Archives of Medical Sciences. Atherosclerotic Diseases最新文献

Anticoagulation and antiplatelet therapy are individually mainstays of treatment for multiple cardiovascular conditions. Antiplatelet therapy, most commonly with dual agents, is vital in the setting of coronary artery disease with acute coronary syndrome requiring percutaneous coronary intervention to prevent in-stent complications. A multitude of cardiovascular conditions with increased thromboembolic risk also require anticoagulation, including atrial fibrillation, venous or arterial thrombosis, and prosthetic heart valves to name a few. There is often an overlap in comorbidities as our patient population ages and becomes more complex, frequently necessitating a combination of both anticoagulation and antiplatelet agents, known as "triple therapy". To reduce or treat thromboembolic disease states as well as reduce platelet aggregation for coronary stent protection, many patients are placed at an increased bleeding risk without compelling evidence of reduction in major adverse cardiac events. With this comprehensive review of the existing literature, we aim to analyse different strategies and durations of triple therapy medication regimens.

Introduction: The presence of chronic obstructive pulmonary disease (COPD) can impact the management of acute myocardial infarction (AMI) and is associated with higher mortality. Few studies addressed COPD impact on heart failure hospitalisations (HFHs) in AMI survivors.

Material and methods: Adult survivors of an AMI between January and June 2014 were identified from the US Nationwide Readmissions Database. The impact of COPD on HFH within 6 months, fatal HFH and the composite of in-hospital HF or 6-month HFH was studied.

Results: Of 237,549 AMI survivors, patients with COPD (17.5%) were older, more likely female, had a higher prevalence of cardiac comorbidities and a lower coronary revascularization rate. In-hospital HF was more frequent in patients with COPD (47.0% vs. 25.4%; p < 0.001). HFH within 6 months occured in 12,934 (5.4%) patients, at a 114% higher rate in patients with COPD (9.4% vs. 4.6%, OR = 2.14, 95% CI : 2.01-2.29; p < 0.001), which was attenuated to a 39% higher adjusted risk (OR = 1.39, 95% CI: 1.30-1.49). Findings were consistent across subgroups of age, AMI type, and major HF risk factors. Mortality during a HFH (5.7% vs. 4.2%, p < 0.001) and the rate of the composite HF outcome (49.0% vs. 26.9%, p < 0.001) were significantly higher in patients with COPD.

Conclusions: COPD was present in 1 of 6 AMI survivors and was associated with worse HF related outcomes. The increased HFH rate in COPD patients was consistent across several clinically relevant subgroups and these findings highlight the need for optimal in-hospital and post-discharge management of these higher-risk patients.

Obstructive sleep apnoea (OSA) is the most common form of abnormal sleep pattern (ASP). It is characterized by narrowing of the upper airways (complete or partial) during sleep. Although continuous positive airway pressure is recognized as the gold standard treatment of OSA, unfortunately treatment adherence is often suboptimal and does not address the pathophysiological mechanisms governing its pathogenesis. Weight gain is an important risk factor for the development and worsening of OSA both in adults and in children. Meaningful and sustained weight reduction using lifestyle modifications alone remains difficult and challenging. Novel therapeutic strategies are vital because currently there are no approved pharmacological therapies. This paper explores thoroughly both preclinical and clinical studies that investigated the possible role of GLP-1 receptor agonists and SGLT-2 inhibitors in individuals with ASP and especially OSA. It also discusses their future role in order to ameliorate the global burden of OSA.

Introduction: Although patients with myocardial infarction (MI) history exhibit individual differences, several psychological problems can be observed in these patients. The present study aimed to investigate the correlation between defence mechanisms and other clinical and sociodemographic data in the early period in patients with MI history.

Material and methods: Sixty patients diagnosed with MI and hospitalized in the cardiology department were included in the study. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Defence Styles Questionnaire (DSQ) were applied.

Results: It was determined that the mean BDI score of the participants was 15.9 ±11.2, and the mean BAI score was 15.98 ±10.9. There was a positive correlation between the depression and immature defence mechanism scores of the patients, and there was a negative correlation between the depression and mature defence mechanism scores of the patients (p = 0.001, r = 0.412; p = 0.005, r = -0.359). A negative correlation was determined between anxiety scores and mature defence mechanism scores (p = 0.002, r = -0. 397).

Conclusions: The findings demonstrated that depressive complaints of the post-MI patients increased as the immature defence mechanism score increased, and depressive complaints decreased as the maturity defence mechanism score increased. The correlation between the defence mechanisms adopted by MI patients and depression and anxiety symptoms should not be neglected.

The coronavirus disease 2019 (COVID-19) pandemic affected everyone's life and especially those with chronic conditions, such as diabetes. Therefore, the need for medical care in such populations resulted in identification of new models of health care avoiding physical consultation and reducing the risk of COVID-19 transmission, giving emphasis to telemedicine. There is an increasing amount of studies showing the beneficial impact of the use of telemedicine in patients with type 1 diabetes, while for patients with type 2 diabetes the existing data are limited and conflicting. Therefore, the aim of the present review is to summarize the existing literature data on the impact of telemedicine on the follow-up of patients with diabetes during the pandemic as well as its place in the management of patients with diabetes in the future.

