Minerva cardiology and angiology最新文献

Introduction: To assess how gender disparities impact major adverse cardiovascular events during hospitalization, as well as in the short and long term, among patients with ST-elevation myocardial infarction who undergo primary PCI.

Evidence acquisition: PubMed, Scopus and Cochrane database were searched for relevant studies. Studies were included if all comers with STEMI, reported gender specific patient characteristics, treatments and outcomes. Odds ratio and 95% confidence interval were calculated using random effect model.

Evidence synthesis: A total of 23 studies were included for the pooled meta-analysis. Average age of female at presentation was 68.61±3.91 years while in male was 60.83±2.48 years. In unadjusted analysis, female patients were at higher risk for mortality (OR=1.98, 95% CI: 1.71-2.30, P<0.0001, I²=35%) at hospitalization, (OR=2.25, 95% CI=1.75-2.88, P≤0.00001) at short term and (OR=1.76, 95% CI: 1.41-2.21, P<0.000, I²=68%) at long term. The adjusted analysis of major adverse cardiovascular events for short term (OR=1.09, 95% CI: 0.91-1.31, P=0.37, I²=76%) and long term (OR=1.05, 95% CI: 0.98-1.12, P=0.17, I²=37%) were not found significant between both genders. However, it remained significant during hospitalization (OR=1.12, 95% CI: 1.03-1.22, I²=15%, Tau²=0.00).

Conclusions: The findings of this comprehensive meta-analysis indicate higher major adverse cardiac events among women with STEMI who underwent PPCI. After adjusting for comorbidities, the difference between women and men showed insignificant at short term and long term but remained significant at in-hospital. Female patients exhibited a higher prevalence of cardiovascular risk factors than men. Implementing intensive cardiovascular risk reduction strategies in women may offer a pathway to address this gender disparity.

Background: Hypertension, prevalent among one-third of US adults, significantly increases the risk of cardiovascular and non-cardiovascular disease and mortality. This study seeks to analyze hypertension mortality patterns and regional disparities among adult patients in the USA.

Methods: Data was sourced from the CDC WONDER database, with hypertension identification based on ICD-10 Codes I10-13 and I15. Both crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 individuals were determined. Using joinpoint regression analysis, annual percentage changes (APC) in AAMR were calculated.

Results: Between 1999 and 2020, hypertensive diseases claimed the lives of 1,479,884 individuals (AAMR: 20.2 per 100,000). An upward trajectory was observed, with the lowest AAMR in 1999 (15.8) and the highest in 2020 (29.1). Men exhibited higher AAMR (21.8) compared to women (18.4). Notably, NH Blacks displayed a remarkably high AAMR of 44.4, whereas other racial groups had similar rates. The Southern region displayed the highest AAMR (22.5), followed by the Western region (20.9). Urban areas demonstrated higher death rates (20.6) than rural areas (18.43). Almost all age-groups witnessed escalating mortality rates from hypertensive diseases, with the highest AAMR seen in individuals aged ≥85 (478.5), followed by the 74-84 age group (112.7).

Conclusions: There was a noticeable rise in hypertension mortality rates in the USA. Major risk factors included being male, residing in the South, identifying as NH Black, living in urban areas, and being aged ≥85. The high economic burden highlights the need to develop strategies to alleviate the burden of hypertensive diseases in high-risk populations.

Background: This study examined trends and disparities in USA mortality rates associated with the co-occurrence of coronary artery disease (CAD) and dyslipidemia from 1999-2020.

Methods: Data were obtained from the multiple cause of death files using CDC WONDER, spanning 1999-2020. ICD-10 codes (I20-I25 for CAD and E78 for dyslipidemia) identified CAD and dyslipidemia-related deaths in adults aged 25 and older. Statistical analyses examined demographic and regional mortality distributions. Joinpoint regression analysis determined trends in age-adjusted mortality rates (AAMR), estimating annual percentage changes (APC).

Results: Between 1999 and 2020, 613,969 CAD and dyslipidemia-related deaths occurred in the USA. The AAMR per 100,000 increased from 6.2 in 1999 to 19.0 in 2020. The AAMR rose sharply from 1999-2005 (APC: 10.2; 95% CI: 9.1, 11.3), increased from 2005-2010 (APC: 3.3; 95% CI: 2.6, 5.0), stabilized through 2010-2016 (APC: 0.8; 95% CI: -0.5, 1.4), and increased again from 2016-2019 (APC: 3.0; 95% CI: 1.7, 4.7). Men accounted for 59.8% of deaths, with an AAMR of 18.2, compared to 8.7 for women. Non-Hispanic (NH) American Indian (13.4) and NH white populations (13.3) had the highest AAMRs, followed by NH black or African American (12), Hispanic or Latino (9.8), and NH Asian or Pacific Islanders (9.1). The Midwest had the highest AAMR (14.1), followed by the West (13.8), South (12.2), and Northeast (11.3). Nonmetropolitan areas had higher AAMRs (14.7) compared to metropolitan areas (12.4).

Conclusions: Mortality due to concurrent CAD and dyslipidemia is increasing. Targeted interventions are needed to reduce mortality among vulnerable groups.

