzi

    2002-12-01

    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.

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

    DEFF Research Database (Denmark)

    Podlekareva, D N; Grint, D; Post, F A; Mocroft, A; Panteleev, A M; Miller, Raymonde; Miro, J M; Bruyand, M; Furrer, H; Riekstina, V; Girardi, E; Losso, M H; Caylá, J A; Malashenkov, E A; Obel, N; Skrahina, A M; Lundgren, J D; Kirk, O

    2013-01-01

    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.

  16. Risk prediction scores for recurrence and progression of non-muscle invasive bladder cancer : an international validation in primary tumours

    DEFF Research Database (Denmark)

    Vedder, Moniek M; Márquez, Mirari

    2014-01-01

    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.

  17. Genetic Risk Score Does Not Correlate with Body Mass Index of Latina Women in a Clinical Trial

    OpenAIRE

    Coenen, Kimberly R.; Sharon M. Karp; Sabina B. Gesell; Dietrich, Mary S.; Morgan, Thomas M.; Shari L. Barkin

    2011-01-01

    Obesity disproportionately affects Latina women. Common genetic variants are convincingly associated with BMI and may be used to create genetic risk scores (GRS) for obesity that could define genetically influenced forms of obesity and alter response to clinical trial interventions. The objective of this study was: 1) to identify the frequency and effect size of common obesity genetic variants in Latina women; 2) to determine the clinical utility of a GRS for obesity with Latina women partici...

  18. Do the malnutrition universal screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients?

    OpenAIRE

    Lee Emma; Moore Nicola; Henderson Sarah; Witham Miles D

    2008-01-01

    Abstract Background Undernutrition is common in older hospitalised patients, and routine screening is advocated. It is unclear whether screening tools such as the Birmingham Nutrition Risk (BNR) score and the Malnutrition Universal Screening Tool (MUST) can successfully predict outcome in this patient group. Methods Consecutive admissions to Medicine for the Elderly assessment wards in Dundee were assessed between mid-October 2003 and mid-January 2004. Body Mass Index (BMI), MUST and BNR scor...

  19. 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)

    Eremi?-Koji? Nevena

    2014-01-01

    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.

  20. Factores de riesgo coronarios asociados al infarto agudo del miocardio en el adulto mayor Coronary risk factors associated with the acute myocardial infarction in the elderly

    Directory of Open Access Journals (Sweden)

    Julia Tamara Alvarez Cortés

    2013-01-01

    Full Text Available Se realizó un estudio observacional, analítico y retrospectivo, de tipo caso-control, de los adultos mayores con infarto agudo del miocardio, pertenecientes al área de salud Municipal de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2011, a fin de identificar los factores de riesgo coronarios asociados al mismo. Se seleccionaron 33 casos y 2 controles por cada uno de ellos. Se calcularon el riesgo relativo a través de la razón de productos cruzados y el riesgo atribuible en expuestos porcentual como medida de impacto. El sedentarismo y la hipertensión arterial tuvieron una acentuada relación significativa de causalidad con el infarto agudo del miocardio y de forma moderada con el tabaquismo, no así los antecedentes familiares ni personales de cardiopatía isquémica, sexo, obesidad y diabetes mellitus.An observational, analytic and retrospective study of case-control type, of aged patients with acute myocardial infarction, belonging to the health Municipal area of Santiago de Cuba was carried out from January, 2006 to December, 2011, in order to identify the coronary risk factors associated with it. Thirty three cases and two controls for each were selected. The relative risk through the odds ratio and the attributable risk in percentage exposed as impact measure were calculated. Sedentarism and hypertension had a considerable significant causative relationship with acute myocardial infarction and in a moderate way with smoking habit. Family or personal history of ischemic cardiopathy, sex, obesity or diabetes mellitus had no relation with it.

  1. Factores de riesgo coronarios asociados al infarto agudo del miocardio en el adulto mayor / Coronary risk factors associated with the acute myocardial infarction in the elderly

    Scientific Electronic Library Online (English)

    Julia Tamara, Alvarez Cortés; Vivian, Bello Hernández; Gipsy de los Ángeles, Pérez Hechavarría; Orlando, Antomarchi Duany; María Emilia, Bolívar Carrión.

    2013-01-01

    Full Text Available Se realizó un estudio observacional, analítico y retrospectivo, de tipo caso-control, de los adultos mayores con infarto agudo del miocardio, pertenecientes al área de salud Municipal de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2011, a fin de identificar los factores de riesgo corona [...] rios asociados al mismo. Se seleccionaron 33 casos y 2 controles por cada uno de ellos. Se calcularon el riesgo relativo a través de la razón de productos cruzados y el riesgo atribuible en expuestos porcentual como medida de impacto. El sedentarismo y la hipertensión arterial tuvieron una acentuada relación significativa de causalidad con el infarto agudo del miocardio y de forma moderada con el tabaquismo, no así los antecedentes familiares ni personales de cardiopatía isquémica, sexo, obesidad y diabetes mellitus. Abstract in english An observational, analytic and retrospective study of case-control type, of aged patients with acute myocardial infarction, belonging to the health Municipal area of Santiago de Cuba was carried out from January, 2006 to December, 2011, in order to identify the coronary risk factors associated with [...] it. Thirty three cases and two controls for each were selected. The relative risk through the odds ratio and the attributable risk in percentage exposed as impact measure were calculated. Sedentarism and hypertension had a considerable significant causative relationship with acute myocardial infarction and in a moderate way with smoking habit. Family or personal history of ischemic cardiopathy, sex, obesity or diabetes mellitus had no relation with it.

  2. The effect of metformin on cardiovascular risk profile in patients without diabetes presenting with acute myocardial infarction: data from the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) trial

    Science.gov (United States)

    Lexis, Chris P H; van der Horst-Schrivers, Anouk N A; Lipsic, Erik; Valente, Mattia A E; Muller Kobold, Anneke C; de Boer, Rudolf A; van Veldhuisen, Dirk J; van der Harst, Pim; van der Horst, Iwan C C

    2015-01-01

    Objective In patients with diabetes mellitus, metformin treatment is associated with reduced mortality and attenuation of cardiovascular risk. As a subanalysis of the Glycometabolic Intervention as adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III) study, we evaluated whether metformin treatment in patients with ST-segment elevation myocardial infarction (STEMI) without diabetes improves the cardiovascular risk profile. Methods A total of 379 patients, without known diabetes, presenting with STEMI were randomly allocated to receive metformin 500?mg twice daily or placebo for 4?months. Results After 4?months, the cardiovascular risk profile of patients receiving metformin (n=172) was improved compared with placebo (n=174); glycated hemoglobin (5.83% (95% CI 5.79% to 5.87%) vs 5.89% (95% CI 5.85% to 5.92%); 40.2?mmol/mol (95% CI 39.8 to 40.6) vs 40.9?mmol/mol (40.4 to 41.2), p=0.049); total cholesterol (3.85?mmol/L (95% CI 3.73 to 3.97) vs 4.02?mmol/L (95% CI 3.90 to 4.14), p=0.045); low-density lipoprotein cholesterol (2.10?mmol/L (95% CI 1.99 to 2.20) vs 2.3?mmol/L (95% CI 2.20 to 2.40), p=0.007); body weight (83.8?kg (95% CI 83.0 to 84.7) vs 85.2?kg (95% CI 84.4 to 86.1), p=0.024); body mass index (26.8?kg/m2 (95% CI 26.5 to 27.0) vs 27.2?kg/m2 (95% CI 27.0 to 27.5), p=0.014). Levels of fasting glucose, postchallenge glucose, insulin, high-density lipoprotein cholesterol, and blood pressure were similar in both groups. Conclusions Among patients with STEMI without diabetes, treatment with metformin for 4?months resulted in a modest improvement of the cardiovascular risk profile compared with placebo. Trial register number NCT01217307.

  3. Towards an Evidence Based Score Card for Aligning Risk Management and Sustainability Goals for Essential NORM Industries: Case Study - Phosphates

    International Nuclear Information System (INIS)

    Approaches to regulating NORM industries risk suffering blight from over-conservative methodologies, whether based on worst case models, extreme event scenarios or unmediated application of the precautionary principle: the outcome can be a significant overestimation of risk and a consequent penalty on both producers and consumers in terms of access to and affordability of the intermediate and end products those industries provide. In particular, for historical reasons derived perhaps from the potentially distracting regulatory focus on what is usually trace radioactivity in products and by-products containing NORM, there is a damaging tendency to seek risk management models and best practices from nuclear industries in general rather than from those sectors to which the end products of NORM industries are specifically aligned. This risk is particularly visible in the phosphate sector, an industry now pivotal to long term security and sustainability in both food production and energy supply, plant based or nuclear. Premised on a companion paper which sets out the theory of 'constructive regulation', presented in 2008 at the 12th International Congress of the International Radiation Protection Association, Buenos Aires, this paper proposes the use of an evidence based score carding system to ensure the future alignment of risk management and sustainability goals for NORM industries, starting with phosphates. The score card elements are broken out into three primary categories along the lines defined in the concept of triple bottom line performance measurement, comprising economic, social and environmental elements. The question is put as to what role constructive regulation and best practices can play in ensuring that the outcome of the regulatory process is the preservation and enhancement of the capability of these industries to deliver sustainable returns to the customers and stakeholders who depend on them. Score carding will facilitate transparent, objective decision making and effective performance monitoring in both the short and long term, as measured against triple bottom line expectations. (author)

  4. Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections

    Directory of Open Access Journals (Sweden)

    Zilberberg Marya D

    2012-07-01

    Full Text Available Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA is a frequent cause of complicated skin and skin structure infections (cSSSI. Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately. Methods We conducted a large multicenter (N=62 hospitals retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA infection risk factors. Results Of the 7,183 patients with cSSSI, 2,387 (33.2% had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose–response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity. Conclusions MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.

  5. 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

  6. 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)

    Lam Christopher W

    2008-04-01

    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.

  7. 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)

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

    2014-04-01

    Full Text Available 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

  8. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk) : a pooled analysis of prospective cohorts and health examination surveys

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter

    2015-01-01

    BACKGROUND: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. METHODS: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation anddata from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). FINDINGS: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas inMexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. INTERPRETATION: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. FUNDING: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

  9. Quantificação da massa infartada do ventrículo esquerdo pela ressonância magnética cardíaca: comparação entre a planimetria e o método de escore visual semi-quantitativo / Quantification of left ventricular infarcted mass on cardiac magnetic resonance imaging: comparison between planimetry and the semiquantitative visual scoring method

    Scientific Electronic Library Online (English)

    Clerio Francisco de, Azevedo Filho; Marcelo, Hadlich; João Luiz Fernandes, Petriz; Luís Antonio, Mendonça; Jorge Neval, Moll Filho; Carlos Eduardo, Rochitte.

    2004-08-01

    Full Text Available OBJETIVO: Validar um novo método de escore visual semi-quantitativo contra a planimetria digital quantitativa para a determinação da massa infartada do ventrículo esquerdo pela ressonância magnética cardíaca com técnica de realce tardio. MÉTODO: Estudados 77 pacientes com infarto miocárdico prévio e [...] m aparelho de ressonância magnética de 1,5T utilizando técnica de realce tardio para avaliação da viabilidade miocárdica e cálculo da massa infartada. Para avaliação da função ventricular esquerda pelo método de Simpson utilizamos técnica de cine-ressonância. O cálculo da massa infartada foi realizado nas imagens de realce tardio de duas formas: planimetria e método de escore. Utilizamos métodos de regressão linear simples, correlação e concordância entre métodos e observadores segundo a análise de Bland-Altman. RESULTADOS: Em todos os 77 pacientes as áreas de infarto foram detectadas pela ressonância magnética cardíaca utilizando a técnica de realce tardio. O tamanho do infarto medido pela planimetria foi semelhante ao obtido pelo método de escore, com a média das diferenças entres as medidas de apenas 1,03% da massa do ventrículo esquerdo. As variabilidades inter (0,41%) e intra-observador (0,34%) evidenciaram excelente reprodutibilidade do método de escore. A massa infartada apresentou boa correlação com a fração de ejeção e volumes distólico e sistólico finais indexados, r=-0,76, r=0,63 e r=0,67, respectivamente. CONCLUSÃO: A avaliação de pacientes com infarto agudo do miocárdio prévio pela ressonância magnética cardíaca, utilizando a técnica de realce tardio, permite a determinação reprodutível do tamanho do infarto, tanto pelo método de planimetria, quanto pelo modelo semi-quantitativo de escore. Abstract in english OBJECTIVE: To compare a new semiquantitative visual scoring method with quantitative digital planimetry for determining left ventricular infarcted mass by use of cardiac delayed contrast-enhanced magnetic resonance imaging. METHOD: Seventy-seven patients with previous myocardial infarction underwent [...] delayed contrast-enhanced magnetic resonance imaging using a 1.5T device for assessing myocardial viability and calculating the infarcted mass. Cine magnetic resonance imaging was used for assessing left ventricular function with the Simpson method. The infarcted mass was calculated on the delayed contrast-enhanced images according to the following 2 methods: planimetry and the scoring method. Simple linear regression and correlation and agreement between the methods and observers according to the Bland-Altman plot were used. RESULTS: The infarcted areas in all 77 patients were detected by use of cardiac delayed contrast-enhanced magnetic resonance imaging. The size of the infarction measured by planimetry was similar to that obtained with the scoring method, with a mean difference between measurements of only 1.03% of the left ventricular mass. Inter- (0.41%) and intraobserver (0.34%) variabilities indicated an excellent reproducibility of the scoring method. Infarcted mass showed a good correlation with ejection fraction and indexed end-diastolic and end-systolic volumes, r=-0.76, r=0.63, and r=0.67, respectively. CONCLUSION: In patients with previous myocardial infarction, delayed-enhanced magnetic resonance imaging provides accurate infarct size quantification by planimetry and by semiquantitative score.

