Role of psoriasis as independent predictor of cardiovascular disease: A meta-regression analysis

Background

Despite the proved association between psoriasis and cardiovascular risk exposure, there are no data about the role of psoriasis as an independent predictor of such risk. The aim of this study was to investigate whether any association between psoriasis and excess cardiovascular risk exposure is independent from confounding factors.

Methods

Meta-analysis and meta-regression analysis were performed using data extracted from observational studies (identified by MEDLINE, EMBASE and CINAHL) investigating the relationship between psoriasis and cardiovascular disease with at least 6 points on the New Castle-Ottawa quality scale. Two reviewers with methodological expertise conducted data extraction independently.

Results

Thirteen studies including patients with psoriasis showed an increased risk of cardiovascular disease (RR = 1.24 [1.18–1.31]; P = 0.0001). These patients still presented a significantly larger cardiovascular risk in the presence of smoking (RR = 1.14 [CI = 1.13–1.15] P < 0.0001), obesity (RR = 1.11 [CI = 1.07–1.14] P = 0.0003) and hyperlipidemia (RR = 1.05 [CI = 1.03–1.07] P = 0.0006), but not in the presence of hypertension (RR = 1.03 [CI = 0.98–1.09] P = 0.4647) and diabetes (RR = 0.95 [CI = 0.90–1.01] P = 0.6502).

Conclusions

Patients with psoriasis carry an about 25% increased relative risk of cardiovascular disease. This risk appears to be independent of smoking, obesity and hyperlipidemia.     

Long-term outcomes of biodegradable polymer versus durable polymer drug-eluting stents in patients with diabetes a pooled analysis of individual patient data from 3 randomized trials

Background

There is ongoing debate on the optimal drug-eluting stent (DES) in diabetic patients with coronary artery disease. Biodegradable polymer drug-eluting stents (BP-DES) may potentially improve clinical outcomes in these high-risk patients. We sought to compare long-term outcomes in patients with diabetes treated with biodegradable polymer DES vs. durable polymer sirolimus-eluting stents (SES).

Methods

We pooled individual patient-level data from 3 randomized clinical trials (ISAR-TEST 3, ISAR-TEST 4 and LEADERS) comparing biodegradable polymer DES with durable polymer SES. Clinical outcomes out to 4 years were assessed. The primary end point was the composite of cardiac death, myocardial infarction and target-lesion revascularization. Secondary end points were target lesion revascularization and definite or probable stent thrombosis.

Results

Of 1094 patients with diabetes included in the present analysis, 657 received biodegradable polymer DES and 437 durable polymer SES. At 4 years, the incidence of the primary end point was similar with BP-DES versus SES (hazard ratio = 0.95, 95% CI = 0.74–1.21, P = 0.67). Target lesion revascularization was also comparable between the groups (hazard ratio = 0.89, 95% CI = 0.65–1.22, P = 0.47). Definite or probable stent thrombosis was significantly reduced among patients treated with BP-DES (hazard ratio = 0.52, 95% CI = 0.28–0.96, P = 0.04), a difference driven by significantly lower stent thrombosis rates with BP-DES between 1 and 4 years (hazard ratio = 0.15, 95% CI = 0.03–0.70, P = 0.02).

Conclusions

In patients with diabetes, biodegradable polymer DES, compared to durable polymer SES, were associated with comparable overall clinical outcomes during follow-up to 4 years. Rates of stent thrombosis were significantly lower with BP-DES.     

Two-year survival and neurological outcome of in-hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation

Background

The clinical benefit of extracorporeal cardiopulmonary resuscitation (E-CPR) has been proved in short-term follow-up studies. However, the benefit of E-CPR beyond 1 year has been not known. We investigated 2-year outcome of patients who received E-CPR or conventional CPR (C-CPR).

Methods

We analyzed a total of 406 adult in-hospital cardiac arrest victims who underwent CPR for more than 10 min from 2003 to 2009. The two-year survival and neurological outcome of E-CPR (n = 85) and C-CPR (n = 321) were compared using propensity score-matched analysis.

