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1.
Mehrshad Abbasi Mohamadreza Neishaboury Jalil Koohpayehzadeh Koorosh Etemad Alipasha Meysamie Fereshteh Asgari Sina Noshad Mohsen Afarideh Alireza Ghajar Morsaleh Ganji Ali Rafei Mostafa Mousavizadeh Elias Khajeh Behnam Heidari Mohammad Saadat Manouchehr Nakhjavani Alireza Esteghamati 《Global Heart》2018,13(2):73-82.e1
Background
Coronary heart disease (CHD) is one of the most common causes of mortality worldwide. The national prevalence remains unclear in most of the developing countries.Objective
This study sought to estimate national prevalence of self-reported CHD and chronic stable angina pectoris in the general adult population of Iran using data from the fourth round of the Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) survey.Methods
The analysis comprised data of 11,867 civilian, nonhospitalized and noninstitutionalized residents ages 6 to 70 years of age. The calculated prevalence of self-reported CHD and chronic stable angina pectoris were extrapolated to the Iranian adult population who were >20 years old using the complex sample analysis. The factor analysis was performed for clustering of the associated cardiometabolic risk factors among people ages >40 years of age.Results
The estimated national prevalence of self-reported CHD and chronic stable angina pectoris were 5.3% (95% confidence interval: 4.6 to 5.9) and 7.7% (95% confidence interval: 4.6 to 8.7), respectively. Higher prevalence of these conditions were observed among the older people, urban residents, and women. Factor analysis generated 4 distinct factors that were mainly indicators of dyslipidemia, hypertension, central obesity, hyperglycemia, and tobacco smoking. The factor incorporating hypertension was a significant correlate of self-reported CHD.Conclusions
We report concerning prevalence of self-reported CHD and chronic stable angina pectoris in the adult population of Iran. The constellation of raised systolic and diastolic blood pressures was significantly predictive of the presence of self-reported CHD. 相似文献2.
Morgana Mongraw-Chaffin Meredith C. Foster Cheryl A.M. Anderson Gregory L. Burke Nowreen Haq Rita R. Kalyani Pamela Ouyang Christopher T. Sibley Russell Tracy Mark Woodward Dhananjay Vaidya 《Journal of the American College of Cardiology》2018,71(17):1857-1865
Background
Debate over the cardiometabolic risk associated with metabolically healthy obesity (MHO) continues. Many studies have investigated this relationship by examining MHO at baseline with longitudinal follow-up, with inconsistent results.Objectives
The authors hypothesized that MHO at baseline is transient and that transition to metabolic syndrome (MetS) and duration of MetS explains heterogeneity in incident cardiovascular disease (CVD) and all-cause mortality.Methods
Among 6,809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) the authors used Cox proportional hazards and logistic regression models to investigate the joint association of obesity (≥30 kg/m2) and MetS (International Diabetes Federation consensus definition) with CVD and mortality across a median of 12.2 years. We tested for interaction and conducted sensitivity analyses for a number of conditions.Results
Compared with metabolically healthy normal weight, baseline MHO was not significantly associated with incident CVD; however, almost one-half of those participants developed MetS during follow-up (unstable MHO). Those who had unstable MHO had increased odds of CVD (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.14 to 2.25), compared with those with stable MHO or healthy normal weight. Dose response for duration of MetS was significantly and linearly associated with CVD (1 visit with MetS OR: 1.62; 95% CI: 1.27 to 2.07; 2 visits, OR: 1.92; 95% CI: 1.48 to 2.49; 3+ visits, OR: 2.33; 95% CI: 1.89 to 2.87; p value for trend <0.001) and MetS mediated approximately 62% (44% to 100%) of the relationship between obesity at any point during follow-up and CVD.Conclusions
Metabolically healthy obesity is not a stable or reliable indicator of future risk for CVD. Weight loss and lifestyle management for CVD risk factors should be recommended to all individuals with obesity. 相似文献3.