  10. Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents

    Directory of Open Access Journals (Sweden)

    Côrtes Rejane LM

    2009-03-01

    Full Text Available Abstract Background Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. Methods A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6% were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. Results The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2 and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7. Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. Conclusion The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.

  11. Comparison of metabolic parameters and Framingham cardiovascular risk scores before and after in-hospital treatment with antipsychotics

    Directory of Open Access Journals (Sweden)

    Wysoki?ski, Adam

    2014-03-01

    Full Text Available Background. The objective of this naturalistic study was to evaluate changes in the prevalence of metabolic syndrome (MetS and Framingham cardiovascular risk scores in adult with schizophrenia after inhospital treatment with antipsychotics. Methods. For 58 patients (36 women and 22 men the following data was acquired on admission and at discharge: body height and weight, waist circumference, cigarette smoking, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides (TGA, fasting plasma glucose (FPG, blood pressure, concomitant use of antidiabetic, antihypertensive and antihyperlipidemic medications. Results. Mean TGA levels increased significantly (140.32 mg/dL vs. 180.17 mg/dL, other parameters did not change. MetS prevalence on admission and at discharge did not differ significantly, irrespective of definition used (IDF: 50.00% vs. 60.34%; ATPIII: 39.66% vs. 43.10%; ATPIII A: 46.55% vs. 51.72%. Two cardiovascular risk scores were reduced at discharge: stroke, 10-year (4.10% vs. 3.46% and hypertension, 4-year (22.18% vs. 16.58%. Other Framingham risk scores did not change. Very high prevalence of abnormal body weight (up to 65%, abdominal obesity (63% in men and 89% in women, hypertension (>50% and lipid abnormalities (31-64% was found. Conclusions. We have found a very high rate of MetS in patients treated with antipsychotics. No metabolic parameters improved after hospital stay, while some worsened. This did not, however, result in increased risk of cardiovascular events. Abnormal body weight and lipid abnormalities were very common in our study population. Our results indicate that metabolic parameters should be monitored regularly, particularly in outpatient settings, and appropriate treatment should be introduced as soon as any signifand appropriate treatment should be introduced as soon as any significant changes are found.

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

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-09-29

    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.

  13. Traditional cardiovascular risk factors in unselected patients with acute myocardial infarction - impact on short-term mortality.

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

    2008-01-01

    Ro?. 117, ?. 19 (2008), s. 21-21. ISSN 0009-7322. [The 2008 World Congress on Cardiology. 18.05.2008-21.05.2008, Buenos Aires ] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * evidence-based medication * mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  14. The SNP rs4804611 in ZNF627 gene and the risk of myocardial infarction: a meta-analysis

    OpenAIRE

    Wu, Nan; Zhang, Xiaowen; Jia, Pengyu; Jia, Dalin

    2015-01-01

    A single nucleotide polymorphism (rs4804611) in zinc finger protein 627 (ZNF627) gene has been demonstrated to be associated with the susceptibility to myocardial infarction (MI), but the results are inconsistent. Therefore, a meta-analysis of eligible studies reporting the association between rs4804611 and MI was carried out to enhance the reliability of published results. A systematic literature search was performed using PubMed, Web of Science, Cochrane Library to search English articles c...

  15. Clot lysis time and the risk of myocardial infarction and ischaemic stroke in young women; results from the RATIO case-control study.

    Science.gov (United States)

    Siegerink, Bob; Meltzer, Mirjam E; de Groot, Philip G; Algra, Ale; Lisman, Ton; Rosendaal, Frits R

    2012-01-01

    Reduced overall fibrinolytic capacity increases the risk of myocardial infarction (MI), as demonstrated in studies with predominantly male participants. We determined the influence of altered fibrinolysis on the risk of MI and ischaemic stroke (IS) in young women. The RATIO (Risk of Arterial Thrombosis In relation to Oral contraceptives) study is a population-based case-control study including young women with MI (n=203), IS (N=175) and 638 matched healthy controls. Fibrinolytic potential was determined with a tissue factor/tissue plasminogen activator induced clot-lysis assay. Odds ratios (OR) adjusted for cardiovascular risk factors were obtained with logistic regression. Clot-lysis time (CLT) was divided into tertiles based on the control group (T1-T3), with T2 as reference. Hypofibrinolysis (prolonged CLT) was associated with an increase in risk of MI (T3 vs. T2, OR 2·8; 95%confidence interval [CI] 1·7-4·7). Hyperfibrinolysis (decreased CLT) had no clear effect (T1 vs. T2, OR 1·6; 95% CI 0·9-2·9). Hypofibrinolysis did not affect the risk of IS (T3 vs. T2, OR 1·5; 95% CI 0·7-3·0), whereas hyperfibrinolysis increased this risk (T1 vs. T2, OR 4·1; 95% CI 2·1-8·0). Oral contraceptive use and smoking further increased these risks. Hypofibrinolysis increases the risk for MI in young women, a finding similar to previous studies. Counter-intuitively, hyperfibrinolysis increased the risk of IS four-fold, which suggests that MI and IS have different aetiologies. PMID:22082241

  16. Validação prospectiva do escore de risco dante pazzanese em síndrome coronariana aguda sem supradesnivelamento do segmento ST / Prospective validation of the dante pazzanese risk score in non-ST-segment elevation acute coronary syndrome

    Scientific Electronic Library Online (English)

    Elizabete Silva dos, Santos; Luiz, Minuzzo; Roberta de, Souza; Ari, Timerman.

    2013-09-01

    Full Text Available FUNDAMENTO: Em Síndrome Coronariana Aguda (SCA) sem Supradesnivelamento do segmento ST (SST) é importante estimar a probabilidade de eventos adversos. Para esse fim, as diretrizes recomendam modelos de estratificação de risco. O escore de risco Dante Pazzanese (escore DANTE) é um modelo simples de e [...] stratificação de risco, composto das variáveis: aumento da idade (0 a 9 pontos); antecedente de diabete melito (2 pontos) ou acidente vascular encefálico (4 pontos); não uso de inibidor da enzima conversora da angiotensina (1 ponto); elevação da creatinina (0 a 10 pontos); combinação de elevação da troponina e depressão do segmento ST (0 a 4 pontos). OBJETIVO: Validar o escore DANTE em pacientes com SCA sem SST. MÉTODOS: Estudo prospectivo, observacional, com inclusão de 457 pacientes, de setembro de 2009 a outubro de 2010. Os pacientes foram agrupados em: muito baixo, baixo, intermediário e alto risco de acordo com a pontuação do modelo original. A habilidade preditiva do escore foi avaliada pela estatística-C. RESULTADOS: Foram 291 (63,7%) homens e a média da idade 62,1 anos (11,04). Dezessete pacientes (3,7%) apresentaram o evento de morte ou (re)infarto em 30 dias. Ocorreu aumento progressivo na proporção do evento, com aumento da pontuação: muito baixo risco = 0,0%; baixo risco = 3,9%; risco intermediário = 10,9%; alto risco = 60,0%; p Abstract in english BACKGROUND: In non-ST-segment elevation acute coronary syndrome (ACS), the likelihood of adverse events should be estimated. Guidelines recommend risk stratification models for that purpose. The Dante Pazzanese risk score (DANTE score) is a simple risk stratification model composed with the followin [...] g variables: age increase (0 to 9 points); history of diabetes mellitus (2 points) or stroke (4 points); no use of angiotensin-converting-enzyme inhibitor (1 point); creatinine elevation (0 to 10 points); combination of troponin elevation and ST-segment depression (0 to 4 points). OBJECTIVE: To validate the DANTE score in patients with non-ST-segment elevation ACS. METHODS: Prospective, observational study including 457 patients, from September 2009 to October 2010. The patients were grouped in risk categories according to the original model score as follows: very low; low; intermediate; and high. The predictive ability of the score was assessed by using C-statistics. RESULTS: The sample comprised 291 (63.7%) men, the mean age being 62.1 years (SD=11.04). The event death or (re)infarction in 30 days was observed in 17 patients (3.7%). Progressive increase in the proportion of events was observed as the score increased: very low risk = 0.0%; low risk = 3.9%; intermediate risk = 10.9%; high risk = 60.0%; p

  17. Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo; Friis-Holmberg, Teresa; Hjelmborg, Jacob V B; Bech, Mickael; Hermann, Anne Pernille; Barkmann, Reinhard; Glüer, Claus C; Brixen, Kim

    2013-01-01

    PURPOSE: To compare the power of FRAX® without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. METHODS: This study was a prospective, population-based study performed in Denmark comprising 3614 women aged 40-90years, who returned a questionnaire concerning items on risk factors for osteoporosis. Fracture risk was calculated using the different screening tools (FRAX®, OST, ORAI, OSIRIS and SCORE) for each woman. The women we...

  18. Assessment of first and second degree relatives of individuals with bipolar disorder shows increased genetic risk scores in both affected relatives and young At-Risk Individuals.

    Science.gov (United States)

    Fullerton, Janice M; Koller, Daniel L; Edenberg, Howard J; Foroud, Tatiana; Liu, Hai; Glowinski, Anne L; McInnis, Melvin G; Wilcox, Holly C; Frankland, Andrew; Roberts, Gloria; Schofield, Peter R; Mitchell, Philip B; Nurnberger, John I

    2015-10-01

    Recent studies have revealed the polygenic nature of bipolar disorder (BP), and identified common risk variants associated with illness. However, the role of common polygenic risk in multiplex families has not previously been examined. The present study examined 249 European-ancestry families from the NIMH Genetics Initiative sample, comparing subjects with narrowly defined BP (excluding bipolar II and recurrent unipolar depression; n = 601) and their adult relatives without BP (n = 695). Unrelated adult controls (n = 266) were from the NIMH TGEN control dataset. We also examined a prospective cohort of young (12-30 years) offspring and siblings of individuals with BPI and BPII disorder (at risk; n = 367) and psychiatrically screened controls (n = 229), ascertained from five sites in the US and Australia and assessed with standardized clinical protocols. Thirty-two disease-associated SNPs from the PGC-BP Working Group report (2011) were genotyped and additive polygenic risk scores (PRS) derived. We show increased PRS in adult cases compared to unrelated controls (P = 3.4 × 10(-5) , AUC = 0.60). In families with a high-polygenic load (PRS score ?32 in two or more subjects), PRS distinguished cases with BPI/SAB from other relatives (P = 0.014, RR = 1.32). Secondly, a higher PRS was observed in at-risk youth, regardless of affected status, compared to unrelated controls (GEE-?(2) = 5.15, P = 0.012). This report is the first to explore common polygenic risk in multiplex families, albeit using only a small number of robustly associated risk variants. We show that individuals with BP have a higher load of common disease-associated variants than unrelated controls and first-degree relatives, and illustrate the potential utility of PRS assessment in a family context. PMID:26178159

  19. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score.

    Science.gov (United States)

    Silva, Barbara C; Broy, Susan B; Boutroy, Stephanie; Schousboe, John T; Shepherd, John A; Leslie, William D

    2015-01-01

    Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%-80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force. PMID:26277849

  20. Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile

    Scientific Electronic Library Online (English)

    Alberto, Fica; Nicolás, Bunster; Felipe, Aliaga; Felipe, Olivares; Lorena, Porte; Stephanie, Braun; Jeannette, Dabanch; Juan Carlos, Hormázabal; Antonio, Hernández; María Guacolda, Benavides.

    2014-04-01

    Full Text Available AIMS: Bacteremic pneumococcal pneumonia (BPP) is a severe condition. To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. PATIENTS AND METHODS: Patients were identified by laboratory data and restr [...] icted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. RESULTS: Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% >60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age >65 years (OR 42.1; IC95 2.2-796), and a platelet count

  1. Factores de riesgo para la ocurrencia de infarto agudo del miocardio en pacientes fumadores / Risk factors for occurrence of acute myocardial infarction in smokers patients

    Scientific Electronic Library Online (English)

    José Antonio, González Pompa; José Manuel, González Pérez.

    2013-12-01

    Full Text Available Introducción: las enfermedades cardiovasculares son la principal causa de muerte en diferentes países. Objetivo: evaluar el efecto de factores de riesgo en la ocurrencia del infarto agudo del miocardio en pacientes fumadores, en una población venezolana. Métodos: se realizó un estudio de casos y tes [...] tigos, la muestra se seleccionó de forma aleatoria y estuvo integrada por 70 casos y 70 testigos. Se estudiaron factores sociodemográficos y premórbidos y hábitos tóxicos. El análisis estádístico se basó en una estrategia univariada con la determinación del odd ratio para cada uno de los factores de riesgo hipotéticamente influyente y sus intervalos de confianza para el 95 %, finalmente, un estudio multivariado para determinar el valor independiente de cada uno de los factores de riesgos. Resultados: según el análisis univariado, todos los factores constituyeron riesgo para la aparición de la enfermedad. En el análisis multivariado, se encontró que la hipercolesterolemia elevó en 4,2 veces el riesgo de ocurrencia del infarto del miocardio (OR 4,20; IC 1,18-14,97) en la población de fumadores, seguido del tiempo de evolución del hábito de fumar (OR 3,60; IC 1,468,91) y del consumo de cigarrillos (OR 2,32; IC 1,02- 4,95). Conclusiones: la hipercolesterolemia tiene un efecto mayor sobre la posible ocurrencia de tener un infarto del miocardio que el del resto de los factores de riesgo estudiados en pacientes fumadores, de ahí que es el factor de mayor peso e importancia. Abstract in english Introduction: cardiovascular diseases are the main causes of death in many countries. Objective: to evaluate the occurrence of acute myocardial infarction in smoking patients in a Venezuelan population section. Methods: a case-control study was carried out with a randomly selected sample of 70 cases [...] and 70 controls. Sociodemographic and premorbid factors as well as toxic habits were studied. The statistical analysis was based on univariate strategy with odd ratios estimated for every hypothetically influential risk factor and their confidence intervals of 95 %. Finally, a multivariate study determined the independent value of each risk factor. Results: in the univariate analysis, all factors represented a risk for the onset of acute myocardial infarction. Hypercholesterolemia was the main risk factor in the multivariate analysis, since it increased the risk of myocardial infarction by 4.2 times (OR 4.20 CI 1.18- 14.97), followed by the length of the smoking habit (OR 3.60 CI 1.46 8.91) and the quantity of cigarettes smoked daily (OR 2.32; IC 1.02 4.95). Conclusions: hypercholesterolemia has greater effect on possible occurrence of myocardial infarction than the rest of risk factors studied in smoking patients; therefore it is the most significant factor.