The burden of cardiovascular disease (CVD) remains a worldwide challenge. CVDs, in particular atherosclerotic CVD, are still an important cause of mortality and morbidity. The increase in life expectancy is a further determining factor in the epidemiology of CVDs in some countries, such as Italy, which increases the urgency of intervening on modifiable risk factors. Among these, hypercholesterolemia is present in a significant percentage of CVD patients. A linear relationship between the risk of acute events and the plasma level of low-density lipoproteins cholesterol (LDL-C) is well known. The reduction of LDL-C levels leads to a decrease in mortality and morbidity. The overall recommendation is to treat hypercholesterolemia intensively and as early as possible. Statins, ezetimibe, bempedoic acid, pro-protein convertase subtilisin/kexin 9 inhibitors (i.e., the monoclonal antibodies alirocumab and evolocumab, or the small interfering RNA inclisiran) are all available for reaching LDL-C targets according to risk profile. While the real-world data confirm the safety of currently recommended LDL-C targets, data on their actual achievement are discouraging, less than half of patients on therapy reach the LDL-C targets recommended by the most recent ESC/EAS Guidelines. The causes of this critical discrepancy are multiple, arising from the various components that characterize the complex relationship between patient and physician within the healthcare system. A call to action is needed. Doctors should be continuously updated on the latest evidence, follow recommendations and engage the patient in the therapeutic process. Regular monitoring of the effects of the prescribed therapy, also through e-health and telemedicine tools, is essential, as well as changing therapy when LDL-C is not adequately controlled. Finally, health systems should align with guidelines and promote good clinical practices, overcoming a silo system, to impact outcomes in terms of overall sustainability.

Introduction: This meta-analysis seeks to evaluate the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA) in individuals with chronic kidney disease (CKD), end-stage renal disease (ESRD), and undergoing hemodialysis (HD) who also have atrial fibrillation (AF).

Evidence acquisition: A comprehensive search of MEDLINE, clinicaltrials.gov, EMBASE, and Cochrane Database for relevant studies reporting the usefulness of OAC therapy for CKD, ESRD, and HD patients with AF was conducted from its inception until 1^st May 2023. The studies that reported OR, RR, or HR for adult AF patients to investigate the efficacy of OAC in CKD, ESRD, and HD were included. Statistical analysis was completed using a generic inverse variance and random-effects model to calculate the combined HR and their corresponding 95% CIs for all outcomes.

Evidence synthesis: The meta-analysis included 33 studies with 178,956 patients. The analysis revealed that the DOACs, when compared to VKA, significantly lowered the risk of stroke or systemic embolism (HR: 0.81 [95% CI: 0.70, 0.93]; P=0.002; I²=62%), bleeding (HR: 0.77, [95% CI: 0.67, 0.89]; P=0.0003; I²=83%), and intracranial hemorrhage (HR: 0.56, [95% CI 0.47, 0.66]; P<0.00001; I²=0%). Similarly, the risks of cardiovascular death (HR: 0.88, [95% CI 0.78, 1.00]; P=0.05; I²=0%), all-cause mortality (HR: 0.88, [95% CI 0.70, 1.10]; P=0.25; I²=96%), and myocardial infarction (HR: 0.80, [95% CI 0.54, 1.17]; P= 0.25; I²= 0%) were lowered by DOAC, but the result was insignificant. No significant difference was seen in the risk of gastrointestinal bleeding between DOAC and VKA as well (HR: 0.95, [95% CI 0.75, 1.20]; P=0.65; I²=83%).

Conclusions: Our meta-analysis confirms that DOACs are effective for managing AF in patients with kidney disease, with potential clinical implications for AF and CKD management. Further research should explore DOACs' reno-protective effects.

Background: The aim of this study is to investigate the effect of hyperuricemia on prognosis of drug-eluting stent implantation for coronary bifurcated lesions and the value of uric acid levels in predicting the prognosis.

Methods: Patients with coronary bifurcation lesions treated with drug-eluting stent implantation were retrospectively enrolled. The clinical, interventional and follow-up data were analyzed.

Results: Totally, 308 patients were enrolled and were divided into three groups according to the uric acid levels: group Q1 (N.=105), Q2 (N.=101), and Q3 (N.=102). Before PCI, the stenosis rate was 0.85 (0.80, 0.90) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. After PCI and stent deployment, the arterial stenosis rate was 0.20 (0.20, 0.20) for the main coronary artery and 0.50 (0.50, 0.50) for the branch artery. At 36-month follow-up, seven patients died of different reasons, with five patients in group Q1, one in group Q2, and one in group Q3, 96 patients were readmitted for treatment of angina pectoris, with 18 in Q1 group, 29 in Q2 group, and 49 in Q3 group. Twenty-seven patients experienced revascularization because of deterioration of the condition, including six patients in group Q1, seven in group Q2, and 14 in group Q3. After correction of the confounding factors, the readmission rate of angina pectoris was significantly (P<0.001) increased with the increase of the uric acid level: Q3 vs. Q1 (220.47/1000 vs. 66.69/1000 person years, HR 3.65, 95% CI 1.92-6.96) and Q2 vs. Q1 (113.76/1000 vs. 66.69/1000 person years, HR 2.20,95% CI 1.16-4.18).

Conclusions: Increased uric acid level is an independent risk factor for cardiogenic readmission rather than for all-cause mortality and revascularization after drug-eluting stent implantation for patients with coronary bifurcation lesions.