Introduction: Coronary artery ectasia (CAE) is localized or diffuse enlargement of the coronary artery more than 1.5 times in diameter in comparison with the adjacent normal coronary artery. The etiology and pathophysiology of CAE are not fully elucidated. Resistin is a newly identified adipocyte secreted hormone belonging to a cysteine-rich protein family. Recently it has been found to be relevant to inflammation-related disease and correlated with serum C-reactive protein (CRP). This research aimed to investigate whether the resistin level has a role in CAE etiopathogenesis.

Material and methods: A hundred and three patients with diagnosis of CAE and 122 with normal coronary anatomy (NCA) were included. Details of baseline clinical characteristics and angiographic findings were recorded. Other necessary biochemical parameters were measured with an autoanalyzer. Blood was collected and stored for serum resistin level analysis.

Results: Serum resistin levels in CAE were higher than in the NCA group and were statistically significant (p = 0.001). Hypertension (OR = 1.006, 95% CI: 1.002-1.008, p = 0.025), tobacco use (OR = 1.089, 95% CI: 1.055-1.124, p < 0.001), serum resistin levels (OR = 2.431, 95% CI: 1.100-4.696, p = 0.01), hyperlipidemia (OR = 1.005, 95% CI: 1.000-1.014, p = 0.004), triglyceride (OR = 1.006, 95% CI: 1.001-1.010, p = 0.012) remained as independent factors for CAE. In the subgroup analysis of the CAE group, in patients with ectasia in three coronary arteries, resistin levels were significantly higher and statistically significant (p = 0.001). In ROC analysis, the sensitivity of serum resistin was 67.6% and specificity was 86.7% (AUC = 0.749, 95% CI: 0.621-0.877, p = 0.0001).

Conclusions: Serum resistin level was significantly higher in CAE. In addition this study showed that serum resistin levels are directly proportional to the number of coronary arteries with ectasia. We think that this study will shed light on this subject and encourage further studies in this field.

Introduction: Acute coronary syndrome represents a major cause of mortality throughout the world. To date, there are only a few reports of ST-segment elevation type 1 myocardial infarction in patients with COVID-19. The aim of this study was to describe the clinical and angiographic characteristics alongside the prediction of in-hospital mortality using the GRACE risk score in this group.

Material and methods: This was a single-center, retrospective study of consecutive patients admitted to a multi-specialist hospital with confirmed ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention. Demographic, clinical and angiographic characteristics were compared between survivors and non-survivors.

Results: Twenty-five patients, of whom 23 (92%) were men, with confirmed STEMI and COVID-19, with a median age of 70 years and high comorbidity burden, were included in this study. They were treated with percutaneous coronary intervention and 12 (48%) of them died. Non-survivors had elevated high-sensitivity C-reactive protein (hsCRP) (p = 0.026) and D-dimer (p = 0.042) and reduced left ventricular ejection fraction (30 ±9 vs. 41 ±7; p = 0.003). Postprocedural TIMI 3 flow grade was less frequently observed in this group (p = 0.039). There was a higher GRACE score in the non-survivor group (mean ± SD; 210 ±35 vs. 169 ±42, p = 0.014). In ROC analysis, GRACE score predicted in-hospital death with an AUC of 0.788 (95% CI: 0.6-0.98, p = 0.014). A score of 176 was identified as the optimal cut-off with a sensitivity of 92% and specificity of 69%.

Conclusions: The GRACE risk score is a good predictor of in-hospital mortality in patients presenting with STEMI with concomitant COVID-19.

Introduction: Obstructive sleep apnea (OSA) can cause several cardiovascular changes that increase the risk of various complications such as acute myocardial infarction (AMI) and acute ischemic stroke (AIS).

Material and methods: We used the 2019 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP), the Agency for Healthcare Research and Quality (AHRQ), and their many collaborators to study the differences in characteristics and outcomes of OSA patients following AMI or AIS and the presence of several cardiac arrhythmias and their associated mortality risks.

Results: A lower mortality rate was seen among OSA patients with AIS (2.5% compared to 3.8% in non-OSA), and AMI (2.8% compared to 4.7% in non-OSA). OSA patients with AIS had a higher risk of dying if they were aged 66 or over, of Hispanic origin, or if they reported ventricular tachycardia, or paroxysmal atrial fibrillation. For those with OSA and admitted for AMI, they were more at risk of dying if they were aged 66 or over, not classified as "White, Black, or Hispanic", with a history of diabetes, reported ventricular tachycardia, or ventricular fibrillation. Lower adjusted odds ratios were noted among OSA patients with hypertension in both AMI and AIS cases.

Conclusions: Further studies comparing these characteristics based on the severity of OSA are therefore encouraged.

Alcohol has been drunk for centuries and in the past also used as a medicine. Alcohol consumption in Poland and in the entire world has gradually increased, which is also nowadays accelerated by the ongoing COVID-19 pandemic. In 2020, the amount of alcohol consumed in Poland was 11.7 l per capita, which was a the highest level since 1961. It is estimated that global alcohol consumption will increase by 17% by the year 2030. There is also increasing alcohol consumption by children and adolescents, as well as pregnant women. Alcohol consumption as a health damaging factor is not always recognized in the general population. Additionally, numerous scientific societies in their guidelines/recommendations indicate that moderate doses of alcohol are beneficial or at least neutral for health. The question remains whether so-called "moderate doses of alcohol" really are not harmful to health. We analyze this issue in this article.