  2. Automated texture scoring for assessing breast cancer masking risk in full field digital mammography

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J; Petersen, Peter Kersten; Lilholm, Martin; Jørgensen, Dan Richter; Diao, Pengfei; Holland, Katharina; Karssemeijer, Nico; Igel, Christian; Nielsen, Mads

    2015-01-01

    PURPOSE: The goal of this work is to develop a method to identify women at high risk for having breast cancer that is easily missed in regular mammography screening. Such a method will provide a rationale for selecting women for adjunctive screening. It goes beyond current risk assessment models that are not specifically adapted to reduce the number of interval cancers. METHOD AND MATERIALS: From the Dutch breast cancer screening program we collected 109 cancers that were screen negative and sub...

  3. Case-control study of second-line therapies for type 2 diabetes in combination with metformin and the comparative risks of myocardial infarction and stroke.

    Science.gov (United States)

    Floyd, J S; Wiggins, K L; Sitlani, C M; Flory, J H; Dublin, S; Smith, N L; Heckbert, S R; Psaty, B M

    2015-12-01

    We conducted a population-based case-control study to assess the myocardial infarction (MI) and stroke risks associated with sulphonylureas and insulin when used in combination with metformin. Cases had type 2 diabetes and used metformin + insulin or metformin + sulphonylureas at the time of a first MI or first stroke between 1995 and 2010; controls used the same treatment combinations and were randomly sampled from the same population. MI and stroke diagnoses and potential confounders were validated by medical record reviews. Compared with metformin + sulphonylurea, metformin + insulin was associated with similar risks of MI or stroke [odds ratio 0.98 (95% confidence interval 0.63-1.52)]. Meta-analysis with another observational study improved the precision of the risk estimate [relative risk 0.92 (95% confidence interval 0.69-1.24)]. Current evidence suggests that there may not be large differences in cardiovascular risk associated with the use of insulin or sulphonylureas when used in combination with metformin. PMID:26179389

  4. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects. The Sefuri brain MRI study

    International Nuclear Information System (INIS)

    Although brain infarction is more common in men, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. This study was to examine the relationship between sex differences in the risk profile and SBI. We conducted a population-based, cross-sectional analysis of cardiovascular risk factors and SBI on MRI. We asked all the female participants about the age at natural menopause and parity. SBI was detected in 77 (11.3%) of 680 participants (266 men and 414 women) with a mean age of 64.5 (range 40-93) years. In the logistic analysis, age (odds ratio (OR)=2.760/10 years, 95% confidence interval (CI)=2.037-3.738), hypertension (OR=3.465, 95% CI=1.991-6.031), alcohol intake (OR=2.494, 95% CI=1.392-4.466) and smoking (OR=2.302, 95% CI=1.161-4.565) were significant factors concerning SBI. Although SBI was more prevalent among men, this sex difference disappeared on the multivariate model after adjustment for other confounders. In 215 women aged 60 years or older, age at natural menopause, early menopause, duration of menopause, number of children and age at the last parity were not significantly associated with SBI after adjustment for age. Hypertension and age were considered to be the major risk factors for SBI in community-dwelling people. Male predominance in SBI was largely due to higher prevalence of alcohol habit and smoking in men than in women in our population. (author)

  5. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Gorgels Anton PM

    2011-03-01

    Full Text Available Abstract Background Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP, while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI. Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI. Methods The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs were estimated using Cox proportional hazards models. Results For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors. Conclusions The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking. Furthermore, the effects of the lifestyle factors on the risk of both coronary diseases were similar for subjects with and without a positive family history.

  6. Monocyte-derived macrophage assisted breast cancer cell invasion as a personalized, predictive metric to score metastatic risk

    Science.gov (United States)

    Park, Keon-Young; Li, Gande; Platt, Manu O.

    2015-01-01

    Patient-to-patient variability in breast cancer progression complicates clinical treatment decisions. Of women undergoing prophylactic mastectomies, many may not have progressed to indolent forms of disease and could have benefited from milder, localized therapy. Tumor associated macrophages contribute significantly to tumor invasion and metastasis, with cysteine cathepsin proteases as important contributors. Here, a method is demonstrated by which variability in macrophage expression of cysteine cathepsins, their inhibitor cystatin C, and kinase activation can be used to train a multivariate model and score patients for invasion risk. These enzymatic profiles were used to predict macrophage-assisted MCF-7 breast cancer cell invasion in the trained computational model. To test these predictions, a priori, signals from monocytes isolated from women undergoing mastectomies were input to score their cancer invasion potential in a patient-specific manner, and successfully predicted that patient monocytes with highest predicted invasion indices matched those with more invasive initial diagnoses of the nine patients tested. Together this establishes proof-of-principle that personalized information acquired from minimally invasive blood draws may provide useful information to inform oncologists and patients of invasive/metastatic risk, helping to make decisions regarding radical mastectomy or milder, conservative treatments to save patients from hardship and surgical recovery. PMID:26349896

  7. Oxidative balance score and risk for incident prostate cancer in a prospective U.S. cohort study

    Science.gov (United States)

    Lakkur, Sindhu; Goodman, Michael; Bostick, Roberd M.; Citronberg, Jessica; McClellan, William; Flanders, William Dana; Judd, Suzanne; Stevens, Victoria L.

    2015-01-01

    Purpose Oxidative stress is defined as an imbalance between pro-oxidants and antioxidants. Previous research found that a single comprehensive oxidative balance score (OBS) that includes individual pro-and anti-oxidant exposures may be associated with various conditions (including prostate cancer) in the absence of associations with the individual factors. We investigated an OBS-incident prostate cancer association among 43,325 men in the Cancer Prevention Study II Nutrition Cohort. Methods From 1999–2007, 3386 incident cases were identified. Twenty different components, used in two ways (unweighted or weighted based on literature reviews), were incorporated into the OBS, and the resulting scores were then expressed as three types of variables (continuous, quartiles, or six equal intervals). Multivariable-adjusted rate ratios were calculated using Cox proportional hazards models. Results We hypothesized that the OBS would be inversely associated with prostate cancer risk; however, the rate ratios (95% confidence intervals) comparing the highest with the lowest OBS categories ranged from 1.17 (1.04–1.32) to 1.39 (0.90–2.15) for all cases, 1.14 (0.87–1.50) to 1.59 (0.57–4.40) for aggressive disease (American Joint Committee on Cancer stage III/IV or Gleason score 8–10), and 0.91 (0.62–1.35) to 1.02 (1.02–1.04) for nonaggressive disease. Conclusions Our findings are not consistent with the hypothesis that oxidative balance–related exposures collectively affect risk for prostate cancer. PMID:24731700

  8. Changes in medical treatment six months after risk stratification with HeartScore and coronary artery calcification scanning of healthy middle-aged subjects

    DEFF Research Database (Denmark)

    SØrensen, Mette Hjortdal; Gerke, Oke

    2012-01-01

    Objectives: The aim was to examine and compare the impact of HeartScore and coronary artery calcification (CAC) score on subsequent changes in the use of medication. Methods: A total of 1156 healthy men and women, aged 50 or 60, had a baseline medical examination and a coronary artery CT-scan as a part of a screening programme. Using the European HeartScore, the total 10-year cardiovascular mortality risk was estimated (?5% risk was considered as high). Risk factors and CAC scores were reported to both the patients and their general practitioner. Six months after the screening, follow-up questionnaires addressing current medication were mailed to the participants. Results: A completed questionnaire was returned by 1075 (93%) subjects. At follow up, the overall use of prophylactic medication was significantly increased. Of those with CAC (n = 462) or high HeartScore (n = 233), 21 and 19%, respectively, received lipid-lowering treatment, while 25 and 32%, respectively, received antihypertensive treatment. In multivariate logistic regression analyses, the presence of CAC was associated with an increased use of lipid-lowering treatment (OR 2.2; 95% CI 1.2-4.0), while the presence of a high HeartScore was associated with an increased use of lipid-lowering (OR 2.9; 95% CI 1.6-5.5) and antihypertensive medication (OR 3.4; 95% CI 1.9-6.0). Conclusion: Knowledge of present cardiovascular risk factors like high HeartScore and/or CAC leads to beneficial changes in medication. However, at follow up only a minority of high-risk subjects did received prophylactic treatment. CAC score was not superior to HeartScore regarding these motivational outcomes.

  9. Association of urinary cadmium and myocardial infarction

    International Nuclear Information System (INIS)

    We conducted a cross-sectional analysis of individuals 45-79 years old in the National Health and Nutrition Examination Survey III (1988-1994) (NHANES III). Myocardial infarction was determined by electrocardiogram (ECG). Our sample included 4912 participants, which when weighted represented 52,234,055 Americans. We performed adjusted logistic regressions with the Framingham risk score, pack-years of smoking, race-ethnicity, and family history of heart attack, and diabetes as covariates. Urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.86 (95% CI 1.26-2.75) compared to urinary cadmium <0.43 ?g/g creatinine. This result supports the hypothesis that cadmium is associated with coronary heart disease. When logistic regressions were done by gender, women, but not men, showed a significant association of urinary cadmium with myocardial infarction. Women with urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.80 (95% CI 1.06-3.04) compared to urinary cadmium <0.43 ?g/g creatinine. When the analysis was restricted to never smokers (N=2187) urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.85 (95% CI 1.10-3.14) compared to urinary cadmium <0.43 ?g/g creatinine

  10. Risk markers of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; JØns, Christian

    2011-01-01

    Aims High-degree atrioventricular block (HAVB) after acute myocardial infarction (AMI) is associated with increased risk of mortality. Risk markers and predictors of HAVB occurring after AMI are largely unknown. The aim of this study was to assess the predictive value of risk markers derived from a series of non-invasive and invasive tests for the development of HAVB documented by an implantable loop recorder (ILR) in late convalescent phases of an AMI. Methods and results The study included 292 patients with AMI and subsequent left ventricular dysfunction without prior HAVB or implanted pacemaker. An ILR was implanted for continuous arrhythmia surveillance. Risk stratification testing was performed at inclusion and 6 weeks after AMI. The tests included echocardiography, electrocardiogram (ECG), 24 h Holter monitoring, and an invasive electrophysiological study. High-degree atrioventricular block was documented in 28 (10%) patients during a median follow-up of 2.0 (0.4-2.0) years. Heart rate variability (HRV)measures and non-sustained ventricular tachycardia occurring at the week 6 Holter monitoring were highly predictive of HAVB. Power law slope

  11. A melanoma risk score in a Brazilian population Um escore de risco para melanoma em uma população brasileira

    Directory of Open Access Journals (Sweden)

    Lucio Bakos

    2013-04-01

    Full Text Available BACKGROUND: Important risk factors for cutaneous melanoma (CM are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study, and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79. Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM. FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenvolver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79. Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo.

  12. A melanoma risk score in a Brazilian population / Um escore de risco para melanoma em uma população brasileira

    Scientific Electronic Library Online (English)

    Lucio, Bakos; Simeona, Mastroeni; Renan Rangel, Bonamigo; Franco, Melchi; Paolo, Pasquini; Cristina, Fortes.

    2013-04-01

    Full Text Available FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenv [...] olver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano) e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79). Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo. Abstract in english BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop [...] a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.

  13. Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Marina Mustilli

    2012-06-01

    Full Text Available Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI during acute coronary syndromes (ACS. Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing transulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

  14. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile / Individual and population risk in acute myocardial infarction: The Chilean INTERHEART study

    Scientific Electronic Library Online (English)

    Fernando, Lanas; Sergio, Potthoff; Enrique, Mercadal; Claudio, Santibáñez; Alejandra, Lanas; Dina, Standen.

    2008-05-01

    Full Text Available [...] Abstract in english Acute myocardial infarction (AMI) is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hyper [...] tension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo) Al and B were determined. Odds ratio (OR) and population attributable risk (PAR) were calculated with 95% confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22% were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2), hypertension: 2.9 (2.1-3.9), permanent stress: 2.2 (1,3-2,8), increased apoB/ApoAl ratio: 2.1 (1.4-3.0) and diabetes: 2.0 (1.4-2.9). A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8), was observed. The highest PAR was due to smoking: 42% (33.2-51.4), increased ApoB/ApoAl ratio: 35.2 (19.0-55.8) and hypertension: 32% (24.5-40.8). These three factors explained 71.3% of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6% (2.4-61.2), permanent stress: 12.0% (2.3-44.1) and diabetes: 10.8% (6.1-18.3). Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country

  15. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile Individual and population risk in acute myocardial infarction: The Chilean INTERHEART study

    Directory of Open Access Journals (Sweden)

    Fernando Lanas

    2008-05-01

    Full Text Available Acute myocardial infarction (AMI is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hypertension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo Al and B were determined. Odds ratio (OR and population attributable risk (PAR were calculated with 95% confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22% were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2, hypertension: 2.9 (2.1-3.9, permanent stress: 2.2 (1,3-2,8, increased apoB/ApoAl ratio: 2.1 (1.4-3.0 and diabetes: 2.0 (1.4-2.9. A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8, was observed. The highest PAR was due to smoking: 42% (33.2-51.4, increased ApoB/ApoAl ratio: 35.2 (19.0-55.8 and hypertension: 32% (24.5-40.8. These three factors explained 71.3% of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6% (2.4-61.2, permanent stress: 12.0% (2.3-44.1 and diabetes: 10.8% (6.1-18.3. Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country

  16. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction : a nationwide study in Denmark

    DEFF Research Database (Denmark)

    Jabbari, Reza; EngstrØm, Thomas

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION: Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.

