Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life

Objective: To describe the pattern and severity of rhinitis in pregnancy and the impact rhinitis has on asthma control and quality of life (QoL) in pregnant women with asthma. Methods: Two hundred and eighteen non-smoking pregnant women with asthma were participants in a randomised controlled trial of exhaled nitric oxide guided treatment adjustment. Rhinitis was assessed using a visual analogue scale (VAS) scored from 0 to 10 and classified as current (VAS?>?2.5), moderate/severe versus mild (VAS?>?6 vs <5), atopic versus non-atopic and pregnancy rhinitis. At baseline, women completed the 20-Item Sino-Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) QoL questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Asthma control was assessed using the asthma control questionnaire (ACQ). Perinatal outcomes were collected after delivery. Results: Current rhinitis was present in 142 (65%) women including 45 (20%) women who developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p?=?0.004), SNOT20 (p?<?0.0001) and AQLQ-M (p?<?0.0001) compared to women with no rhinitis. Current rhinitis was associated with increased anxiety symptoms (p?=?0.002), rhinitis severity was associated with higher ACQ score (p?=?0.004) and atopic rhinitis was associated with poorer lung function (p?=?0.037). Rhinitis symptom severity improved significantly during gestation (p?<?0.0001). There was no impact on perinatal outcomes. Improved asthma control was associated with improvement in rhinitis. Conclusion: Rhinitis in pregnant women with asthma is common and associated with poorer asthma control, sino-nasal and asthma-specific QoL impairment and anxiety. In the context of active asthma management there was significant improvement in rhinitis symptoms and severity as pregnancy progressed.     

Delay in invasive risk stratification of women with acute coronary syndrome is associated with worse outcomes

Background Invasive risk stratification in patients with acute coronary syndromes (ACS) has been shown to improve outcomes. There is paucity of data on women undergoing invasive risk stratification. We investigated whether the time to coronary angiography affects survival of female patients admitted with ACS. Method Female patients admitted to the coronary intensive care unit with ACS between 1/1/97 and 12/31/00 and undergoing coronary angiography during same hospitalization were divided into three groups based on the time to angiography: same day, 1–2 days and >2 days. The baseline clinical features, angiography results and outcomes were compared between the angiography groups. Results Of the total 350 female patients who fulfilled the inclusion criteria, 63% underwent angiography within two days of presentation. Three year mortality rates in women undergoing angiography on the same day, 1–2 days and >2-days were 7%, 7% and 22% respectively (p = 0.001). Using multivariate analysis, angiography beyond 2 days was a significant predictor of mortality among women (OR 2.6, 95% CI 1.3–5.0, p = 0.006) after adjusting for confounding variables. Conclusion Later invasive risk stratification after 2 days of presentation in women with ACS is associated with worse survivial. Gender should not be a reason to defer early coronary angiography in these patients.     

Predictors of quality of life in Chinese patients with acute coronary syndrome

Predictors of quality of life in Chinese patients with acute coronary syndrome remain unknown. Between January 2006 and March 2009, a prospective cohort study of 782 patients with acute coronary syndrome was carried out, with follow-up 7 months later. Depression and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale. Quality of life was assessed using the 36-Item Short-Form Health Survey. To identify predictors of decreased quality of life, both the physical and mental component summary scores were analyzed using multiple and ordinal logistic regression. In our quality-of-life model, diabetes mellitus was an independent risk factor for a low mental component summary score. Anxiety symptoms and the baseline mental component summary score were significant independent predictors of a low mental component summary score. Acute myocardial infarction was found to be a risk factor for a low physical component summary score. Anxiety symptoms, baseline physical component summary score, and systolic blood pressure on admission were significant independent predictive factors. Among patients with acute coronary syndrome, those with acute myocardial infarction, diabetes, or a low baseline quality of life need more care and effective intervention to improve their quality of life.     

Unemployment and deprivation are associated with a poorer outcome following percutaneous coronary angioplasty

This prospective observational study aimed to assess the impact of employment status and deprivation on quality of life 12 months after percutaneous coronary intervention (PCI). Patients completed a questionnaire at baseline and at 1 year follow-up including a health utility score (EQ-5D), symptoms and employment status. Deprivation was assessed using the Carstairs' deprivation category based on area postcodes. The majority (79.6%) of patients of working age returned to work within 12 months. Unemployment was associated with a lower quality of life (QoL) at baseline (0.49 (0.32) vs 0.61 (0.27), p=0.002) and less improvement in QoL 1 year after PCI (0.15 (0.37) vs 0.26 (0.31), p<0.012). Furthermore, unemployed patients had significantly less improvement in chest pain score (p=0.002) and breathlessness (p<0.001). Unemployed patients from the most deprived areas had lowest QoL at follow-up and least improvement in QoL at 1 year. Unemployment and deprivation are associated with poorer outcomes following PCI.     