Leslee J. Shaw Abhinav Goyal Christina Mehta Joe Xie Lawrence Phillips Anita Kelkar Joseph Knapper Daniel S. Berman Khurram Nasir Emir Veledar Michael J. Blaha Roger Blumenthal James K. Min Reza Fazel Peter W.F. Wilson Matthew J. Budoff 《Journal of the American College of Cardiology》2018,71(10):1078-1089
Background
Cardiovascular disease (CVD) imparts a heavy economic burden on the U.S. health care system. Evidence regarding the long-term costs after comprehensive CVD screening is limited.Objectives
This study calculated 10-year health care costs for 6,814 asymptomatic participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a registry sponsored by the National Heart, Lung, and Blood Institute, National Institutes of Health.Methods
Cumulative 10-year costs for CVD medications, office visits, diagnostic procedures, coronary revascularization, and hospitalizations were calculated from detailed follow-up data. Costs were derived by using Medicare nationwide and zip code–specific costs, inflation corrected, discounted at 3% per year, and presented in 2014 U.S. dollars.Results
Risk factor prevalence increased dramatically and, by 10 years, diabetes, hypertension, and dyslipidemia was reported in 19%, 57%, and 53%, respectively. Self-reported symptoms (i.e., chest pain or shortness of breath) were common (approximately 40% of enrollees). At 10 years, approximately one-third of enrollees reported having an echocardiogram or exercise test, whereas 7% underwent invasive coronary angiography. These utilization patterns resulted in 10-year health care costs of $23,142. The largest proportion of costs was associated with CVD medication use (78%). Approximately $2 of every $10 were spent for outpatient visits and diagnostic testing among the elderly, obese, those with a high-sensitivity C-reactive protein level >3 mg/l, or coronary artery calcium score (CACS) ≥400. Costs varied widely from <$7,700 for low-risk (Framingham risk score <6%, 0 CACS, and normal glucose measurements at baseline) to >$35,800 for high-risk (persons with diabetes, Framingham risk score ≥20%, or CACS ≥400) subgroups. Among high-risk enrollees, CVD costs accounted for $74 million of the $155 million consumed by MESA participants.Conclusions
Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals. 相似文献4.
Raquel P. Amier Martijn W. Smulders Wiesje M. van der Flier Sebastiaan C.A.M. Bekkers Alwin Zweerink Cornelis P. Allaart Ahmet Demirkiran Sebastiaan T. Roos Paul F.A. Teunissen Yolande Appelman Niels van Royen Raymond J. Kim Albert C. van Rossum Robin Nijveldt 《JACC: Cardiovascular Imaging》2018,11(12):1773-1781
Objectives
This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.Background
Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.Methods
A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.Results
Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.Conclusions
Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness. 相似文献5.
Eisuke Usui Taishi Yonetsu Yoshihisa Kanaji Masahiro Hoshino Masao Yamaguchi Masahiro Hada Tadashi Fukuda Yohei Sumino Hiroaki Ohya Rikuta Hamaya Yoshinori Kanno Haruhito Yuki Tadashi Murai Tetsumin Lee Kenzo Hirao Tsunekazu Kakuta 《JACC: Cardiovascular Interventions》2018,11(20):2058-2068
Objectives
This study sought to investigate the relationship of unstable plaque features with physiological lesion severity and microvascular dysfunction.Background
The functional severity of epicardial lesions and microvascular dysfunction are both related to adverse clinical outcomes.Methods
We investigated 382 de novo intermediate and severe coronary lesions in 340 patients who underwent optical coherence tomography, fractional flow reserve (FFR), and index of microcirculatory resistance (IMR) examinations. Lesions were divided into tertiles based on either FFR or IMR values. The optical coherence tomography findings were compared among the tertiles of FFR and IMR. Each tertile was defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74 ≤ FFR ≤0.81), and FFR-T3 (FFR >0.81); and IMR-T1 (IMR ≥25), IMR-T2 (15 < IMR <25), and IMR-T3 (IMR ≤15).Results
No significant relationship was observed between FFR and IMR. The prevalence of optical coherence tomography–defined thin-cap fibroatheroma (TCFA) was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3. An overall significant difference in the prevalence of TCFAs was detected among FFR tertiles, although no pairwise comparison revealed statistical significance. The prevalence of ruptured plaque was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3, although no significant difference was observed between FFR tertiles. Multivariate analysis showed that FFR and IMR were independent predictors of the prevalence of TCFAs (odds ratio: 0.036; 95% confidence interval: 0.004 to 0342; p = 0.004; and odds ratio: 1.034; 95% confidence interval: 1.014 to 1.054; p = 0.001, respectively).Conclusions
Lower FFR and higher IMR values were independent predictors of the presence of a TCFA in angiographically intermediate-to-severe stable lesions or nonculprit lesions in acute coronary syndrome. 相似文献6.