Results

The 2-year survival with minimal neurological impairment was 4-fold higher in the E-CPR group than the C-CPR group (23.5% versus 5.9%, hazard ratio (HR) = 0.57, 95% confidence interval (CI) = 0.43–0.75, p < 0.001) by unadjusted analysis. After propensity-score matching, it was still 4-fold higher in the E-CPR group than the C-CPR group (20.0% versus 5.0%, HR = 0.53, 95% CI = 0.36–0.80, p = 0.002). In the E-CPR group, the independent predictors associated with minimal neurological impairment were age ≤ 65 years (HR = 0.46; 95% CI = 0.26–0.81; p = 0.008), CPR duration ≤ 35 min (HR = 0.37; 95% CI = 0.18–0.76; p = 0.007), and subsequent cardiovascular intervention including coronary intervention or cardiac surgery (HR = 0.36; 95% CI = 0.18–0.68; p = 0.002).

Conclusions

The initial survival benefit of E-CPR for cardiac arrest patients persisted at 2 years.     

Renal disease and left atrial remodeling predict atrial fibrillation in patients with cardiovascular risk factors

Objectives

In this prospective population-based study, we tested the possible interaction between chronic kidney disease (CKD) and left atrium volume index (LAVI) in predicting incident atrial fibrillation (AF).

Methods

We enrolled 3549 Caucasian subjects, 1829 men and 1720 women, aged 60.7 ± 10.6 years, without baseline AF and thyroid disorders. Echocardiographic left ventricular mass and LAVI were measured. Renal function was calculated by estimated glomerular filtration rate (e-GFR). To test the effect of some clinical confounders on incident AF, we constructed different models including clinical and laboratory parameters. AF diagnosis was made by standard electrocardiogram or 24-h ECG-Holter, hospital discharge diagnoses, and by the all-clinical documentation.

Results

During the follow-up (53.3 ± 18.1 months), 546 subjects developed AF (4.5 events/100 patient-years). Progressors to AF were older, had a higher body mass index, blood pressure, LDL-cholesterol, glucose, cardiac mass, and LAVI, and had lower e-GFR. Hypertension, metabolic syndrome, diabetes, cardiac hypertrophy and CKD were more common among AF cases than controls. In the final Cox regression model, variables that remained significantly associated with AF were: cardiac hypertrophy (HR = 1.495, 95% CI = 1.215–1.841), renal disease (HR = 1.528, 95% CI = 1.261–1.851), age (HR = 1.586, 95% CI = 1.461–1.725) and LAVI (HR = 2.920, 95% CI = 2.426–3.515). The interaction analysis demonstrated a synergic effect between CKD and cardiac hypertrophy (HR = 4.040, 95% CI = 2.661–6.133), as well as between CKD and LAVI (HR = 4.875, 95% CI = 2.699–8.805). The coexistence of all three subclinical organ damages significantly increases the arrhythmic risk (HR = 7.185, 95% CI = 5.041–10.240).

Conclusions

Our data demonstrate that LAVI and CKD significantly interact in a synergic manner in increasing AF risk.     

Prognostic value of cardiovascular magnetic resonance in patients with suspected arrhythmogenic right ventricular cardiomyopathy

Background

Early recognition and accurate risk stratification are important in the management of arrhythmogenic right ventricular cardiomyopathy (ARVC). Identification of predictors of outcome by cardiovascular magnetic resonance (CMR) in patients undergoing evaluation for ARVC is limited. We investigated the predictive value of morphological abnormalities detected by CMR for major clinical events in patients with suspected ARVC.

Methods

We performed a longitudinal study on 369 consecutive patients with at least one criterion for ARVC. Abnormal CMR was defined by the presence of one of the following: increased right ventricular (RV) volumes, reduced RV ejection fraction, RV regional wall motion abnormalities, myocardial fatty infiltration, and myocardial fibrosis. The end-point was a composite of cardiac death, sustained ventricular tachycardia, ventricular fibrillation, and appropriate ICD discharge.

Results

Twenty patients met the composite end-point over a mean follow-up of 4.3 ± 1.5 years. An abnormal CMR was an independent predictor of outcomes (p < 0.001). The presence of multiple abnormalities heralded a particular high risk of events (HR 23.0, 95% CI 5.7–93.2, p < 0.001 for 2 abnormalities; HR 35.8, 95% CI 9.7–132.6, p < 0.001 for 3 or more abnormalities). The positive predictive value of an abnormal CMR study was 21.0% for an adverse event, whilst the negative predictive value of a normal CMR study was 98.8% over the follow-up period.