  17. Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST-Elevation Myocardial Infarction : A Nationwide Study in Denmark

    DEFF Research Database (Denmark)

    Jabbari, Reza; EngstrØm, Thomas

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION: Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.

  18. A Hypertension Risk Score for Middle-Aged and Older Adults

    OpenAIRE

    Kshirsagar, Abhijit V.; Chiu, Ya-Lin; Bomback, Andrew S.; August, Phyllis A; Viera, Anthony J; Colindres, Romulo E.; BANG, HEEJUNG

    2010-01-01

    Determining which demographic and medical variables predict the development of hypertension could help clinicians stratify risk in both prehypertensive and nonhypertensive persons. Subject-level data from 2 community-based biracial cohorts were combined to ascertain the relationship between baseline characteristics and incident hypertension. Hypertension, defined as diastolic blood pressure ?90 mm Hg, systolic blood pressure ?140 mm Hg, or reported use of medication known to treat hypertensio...

  19. Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population

    OpenAIRE

    Yang, Justin; Farioli, Andrea; Korre, Maria; Kales, Stefanos N.

    2014-01-01

    Introduction: Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD) biomarkers, metabolic syndrome and body composition in an occupationally ...

  20. Usefulness of the Obesity Surgery Mortality Risk Score (OR-MRS) in choosing the laparoscopic bariatric procedure

    Science.gov (United States)

    Or?owski, Miko?aj; Pa?nik, Krzysztof; J?drzejewski, Emil

    2015-01-01

    Introduction The most popular scale to stratify the postoperative risk is the Obesity Surgery Mortality Risk Score (OS-MRS). The design and ease of interpretation make the scale a potential tool for clinical use. Aim To evaluate the usefulness of the OS-MRS scale in the enrollment of patients for laparoscopic bariatric procedures, including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Material and methods The medical records of patients who underwent LSG or LRYGB due to obesity between January 2010 and December 2010 were reviewed retrospectively. The decision of choosing the surgical procedure was made on the basis of OS-MRS risk category. The primary endpoint of this study was the 90-day mortality, and the secondary endpoint was the presence of major complications. Results There were 107 patients including 66 women and 41 men. The OS-MRS classes were A (48%), B (47%) and C (5%). The LSG was applied to patients with higher body mass index and to patients of class C. The secondary endpoints occurred in 6 patients, distributed in 10% of class A, 2% of class B and 0% of class C patients (p < 0.05). In 5 of 6 cases the endpoint was observed after LRYGB. Fatal cases were not observed. Conclusions The OS-MRS can be a useful clinical tool for choosing the appropriate laparoscopic bariatric procedure, depending on the risk of postoperative complications. Low risk of postoperative complications should not lower the watchfulness of the surgeon. PMID:26240623

  1. Genetic Risk Scores Associated with Baseline Lipoprotein Subfraction Concentrations Do Not Associate with Their Responses to Fenofibrate

    Directory of Open Access Journals (Sweden)

    Alexis C. Frazier-Wood

    2014-08-01

    Full Text Available Lipoprotein subclass concentrations are modifiable markers of cardiovascular disease risk. Fenofibrate is known to show beneficial effects on lipoprotein subclasses, but little is known about the role of genetics in mediating the responses of lipoprotein subclasses to fenofibrate. A recent genomewide association study (GWAS associated several single nucleotide polymorphisms (SNPs with lipoprotein measures, and validated these associations in two independent populations. We used this information to construct genetic risk scores (GRSs for fasting lipoprotein measures at baseline (pre-fenofibrate, and aimed to examine whether these GRSs also associated with the responses of lipoproteins to fenofibrate. Fourteen lipoprotein subclass measures were assayed in 817 men and women before and after a three week fenofibrate trial. We set significance at a Bonferroni corrected alpha <0.05 (p < 0.004. Twelve subclass measures changed with fenofibrate administration (each p = 0.003 to <0.0001. Mixed linear models which controlled for age, sex, body mass index (BMI, smoking status, pedigree and study-center, revealed that GRSs were associated with eight baseline lipoprotein measures (p < 0.004, however no GRS was associated with fenofibrate response. These results suggest that the mechanisms for changes in lipoprotein subclass concentrations with fenofibrate treatment are not mediated by the genetic risk for fasting levels.

  2. Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population

    Directory of Open Access Journals (Sweden)

    González-Pérez Antonio

    2005-11-01

    Full Text Available Abstract Background Recent data indicate that chronic use of coxibs leads to an increased occurrence of thrombotic cardiovascular events. This raises the question as to whether traditional non-steroidal anti-inflammatory drugs (tNSAIDs might also produce similar hazards. Our aim has been to evaluate the association between the chronic use of tNSAIDs and the risk of myocardial infarction (MI in patients. Methods We performed a nested case-control analysis with 4,975 cases of acute MI and 20,000 controls, frequency matched to cases by age, sex, and calendar year. Results Overall, current use of tNSAID was not associated with an increased risk of MI (RR:1.07;95%CI: 0.95–1.21. However, we found that the relative risk (RR of MI for durations of tNSAID treatment of >1 year was 1.21 (95% CI, 1.00–1.48. The corresponding RR was 1.34 (95% CI, 1.06–1.70 for non-fatal MI. The effect was independent from dose. The small risk associated with long-term use of tNSAIDs was observed among patients not taking low-dose aspirin (RR: 1.29; 95% CI, 1.01–1.65. The effect of long-term use for individual tNSAIDs ranged from a RR of 0.87 (95% CI, 0.47–1.62 with naproxen to 1.38 (95% CI, 1.00–1.90 with diclofenac. Conclusion This study adds support to the hypothesis that chronic treatment with some tNSAIDs is associated with a small increased risk of non-fatal MI. Our data are consistent with a substantial variability in cardiovascular risks between individual tNSAIDs.

  3. Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: a cross-sectional population-based study

    Directory of Open Access Journals (Sweden)

    Michels Bob PJ

    2008-08-01

    Full Text Available Abstract Background While the prevalence of type 2 diabetes mellitus (DM is high, tailored risk scores for screening among South Asian and African origin populations are lacking. The aim of this study was, first, to compare the prevalence of (known and newly detected DM among Hindustani Surinamese, African Surinamese and ethnic Dutch (Dutch. Second, to develop a new risk score for DM. Third, to evaluate the performance of the risk score and to compare it to criteria derived from current guidelines. Methods We conducted a cross-sectional population based study among 336 Hindustani Surinamese, 593 African Surinamese and 486 Dutch, aged 35–60 years, in Amsterdam. Logistic regressing analyses were used to derive a risk score based on non-invasively determined characteristics. The diagnostic accuracy was assessed by the area under the Receiver-Operator Characteristic curve (AUC. Results Hindustani Surinamese had the highest prevalence of DM, followed by African Surinamese and Dutch: 16.7, 8.1, 4.2% (age 35–44 and 35.0, 19.0, 8.2% (age 45–60, respectively. The risk score included ethnicity, body mass index, waist circumference, resting heart rate, first-degree relative with DM, hypertension and history of cardiovascular disease. Selection based on age alone showed the lowest AUC: between 0.57–0.62. The AUC of our score (0.74–0.80 was higher than that of criteria from guidelines based solely on age and BMI and as high as criteria that required invasive specimen collection. Conclusion In Hindustani Surinamese and African Surinamese populations, screening for DM should not be limited to those over 45 years, as is advocated in several guidelines. If selective screening is indicated, our ethnicity based risk score performs well as a screening test for DM among these groups, particularly compared to the criteria based on age and/or body mass index derived from current guidelines.

  4. Association of the 894G>T polymorphism in the endothelial nitric oxide synthase gene with risk of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Foussas Stefanos G

    2008-05-01

    Full Text Available Abstract Background This study was designed to investigate the association of the 894G>T polymorphism in the eNOS gene with risk of acute myocardial infarction (AMI, extent of coronary artery disease (CAD on coronary angiography, and in-hospital mortality after AMI. Methods We studied 1602 consecutive patients who were enrolled in the GEMIG study. The control group was comprised by 727 individuals, who were randomly selected from the general adult population. Results The prevalence of the Asp298 variant of eNOS was not found to be significantly and independently associated with risk of AMI (RR = 1.08, 95%CI = 0.77–1.51, P = 0.663, extent of CAD on angiography (OR = 1.18, 95%CI = 0.63–2.23, P = 0.605 and in-hospital mortality (RR = 1.08, 95%CI = 0.29–4.04, P = 0.908. Conclusion In contrast to previous reports, homozygosity for the Asp298 variant of the 894G>T polymorphism in the eNOS gene was not found to be associated with risk of AMI, extent of CAD and in-hospital mortality after AMI

  5. Notching early repolarization pattern in inferior leads increases risk of ventricular tachyarrhythmias in patients with acute myocardial infarction: a meta-analysis

    Science.gov (United States)

    Zhang, Zhiwei; Letsas, Konstantinos P.; Yang, Yajuan; Korantzopoulos, Panagiotis; Li, Guangping; Yan, Gan-Xin; Liu, Tong

    2015-01-01

    The aim of this of this meta-analysis was to examine the potential association between certain early repolarization (ER) characteristics and ventricular tachyarrhythmias (VTAs) in patients with acute myocardial infarction (AMI). We searched PubMed, Embase and Web of Science databases for records published until December 2014. Of the 658 initially identified records, 7 studies with a total of 1,565 patients (299 with ER and 1,266 without ER) were finally analyzed. Overall, patients with ER displayed a higher risk of VTAs following AMI compared to patients without ER [odds ratio (OR): 3.75, 95% CI: 2.62–5.37, p?AMI onset is a better predictor of VTAs (OR: 5.70, p?AMI onset (OR: 2.60, p?=?0.00001). Remarkably, a notching morphology was a significant predictor of VTAs compared to slurring morphology (OR: 3.85, p?=?0.002). Finally, an inferior ER location (OR: 8.85, p?AMI patients. In conclusion, our meta-analysis suggests that ER pattern is associated with greater risk of VTAs in patients with AMI. A notched ER pattern located in inferior leads confers the highest risk for VTAs in AMI. PMID:26521690

  6. SELF-LEARNING SCORING MODELS – INTRODUCTION OF AN ON-LINE APPROACH TO RISK ASSESMENT

    Directory of Open Access Journals (Sweden)

    Ryszard Kozera

    2014-06-01

    Full Text Available The problem considered in this article involves the construction of evaluation model, which could subsequently be used in the fieldof modeling and risk management. The research work is finalizedby a construction of a new model on the basis of observa-tions of the models used for risk management and knowledge of information theory, machine learning and artificialneural networks. The developed tools are trained on-line, using their ability for automatic deduction rules based on data, during model application for evaluation tasks. The model, consequently changes the data analysis stage, limits the scope of the necessary expertise in the area, where the assessment model can be used and, to some extent, the shape of the model becomes independent from the current range of available data. These features increase its ability to general-ize and to cope with the data of previously undefinedclasses, as well as improve its resistance to gaps occurring in the data. Performance of the model presented in this paper is tested and verifiedon the basis of real-life data, which would resemble a potentially real practical application. Preliminary tests performed within the scope of this work indicate that the developed model can form a starting point for further research as some of the used mechanisms have a fairly high efficiency and flexibility.

  7. Development and Validation of a Risk Score predicting substantial Weight Gain over 5 Years in middle-aged European Men and Women

    OpenAIRE

    Steffen, Annika

    2012-01-01

    Given the rapid rise in obesity prevalence around the world in recent years and the considerable strains involved with the treatment of overweight and obesity, primary prevention of weight gain is of paramount public health importance. Due to limited resources, prevention efforts might be particularly targeted to individuals at high risk of excess weight gain that may result in overweight and obesity. Therefore, the aim of the present thesis was to develop a risk score predicting risk of subs...

  8. Diastolic myocardial dysfunction by tissue Doppler imaging predicts mortality in patients with cerebral infarction.

    Science.gov (United States)

    Olsen, Flemming J; Jørgensen, Peter G; Møgelvang, Rasmus; Jensen, Jan S; Fritz-Hansen, Thomas; Bech, Jan; Sivertsen, Jacob; Biering-Sørensen, Tor

    2015-10-01

    Several clinical prediction score models have been investigated for predicting mortality in patients with cerebral infarction. However, none of these include echocardiographic measures. Our objective was to evaluate the prognostic value of tissue Doppler imaging (TDI) of the myocardium in patients with cerebral infarction. Two hundred forty-four patients with cerebral infarction and subsequent echocardiographic examination in sinus rhythm were identified. Using TDI in three apical projections, longitudinal mitral annular velocities were obtained in six segments. Cox regression models, C-statistics and reclassification analysis were performed for global and segmental e'. During a median follow-up of 3 years 42 patients died. Patients who died had significantly impaired systolic and diastolic function (determined by LVEF and E/e'). The risk of dying increased with decreasing global e', being approximately 13 times higher for patients in the lowest tertile compared to patients in the highest tertile (HR 13.4 [3.2;56.3], p carotid stenosis, mitral regurgitation, liver disease and thromboembolisms (HR 1.9 [1.1;3.2]), per 1 cm/s decrease, p < 0.05). Similar pattern was seen in segmental analyses of the e'. In contrast to e', no conventional echocardiographic parameters remained independent predictors of mortality after multivariable adjustment. Diastolic myocardial dysfunction determined as e' by TDI is a significant predictor of mortality in patients with cerebral infarction. Applying this parameter can aid the prognostic assessment after cerebral infarction. PMID:26195231

  9. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Daniel Rios Pinto; Ramos, Adriane Monserrat; Vieira, Pedro Lima; Menti, Eduardo; Bordin, Odemir Luiz Jr.; Souza, Priscilla Azambuja Lopes de; Quadros, Alexandre Schaan de; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia - Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-07-15

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ?0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality.

  10. Validação de um novo escore de risco cirúrgico para cirurgia valvar: VMCP / Validation of a new surgical risk score for heart valve surgery: VMCP / Validación de un nuevo score de riesgo quirúrgico para cirugía valvular: VMCP

    Scientific Electronic Library Online (English)

    Max, Grinberg; Vívian Masutti, Jonke; Roney Orismar, Sampaio; Guilherme Sobreira, Spina; Flavio, Tarasoutchi.