Hanne D. Heerkens Lisanne van Berkel Dorine S.J. Tseng Evelyn M. Monninkhof Hjalmar C. van Santvoort Jeroen Hagendoorn Inne H.M. Borel Rinkes Irene M. Lips Martijn Intven I. Quintus Molenaar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(2):188-195
Background
Surgery for pancreatic cancer yields significant morbidity and mortality risks and survival is limited. Therefore, the influence of complications on quality of life (QoL) after pancreatic surgery is important. This study compares QoL in patients with and without severe complications after surgery for pancreatic (pre-)malignancy.Methods
This prospective cohort study scored complications after pancreatic surgery according to the Clavien–Dindo system and the definitions of the International Study Group of Pancreatic Surgery. QoL was measured by the RAND36 questionnaire, the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30) and the pancreas specific QLQ-PAN26. QoL in patients with severe complications was compared with QoL in patients with no or mild complications over a period of 12 months. Analysis was performed with linear mixed models for repeated measurements.Results
Between March 2012 and July 2016, 137 patients were included. Sixty-eight patients (50%) had at least 1 severe complication. There were no statistically significant and clinically relevant differences between both groups in QoL up to 12 months after surgery.Conclusion
In this study, no differences in QoL between patients with and without severe postoperative complications were encountered during the first 12 months after surgery for pancreatic (pre-)malignancy.7.
Xiaolei Liu Zhiying Yang Haidong Tan Li Xu Liguo Liu Jia Huang Shuang Si Yongliang Sun Wenying Zhou 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(1):64-68
Background
The aim of this study was to report the prevalence of liver haemangioma and describe growth rates by age.Methods
A retrospective study of people undergoing a health examination. The collected data included gender, age, presence or absence and size of liver haemangioma. A second database of liver haemangioma patients with a minimum follow up period of 5 years was analysed. The collected data included gender, initial age at diagnosis, follow-up period, initial and final size.Results
Patients were divided into four age groups: 20–29 years, 30–39 years, 40–49 years and ≥50 years. Patients in the 20–29 years group had the lowest prevalence of liver haemangioma (1.78%) and the smallest size (1.3 ± 0.7 cm), while 40–49 years group had the highest prevalence (3.94%) and largest size (1.9 ± 1.3 cm). Patients between 30 and 39 years had the greatest increase in haemangioma size (4.0 cm, (3.0, 6.0) cm), while patients of ≥50 years had the least (1.4 cm (0.5, 3.8) cm). The proportion of patients without an increase in haemangioma size increased with age (P = 0.031).Conclusion
Age is an important factor affecting the prevalence and growth rate of liver haemangioma. 相似文献8.
