1
|
Manolis A, Kallistratos M, Poulimenos L, Thomopoulos C. Anti-ischemic and pleiotropic effects of ranolazine in chronic coronary syndromes. Am J Med Sci 2024; 367:155-159. [PMID: 38072070 DOI: 10.1016/j.amjms.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
The vast majority of antianginal drugs decrease heart rate and or blood pressure levels or the inotropic status of the left ventricle to decrease myocardial oxygen consumption (MVO2) and thus anginal symptoms. Ranolazine presents a completely different mechanism of action, which reduces the sodium-dependent calcium overload inhibiting the late sodium current. Current European Society of Cardiology (ESC) guidelines for the management of angina in patients with chronic coronary symptoms recommend the use of several drugs such as ranolazine, b-blockers, calcium channel blockers, long-acting nitrates, ivabradine, nicorandil and trimetazidine for angina relief. However, ranolazine, in addition to symptom relief properties, is an antianginal drug showing favorable effects in decreasing the arrhythmic burden and in ameliorating the glycemic profile of these patients. In this review, we summarize the available data regarding the antianginal and pleiotropic effects of this drug.
Collapse
Affiliation(s)
- Athanasios Manolis
- Metropolitan General Hospital, 2nd Cardiology Department, Athens, Greece
| | | | | | | |
Collapse
|
2
|
Wu Z, Li M, Liu J, Xie F, Chen Y, Yang S, Li X, Wu Y. Association study of urinary iodine concentrations and coronary artery disease among adults in the USA: National Health and Nutrition Examination Survey 2003-2018. Br J Nutr 2023; 130:2114-2122. [PMID: 37424297 PMCID: PMC10657749 DOI: 10.1017/s0007114523001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023]
Abstract
Iodine is a vital trace element in the human body and is associated with several important coronary artery disease (CAD) risk factors. We aimed to explore the correlation between urinary iodine concentration (UIC) and CAD. Data from 15 793 US adults in the National Health and Nutrition Examination Survey (2003-2018) were analysed. We conducted multivariable logistic regression models and fitted smoothing curves to study the correlation between UIC and CAD. Furthermore, we performed subgroup analysis to investigate possible effect modifiers between them. We found a J-shaped association between UIC and CAD, with an inflection point at Lg UIC = 2·65 μg/l. This result indicated a neutral association (OR 0·89; 95 % CI 0·68, 1·16) between UIC and CAD as Lg UIC < 2·65 μg/l, but the per natural Lg [UIC] increment was OR 2·29; 95 % CI 1·53, 3·43 as Lg UIC ≥ 2·65 μg/l. An interaction between diabetes and UIC might exist. The increase in UIC results in an increase in CAD prevalence (OR 1·84, 95 % CI 1·32, 2·58) in diabetes but results in little to no difference in non-diabetes (OR 0·98, 95 % CI 0·77, 1·25). The J-shaped correlation between UIC and CAD and the interaction between diabetes and UIC should be confirmed in a prospective study with a series of UIC measurements. If excessive iodine precedes CAD, then this new finding could guide clinical practice and prevent iodine deficiency from being overcorrected.
Collapse
Affiliation(s)
- Zhijian Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Meng Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Jiandi Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Feng Xie
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Yang Chen
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Shuai Yang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Xiaozhong Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| | - Yanqing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, 330006Nanchang, Jiangxi, People’s Republic of China
| |
Collapse
|
3
|
Wu Z, Yang W, Li M, Li F, Gong R, Wu Y. Relationship between Dietary Decanoic Acid and Coronary Artery Disease: A Population-Based Cross-Sectional Study. Nutrients 2023; 15:4308. [PMID: 37892384 PMCID: PMC10609701 DOI: 10.3390/nu15204308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a cardiovascular disease with significant personal health and socioeconomic consequences. The biological functions of decanoic acid and the pathogenesis of CAD overlap considerably; however, studies exploring their relationship are limited. METHODS Data from 34,186 Americans from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018 were analyzed. The relationship between dietary decanoic acid (DDA) and CAD prevalence was explored using weighted multivariate logistic regression models, generalized summation models, and fitted smoothing curves. Stratified analyses and interaction tests were conducted to explore the potential modifiers between them. RESULTS DDA was negatively associated with CAD prevalence, with each 1 g/d increase in the DDA being associated with a 21% reduction in CAD prevalence (odds ratio (OR) 0.79, 95% confidence interval (CI) 0.61-1.02). This relationship persisted after log10 and trinomial transformations, respectively. The OR after log10 transformation was 0.81 (95% CI 0.69-0.96), and the OR for tertile 3 compared with tertile 1 was 0.83 (95% CI 0.69-1.00). The subgroup analyses found this relationship to be significant among males and non-Hispanic white individuals, and there was a significant interaction (interaction p-values of 0.011 and 0.012, respectively). CONCLUSIONS DDA was negatively associated with the prevalence of CAD, and both sex and race may modify this relationship.