    2009-04-01

    Full Text Available FUNDAMENTO: Alguns estudos desenvolveram escores para avaliar o risco cirúrgico, particularmente o EuroSCORE que, entretanto, é complexo e trabalhoso. Sugerimos um escore novo e simples, mais adequado para a prática clínica e para a avaliação de risco cirúrgico em pacientes valvopatas. OBJETIVO: Est [...] e estudo foi realizado para criar e validar um escore simples e prático para predizer mortalidade e morbidade em cirurgia valvar. MÉTODOS: Coletamos dados hospitalares de 764 pacientes e realizamos a validação do escore, utilizando dois modelos estatísticos: óbito (= mortalidade) e tempo de internação hospitalar (TIH) > 10 dias (= morbidade). O escore foi composto de quatro índices (V [lesão valvar], M [função miocárdica], C [doença arterial coronariana] e P [pressão da artéria pulmonar]). Estabelecemos um valor de corte para o escore, e foram utilizadas análises uni e multivariada para confirmar se o escore seria capaz de predizer mortalidade e morbidade. Também estudamos se havia associação com outros fatores de risco. RESULTADOS: O escore foi validado, com boa consistência interna (0,65), e o melhor valor de corte para mortalidade e morbidade foi 8. O escore com valor > 8 pode predizer TIH > 10 dias (odds ratio (OR) = 1,7 p=0,006), e um maior risco de óbito ao menos na análise univariada (p=0,049). Entretanto, o risco de óbito não foi previsível na análise multivariada (p=0,258). CONCLUSÃO: O escore VMCP > 8 pode predizer TIH > 10 dias e pode ser usado como uma nova ferramenta para o seguimento de pacientes portadores de valvopatia submetidos a cirurgia. Abstract in spanish FUNDAMENTO: Algunos estudos desarrollaron scores para evaluar el riesgo quirúrgico, particularmente el EuroSCORE que, sin embargo, es complejo y de difícil aplicación. Sugerimos una puntuación nueva y sencilla, más adecuada para la práctica clínica y para la evaluación de riesgo quirúrgico en pacien [...] tes con valvulopatías. OBJETIVO: Se realizó este estudio con el objetivo de crear y validar un score sencillo y práctico para predecir mortalidad y morbilidad en cirugía valvular. MÉTODOS: Recoleccionamos datos hospitalarios de 764 pacientes y realizamos la validación del score, con la utilización de dos modelos estadísticos: óbito (= mortalidad) y tiempo de internación hospitalaria (TIH) > 10 días (= morbilidad). El score estaba conpuesto por cuatro índicadores (V [lesión valvular], M [función miocárdica], C [enfermedad arterial coronaria] y P [presión de la arteria pulmonar]). Establecemos un valor de corte para el score, y utilizamos el análisis uni y multivariado para confirmar si la puntuación sería capaz de predecir mortalidad y morbilidad. También investigamos si había asociación con otros factores de riesgo. RESULTADOS: Se validó el score, con satisfactoria consistencia interna (0,65). El mejor valor de corte para mortalidad y morbilidad fue 8. El score con valor > 8 es adecuado para predecir tanto el TIH > 10 días (odds ratio (OR) = 1,7 p=0,006), como un mayor riesgo de óbito, por lo menos en el análisis univariado (p=0,049). No obstante, el riesgo de óbito no se mostró previsible en el análisis multivariado (p=0,258). CONCLUSIÓN: El score VMCP > 8 es adecuado para predecir TIH > 10 días, y se puede utilizarlo como una nueva herramienta para el seguimiento de pacientes portadores de valvulopatía sometidos a cirugía. Abstract in english BACKGROUND: Some studies have developed scores for the assessment of surgical risk, particularly the EuroSCORE, which, however, is complex and difficult to apply. We suggest a new and simpler score, which is more appropriate for the clinical practice and for the assessment of surgical risk in patien [...] ts with heart valve diseases. OBJECTIVE: This study was conducted to create and validate a simple and practical score to predict mortality and morbidity related to heart valve surgery. METHODS: Hospital data from 764 patients were collected, and the score was validated using two statistical models: death (= mo

  11. Thrombotic stroke and myocardial infarction with hormonal contraception

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Løkkegaard, Ellen; Jensen, Aksel Karl Georg; Skovlund, Charlotte Wessel; Keiding, Niels

    2012-01-01

    Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting.

  12. Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; KØber, Lars

    2008-01-01

    AIMS: To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). METHODS AND RESULTS: Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight [body mass index (BMI) 18.5-24.9 kg/m2], obesity class II (BMI >or= 35 kg/m2) was associated with increased risk of death in patients with MI but not HF [HR = 1.23 (1.06-1.44), P = 0.006 and HR = 1.13 (0.95-1.36), P = 0.95] (P-value for interaction = 0.004). Obesity class I (BMI 30-34.9 kg/m2) was not associated with increased risk of death in MI or HF [HR = 0.99 (0.92-1.08) and 1.00 (0.90-1.11), P > 0.1]. Pre-obesity (BMI 25-29.9 kg/m2) was associated with decreased death risk in MI but not HF [HR = 0.91 (0.87-0.96), P = 0.0006 and 1.04 (0.97-1.12), P = 0.34] (P-value for interaction = 0.007). Underweight (BMI < 18.5 kg/m2) patients were in increased death risk regardless of MI or HF [HR = 1.54 (1.35-1.75) and 1.37 (1.18-1.59), P < 0.001]. CONCLUSION: In patients with MI but not HF, the relationship between BMI and mortality is U-shaped with highest mortality in underweight and obese class II, but lowest in the other BMI classes.

  13. Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Rasool Syed I

    2006-04-01

    Full Text Available Abstract Background Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD. There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI in a tertiary care hospital in Karachi, Pakistan. Methods A hospital based cross-sectional study was conducted at the National Institute of Cardiovascular Disease, a major tertiary care hospital in Karachi Pakistan. Patients admitted with their first AMI were eligible to participate. Standard questionnaire was used to interview 720 subjects. Knowledge of four modifiable risk factors of heart disease: fatty food consumption, smoking, obesity and exercise were assessed. The participants knowing three out of four risk factors were regarded as having a good level of knowledge. A multiple logistic regression model was constructed to identify the determinants of good level of knowledge. Results The mean age (SD was 54 (11.66 years. A mere 42% of our study population had a good level of knowledge. In multiple logistic regression analysis, independent predictors of "good" level of knowledge were (odds ratio [95% confidence interval] more than ten years of schooling were 2.5 [1.30, 4.80] (verses no schooling at all and nuclear family system (verses extended family system 2.54 [1.65, 3.89]. In addition, Sindhi ethnicity OR [3.03], higher level of exercise OR [2.76] and non user of tobacco OR [2.53] were also predictors of good level of knowledge. Conclusion Our findings highlight the lack of good level of knowledge of modifiable risk factors for heart disease among subjects admitted with AMI in Pakistan. There is urgent need for aggressive and targeted educational strategies in the Pakistani population.

  14. Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? : Study from the Copenhagen Centre for Prospective Population Studies

    DEFF Research Database (Denmark)

    Andersen, I; Burr, H

    2004-01-01

    AIM: To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment. METHODS: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 214 employees, 44% women, aged 20-75 years, with initial examination between 1974 and 1992 were followed until 1996 for incident (hospital admission or death) MI. Register based information on job categories was used. Psychosocial job exposures were measured indirectly by means of a job exposure matrix based on the Danish Work Environment Cohort Study 1990. RESULTS: During follow up, 731 subjects were diagnosed with an MI: 610 men and 121 women (35% fatal). The hazards by socioeconomic position showed a graded effect with a hazard ratio (HR) of 1.57 (95% CI 1.23 to 2.03) for unskilled workers compared to executive managers. Despite a strong and graded association in risk of MI related to decision authority and skill discretion, only skill discretion mediated the effect of socioeconomic position. The HR for unskilled workers was reduced to 1.47 (0.93 to 2.31) after adjustment for decision authority and other cardiovascular risk factors, and to 1.07 (0.72 to 1.60) after adjustment for skill discretion and cardiovascular risk factors. No sign of synergy was found. CONCLUSIONS: Decision authority and skill discretion were strongly related to socioeconomic position; and the effect on risk of MI was partially mediated by skill discretion. Improvements in psychosocial work environment, especially possibilities for skill discretion, might contribute to reducing the incidence of MI and social inequality in MI.

  15. Genetic Variation, ?-Blockers, and Perioperative Myocardial Infarction

    OpenAIRE

    Nagele, Peter; Liggett, Stephen B

    2011-01-01

    Perioperative myocardial infarction is a common and potentially fatal complication after noncardiac surgery, particular among patients with cardiovascular risk factors. ?-blockers have been considered a mainstay in prevention and treatment of perioperative myocardial infarction, yet recent evidence suggests that ?-blockers may have an unfavorable risk profile in this setting and the use has become controversial. What seems conspicuously absent from the current discussion is the appreciation o...

  16. Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Takahashi Mauro

    2011-05-01

    Full Text Available Abstract Background Coronary artery disease (CAD is among the main causes of death in developed countries, and diet and lifestyle can influence CAD incidence. Objective To evaluate the association of coronary artery disease risk score with dietary, anthropometric and biochemical components in adults clinically selected for a lifestyle modification program. Methods 362 adults (96 men, 266 women, 53.9 ± 9.4 years fulfilled the inclusion criteria by presenting all the required data. The Framingham score was calculated and the IV Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis was adopted for classification of the CAD risks. Anthropometric assessments included waist circumference (WC, body fat and calculated BMI (kg/m2 and muscle-mass index (MMI kg/m2. Dietary intake was estimated through 24 h dietary recall. Fasting blood was used for biochemical analysis. Metabolic Syndrome (MS was diagnosed using NCEP-ATPIII (2001 criteria. Logistic regression was used to determine the odds of CAD risks according to the altered components of MS, dietary, anthropometric, and biochemical components. Results For a sample with a BMI 28.5 ± 5.0 kg/m2 the association with lower risk ( Conclusion Recommended intake of saturated fat and dietary fiber, together with proper muscle mass, are inversely associated with CAD risk score. On the other hand, the presence of MS and high plasma uric acid are associated with CAD risk score.

  17. Impact of risk score calculations in choosing front-line tyrosine kinase inhibitors for patients with newly diagnosed chronic myeloid leukemia in the chronic phase.

    Science.gov (United States)

    Hu, Bei; Savani, Bipin N

    2014-09-01

    The approval of multiple tyrosine kinase inhibitors targeting BCR-ABL has broadened the number of available therapeutic options for chronic myeloid leukemia in the chronic phase (CML-CP). This provides an impetus for optimizing prognostic risk score systems that can guide treatment decisions. Presently, three risk scores-the Sokal, Hasford, and European Treatment and Outcome Study (EUTOS) metrics-have been implemented clinically in CML-CP. While these three formulations all endeavor to gauge likely disease course, they differ from one another in several important respects, with potential implications for prognosis and therapy. Here, we review these risk scores and propose how prognostic systems in CML-CP might be refined to direct patients to optimally effective therapies as efficiently and accurately as possible. PMID:24766312

  18. Does the routine use of global coronary heart disease risk scores translate into clinical benefits or harms? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Crespo Eric

    2008-03-01

    Full Text Available Abstract Background Guidelines now recommend routine assessment of global coronary heart disease (CHD risk scores. We performed a systematic review to assess whether global CHD risk scores result in clinical benefits or harms. Methods We searched MEDLINE (1966 through June 13, 2007 for articles relevant to our review. Using predefined inclusion and exclusion criteria, we included studies of any design that provided physicians with global risk scores or allowed them to calculate scores themselves, and then measured clinical benefits and/or harms. Two reviewers reviewed potentially relevant studies for inclusion and resolved disagreement by consensus. Data from each article was then abstracted into an evidence table by one reviewer and the quality of evidence was assessed independently by two reviewers. Results 11 studies met criteria for inclusion in our review. Six studies addressed clinical benefits and 5 addressed clinical harms. Six studies were rated as "fair" quality and the others were deemed "methodologically limited". Two fair quality studies showed that physician knowledge of global CHD risk is associated with increased prescription of cardiovascular drugs in high risk (but not all patients. Two additional fair quality studies showed no effect on their primary outcomes, but one was underpowered and the other focused on prescribing of lifestyle changes, rather than drugs whose prescribing might be expected to be targeted by risk level. One of these aforementioned studies showed improved blood pressure in high-risk patients, but no improvement in the proportion of patients at high risk, perhaps due to the high proportion of participants with baseline risks significantly exceeding the risk threshold. Two fair quality studies found no evidence of harm from patient knowledge of global risk scores when they were accompanied by counseling, and optional or scheduled follow-up. Other studies were too methodologically limited to draw conclusions. Conclusion Our review provides preliminary evidence that physicians' knowledge of global CHD risk scores may translate into modestly increased prescribing of cardiovascular drugs and modest short-term reductions in CHD risk factors without clinical harm. Whether these results are replicable, and translate across other practice settings or into improved long-term CHD outcomes remains to be seen.