Prevalence and clinical characteristics of fatty pancreas in Yangzhou,China: A cross-sectional study
Dan Wang Xiao-ping Yu Wei-ming Xiao Xiu-ping Jiao Jian Wu Dong-ling Teng Ke-yan Wu Min Zhang Qing-tian Zhu Xin-nong Liu Yan-bing Ding Guo-tao Lu 《Pancreatology》2018,18(3):263-268
Objective
The aim of this study was to investigate the prevalence and risk factors of fatty pancreas in Yangzhou, China.Methods
This was a cross-sectional study. Initially, 2093 subjects were included in the study. After the exclusion of 865 subjects based on incomplete information, a total of 1228 subjects were selected for further analysis. The subjects were stratified into two groups (the fatty pancreas group and the non-fatty pancreas group) based on the results. Anthropometric and biochemical findings were compared between the groups.Results
Among the 2093 study subjects, 56 (2.7%) had fatty pancreas. Overall, 53 out of 1228 subjects were diagnosed with fatty pancreas and included into the fatty pancreas group. Univariate analysis showed significant differences in age and the prevalence of general obesity, central obesity, alcohol consumption, metabolic syndrome and fatty liver between the two groups (all p?<?0.01). The fatty pancreas group had higher levels of aspartate aminotransferase, alanine aminotransferase, serum uric acid, fasting blood glucose, total cholesterol, triglycerides and low-density lipoprotein, and lower levels of high-density lipoprotein than did the non-fatty pancreas group (all p < 0.05). Multivariate logistic regression analysis showed that age (p?=?0.007), central obesity (p?=?0.002) and fatty liver (p?=?0.006) were independent risk factors for fatty pancreas, with odds ratios (ORs) of 1.034 (95% confidence interval (CI): 1.009–1.059), 5.364 (95% CI: 1.890–15.227), and 2.666 (95% CI: 1.332–5.338), respectively.Conclusion
The prevalence of fatty pancreas in the examined population is approximately 2.7%. Increased age, central obesity and fatty liver disease are independent risk factors for fatty pancreas. 相似文献9.
Di Zhao Eliseo Guallar Pamela Ouyang Vinita Subramanya Dhananjay Vaidya Chiadi E. Ndumele Joao A. Lima Matthew A. Allison Sanjiv J. Shah Alain G. Bertoni Matthew J. Budoff Wendy S. Post Erin D. Michos 《Journal of the American College of Cardiology》2018,71(22):2555-2566
Background
Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results.Objectives
The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline.Methods
The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use.Results
The mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interval [CI]) associated with 1 SD greater log-transformed sex hormone level for the respective outcomes of CVD, CHD, and HF were as follows: total testosterone: 1.14 (95% CI: 1.01 to 1.29), 1.20 (95% CI: 1.03 to 1.40), 1.09 (95% CI: 0.90 to 1.34); estradiol: 0.94 (95% CI: 0.80 to 1.11), 0.77 (95% CI: 0.63 to 0.95), 0.78 (95% CI: 0.60 to 1.02); and testosterone/estradiol ratio: 1.19 (95% CI: 1.02 to 1.40), 1.45 (95% CI: 1.19 to 1.78), 1.31 (95% CI: 1.01 to 1.70). Dehydroepiandrosterone and SHBG levels were not associated with these outcomes.Conclusions
Among post-menopausal women, a higher testosterone/estradiol ratio was associated with an elevated risk for incident CVD, CHD, and HF events, higher levels of testosterone associated with increased CVD and CHD, whereas higher estradiol levels were associated with a lower CHD risk. Sex hormone levels after menopause are associated with women’s increased CVD risk later in life. 相似文献10.