Conclusions

CMR provides important prognostic information in patients under evaluation for ARVC. A normal study portends a good prognosis. Conversely, the presence of multiple abnormalities identifies a high risk group of patients who may benefit from ICD implantation.     

Dental scaling and atrial fibrillation: A nationwide cohort study

Background

Improvement of oral hygiene through dental scaling was associated with a decreased risk of cardiovascular events. The goal of the present study was to investigate whether dental scaling can reduce the risk of atrial fibrillation (AF).

Methods

In year 2000, a total of 28,909 subjects who were age 60 or more without past history of cardiac arrhythmias were identified from the “National Health Insurance Research Database” in Taiwan. Among these subjects, those who have received dental scaling at least 1 time/year for 3 consecutive years (1998–2000) were selected to be the exposed group (n = 3391). A total of 13,564 age, sex and underlying disease-matched subjects without receiving dental scaling were identified to be the non-exposed group. The study endpoint was the occurrence of new-onset AF.

Results

During a follow-up of 4.6 ± 1.1 years, 478 participants (2.8%) developed AF. The exposed group had a lower AF occurrence rate than non-exposed group (2.2% versus 3.0%; p value = 0.017). After an adjustment with age, gender, and comorbidities in the multivariate analysis, dental scaling was associated with a reduced risk of AF (hazard ratio = 0.671, 95% CI = 0.524–0.859; p value = 0.002). Among the exposed group, the hazard ratio in developing AF was 0.340 (95% CI = 0.247–0.489; p value < 0.001) when subjects received 1 more dental scaling per year.

Conclusions

The risk of AF was lower in subjects receiving dental scaling. Improvement of oral hygiene by dental scaling may be a simple and useful way to prevent AF.     

Myocardial fibrosis and QTc are reduced following treatment with spironolactone or amiloride in stroke survivors: A randomised placebo-controlled cross-over trial

Introduction

Myocardial fibrosis is dysrhythmogenic and may contribute to the high incidence of cardiac death in stroke survivors, especially if they have long QTc. We tested the hypothesis that procollagen-1-carboxy terminal peptide (P1CP), a biomarker of myocardial fibrosis, might be improved following treatment with spironolactone or amiloride in stroke survivors. We also tested the hypothesis that both drugs would shorten QTc.

Methods

Study design: randomised, double-blinded, placebo-controlled, cross-over trial (spironolactone vs. amiloride vs. placebo).Duration of Study: 3 months (1 month per drug).Primary endpoints: P1CP, QTc

Results

11 stroke survivors (5 female), aged 71 + 4, BP 139/81 mmHg + 20/11 mmHg, completed the study. Both spironolactone and amiloride significantly reduced P1CP [Spironolactone–Placebo = − 24 ug/L, 95% CI = − 40 to − 6.9; Amiloride–Placebo = − 28 ug/L, 95% CI = − 44 to − 11]. Spironolactone and amiloride both shortened QTc [Spironolactone vs. Placebo = − 18 ms^1/2, 95% CI = − 36 to − 0.55; Amiloride vs Placebo = − 25 ms^1/2, 95% CI = − 42 to − 7.5].

Conclusions

Procollagen-1-carboxy terminal peptide was reduced following treatment with spironolactone within a month. Further, this is the first study demonstrating amiloride could also improve myocardial fibrosis. The beneficial effects of both drugs on myocardial fibrosis, coupled with their effects on raising potassium translated to a shortening of QTc. Future studies should test the hypothesis that these drugs might reduce the risk of sudden cardiac death in stroke survivors.     

PDE5 inhibitor sildenafil in the treatment of heart failure: A meta-analysis of randomized controlled trials

Background

Clinical trials have evaluated the use of phosphodiesterase (PDE) 5 inhibitors sildenafil as a potential adjunct in the treatment of heart failure (HF) with mixed results. Thus, we undertook a meta-analysis to evaluate the clinical viability of sildenafil in HF.

Methods

Relevant studies were searched and identified in the MEDLINE and EMBASE databases. Randomized clinical trials (RCT) comparing sildenafil to placebo, in heart failure patients, reporting at least one outcome of interest were included. Data were extracted regarding the characteristics and clinical outcomes.

