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- Hess, Connie N., et al.
(författare)
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Differential occurrence, profile, and impact of first recurrent cardiovascular events after an acute coronary syndrome
- 2017
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Ingår i: American Heart Journal. - : MOSBY-ELSEVIER. - 0002-8703 .- 1097-6744. ; 187, s. 194-203
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Tidskriftsartikel (refereegranskat)abstract
- Objective Acute coronary syndrome (ACS) trials typically use a composite primary outcome (myocardial infarction [MI], stroke, or cardiovascular death), but differential patient characteristics, timing, and consequences associated with individual component end points as first events have not been well studied. We compared patient characteristics and prognostic significance associated with first cardiovascular events in the post-ACS setting for initially stabilized patients. Methods We combined patient-level data from 4 trials of post-ACS antithrombotic therapies (PLATO, APPRAISE-2, TRACER, and TRILOGY ACS) to characterize the timing of and characteristics associated with first cardiovascular events (MI, stroke, or cardiovascular death). Landmark analysis at 7 days after index ACS presentation was used to focus on spontaneous, postdischarge events that were not confounded by in-hospital procedural complications. Using a competing risk framework, we tested for differential associations between prespecified covariates and the occurrence of nonfatal stroke vs MI as the first event, and we examined subsequent events after the first nonfatal event. Results Among 46,694 patients with a median follow-up of 358 (25th, 75th percentiles 262, 486) days, a first ischemic event occurred in 4,307 patients (9.2%) as follows: MI in 5.8% (n = 2,690), stroke in 1.0% (n = 477), and cardiovascular death in 2.4% (n = 1,140). Older age, prior stroke/transient ischemic attack, prior atrial fibrillation, and higher diastolic blood pressure were associated with a significantly greater risk of stroke vs MI, whereas prior percutaneous coronary intervention was associated with a greater risk of MI vs stroke. Second events occurred in 32% of those with a first nonfatal stroke at a median of 13 (3, 59) days after the first event and in 32% of those with a first nonfatal MI at a median of 35 (5, 137) days after the first event. The most common second event was a recurrent MI among those with MI as the first event and cardiovascular death among those with stroke as the first event. Conclusions Approximately 9% of patients experienced a first cardiovascular event in the post-ACS setting during a median follow-up of 1 year. Although the profile and prognostic implications of stroke vs MI as the first nonfatal event differ substantially, approximately one-third of these patients experienced a second event, typically soon after the first event. These findings have implications for improving post-ACS care and influencing the design of future cardiovascular trials.
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| 2. |
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| 3. |
- Tricoci, Pierluigi, et al.
(författare)
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Effects of genetic variation in protease activated receptor 4 after an acute coronary syndrome : Analysis from the TRACER trial
- 2018
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Ingår i: Blood Cells, Molecules & Diseases. - : Elsevier BV. - 1079-9796 .- 1096-0961. ; 72, s. 37-43
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Tidskriftsartikel (refereegranskat)abstract
- Variation in platelet response to thrombin may affect the safety and efficacy of PAR antagonism. The Thr120 variant of the common single nucleotide polymorphism (SNP) rs773902 in the protease-activated receptor (PAR) 4 gene is associated with higher platelet aggregation compared to the Ala120 variant. We investigated the relationship between the rs773902 SNP with major bleeding and ischemic events, safety, and efficacy of PAR1 inhibition in 6177 NSTE ACS patients in the TRACER trial. There was a lower rate of GUSTO moderate/severe bleeding in patients with the Thr120 variant. The difference was driven by a lower rate in the smaller homozygous group (recessive model, HR 0.13 [0.02-0.92] P= 0.042). No significant differences were observed in the ischemic outcomes. The excess in bleeding observed with PAR1 inhibition was attenuated in patients with the Thr120 variant, but the interactions were not statistically significant. In summary, lower major bleeding rates were observed in the overall TRACER cohort with the hyperreactive PAR4 Thr120 variant. The increase in bleeding with vorapaxar was attenuated with the Thr120 variant, but we could not demonstrate an interaction with PAR1 inhibition. These findings warrant further exploration, including those of African ancestry where the A allele (Thr120) frequency is similar to 65%.