V.K. Chadha Bhoomika Bajaj Bhalla Sowmya B. Ramesh J. Gupta N. Nagendra R. Padmesh J. Ahmed R.K. Srivastava R.K. Jaiswal P. Praseeja 《The Indian journal of tuberculosis》2018,65(4):315-321
Setting
Implementation study in private health facilities in an Indian metropolis.Objectives
Improve Tuberculosis (TB) care by private practitioners (PPs).Methods
PPs from a defined city area were imparted short training in TB care and linkages made with public facilities; subsequent practices were recorded.Results
Of 364 presumptive TB patient records, 70 (19.3%) did not conform to its definition. Of the conforming, 174 (59.2%) had presumptive pulmonary TB (PTB), 53 (18%) presumptive extra-pulmonary (EPTB) and 67 (24%) had both. Of conforming presumptive PTB, most underwent Chest X-ray and sputum examination in private laboratories. Tissue based diagnostics were not advised for most presumptive EPTB patients. Of 101 cases diagnosed with TB, 82% were new, 23% known diabetic and 4.7% human immune deficiency virus (HIV) reactive out of 64 tested. Most were notified and initiated treatment within 15 days of diagnosis. One-fourth was prescribed standard treatment regimen and treatment was not directly observed for most. One third was initial defaulters or lost during treatment; 62% of PTB and 46% EPTB cases initiated on treatment in private were successfully treated. Of successfully treated PTB cases, 61% had undergone follow-up sputum examination.Conclusion
Much intensified support mechanisms are needed to improve TB care in private sector. 相似文献11.
Yiyin Chen Marjorie Funk Jia Wen Xianghua Tang Guixiang He Hong Liu 《Heart & lung : the journal of critical care》2018,47(1):24-31
Background
Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited.Objective
To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China.Methods
This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31).Results
Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up.Conclusions
A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China. 相似文献12.
Andrea Rossi Giacomo Zoppini Giovanni Benfari Giulia Geremia Stefano Bonapace Enzo Bonora Corrado Vassanelli Maurice Enriquez-Sarano Giovanni Targher 《The American journal of medicine》2017,130(1):70-76.e1
Background
Mitral regurgitation is the most common heart valve disease in the general population, but little is known about the prevalence and prognostic implications of mitral regurgitation in patients with type 2 diabetes.Methods
We retrospectively analyzed the data from 814 outpatients with type 2 diabetes who had undergone a conventional echocardiography for clinical reasons during the years 1992-2007. Mitral regurgitation was evaluated by using an integrated multiparametric echocardiographic approach. The study outcomes were all-cause and cardiovascular mortality.Results
At baseline, 261 (32%) patients had mitral regurgitation (25% mild, 5% moderate, and 2% severe). Over a mean follow-up of 9 years, 120 (14%) patients died, 50 of them from cardiovascular causes. Compared with those without valve disease, patients with mild mitral regurgitation had a 3.3-fold increased risk of all-cause mortality, whereas those with moderate-to-severe mitral regurgitation had a 5.1-fold increased risk of all-cause mortality. Results remained statistically significant after adjustment for multiple potential confounders. Similar results were found for cardiovascular mortality.Conclusions
Mitral regurgitation is a common pathologic condition in patients with type 2 diabetes and is independently associated with an increased risk of both all-cause and cardiovascular mortality, even if the severity of mitral regurgitation is mild. 相似文献13.
Maayan Konigstein Ori Ben-Yehuda Pieter C. Smits Michael P. Love Shmuel Banai Gidon Y. Perlman Mordechai Golomb Melek Ozgu Ozan Mengdan Liu Martin B. Leon Gregg W. Stone David E. Kandzari 《JACC: Cardiovascular Interventions》2018,11(24):2467-2476
Objectives
The authors sought to investigate the impact of diabetes mellitus (DM) on outcomes following contemporary drug-eluting stent (DES) implantation in the BIONICS (BioNIR Ridaforolimus Eluting Coronary Stent System in Coronary Stenosis) trial.Background
Patients with DM are at increased risk for adverse events following percutaneous coronary intervention (PCI).Methods
A prospective, multicenter, 1:1 randomized trial was conducted to evaluate in a noninferiority design the safety and efficacy of ridaforolimus-eluting stents versus zotarolimus-eluting stents among 1,919 patients undergoing PCI. Randomization was stratified to the presence of medically treated DM, and a pre-specified analysis compared outcomes according to the presence or absence of DM up to 2 years.Results
The overall prevalence of DM was 29.1% (559 of 1,919). DM patients had higher body mass index, greater prevalence of hyperlipidemia and hypertension, and smaller reference vessel diameter. One-year target lesion failure (cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization) was significantly higher among diabetic patients (7.8% vs. 4.2%; p = 0.002), mainly due to higher target lesion revascularization (4.5% vs. 2.0%; p = 0.002). Rates of cardiac death, myocardial infarction, and stent thrombosis did not statistically vary. Among 158 patients undergoing 13-month angiographic follow-up, restenosis rates were 3 times higher in diabetic patients compared with nondiabetic patients (15.2% vs. 4.7%; p = 0.01). Clinical and angiographic outcomes were similar between ridaforolimus-eluting stent– and zotarolimus-eluting stent–treated patients.Conclusions
Despite advances in interventional therapies, and the implementation of new-generation DES, diabetic patients still have worse angiographic and clinical outcomes compared with nondiabetic patients undergoing PCI. 相似文献14.