Results

We identified 9 RCTs enrolling 612 HF patients. There were no significant differences in adverse events between sildenafil group and placebo group (RR = 1.10, 95% CI = 0.74 to 1.65, P = 0.41), whereas sildenafil therapy was associated with a marked improvement in hemodynamic parameter peak VO₂ (MD = 3.25, 95% CI = 2.07 to 4.42, P < 0.00001) in HF with reduced ejection fraction (HFrEF) patients but not in HF with preserved ejection fraction (HFpEF) patients. Also, sildenafil therapy improved VO₂ at anaerobic threshold (AT) (MD = 3.47, 95% CI = 1.68 to 5.27, P = 0.0002), VE/VCO₂ slope (MD = − 7.06, 95% CI = − 8.93 to − 5.19, P < 0.00001) and LV ejection fraction (MD = 5.43, 95% CI = 3.66 to 7.20, P < 0.00001) compared to placebo in HF patients, which had no impact on blood pressure and heart rate. For quality of life (emotional function, fatigue and breathlessness), there was no significant difference between the two groups.

Conclusions

Sildenafil improved hemodynamic parameters particularly in HFrEF patients when compared to placebo, with no increase in adverse events. Sildenafil treatment was well tolerated and had no impact on quality of life.     

Clinical significance of fat infiltration in the moderator band and right ventricular myocardium in multislice CT,and its association with abnormal conduction seen in electrocardiogram

Purpose

We evaluated the clinical significance of fat infiltration in the moderator-band (MB) of the right ventricle (RV) and in the RV myocardium (RVM) and its association with conduction abnormalities in the electrocardiogram.

Materials and methods

132 subjects (58 male; age 59 ± 27 years) with no findings of organic-disease (all right and left side hearts were normal) undergoing electrocardiogram-gated non-contrast multislice-CT (Light-Speed-Ultra-16) were retrospectively analyzed for the presence of fat infiltrating the MB or RVM.

Results

MB fat infiltration was detected in 42 subjects, but these individuals showed no significant differences in the incidence of right bundle branch-block, mean QRS-width or standard-deviation of the QRS-axis, which would have suggested the presence of hemi left bundle branch-block. Only age (64.3 vs 57.9 years, p = 0.025) was significantly different in subjects with MB fat infiltration. But logistic regression showed none of the factor associated with increased presence of MB fat infiltration. RVM fat infiltration was detected in 35 subjects, again with no significant differences in the incidence of right bundle branch-block, QRS width or standard-deviation of the QRS axis. Only age (65.9 vs 57.8 years, p = 0.001) and gender (71% vs 51% female, p = 0.033) were significantly different in subjects with RVM fat infiltration. Logistic regression showed age (Odd-ratio = 1.05 and 95% CI = 1.01–1.08 p = 0.008) and female sex (Odd-ratio = 2.44 and 95% CI = 1.03–5.88; p = 0.043) were associated with increased RV fat infiltration.

Conclusions

MB or RVM fat infiltration seen on CT may not indicate organized abnormal myocardial conduction, but RVM fat infiltration may indicate only degeneration due to aging, especially in females.     

Risk factors for serum alanine aminotransferase elevation: A cross-sectional study of healthy adult males in Tokyo,Japan

Background

Liver-protective effects of light-to-moderate alcohol consumption have been suggested.

Aims

To determine predictors of ALT elevation in asymptomatic subjects with and without ultrasonographical evidence of fatty liver.

Methods

Cross-sectional survey of 9703 healthy males. Exclusion criteria were HBV or HCV infection, any use of hepatotoxic medication, history of alcohol abuse, chronic renal or hepatic failure, or treatment for metabolic disorders. Presence of fatty liver was evaluated by ultrasonography; visceral adipose tissue (VAT) was measured by computed tomography (CT).

Results

7148 males (mean age, 50.3 ± 7.8 years) were included; 2406 (33.7%) had fatty liver at ultrasonography. ALT was elevated in 163 (3.4%) and 554 subjects (23.0%) of fatty liver-negative and fatty liver-positive subgroups, respectively. Light (40–140 g/week) alcohol consumption was significantly and independently associated with reduced prevalence of ALT elevation in the fatty liver-negative subgroup (OR = 0.568, 95% CI = 0.342–0.943, P = 0.029). ALT elevation was significantly related to age, VAT, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) in the fatty liver-negative subgroup.

Conclusion

Light alcohol consumption is not associated with serum ALT elevation in the Japanese male population. Metabolic syndrome factors are significantly associated with prevalence of ALT elevation, irrespective of the presence of fatty liver.     