Serum tenascin-C level is associated with coronary plaque rupture in patients with acute coronary syndrome

Tenascin-C, a large oligometric glycoprotein of the extracellular matrix, increases the expression of matrix metalloproteinases that lead to plaque instability and rupture, resulting in acute coronary syndrome (ACS). We hypothesized that a high serum tenascin-C level is associated with plaque rupture in patients with ACS. Fifty-two consecutive ACS patients who underwent emergency percutaneous coronary intervention (PCI) and, as a control, 66 consecutive patients with stable angina pectoris (SAP) were enrolled in this study. Blood samples were obtained from the ascending aorta just prior to the PCI procedures. After coronary guide-wire crossing, intravascular ultrasonography (IVUS) was performed for assessment of plaque characterization. Based on the IVUS findings, ACS patients were assigned to two groups according to whether there was ruptured plaque (ruptured ACS group) or not (nonruptured ACS group). There were 23 patients in the ruptured group and 29 patients in the nonruptured group. Clinical characteristics and IVUS measurements did not differ between the two groups. Tenascin-C levels were significantly higher in the ruptured ACS group than in the SAP group, whereas there was no significant difference between the nonruptured ACS and SAP groups. Importantly, in the ruptured ACS group, tenascin-C levels were significantly higher than in the nonruptured ACS group (71.9 ± 34.9 vs 50.5 ± 20.5 ng/ml, P < 0.005). Our data demonstrate that tenascin-C level is associated with pathologic conditions in ACS, especially the presence of ruptured plaque.     

急性冠状动脉综合征患者不同血运重构治疗后生活质量的评价

调查急性冠状动脉综合征患者6个月生活质量变化,并了解冠状动脉介入(PCI)和冠状动脉搭桥(CABG)治疗对患者生活质量影响,为提高急性冠状动脉综合征患者生活质量提供依据。方法:收集北京安贞医院2008年7月至2011年12月就诊患者中符合急性冠状动脉综合征诊断,以及多支病变适于冠状动脉支架置入术或冠状动脉搭桥术患者共1 012例,随机将患者PCI组(n=510)和CABG组(n=502),对患者进行6个月随访。使用西雅图心绞痛量表(SAQ)对患者就诊时和6个月的生活质量进行评估。6个月后总结2组患者生活质量变化,以及影响因素与生活质量变化的关系。结果:6个月后,2组治疗方法患者生活质量均较前明显改善(P<0.001),西雅图心绞痛量表5项分数均有明显提高。6个月时,生活质量分数中躯体活动受限程度(PL)部分,PCI和CABG差异无统计学意义(P>0.05)。其余4部分分数,CABG均优于冠状动脉介入组。在改善比率方面经比较CABG组在躯体受限程度(P<0.05)、心绞痛发作频率(P<0.05)和治疗满意程度(P<0.016)3项中优于PCI组。结论:以SAQ量表作为标准,PCI和CABG可以使生活质量明显改善,CABG组在躯体受限程度、心绞痛发作频率和治疗满意程度3项改善优于PCI组(P<0.05)。     

Influence of diabetes on health-related quality of life results in patients with acute coronary syndrome treated with coronary angioplasty