  19. Sleep Duration and Sleep Complaints and Risk of Myocardial Infarction in Middle-aged Men and Women from the General Population: The MONICA/KORA Augsburg Cohort Study

    Science.gov (United States)

    Meisinger, Christa; Heier, Margit; Löwel, Hannelore; Schneider, Andrea; Döring, Angela

    2007-01-01

    Study Objectives: To examine gender-specific associations between sleep duration and sleep complaints and incident myocardial infarction (MI). Design: Cohort study. Setting: A representative population sample of middle-aged subjects in Germany. Participants: The study was based on 3508 men and 3388 women (aged 45 to 74 years) who participated in one of the 3 MONICA (Monitoring trends and determinants on cardiovascular diseases) Augsburg surveys between 1984 and 1995, who were free of MI and angina pectoris at baseline and were followed up until 2002. Interventions: N/A Measurements and Results: A total of 295 cases of incident MI among men and 85 among women occurred during a mean follow-up period of 10.1 years. Compared with women sleeping 8 hours, the multivariable adjusted hazard ratio (HR) of MI among women sleeping ?5 hours was 2.98 (95% CI, 1.48–6.03), and among women sleeping ?9 hours 1.40 (95% CI, 0.74–2.64); the corresponding HRs among men were 1.13 (95% CI, 0.66–1.92) and 1.07 (95% CI, 0.75–1.53). In multivariable analysis the relative risk of an incident MI for men and women with difficulties maintaining sleep was 1.12 (95% CI, 0.84–1.48) and 1.53 (95% CI, 0.99–2.37), respectively, and for men and women with difficulties initiating sleep the relative risk was 1.16 (95% CI, 0.82–1.63) and 1.30 (95% CI, 0.81–2.06), respectively. Conclusions: Modest associations between short sleep duration and difficulties maintaining sleep and incident MI were seen in middle-aged women but not men from the general population. Citation: Meisinger C; Heier M; Löwel H et al. Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: the monica/kora augsburg cohort study. SLEEP 2007;30(9):1121-1127. PMID:17910384

  20. Comparative value of maximal treadmill testing, exercise thallium myocardial perfusion scintigraphy and exercise radionuclide ventriculography for distinguishing high- and low-risk patients soon after acute myocardial infarction

    International Nuclear Information System (INIS)

    The prognostic value of symptom-limited treadmill exercise electrocardiography, exercise thallium myocardial perfusion scintigraphy and rest and exercise radionuclide ventriculography was compared in 117 men, aged 54 +/- 9 years, tested 3 weeks after a clinically uncomplicated acute myocardial infarction (MI). During a mean follow-up period of 11.6 months, 8 men experienced ''hard'' medical events (cardiac death, nonfatal ventricular fibrillation or recurrent MI) and 14 were hospitalized for unstable angina pectoris, congestive heart failure or coronary bypass surgery (total of 22 combined events). By multivariate analysis (Cox proportional hazards model), peak treadmill work load and the change in left ventricular ejection fraction (EF) during exercise were significant (p less than 0.01) predictors of hard medical events; these 2 risk factors and recurrent ischemic chest pain in the coronary care unit were also significantly predictive (p less than 0.001) for combined events. A peak treadmill work load of 4 METs or less or a decrease in EF of 5% or more below the value at rest during submaximal effort distinguished 22 high-risk patients (20% of the study population) from 89 low-risk patients. The rate of hard medical events within 12 months was 23% (5 of 22 patients), vs 2% (2 of 89 patients) in the high- and low-risk patient subsets, respectively (p less than 0.001). Thus, in patients who underwent evaluation 3 weeks after a clinically uncomplicated MI, exercise radionuclide ventriculography contributed independent prognostic information to that provided by symptom-limited treadmill testing and was superior to exercise thallium scintigraphy for this purpose

  1. Silent cerebral infarcts in very young children with sickle cell anaemia are associated with a higher risk of stroke.

    Science.gov (United States)

    Cancio, Maria I; Helton, Kathleen J; Schreiber, Jane E; Smeltzer, Matthew P; Kang, Guolian; Wang, Winfred C

    2015-10-01

    Silent cerebral infarctions (SCI) are the most common neurological injury in children with sickle cell anaemia (SCA), but their incidence/prognosis in early childhood has not been well described. We report clinical, neuroradiological, psychometric and academic follow-up over an average period of 14 years in 37 children with SCA who had magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain between ages 7 and 48 months. Ten patients (27%) younger than age 5 years (Group I) had SCI, as did 12 (32%) older than 5 years (Group II). Fifteen (41%) had no lesions (Group III). Overt stroke or transient ischaemic attack occurred in 5/9 (56%) in Group I. Most Group I patients had progressive MRI abnormalities, concurrent stenosis, decreased cognitive ability, attention/executive function deficits and hindered academic attainment. The proportions of subjects in Group I with subsequent neurological events (P ? 0·006), progressive ischaemia (P ? 0·001) and vascular stenosis (P ? 0·006) were greater than in Groups II and III. Thus, SCI in young children with SCA may predict overt central nervous system events, progressive MRI abnormalities, stenosis, cognitive dysfunction and poor academic performance. Children younger than 5 years may benefit from MRI/MRA testing and should be considered for aggressive intervention when SCI are detected. PMID:26058476

  2. Risk prediction models for biochemical recurrence after radical prostatectomy using prostate-specific antigen and Gleason score

    Directory of Open Access Journals (Sweden)

    Xin-Hai Hu

    2014-12-01

    Full Text Available Many computer models for predicting the risk of prostate cancer have been developed including for prediction of biochemical recurrence (BCR. However, models for individual BCR free probability at individual time-points after a BCR free period are rare. Follow-up data from 1656 patients who underwent laparoscopic radical prostatectomy (LRP were used to develop an artificial neural network (ANN to predict BCR and to compare it with a logistic regression (LR model using clinical and pathologic parameters, prostate-specific antigen (PSA, margin status (R0/1, pathological stage (pT, and Gleason Score (GS. For individual BCR prediction at any given time after operation, additional ANN, and LR models were calculated every 6 months for up to 7.5 years of follow-up. The areas under the receiver operating characteristic (ROC curve (AUC for the ANN (0.754 and LR models (0.755 calculated immediately following LRP, were larger than that for GS (AUC: 0.715; P = 0.0015 and 0.001, pT or PSA (AUC: 0.619; P always <0.0001 alone. The GS predicted the BCR better than PSA (P = 0.0001, but there was no difference between the ANN and LR models (P = 0.39. Our ANN and LR models predicted individual BCR risk from radical prostatectomy for up to 10 years postoperative. ANN and LR models equally and significantly improved the prediction of BCR compared with PSA and GS alone. When the GS and ANN output values are combined, a more accurate BCR prediction is possible, especially in high-risk patients with GS ?7.

  3. Risk stratification using a new prognostic score for patients with secondary acute myeloid leukemia: results of the prospective AML96 trial.

    Science.gov (United States)

    Stölzel, F; Pfirrmann, M; Aulitzky, W E; Kaufmann, M; Bodenstein, H; Bornhäuser, M; Röllig, C; Kramer, M; Mohr, B; Oelschlägel, U; Schmitz, N; Soucek, S; Thiede, C; Ehninger, G; Schaich, M

    2011-03-01

    Patients with secondary acute myeloid leukemia (sAML) are generally thought to have a poor prognosis. As there are no prognostic risk stratification models for patients with sAML available, the aim of this study was to obtain a scoring system. Prognostic factors influencing overall survival (OS) and event-free survival (EFS) were analyzed in 305 sAML patients treated in the prospective AML96 trial. The obtained prognostic scoring system was then validated in an independent patient cohort included in the AML2003 and AML60+ trials. In addition to the known risk factors for AML, age and karyotype, we identified the absolute platelet count and the Nucleophosmin 1 mutational status at diagnosis as prognostic factors of sAML patients. A pronounced distribution of sAML patients into three score groups was achieved showing a 2-year OS/EFS of 52/44% for patients in the low-risk group, 21/12% in the intermediate-risk group and 7/3% in the high-risk group (both PsAML patients revealed similar significantly different survival results. In conclusion, for the first time, a prognostic scoring system is provided for sAML patients, allowing differential treatment strategies in the future. PMID:21135859

  4. Derivation and Validation of a Scoring System to Identify Patients with Bacteremia and Hematological Malignancies at Higher Risk for Mortality

    Science.gov (United States)

    Tumbarello, Mario; Trecarichi, Enrico Maria; Caira, Morena; Candoni, Anna; Pastore, Domenico; Cattaneo, Chiara; Fanci, Rosa; Nosari, Annamaria; Spadea, Antonio; Busca, Alessandro; Vianelli, Nicola; Spanu, Teresa; Pagano, Livio

    2012-01-01

    Background The aim of this study was to develop and validate a reliable clinical prediction rule that could be employed to identify patients at higher likelihood of mortality among those with hematological malignancies (HMs) and bacterial bloodstream infections (BBSIs). Methods and Findings We conducted a retrospective cohort study in nine Italian hematological units. The derivation cohort consisted of adult patients with BBSI and HMs admitted to the Catholic University Hospital (Rome) between January 2002 and December 2008. Survivors and nonsurvivors were compared to identify predictors of 30-day mortality. The validation cohort consisted of patients hospitalized with BBSI and HMs who were admitted in 8 other Italian hematological units between January 2009 and December 2010. The inclusion and exclusion criteria were identical for both cohorts, with type and stage of HMs used as matching criteria. In the derivation set (247 episodes), the multivariate analysis yielded the following significant mortality-related risk factors acute renal failure (Odds Ratio [OR] 6.44, Confidential Interval [CI], 2.36–17.57, P<0.001); severe neutropenia (absolute neutrophil count <100/mm3) (OR 4.38, CI, 2.04–9.43, P<0.001); nosocomial infection (OR, 3.73, CI, 1.36–10.22, P?=?0.01); age ?65 years (OR, 3.42, CI, 1.49–7.80, P?=?0.003); and Charlson Comorbidity Index ?4 (OR, 3.01, CI 1.36–6.65, P?=?0.006). The variables unable to be evaluated at that time (for example, prolonged neutropenia) were not included in the final logistic model. The equal-weight risk score model, which assigned 1 point to each risk factor, yielded good-excellent discrimination in both cohorts, with areas under the receiver operating curve of 0.83 versus 0.93 (derivation versus validation) and good calibration (Hosmer-Lemshow P?=?0.16 versus 0.75). Conclusions The risk index accurately identifies patients with HMs and BBSIs at high risk for mortality; a better initial predictive approach may yield better therapeutic decisions for these patients, with an eventual reduction in mortality. PMID:23272123

  5. Correlation of histological risk assessment/ scoring system with lymph node metastasis and recurrence/progression of disease in oral squamous cell carcinoma

    International Nuclear Information System (INIS)

    Objective: To correlate the scoring system using histopathologic parameters; worst pattern of invasion (WPOI), lymphocytic host response (LHR) and peri-neural invasion (PNI), with disease recurrence, overall survival and cervical lymph node metastasis in OSCC patients. Study Design: Cross sectional. Place and Duration of Study: Department of Histopathology, Shaukat Khanam Memorial Cancer and Research Hospital, Lahore in collaboration with Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi. Study completed in 2 years. Material and Methods: A Risk Scoring system was applied to 50 cases of OSCC with 2 years follow-up data, based on histopathologic parameters WPOI, LHR and PNI. The cases were divided into High risk and Non-High risk categories according to the specified parameters and then correlated with disease recurrence, overall survival and cervical lymph node metastasis. Results: There were 7 low risk, 17 intermediate risk and 26 high risk cases. No correlation was seen between the risk groups and disease recurrence, overall survival or cervical lymph node metastasis. However, when assessing the individual parameters, significant correlation was observed between PNI with disease recurrence (p = 0.03), and between WPOI and overall survival (p = 0.02) and cervical lymph node metastasis (p = 0.005). Conclusion: The individual parameters, peri-neural invasion and worst pattern of invasion are observed to be significant prognostic indicators in OSCC patients. A study with a larger number of cases is required to truly assess the value of the scoring system in Pakistani patients. (author)

  6. Cardiac sympathetic dysfunction contributes to left ventricular remodelling after acute myocardial infarction

    International Nuclear Information System (INIS)

    To investigate the role of the cardiac sympathetic nervous system in left ventricular remodelling, 50 patients with first-time acute myocardial infarction (AMI) and patency of the infarct-related artery after reperfusion underwent quantitative iodine-123 metaiodobenzylguanidine (MIBG) imaging at 4 days and 4 weeks (n=42), and quantitative technetium-99m tetrofosmin imaging at 2 days after AMI. They also underwent both ventriculography and coronary angiography on admission and about 4 weeks after AMI. On the basis of left ventricular end-systolic volume (LVESV), patients were divided into two groups. Patients with LVESV dilatation (n=20) had a significantly lower ejection fraction (P99mTc-tetrofosmin (P<0.04), and total severity (P<0.01), ? extent (P<0.007) and ? severity (P<0.0008) scores of MIBG than patients without LVESV dilatation (n=30). ? severity score of MIBG was directly correlated with change in LVESV at 4 weeks (r=0.63, P<0.0001). Stepwise linear discriminant function analysis showed that ? severity score of MIBG (P<0.0002) was the only discriminator of LVESV dilatation. Patients with LVESV dilatation had higher regional washout rates in both the infarct and the non-infarct zones than patients without such dilatation. Furthermore, no MIBG parameters changed significantly between 4 days and 4 weeks after AMI. In reperfused AMI, ? severity score of MIBG was related to the degree of ventricular dilatation and was the only powerful discriminator of ventricular dilatation. These results suggest that cardiac sympathetic nervous abnormality might contribute to left ventricular remodelling in reperfused AMI. MIBG imaging may allow identification of reperfused AMI patients at high risk for left ventricular remodelling. (orig.)

  7. On the estimation of survival and death probabilities under myocardial infarctions in the presence of competing risks based on an illness-death model.