A novel scale predicting postoperative delirium (POD) in patients undergoing cerebrovascular surgery

Purpose

The purpose of this study was to develop and test a scale for predicting POD in patients undergoing cerebrovascular surgery.

Methods

The predictive scale for POD was composed of 32 items reflecting the strongest risk factors as determined by a literature review. The NEECHAM Confusion Scale determined POD onset and severity.

Results

Delirium developed in 38 (31.1%) of the 122 patients in our sample. Logistic regression revealed the following risk factors: dehydration, age, disturbance of consciousness, underlying illness, and anxiety or depression. The final scale was weighted by referring to odds ratios. The area under the curve was 0.844 (95% CI = 0.766–0.921). The possible total score on this scale was 20 points. A cutoff score of 11 was set for risk of POD (patients scoring over 12 were considered at higher risk). The median score was 8 (range: 4–9) in the non-delirium group and 13 (range: 9–16) in the delirium group (U = 499.0; df = 120; p < 0.001). Scale scores were moderately correlated with delirium duration (ρ = 0.532; p < 0.001).

Conclusion

The present scale is a promising a tool for predicting POD but needs to be studied further.     

Long-term mortality risk in patients with an implantable cardioverter–defibrillator: Influence of heart rate and QRS duration

Background

A paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress.

Methods

Resting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0 year follow-up, median follow-up of 5.6 years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety.

Results

Mean (SD) heart rate was 68.0 ± 13.3 bpm and mean QRS duration was 130.9 ± 36.9 ms. Heart rate of ≥ 80 bpm was associated with increased risk of mortality (HR = 1.86; 95% CI = 1.15–3.00; p = .011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR = 1.86, 95% CI = 1.12–3.09; p = .017) and anxiety (HR = 1.82, 95% CI = 1.10–3.03; p = .021) and clinical measures as covariates. QRS duration of ≥ 120 ms was associated with impaired prognosis in unadjusted analysis (HR = 2.00, 95% CI = 1.27–3.14; p = .003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR = 1.15, 95% CI = 0.70–1.89; p = .60).

Conclusions

This study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.     

LCT-13910C > T polymorphism-associated lactose malabsorption and risk for colorectal cancer in Italy

Background

The activity of epithelial lactase (LCT) associates with a polymorphism 13910 bp upstream the LCT-encoding gene (LCT-13910C > T). The relationship between LCT-13910C > T polymorphism and risk for colorectal cancer is unclear.

Aims

We examined the relationship between the LCT-13910C > T polymorphism causing lactose intolerance and risk for colorectal cancer/polyps onset in the Italian population.

Patients and methods

793 subjects (306 with colorectal cancer, 176 with polyps and 311 controls) were genotyped for the LCT-13910C > T variant by TaqMan real time-PCR.

Results

Lactose malabsorption linked to the CC genotype did not associate with an increased risk for either colorectal cancer (OR = 1.041; 95% CI = 0.751–1.442; p = 0.868) or polyps (OR = 0.927; 95% CI = 0.630–1.363; p = 0.769). There was no association with colorectal cancer/polyps site. 60% of the subjects overall bore the CC genotype.

Conclusion

In the Italian population the LCT-13910C > T polymorphism is not associated to the risk for colorectal cancer or polyps.     

Early repolarization is associated with atrial and ventricular tachyarrhythmias in patients with acute ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background

Recent studies found that early repolarization (ER) is significantly more common in survivors of aborted sudden cardiac death. We hypothesized that ER might be more common in patients with ST elevation myocardial infarction (STEMI) who have complications of atrial and ventricular arrhythmias.

Methods

This study included 266 patients with acute STEMI undergoing primary percutaneous coronary intervention. Twelve-lead electrocardiograms were analyzed for ER, defined as J-point elevation ≥ 0.1 mV and “notching” and “slurring” of the terminal part of the QRS complex in at least 2 lateral or inferior leads. Acute and late atrial and ventricular arrhythmic events were evaluated.

Results

The ER pattern was observed in 76 patients (28.6%). Atrial arrhythmia [21/76 (27.6%) vs. 22/190 (11.6%), p = 0.001] and ventricular arrhythmia [16/76 (21.1%) vs. 16/190 (8.4%), p = 0.004] were more frequently complicated in patients with ER than those without during hospitalization. ER was a significant independent predictor of developing atrial (HR = 2.682, 95% CI = 1.355–5.310, p = 0.005) and ventricular arrhythmia (HR = 2.936, 95% CI = 1.360–6.335, p = 0.006). Three patients with ER and ventricular fibrillation expired during hospitalization [3.9% (3/76) vs. 0% (0/190), p = 0.023]. However, the presence of ER did not affect the late recurrence of atrial and ventricular arrhythmia.