The objective of this study was to prospectively evaluate the impact of diabetes on HRQOL at baseline and 6-months following ACS treated by PCI and to determine which predictors: demographic, clinical, and other variables influence QOL results in physical component summary (PCS) and mental component summary (MCS) of SF-36 health survey. The 120 consecutive patients (mean age 62.5, SD ± 9.8) with acute coronary syndrome ACS including non-ST-elevation myocardial infarction NSTEMI, n = 60 and ST-elevation myocardial infarction STEMI, n = 60 were entered into the study. Each patient was prospectively interviewed at baseline (at discharge) and 6-months following ACS. We relied on previously validated questionnaire to assess the patient’s overall health perception, namely the SF-36 health survey. Generally, the whole group demonstrated the better PCS score at 6-month follow-up: 54.7 versus 55.5; P < 0.0001. With regard to PCS, an increase in life quality results was observed in both groups. However, it should be emphasize that the diabetic group demonstrated considerably lower life quality baseline. Also, the whole group demonstrated better MCS score at 6-month follow-up: 55.9 versus 56.5; P < 0.0001. The influence of diabetes, multivessel disease, hypertension, and the high triglyceride level have negative impact on life quality evaluation, whereas male patients and patients with ACS–STEMI had better quality of life results. The influence of diabetes, multivessel disease, hypertension, and the high triglyceride level have negative impact on life quality evaluation, whereas male patients and patients with ACS–STEMI had better quality of life results. The influence of diabetes, the history of myocardial infarction, and the high triglyceride level have negative impact on life quality evaluation. Patients with ACS–STEMI had better quality of life results. The influence of diabetes, the history of myocardial infarction, and the high triglyceride level have negative impact on quality of life evaluation. Male patients had better quality of life results. (1) Diabetic patients obtain worse life quality results than non-diabetic patients, both at baseline and 6-months following PCI. (2) Positive predictors of patient’s life quality are the male sex and clinical manifestation of the disease (STEMI). (3) As regards PCS, negative predictors of patient’s life quality are diabetes, multivessel disease, high triglyceride level, and arterial hypertension. (4) As regards MCS, negative predictors are diabetes, the history of myocardial infarction, and high triglyceride level.     

Low total cholesterol is associated with high total mortality in patients with coronary heart disease

The present non-intervention screening study was undertakento explore the relationships between pre-existing low totalcholesterol and all-cause mortality. Eleven thousand, five hundredand sixty-three patients with coronary heart disease who attendeda screening visit but were not included in the Bezafibrate InfarctionPrevention study were followed-up for a mean of 3·3 yearsafter determination of baseline total cholesterol. Five hundredand ninety-five (5%) of this largely unselected population whohad total cholesterol levels 160 mg. dl^–1 formed thestudy population. The remaining 10 968 patients acted as controls.The relative risk of all-cause mortality among patients withlow cholesterol compared to others was 1·49 (95% CI:1·16–1·91). The relative risk of non-cardiacdeath was 2·27 times higher in the low cholesterol groupthan in the controls (95· CI: 1·49–3·45),whereas the risk of cardiac death was the same in both groups(relative risk 1·09; 95% CI: 0·76–1·56).The most frequent cause of non-cardiac death associated withlow total cholesterol was cancer. These results in patientswith coronary heart disease add weight to previous studies associatinglow total cholesterol with an increased risk of non-cardiacdeath. However, a longer follow-up of this cohort of patientsis necessary in order to clarify this association.     

Abdominal obesity is associated with increased risk of acute coronary events in men.

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

Low serum high density lipoprotein is associated with the greatest risk of metabolic syndrome among U.S. adults

Aims

Better understanding risk factors for metabolic syndrome (MetS) will allow early targeted intervention to mitigate long term risk. We aim to determine the disparate impact of each individual MetS component on overall risk of developing MetS, stratified by sex, race/ethnicity, and age.

Expression of platelet collagen receptor glycoprotein VI is associated with acute coronary syndrome.

AIMS: Platelet collagen receptor glycoprotein VI (GPVI) is critical for the formation of arterial thrombosis. In this observational study, we examined the platelet surface expression of GPVI in patients with symptomatic coronary artery disease (CAD). METHODS AND RESULTS: We evaluated a consecutive cohort of 367 patients with symptomatic CAD, who underwent coronary angiography. The surface expression of platelet activation markers (GPVI, CD62P, and CD42b) was determined by flow cytometry. Patients with acute coronary syndrome (ACS) showed a significantly enhanced GPVI expression on admission when compared with patients with stable angina pectoris (SAP) (ACS: 21.4+/-9.7; SAP: 18.6+/-7.1 mean fluorescence intensity+/-SD; P=0.004). The expression of GPVI correlated with CD62P (r=0.702; P=0.001). Logistic regression analysis demonstrated that on admission, elevated platelet GPVI expression was associated with ACS, independent of markers of myocardial necrosis such as troponin and creatine kinase. CONCLUSION: Platelet GPVI surface expression is elevated in patients with ACS and is associated with imminent acute coronary events. The determination of the platelet-specific thrombotic marker GPVI may help to identify patients at risk before myocardial ischaemia is evident.