    Science.gov (United States)

    Grover, Gurprit; Makhija, Neeta

    2010-03-01

    This paper is concerned with the development of an illness-death model for the study of survivability of heart patients. The Myocardial Infarctions (MI) experienced in heart disease have been categorized as fatal and nonfatal. Fatal MI's are easily recognizable and identified and are always reported in the case history of the patient suffering from heart disease whereas non-fatal MI's are not easily identified and are rarely reported in the case history of the patient. Also, in the case of human population, all individuals are not equally healthy and the chance of dying varies from one person to another. Moreover illness and death are two different types of events. Illness may be transient, repetitive and reversible, whereas death is an irreversible or absorbing state. Further complexity is introduced by competition among various risks of death. The probability of an individual dying from one cause is influenced by the presence of competition from other causes. Here in our problem we have taken two health states viz. normal state and illness state due to non-fatal MI's, and two death states viz. death state due to fatal MI and death state due to competing risk. The study population of n individuals is divided into two groups viz. n1 individuals who are in the normal state and n2 individuals who are in the illness state due to non-fatal MI's, at the time of start of the study. The expressions for survival and death probabilities have been obtained by using the concep of crude probability of death under competing risks. The likelihood estimates of the survival and death probabilities have also been obtained. Application of the model is discussed. PMID:22468546

  8. Risk stratification and effects of percutaneous coronary intervention and the pharmacotherapy initiated in the first 24 hours on in-hospital mortality in patients with the first myocardial Infarction.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Reissigová, Jindra; Tome?ková, Marie; Grünfeldová, H.; Janský, P.; Monhart, Z.; Vojá?ek, J.; Widimský, P.; Zvárová, Jana

    2011-01-01

    Ro?. 28, e-Supplement A (2011), e418. ISSN 0263-6352. [European Meeting on Hypertension and Cardiovascular Prevention /21./. 17.06.2011-20.06.2011, Milano] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * cardiovascular risk factors Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  9. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction.

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Jacobsen, SØren

    2006-01-01

    BACKGROUND: 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. We analyzed the risk of rehospitalization for acute myocardial infarction (MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with prior MI. METHODS AND RESULTS: All patients with first-time MI between 1995 and 2002 as well as all prescription claims for NSAIDs after discharge were identified from nationwide Danish administrative registers. The risk of death and rehospitalization for MI associated with the use of selective COX-2 inhibitors and nonselective NSAIDs was studied with the use of multivariable proportional hazards models and case-crossover analysis. A total of 58 432 patients were discharged alive and included in the study; 9773 experienced rehospitalization for MI, and 16 573 died. A total of 5.2% of patients received rofecoxib, 4.3% celecoxib, 17.5% ibuprofen, 10.6% diclofenac, and 12.7% other NSAIDs. For any use of rofecoxib, celecoxib, ibuprofen, diclofenac, and other NSAIDs, the hazard ratios and 95% confidence intervals for death were 2.80 (2.41 to 3.25; for rofecoxib), 2.57 (2.15 to 3.08; for celecoxib), 1.50 (1.36 to 1.67; for ibuprofen), 2.40 (2.09 to 2.80; for diclofenac), and 1.29 (1.16 to 1.43; for other NSAIDS); there were dose-related increases in risk of death for all of the drugs. There were trends for increased risk of rehospitalization for MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs. CONCLUSIONS: Selective COX-2 inhibitors in all dosages and nonselective NSAIDs in high dosages increase mortality in patients with previous MI and should therefore be used with particular caution in these patients. Udgivelsesdato: 2006-Jun-27

  10. Genetic risk score of 46 type 2 diabetes risk variants associates with changes in plasma glucose and estimates of pancreatic beta-cell function over 5 years of follow-up

    DEFF Research Database (Denmark)

    Galijatovic, Ehm Astrid Andersson; Allin, Kristine H; Sandholt, Camilla H; Borglykke, Anders; Lau, Cathrine J; Ribel-Madsen, Rasmus; Sparsø, Thomas; Justesen, Johanne M; Harder, Marie N; Jørgensen, Marit E; Jørgensen, Torben; Hansen, Torben; Pedersen, Oluf

    2013-01-01

    More than 40 genetic risk variants for type 2 diabetes have been validated. We aimed to test if a genetic risk score associates with the incidence of type 2 diabetes and with 5-year changes in glycemic traits and if the effects were modulated by changes in BMI and lifestyle.The Inter99 study population was genotyped for 46 variants and a genetic risk score was constructed. During a median follow-up of 11 years 327 of 5,850 individuals developed diabetes. Physical examinations and oral glucose to...

  11. Genetic risk score of 46 type 2 diabetes risk variants associates with changes in plasma glucose and estimates of pancreatic ?-cell function over 5 years of follow-up

    DEFF Research Database (Denmark)

    Andersson, Ehm A; Allin, Kristine Højgaard; Sandholt, Camilla H; Borglykke, Anders; Lau, Cathrine J; Ribel-Madsen, Rasmus; Sparsø, Thomas; Justesen, Johanne Marie; Harder, Marie Neergaard; Jørgensen, Marit Eika; Jørgensen, Torben; Hansen, Torben; Pedersen, Oluf

    2013-01-01

    More than 40 genetic risk variants for type 2 diabetes have been validated. We aimed to test if a genetic risk score associates with the incidence of type 2 diabetes and with 5-year changes in glycemic traits and if the effects were modulated by changes in BMI and lifestyle.The Inter99 study population was genotyped for 46 variants and a genetic risk score was constructed. During a median follow-up of 11 years 327 of 5,850 individuals developed diabetes. Physical examinations and oral glucose to...

  12. Primer puntaje de riesgo latinoamericano en cirugía cardíaca (ArgenSCORE): validación externa y temporal a 10 años de su desarrollo / External and Temporal Validation 10 Years after the Development of the First Latin- American Risk Stratification Score for Cardiac Surgery (ArgenSCORE)

    Scientific Electronic Library Online (English)

    Victorio C, Carosella; Hugo, Grancelli; Walter, Rodríguez; Miguel, Sellanes; Miguel, Cáceres; Hernán, Cohen Arazi; César, Cárdenas; Carlos, Nojek.

    2011-12-01

    Full Text Available Introducción En las últimas décadas se han aplicado diversos modelos de riesgo para predecir mortalidad en cirugía cardíaca, pero ninguno de estos sistemas de evaluación fue desarrollado en poblaciones de América Latina. Estos modelos presentan un rendimiento menor cuando son aplicados en poblacione [...] s diferentes de aquellas en las que fueron desarrollados. Objetivos Validar un modelo de riesgo local de mortalidad intrahospitalaria en cirugía cardíaca [Argentinean System for Cardiac Operative Risk Evaluation (ArgenSCORE)] en forma externa y temporal y compararlo con el EuroSCORE. Material y métodos Se incluyeron 5.268 pacientes adultos, consecutivos, intervenidos quirúrgicamente desde junio de 1994 hasta diciembre de 2009. El modelo fue desarrollado mediante regresión logística en 2.903 pacientes intervenidos en un centro desde junio de 1994 hasta diciembre de 1999. Se realizó validación interna prospectiva desde enero de 2000 hasta junio de 2001 en 708 pacientes. Desde febrero de 2000 hasta diciembre de 2009 se validó en forma externa y temporal el modelo recalibrado evaluando su discriminación y calibración en pacientes operados en cuatro centros diferentes del de su desarrollo y se comparó su rendimiento con el EuroSCORE. Resultados La población de validación externa incluyó 1.657 pacientes, con una edad media de 62,8 ± 13,3 años y una mortalidad global del 4,58%. El ArgenSCORE mostró un buen poder de discriminación (curva ROC: 0,80) y buena capacidad para asignar riesgo en todos los pacientes (relación mortalidad observada: 4,58% vs. mortalidad predicha: 4,54%; p = 0,842). El EuroSCORE mostró un buen poder discriminativo (curva ROC: 0,79), pero sobrevaloró el riesgo estimado (relación mortalidad observada: 4,58% vs. mortalidad predicha: 5,23%; p Abstract in english Background During the last decades, several risk assessment models have been applied to predict the risk of mortality after cardiac surgery; however, none of them have been developed in Latin American populations. These models have inferior performance when applied to patient groups other than the o [...] nes on whom they were developed. Objectives To perform external and temporal validation of a local risk score for cardiac surgery [Argentinean System for Cardiac Operative Risk Evaluation (ArgenSCORE)] and compare it to the EuroSCORE. Material and Methods A total of 5268 consecutive adult patients undergoing cardiac surgery were included from June 1994 to December 2009. The risk model was developed through logistic regression on the data of 2903 patients who underwent cardiac surgery between June 1994 and December 1999 at a center. Prospective internal validation was performed on 708 patients between January 2000 and June 2001. External and temporal validation of the recalibrated model were performed between February 2000 and December 2009, evaluating model discrimination and calibration in patients operated on at four centers different from the one where the score had been originally developed. The method was also compared to the EuroSCORE. Results The external validation was performed on 1657 patients, mean age was 62.8±13.3 years and global mortality was 4.58%. The ArgenSCORE showed both good discriminatory power with an area under the ROC curve of 0.80 and predictive capacity for risk assessment in all patients (observed mortality 4.58% vs. expected mortality 4.54%; p=0.842). The EuroSCORE showed good discriminatory power (area under the ROC curve of 0.79) but overestimated the risk (observed mortality 4.58% vs. expected mortality 5.23%; p

  13. Clopidogrel bioactivation and risk of bleeding in patients cotreated with angiotensin-converting enzyme inhibitors after myocardial infarction : a proof-of-concept study

    DEFF Research Database (Denmark)

    Kristensen, K E; Zhu, H-J

    2014-01-01

    Clopidogrel is an oral antiplatelet prodrug, the majority of which is hydrolyzed to an inactive metabolite by hepatic carboxylesterase 1 (CES1). Most angiotensin-converting enzyme inhibitors (ACEIs) are also metabolized by this enzyme. We examined the effects of ACEIs on clopidogrel bioactivation in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10 (95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0.002). We conclude that cotreatment with selected ACEIs and clopidogrel may increase the risk of bleeding. Combination of in vitro and pharmacoepidemiological studies may be a useful paradigm for assessment of drug-drug interactions.

  14. Clopidogrel Bioactivation and Risk of Bleeding in Patients Cotreated With Angiotensin-Converting Enzyme Inhibitors After Myocardial Infarction: A Proof-of-Concept Study

    DEFF Research Database (Denmark)

    Kristensen, K. E.; Zhu, H. J.

    2014-01-01

    Clopidogrel is an oral antiplatelet prodrug, the majority of which is hydrolyzed to an inactive metabolite by hepatic carboxylesterase 1 (CES1). Most angiotensin-converting enzyme inhibitors (ACEIs) are also metabolized by this enzyme. We examined the effects of ACEIs on clopidogrel bioactivation in vitro and linked the results with a pharmacoepidemiological study. In vitro, ACEIs inhibited CES1-mediated hydrolysis of a model substrate, and trandolapril and enalapril increased formation of clopidogrel active metabolite. In 70,934 patients with myocardial infarction, hazard ratios for clinically significant bleeding in ACEI-treated patients cotreated with or without clopidogrel were 1.10(95% confidence interval (CI): 0.97-1.25, P = 0.124) and 0.90 (95% CI: 0.81-0.99, P = 0.025), respectively, as compared with patients who did not receive ACEIs. This difference was statistically significant (P = 0.002). We conclude that cotreatment with selected ACEIs and clopidogrel may increase the risk of bleeding. Combination of in vitro and pharmacoepidemiological studies may be a useful paradigm for assessment of drug-drug interactions.

  15. An application of conditional logistic regression and multifactor dimensionality reduction for detecting gene-gene Interactions on risk of myocardial infarction: The importance of model validation

    Directory of Open Access Journals (Sweden)

    Coffey Christopher S

    2004-04-01

    Full Text Available Abstract Background To examine interactions among the angiotensin converting enzyme (ACE insertion/deletion, plasminogen activator inhibitor-1 (PAI-1 4G/5G, and tissue plasminogen activator (t-PA insertion/deletion gene polymorphisms on risk of myocardial infarction using data from 343 matched case-control pairs from the Physicians Health Study. We examined the data using both conditional logistic regression and the multifactor dimensionality reduction (MDR method. One advantage of the MDR method is that it provides an internal prediction error for validation. We summarize our use of this internal prediction error for model validation. Results The overall results for the two methods were consistent, with both suggesting an interaction between the ACE I/D and PAI-1 4G/5G polymorphisms. However, using ten-fold cross validation, the 46% prediction error for the final MDR model was not significantly lower than that expected by chance. Conclusions The significant interaction initially observed does not validate and may represent a type I error. As data-driven analytic methods continue to be developed and used to examine complex genetic interactions, it will become increasingly important to stress model validation in order to ensure that significant effects represent true relationships rather than chance findings.

  16. Willingness to pay for a reduction in mortality risk after a myocardial infarction: an application of the contingent valuation method to the case of eplerenone.

    Science.gov (United States)

    Pinto-Prades, Jose-Luis; Farreras, Veronica; de Bobadilla, Jaime Fernandez

    2008-02-01

    In order to allocate health care resources more efficiently, it is necessary to relate health improvements provided by new medicines to their cost. It is necessary to ascertain when the additional cost of introducing a new health technology is justified by the additional health gain produced. Eplerenone is a new medicine that reduces the risk of death after myocardial infarction (MI) but produces additional cost to the health system. The contingent valuation approach can be used to measure the monetary value of this risk reduction and to estimate society's willingness to pay (WTP) for a new medicine that reduces the risk of death after MI by 2% points. We used a contingent valuation approach to evaluate WTP amongst members of the general population. We used the ex-ante and the ex-post approach. In the ex-ante approach, subjects are asked if they would accept an increase in their taxes in order to have access to eplerenone should they need it in the future. In the ex-post approach, subjects are asked if they would pay a certain amount of money as co-payment per month during 5 years if they suffered an MI. We used the dichotomous choice method, using five bids in each approach. The WTP was estimated using both single-bound and double-bound dichotomous choice (SBDC, DBDC). Extensive piloting (n = 187) preceded the final survey (n = 350). The WTP in the ex-ante case was euro 58 per year under both SBDC and DBDC. In the ex-post case, monthly WTP was euro 141 for the SBDC and euro 85 for the DBDC. Subjects with higher income and subjects with a higher perception of risk showed a higher WTP (P 0.05). Society is willing to pay an additional amount of money in order to give eplerenone to present and future patients. We estimate that euro 85 per month is a conservative estimate of the monetary value of a 2% risk reduction in mortality after MI and to spend this additional amount of money in Eplerenone can be considered an efficient policy. PMID:17447095

  17. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study1234

    OpenAIRE

    Gardener, Hannah; Wright, Clinton B; Gu, Yian; Demmer, Ryan T.; Boden-Albala, Bernadette; Elkind, Mitchell SV; SACCO, RALPH L.; Scarmeas, Nikolaos

    2011-01-01

    Background: A dietary pattern common in regions near the Mediterranean appears to reduce risk of all-cause mortality and ischemic heart disease. Data on blacks and Hispanics in the United States are lacking, and to our knowledge only one study has examined a Mediterranean-style diet (MeDi) in relation to stroke.