Conclusions

The ER pattern is commonly observed in patients with STEMI and associated with atrial and ventricular tachyarrhythmia during acute setting.     

Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

Background

This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial.

Methods

124 patients with definite ST were assessed by IVUS during the acute ST event. The study was conducted in 15 high-volume percutaneous coronary intervention -centers in the Nordic–Baltic countries.

Results

In early or late ST there were no differences in ISA between DES and BMS. In very late ST, ISA was a more frequent finding in DES than in BMS (52% vs.16%; p = 0.005) and the maximum ISA area was larger in DES compared to BMS (1.1 ± 2.3 mm² vs. 0.1 ± 0.5 mm²; p = 0.004). Further, ISA was more prevalent in sirolimus-eluting than in paclitaxel-eluting stents (58% vs. 37%; p = 0.02). Stent fractures were found both in DES (16%) and BMS (24%); p = 0.28, and not related to time of stent thrombosis occurrence. For stents with nominal diameters ≥ 2.75 mm, 38% of the DES and 22% of the BMS had a minimum stent area of less than 5 mm²; p = 0.14.

Conclusions

Very late stent thrombosis was more prevalent and associated with more extensive ISA in DES than in BMS treated patients. Stent fracture was a common finding in ST after DES and BMS implantation.     

Hypertriglyceridemic waist phenotype and risk of cardiovascular diseases in China: Results from the Kailuan Study

Background

While some case–control studies have showed the correlation between the hypertriglyceridemic waist (HTGW) phenotype (increased WC and hypertriglyceridemia) and cardiovascular disease (CVD) events, there are few data regarding this correlation in cohort studies, especially in Asian populations that have a higher prevalence of central obesity than other populations.

Objective

The aim of this study was to explore the relationship between HTGW phenotype and risk of incident CVD events among men and women in China.

Methods

We analyzed 95,015 participants (18–98 years old) in the Kailuan Study. CVDs developed in 1958 people during follow-up. The cutoffs for defining HTGW phenotype were a waist circumference (WC) of 90 cm or more and a triglyceride level of 2.0 mmol/L or more for men and a WC of 85 cm or more and a triglyceride level of 1.5 mmol/L or more for women. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated from Cox regression models.

Results

Compared with participants who had a normal WC and a normal triglyceride level (NWNT), those with HTGW phenotype had a higher WC, body mass index, prevalence of hypertension and diabetes mellitus; and a lower level of high-density lipoprotein cholesterol. The HTGW group had an unadjusted HR of 1.76 (95% CI = 1.55–1.99) for future CVDs compared with the NWNT group. After adjustment for confounders, the HR still remained significant (HR = 1.24, 95% CI = 1.07–1.44).

Conclusions

HTGW phenotype was associated with the risk of CVDs independently. HTGW phenotype might be a simple but useful tool to screen the individuals at a high risk for future CVDs, and it might be recommended in most clinical practices.     

Genetic variants of membrane metallopeptidase genes in inflammatory bowel diseases

Background

The substance P pathway modulates neuroimmune interactions during intestinal inflammation.

Aims

To analyse mucosal expression and genetic variants of the genes coding for substance P, neurokinin-1 receptor and neutral endopeptidase in patients with inflammatory bowel disease.

Methods

qRT-PCR was used to analyse mRNA levels in matched, paired samples of inflamed colonic mucosa and adjacent non-inflamed endoscopic tissue from 26 Crohn's disease and 25 ulcerative colitis patients. Allele and genotype frequencies of tag-SNPs were determined in 908 Crohn's disease, 929 ulcerative colitis, and 853 controls. Expression levels and genotype distributions were examined within patients’ clinical sub-phenotypes.