15.
Randi E. Foraker Avirup Guha Henry Chang Emily C. O&#x;Brien Julie K. Bower Elliott D. Crouser Wayne D. Rosamond Subha V. Raman 《Global Heart》2018,13(1):13-18
Background
Non–ST-segment elevation myocardial infarction (NSTEMI) comprises the majority of MI worldwide, yet mortality remains high. Management of NSTEMI is relatively delayed and heterogeneous compared with the “time is muscle” approach to ST-segment elevation MI, though it is unknown to what extent comorbid conditions drive NSTEMI mortality.Objectives
We sought to quantify mortality due to MI versus comorbid conditions in patients with NSTEMI.Methods
Participants of the ARIC (Atherosclerosis Risk in Communities) study cohort ages 45 to 64 years, who developed incident NSTEMI were identified and incidence-density matched to participants who did not experience an MI by age group, sex, race, and study community. We estimated hazard ratios for all-cause mortality, comparing those who developed NSTEMI to those who did not experience an MI.Results
ARIC participants with incident NSTEMI were more likely at baseline to be smokers, have diabetes and renal dysfunction, and take blood pressure or cholesterol-lowering medications than were participants who did not have an MI. Over one-half of participants experiencing NSTEMI died over a median follow-up of 8.4 years; incident NSTEMI was associated with 30% higher risk of mortality after adjusting for comorbid conditions (hazard ratio: 1.30; 95% confidence interval: 1.11 to 1.53).Conclusions
NSTEMI confers a significantly higher mortality hazard beyond what can be attributed to comorbid conditions. More consistent and effective strategies are needed to reduce mortality in NSTEMI amid comorbid conditions. 相似文献16.
Cíntia Freitas Martins Karina Lopes Morais Pamela Figueroa Natasha Favoretto Dias Neusa Sakai Valente Celina Wakisaba Maruta Paulo Ricardo Criado 《Allergology international》2018,67(1):114-118
Background
Chronic urticaria has an expressive prevalence in general population, especially in adults, and is defined by the presence of intermittent hives for six weeks or longer. Our study aims to characterize the histological patterns of chronic spontaneous urticaria, based on the inflammatory cell infiltrate, and correlate them to laboratory exams.Methods
It was performed a retrospective analysis of laboratory, histopathology and direct immunofluorescence data of 93 patients with chronic urticaria. For histopathological analysis, cell count was performed in four fields at high magnification (×400) for each specimen. The resulting cell count medians were submitted to statistical analysis and, then, were correlated to laboratorial findings.Results
We found a female predominance (76.34%) of chronic urticaria cases, and an average age of 42.5 years (SD ± 15). Two histological groups were distinctive: 1) chronic urticaria with predominance of neutrophils or eosinophils – N (%) = 39 (42.4%) – and 2) chronic urticaria with predominance of lymphocytes – N (%) = 53 (57.6%). There was not significant correlation between histological groups and laboratorial tests. Moreover, direct immunofluorescence was positive in 21 (33,87%) from 62 patients.Conclusions
There is not enough scientific evidence to support neutrophilic urticaria as a solid, separate entity. 相似文献17.