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| 4. |
- Vedin, Ola, et al.
(författare)
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Periodontal disease in patients with chronic coronary heart disease : Prevalence and association with cardiovascular risk factors
- 2015
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:6, s. 771-778
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Tidskriftsartikel (refereegranskat)abstract
- Aim There are reported links between periodontal disease (PD) and cardiovascular (CV) risk but data are lacking, especially from populations with established coronary heart disease (CHD). This study describes self-reported indicators of PD and associations with CV risk factors in a global stable CHD population.Methods and results A total of 15,828 participants in the global STABILITY trial underwent a physical examination, blood sampling, and completed a lifestyle questionnaire. They reported remaining number of teeth (none, 1–14, 15–20, 21–25 or 26–32 (all)) and frequency of gum bleeding (never/rarely, sometimes, often or always). Adjusted linear and logistic regression models assessed associations between tooth loss, gum bleeding, and socioeconomic and CV risk factors.A total of 40.9% of participants had <15 remaining teeth; 16.4% had no teeth; and 25.6% reported gum bleeding with large differences in prevalence among countries, regions and ethnic groups. Less tooth loss was associated with lower levels of glucose, low-density lipoprotein (LDL) cholesterol, systolic blood pressure, waist circumference and hs-CRP; higher estimated glomerular filtration rate; decreased odds for diabetes and smoking, and increased odds for higher education, alcohol consumption and work stress. Gum bleeding was associated with higher LDL cholesterol and systolic blood pressure; decreased odds for smoking, but increased odds for higher education, alcohol consumption and stress.Conclusion Self-reported indicators of PD were common in this chronic CHD population and were associated with an increasing socioeconomic and CV risk factor burden. However, causality between self-reported PD and CV risk and outcome needs further investigation.
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| 5. |
- Vedin, Ola, et al.
(författare)
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Tooth loss is highly prevalent and associated with cardiovascular risk factors in patients with chronic coronary heart disease in the global stability trial
- 2013
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Ingår i: Journal of the American College of Cardiology. - 0735-1097 .- 1558-3597. ; 61:10, s. E1368-E1368
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundSeveral reports have proposed a link between periodontal disease (PD) and coronary heart disease (CHD). However, knowledge regarding PD in patients with established CHD is scarce. Therefore, we investigated the prevalence of self-reported PD and its relation to cardiovascular (CV) risk factors in high-risk patients with CHD participating in the ongoing STABILITY study, a global clinical trial evaluating the lipoprotein phospho-lipase A2 inhibitor darapladib.MethodsAt study baseline, 15,828 study participants from 39 countries reported their remaining number of teeth (none, 1-14, 15-19, 20-25 or 26-32) and frequency of gum bleeds (never/rarely, sometimes, often or always). Data on CV risk factors were also obtained. Statistical analyses were performed using linear and logistic regression, adjusting for age, smoking, diabetes and education.ResultsApproximately 40 % of participants had < 15 teeth and 16 % had no teeth; 25 % of subjects reported gum bleeds. For every decrease in number of teeth category we observed increasing levels of Lp-PLA2 activity (+1.98 mmol/L/min), hs-CRP (+0.07 g/L), LDL cholesterol (+0.015 mmol/L), fasting plasma glucose (+0.015 mmol/L), systolic blood pressure (+0.41 mmHg) and waist circumference (+0.52 cm) (p < 0.0001 for all), as well as a higher probability of having diabetes (odds increasing by 11% for every decrease in number of teeth category), being a current or former smoker vs. being a non-smoker (+39% and +21%, respectively), and having a lower education (p < 0.0001 for all). Gum bleeds were associated with increasing LDL cholesterol and systolic blood pressure, as well as a greater probability of being a non-smoker and having a higher education (p < 0.0001 for all).ConclusionTooth loss was highly prevalent in this global CHD population and was associated with several traditional CV risk factors and inflammatory markers, including the novel Lp-PLA2 activity. Gum bleeding was less common and associations to CV risk factors were less evident compared to tooth loss. These findings require confirmation in large independent populations to elucidate whether PD can be used as a clinically useful risk marker for CHD.
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