Results

All 3 evaluated genes were overexpressed in inflamed tissues from Crohn's disease (P = 0.033, P = 4 × 10⁻⁵, P = 0.001), while in ulcerative colitis only higher levels of the gene coding for neutral endopeptidase were statistically significant (P = 2.5 × 10⁻⁵). Smoking habit and perianal disease were significantly associated with substance P (P = 0.002) and neurokinin-1 receptor levels (P = 0.02) in Crohn's disease. Neutral endopeptidase rs701109 variant was associated with inflammatory bowel disease (Crohn's disease: P = 0.022; ulcerative colitis: P = 0.045), and with the need for colectomy in ulcerative colitis (P = 0.008, OR = 2.46, 95% CI = 1.27–4.76).

Conclusions

Genetic variants of the gene coding for neutral endopeptidase might affect the neuroimmune interaction during intestinal inflammation and influence clinical sub-phenotypes in patients with inflammatory bowel disease.     

Clinical outcomes of patients treated with Nobori biolimus-eluting stent: Meta-analysis of randomized trials

Backgrounds

The Nobori is a new-generation, biodegradable-polymer coated, biolimus-eluting stent (BES) that has recently been investigated in several randomized trials with inconsistent results. The aim of this study was to assess the efficacy and safety of Nobori BES versus other drug-eluting stents (DES) in patients treated with percutaneous coronary intervention (PCI).

Methods

We undertook a meta-analysis of randomized trials investigating Nobori BES versus other DES. Primary efficacy and safety outcomes were target lesion revascularization (TLR) and definite/probable stent thrombosis (ST), respectively. Secondary outcomes were the composite of cardiac death/myocardial infarction (MI)/target vessel revascularization (TVR), MI and death.

Results

A total of 9114 PCI-patients randomly received Nobori BES (n = 5080) or other DES (n = 4034). This latter group comprised patients receiving everolimus- (n = 2533), sirolimus- (n = 1376) or paclitaxel-eluting stents (n = 125). Median follow-up was 11 months [interquartile range 9–12]. The Nobori BES versus other DES showed comparable risk of TLR (odds ratio [95% confidence interval] = 0.91 [0.57–1.46], p = 0.71). There was significant heterogeneity across trials due to significant lower TLR risk with Nobori BES versus paclitaxel-eluting stent (0.32 [0.10–0.98], p = 0.046; p for interaction = 0.009). Nobori BES versus other DES showed comparable risk of definite/probable ST (1.40 [0.66–2.97], p = 0.39), cardiac death/MI/TVR (1.05 [0.88–1.25], p = 0.59), MI (1.13 [0.87–1.48], p = 0.37) and death (1.09 [0.81–1.48], p = 0.56).

Conclusions

Nobori BES has comparable efficacy with other limus-eluting stents at 1-year follow-up. There is no difference in terms of safety profile between these stent platforms.     

Five-year clinical outcome of titanium-nitride-oxide-coated bioactive stents versus paclitaxel-eluting stents in patients with acute myocardial infarction: Long-term follow-up from the TITAX AMI trial

Background

The TITAX-AMI randomized controlled trial demonstrated a better clinical outcome with titanium-nitride-oxide-coated bioactive stents (BAS) as compared with paclitaxel-eluting stents (PES) at 2-year follow-up, in patients with acute myocardial infarction (MI) undergoing early percutaneous coronary intervention (PCI). We sought to present the 5-year clinical outcome of the TITAX-AMI trial.

Methods

A total of 425 patients with acute MI were randomly assigned to receive either BAS (214), or PES (211). The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, recurrent MI or ischemia-driven target lesion revascularization (TLR). Clinical follow-up was performed to 5 years.

Results

The 5-year cumulative incidence of MACE was significantly lower in patients assigned to BAS as compared with those assigned to PES (16.4% versus 25.1%, respectively, p = 0.03). Similarly, the 5-year rates of cardiac death and recurrent MI were significantly lower in patients assigned to BAS (1.9% versus 5.7%, and 8.4% versus 18.0%, p = 0.04 and p = 0.004, respectively). Yet, the rates of ischemia-driven TLR were similar between the two study groups (11.2% versus 10.9%, respectively, p = 0.92). The rate of definite stent thrombosis (ST) was again significantly lower in patients assigned to BAS (0.9% versus 7.1%, respectively, p = 0.001).

Conclusions

In the current prospective randomized TITAX-AMI trial, among patients presenting with acute MI who underwent early PCI, BAS achieved a better clinical outcome as compared with PES at 5-year follow-up, as reflected by lower cumulative rates of overall MACE, cardiac death, recurrent MI, and definite ST; yet, with statistically similar rates of ischemia-driven TLR.