Paul Muntner Robert M. Carey Samuel Gidding Daniel W. Jones Sandra J. Taler Jackson T. Wright Paul K. Whelton 《Journal of the American College of Cardiology》2018,71(2):109-118
Background
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals.Objectives
This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).Methods
The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates.Results
According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.Conclusions
Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication. 相似文献18.
Chen Lin Hongmei Dai Xiafei Hong Haiyu Pang Xianze Wang Peiran Xu Jialin Jiang Wenming Wu Yupei Zhao 《Pancreatology》2018,18(5):608-614
Background
Whether primary tumor resection benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors remains controversial. We investigated whether primary tumor resection significantly affects survival in this study.Methods
A retrospective study of patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors between 1998 and 2016 was performed. Patient demographics, operation details, adjuvant treatment, and pathological and survival information were collected, and relevant clinical-pathological parameters were assessed in univariate and multivariate survival analyses.Results
Sixty-three patients were included in this study, including 35 who underwent primary tumor resection. The median survival time and 5-year survival rate of this cohort were 50 months and 44.5%, respectively. Median survival time in the resected group was significantly longer at 72 months than that of 32 months in the nonresected group (p?=?0.010). Multivariate analysis showed that primary tumor surgery was a significant independent prognostic factor (HR 0.312, 95% CI: 0.128–0.762, p?=?0.011).Conclusions
Primary tumor resection significantly benefits patients with synchronous multifocal liver metastases from pancreatic neuroendocrine tumors. 相似文献19.
Lee Joseph Mohammad Bashir Qun Xiang Babatunde A. Yerokun Roland Albert Matsouaka Sreekanth Vemulapalli Samir Kapadia Joaquin E. Cigarroa Firas Zahr 《JACC: Cardiovascular Interventions》2018,11(7):693-702
Objectives
This study sought to examine the prevalence of mitral stenosis (MS) and its impact on in-hospital and 1-year clinical outcomes among patients undergoing transcatheter aortic valve replacement (TAVR).Background
Patients with coexisting severe aortic stenosis and MS are increasingly being considered for TAVR.Methods
The study cohort included 44,755 patients (age ≥18 years) who underwent TAVR during November 1, 2011, to September 30, 2015, and were registered in Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (TVT) Registry. One-year outcomes were assessed by linking TVT registry data of this cohort to patient-specific Centers for Medicare & Medicaid Services administrative claims data (n = 31,453). The primary outcome was the composite of death, stroke, heart failure–related hospitalization, and mitral valve intervention at 1 year.Results
MS was present in 11.6% of cohort (mean age, 82 years; 52% males), being severe in 2.7%. Severe MS was associated with higher in-hospital mortality rates (5.6% vs. 3.9% for nonsevere MS and 4.1% for no MS; p = 0.02). In contrast to those without MS, severe MS group had significantly higher risk for the primary outcome, mortality (1 year), and heart failure–related hospitalization (1 year) (adjusted hazard ratio: 1.2 [95% confidence interval (CI): 1.1 to 1.4], 1.2 [95% CI: 1.0 to 1.4], and 1.3 [95% CI: 1.1 to 1.5], respectively; p < 0.05 for all).Conclusions
Approximately one-tenth of patients undergoing TAVR have concomitant MS. Severe MS is an independent predictor of 1-year adverse clinical outcomes following TAVR. The higher risk for long-term adverse events must be considered when evaluating patients with combined aortic stenosis and MS for TAVR. 相似文献20.
Noriaki Moriyama Koki Shishido Yutaka Tanaka Shohei Yokota Takahiro Hayashi Hirokazu Miyashita Tatsuya Koike Hiroaki Yokoyama Takuma Takada Takashi Nishimoto Tomoki Ochiai Kazuki Tobita Futoshi Yamanaka Shingo Mizuno Masato Murakami Saeko Takahashi Shigeru Saito 《Journal of the American College of Cardiology》2018,71(17):1882-1893