  18. The prevalence of cardiovascular disease risk factors and the Framingham Risk Score in patients undergoing percutaneous intervention over the last 17 years by gender: time-trend analysis from the Mayo Clinic PCI Registry

    OpenAIRE

    Lee, M.S.; Flammer, A J; Kim, H.S.; Hong, J Y; Li, J.; Lennon, R J; Lerman, A

    2014-01-01

    OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age ...

  19. Cardiovascular Disease Burden: Evolving Knowledge of Risk Factors in Myocardial Infarction and Stroke through Population-Based Research and Perspectives in Global Prevention.

    Science.gov (United States)

    Oliveira, Gustavo B F; Avezum, Alvaro; Roever, Leonardo

    2015-01-01

    Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.e., ischemic heart disease and cerebrovascular diseases have developed rapidly. In fact, until recently, the evidence describing the incidence of acute myocardial infarction, the underlying risk factors, and the clinical outcomes of those who have this acute ischemic coronary event has largely been based on studies conducted in developed countries, with limited data for women and usually of low-ethnic diversity. Recent reports by the WHO have provided striking public health information, i.e., the global burden of cardiovascular mortality for the next decades is expected to predominantly occur among developing countries. Therefore, multiethnic population-based research including prospective cohorts and, when appropriate, case-control studies, is warranted. These studies should be specifically designed to ascertain key public health measures, such as geographic variations in non-communicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention (both primary and secondary) and specific treatments. As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology study, which is the largest global initiative of nearly 200,000 adults aged 35-70?years, looking at environmental, societal, and biological influences on obesity and chronic health conditions, such as ischemic heart disease, stroke, and cancer among urban and rural communities in low-, middle-, and high-income countries, with national, community, household, and individual-level data. Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity and mortality. PMID:26664903

  20. Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; JØns, Christian

    2011-01-01

    High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function.

  1. Short term clinical disease progression in HIV-1 positive patients taking combination antiretroviral therapy : The EuroSIDA risk-score

    DEFF Research Database (Denmark)

    Mocroft, A; Ledergerber, B

    2007-01-01

    OBJECTIVES: To derive and validate a clinically applicable prognostic score for predicting short-term disease progression in HIV-infected patients taking combination antiretroviral therapy (cART). DESIGN AND METHODS: Poisson regression was used to identify prognostic markers for new AIDS/death in patients taking cART. A score was derived for 4169 patients from EuroSIDA and validated on 5150 patients from the Swiss HIV Cohort Study (SHCS). RESULTS: In EuroSIDA, 658 events occurred during 22 321 person-years of follow-up: an incidence rate of 3.0/100 person-years of follow-up [95% confidence interval (CI), 2.7-3.3]. Current levels of viral load, CD4 cell count, CD4 cell slope, anaemia, and body mass index all independently predicted new AIDS/death, as did age, exposure group, a prior AIDS diagnosis, prior antiretroviral treatment and stopping all antiretroviral drugs. The EuroSIDA risk-score was divided into four strata; a patient in the lowest strata would have predicted chance of new AIDS/death of 1 in 801, 1in 401 and 1 in 201 within the next 3, 6 or 12 months, respectively. The corresponding figures for the highest strata were 1 in 17, 1 in 9 and 1 in 5, respectively. A single-unit increase in the risk-score was associated with a 2.70 times higher incidence of clinical progression (95% CI, 2.56-2.84) in EuroSIDA and 2.88 (95% CI, 2.75-3.02) in SHCS. CONCLUSIONS: A clinically relevant prognostic score was derived in EuroSIDA and validated within the SHCS, with good agreement. The EuroSIDA risk-score will be made available publicly via an interface that will perform all calculations for the individual. Udgivelsesdato: Sep 12

  2. Does heavy physical exertion trigger myocardial infarction?

    DEFF Research Database (Denmark)

    Hallqvist, J; Möller, J; Ahlbom, A; Diderichsen, Finn; Reuterwall, C; de Faire, U

    2000-01-01

    To study possible triggering of first events of acute myocardial infarction by heavy physical exertion, the authors conducted a case-crossover analysis (1993-1994) within a population-based case-referent study in Stockholm County, Sweden (the Stockholm Heart Epidemiology Program). Interviews were carried out with 699 myocardial infarction patients after onset of the disease. These cases represented 47 percent of all cases in the study base, and 70 percent of all nonfatal cases. The relative risk...

  3. SSRIs and risk of suicide attempts in young people : A Danish observational register-based historical cohort study, using propensity score

    DEFF Research Database (Denmark)

    Christiansen, Erik; Agerbo, Esben

    2015-01-01

    BACKGROUND: SSRIs are widely used in the treatment of mental illness for both children and adults. Studies have found a slightly increased risk of suicidal thoughts and suicide attempts in young people using SSRIs but SSRIs' impact on risk for suicides in youth is not well-established. AIM: Is there indication that SSRIs might raise risk for suicide attempts in young people? METHODS: We used an observational register-based historical cohort design, a large cohort of all Danish individuals born in 1983-1989 (n = 392,458) and a propensity score approach to analyse the impact from SSRIs on risk for suicide attempts. Every suicide attempt and redeemed prescription of SSRIs was analysed by Cox regression. RESULTS: We found a significant overlap between redeeming a prescription on SSRIs and subsequent suicide attempt. The risk for suicide attempt was highest in the first 3 months after redeeming the first prescription. The hazard ratio for suicide attempts after redeeming a prescription was estimated to 5.23, 95% CI 4.82-5.68. CONCLUSION: We conclude that the risk of suicide attempt is higher for young people in the first months after redeeming their first prescription for SSRIs, compared to non-users. For SSRI users with lower propensity score (fewer risk factors for SSRIs) the risk of suicide attempt is estimated to be highest. Although the design may miss some explicit reason for prescription of SSRIs and SSRIs might be a marker for those in high risk rather than a causal risk factor, we would recommend systematic risk assessment in the period after redeeming the first prescription.

  4. Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (The Secondary Prevention and Compliance following Acute Myocardial Infarction-study

    Directory of Open Access Journals (Sweden)

    Tydén Patrik

    2011-07-01

    Full Text Available Abstract Background Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI. Methods MI-patients (n = 147 completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB, Q-wave infarctions, and a left ventricular ejection fraction (LVEF ? 50%. Results Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04 and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03. No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF. Conclusions Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction.

  5. Usefulness of J-CAPRA score for high-risk prostate cancer patients treated with carbon ion radiotherapy plus androgen deprivation therapy

    International Nuclear Information System (INIS)

    A novel risk assessment method, Japan Cancer of the Prostate Risk Assessment, has been developed based on database of patients receiving primary androgen deprivation therapy. To investigate the usefulness of Japan Cancer of the Prostate Risk Assessment for non-metastatic, high-risk prostate cancer patients treated with carbon ion radio-therapy plus androgen deprivation therapy. Patients with non-metastatic, high-risk prostate cancer (T3, initial prostate specific antigen level ?20 ng/ml, and/or Gleason score ?8) were included. The patients were treated with carbon ion radiotherapy (the total dose from 57.6 Gy (relative biological effectiveness)/16 fractions to 66.0 Gy (relative biological effectiveness)/20 fractions), and neoadjuvant as well as adjuvant androgen deprivation therapy for at least 24 months. Four hundred and twenty-six patients were included with the median follow-up of 68.1 months. Of 426, 210 (49.3%), 270 (63.4%) and 251 (58.9%) had Gleason 8-10, prostate specific antigen ?20 ng/ml and T3, respectively. The 10-year progression-free and cause-specific survival rates in Japan Cancer of the Prostate Risk Assessment 1-2 group (76.5 and 98.9%) were significantly better than those in Japan Cancer of the Prostate Risk Assessment 3-6 group (52.6 and 93.1%), (P < 0.001 and P=0.044, respectively). The median progression-free survivals in the Japan Cancer of the Prostate Risk Assessment 1-2 and 3-6 groups were 158.9 months and 125.9 months (95% confidence interval: 108.6-143.2 months), respectively. For non-metastatic, high-risk prostate cancer patients treated with carbon ion radiotherapy plus androgen deprivation therapy, Japan Cancer of the Prostate Risk Assessment score was useful for predicting the progression-free and cause-specific survivals. (author)

  6. Modeling of the relationship between the environmental air pollution, clinical risk factors, and hospital mortality due to myocardial infarction in Isfahan, Iran

    Science.gov (United States)

    Sadeghi, Mehraban; Ahmadi, Ali; Baradaran, Azar; Masoudipoor, Neda; Frouzandeh, Soleiman

    2015-01-01

    Background: This study aimed to determine the relationship between the environmental factor, clinical risk factors, and individual variables with mortality due to acute myocardial infarction (MI) in Isfahan. Materials and Methods: This cross-sectional study was performed between April 2012 and March 2013. The data on the patients’ mortality due to MI in Isfahan were obtained from the MI National Registry. The international classification system (ICD10: I21-I22) was used to diagnose MI. The air quality indicators and environmental variables were used to measure the air pollution. Multilevel logistic regression in the Stata software was used to determine the factors associated with mortality in patients and odds ratios (ORs) were calculated. Results: Six hundred eleven patients with MI were studied during 1-year. 444 (72.2%) patients were male and the rest were female. 4.7% of the patients died due to MI. The mean age at MI incidence was 62.2 ± 13 years. Of the air pollution parameters, PM10 had the maximum mean concentration (49.113 ppm), followed by NOX, NO, NO2, CO, SO2, and O3. The adjusted OR of mortality was derived 2.07 (95% CI: 1.5-2.85) for right bundle branch block, 1.5 (95% CI: 1.3-1.7) for ST-segment elevation MI, 1.84 (95% CI: 1.13-3) for age, 1.06 (95% CI: 1.01-1.20) for CO, 1.1 (95% CI: 1.03-1.30) for O3, and 1.04 (95% CI: 1.01-1.4) for SO2, all of which were considered as the risk factors of mortality. However, OR of mortality was 0.79 for precipitation (95% CI: 0.74-0.84) and 0.52 for angioplasty (95% CI: 0.4-0.68) were considered as protective factors of mortality. The individual characteristics including age, history of MI in the immediate family, hypertension, and diabetes were significantly associated with mortality from MI. The indices of air pollution including SO2, CO, O3, and environmental factors such as the precipitation and temperature were the determinants of mortality in patients with MI. Conclusion: With regards to the factors associated with mortality from MI reported in this study, air pollution and environmental factors, in addition to the risk factors and predictive factors, should be particularly addressed to control the mortality from MI.

  7. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar Hilmar

    2011-01-01

    Aims The impact of insulin secretagogues (ISs) on long-term major clinical outcomes in type 2 diabetes remains unclear. We examined mortality and cardiovascular risk associated with all available ISs compared with metformin in a nationwide study. Methods and results All Danish residents >20 years, initiating single-agent ISs or metformin between 1997 and 2006 were followed for up to 9 years (median 3.3 years) by individual-level linkage of nationwide registers. All-cause mortality, cardiovascular mortality, and the composite of myocardial infarction (MI), stroke, and cardiovascular mortality associated with individual ISs were investigated in patients with or without previous MI by multivariable Cox proportional-hazard analyses including propensity analyses. A total of 107 806 subjects were included, of whom 9607 had previous MI. Compared with metformin, glimepiride (hazard ratios and 95% confidence intervals): 1.32 (1.24-1.40), glibenclamide: 1.19 (1.11-1.28), glipizide: 1.27 (1.17-1.38), and tolbutamide: 1.28 (1.17-1.39) were associated with increased all-cause mortality in patients without previous MI. The corresponding results for patients with previous MI were as follows: glimepiride: 1.30 (1.11-1.44), glibenclamide: 1.47 (1.22-1.76), glipizide: 1.53 (1.23-1.89), and tolbutamide: 1.47 (1.17-1.84). Results for gliclazide [1.05 (0.94-1.16) and 0.90 (0.68-1.20)] and repaglinide and [0.97 (0.81-1.15) and 1.29 (0.86-1.94)] were not statistically different from metformin in both patients without and with previous MI, respectively. Results were similar for cardiovascular mortality and for the composite endpoint. Conclusion Monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.

  8. THE INFLUENCE OF MYCOPLASMA INFECTION ON ACUTE MYOCARDIAL INFARCTION

    OpenAIRE

    Maxim V. Trushin; Indus N. Saphin; Chernova, Olga A.; Igor P. Arleevskiy; Chernov, Vladislav M.

    2006-01-01

    ABSTRACT:We studied haemostatic, immunologic and microelement parameters in patients with acute myocardial infarction, some infected with mycoplasma and some not. Clinical patterns of acute myocardial infarction in the mycoplasma-infected patients were also investigated. Infection with mycoplasmas and other microorganisms of the TORCH group (Toxoplasma, Others, Rubella, Chlamidia) may be risk factors for the development of acute myocardial infarction. However, mycoplasma-infected patients did...

  9. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction

    DEFF Research Database (Denmark)

    Anavekar, Nagesh S; McMurray, John J V; Velazquez, Eric J; Solomon, Scott D; Køber, Lars Valeur; Rouleau, Jean-Lucien; White, Harvey D; Nordlander, Rolf; Maggioni, Aldo; Dickstein, Kenneth; Zelenkofske, Steven; Leimberger, Jeffrey D; Califf, Robert M; Pfeffer, Marc A

    2004-01-01

    BACKGROUND: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees of renal impairment is less well defined. METHODS: As part of the Valsartan in Acute Myocardial Infarction Trial (VALIANT), we identified 14,527 patients with acute myocardial infarction complicated by clinical or radiologic signs of heart failure, left ventricular dysfunction, or b...

  10. Apgar score

    Science.gov (United States)