Collapse
Affiliation(s)
- Zhijian Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China; (Z.W.); (R.G.)
| | - Weichang Yang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China;
| | - Meng Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China; (Z.W.); (R.G.)
| | - Fengyuan Li
- Department of Respiratory Medicine, Nanchang First Hospital, Nanchang 330006, China;
| | - Ren Gong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China; (Z.W.); (R.G.)
| | - Yanqing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China; (Z.W.); (R.G.)
| |
Collapse
|
4
|
Fadah K, Hechanova A, Mukherjee D. Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly. Int J Angiol 2022; 31:244-250. [PMID: 36588871 PMCID: PMC9803549 DOI: 10.1055/s-0042-1751234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Elderly patients over the age of ≥ 75 years are especially susceptible to coronary artery disease (CAD) as age is an important nonmodifiable risk factors for atherosclerosis and a predictor of poorer outcomes. In fact, CAD is a major cause of mortality and morbidity in this population. Due to concerns of functional frailty, comorbidities, and patient preference of conservative to no treatment have played a role in reducing the interest in pursuing prospective studies in this high-risk group. In this review, we provide an overview of the epidemiology, pathophysiology, and management of CAD in older adults.
Collapse
Affiliation(s)
- Kahtan Fadah
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Aimee Hechanova
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| |
Collapse
|
5
|
Efficacy of coronary sinus Reducer in patients with refractory angina and diabetes mellitus. Heart Vessels 2021; 37:194-199. [PMID: 34374824 DOI: 10.1007/s00380-021-01909-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Coronary sinus Reducer (CSR) implantation is currently recommended to relieve angina in patients with refractory symptoms despite optimal medical therapy and maximally achievable revascularization. The impact of diabetes mellitus on outcome after CSR implantation is at present unknown. We aimed to explore the impact of CSR in refractory angina patients with diabetes mellitus. Data from consecutive patients undergoing CSR implantation at four different centres between 2014 and 2018 were included. Patients were divided according to the presence or absence of diabetes mellitus. Primary objective of this analysis was to evaluate the clinical response to CSR implantation defined as an improvement of ≥ 1 classes of the Canadian Cardiovascular Society (CCS) Classification. A total of 219 patients were included, 116 (53%) of whom had diabetes mellitus. The median age of the population was 69 years and 167 patients (76%) were male. There were no significant differences between groups of patients with and without diabetes mellitus with respect to CCS class at baseline (p value = 0.32) and at follow-up (p = 0.75). Over a median follow-up of 393 [224-1004] days, 84 (72%) of the patients with diabetes mellitus met the primary outcome, similarly to those without diabetes mellitus (p = 0.28). Fifty-three patients (24%) did not have an improvement in CCS class and no one experienced worsening of angina. CSR implantation was equally effective in improving angina symptoms among patients with refractory angina and diabetes mellitus compared to patients without diabetes mellitus.
Collapse
|
6
|
Prevalence of angina and use of medical therapy among US adults: A nationally representative estimate. Am Heart J 2020; 228:44-46. [PMID: 32771699 DOI: 10.1016/j.ahj.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022]
Abstract
Recent results from the ISCHEMIA trial highlight the importance of medical management for patients with stable ischemic heart disease. We determine the prevalence of angina in the United States, as well as the use of first-line goal directed therapy by US patients with angina. We used individual patient level data from the National Health and Nutrition Examination Survey (NHANES), 2007-2016. Using the complex survey weights, we create projections for the US population with angina as well as those using β-blockers, antiplatelet agents, or statins-3 first-line medications for patients with angina. Among adults ≥40 years old, 4,469,934 US adults are estimated to have physician-diagnosed angina. Of the patients with angina, 2,757,171 (61.7%) were on β-blockers, 2,984,902 (66.8%) were on statins, and 2,433,088 (54.4%) were on any antiplatelet medication; 1,457,983 patients were on all 3 medications, for an overall proportion of 32.6% of angina patients taking all three first-line medications in the United States. While the prevalence of angina in the US is high, the use of goal-directed medical therapy remains low. Strategies to improve the use of medications for preventing secondary events are urgently needed.
Collapse
|
7
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4685] [Impact Index Per Article: 1171.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
8
|
Mathenge N, Fan W, Wong ND, Hirsch C, Delaney C(J, Amsterdam EA, Koch B, Calara R, Gardin JM. Pre-diabetes, diabetes and predictors of incident angina among older women and men in the Cardiovascular Health Study. Diab Vasc Dis Res 2020; 17:1479164119888476. [PMID: 31778070 PMCID: PMC7510359 DOI: 10.1177/1479164119888476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus and angina pectoris are important conditions in older persons. The utility of pre-diabetes mellitus, diabetes mellitus and other risk factors as predictors of incident angina pectoris among older adults has not been characterized. We examined incident angina pectoris rates by sex and diabetes mellitus status in 4511 adults aged ⩾65 years without coronary heart disease at baseline from the Cardiovascular Health Study. Cox regression examined predictors of incident angina pectoris, including pre-diabetes mellitus or diabetes mellitus adjusted for sociodemographic characteristics and other risk factors, over 12.2 ± 6.9 years of follow-up. Overall, 39.1% of participants had pre-diabetes mellitus, 14.0% had diabetes mellitus and 532 (11.8%) had incident angina pectoris. Incident angina pectoris rates per 1000 person-years in those with neither condition, pre-diabetes mellitus, and diabetes mellitus were 7.9, 9.0 and 12.3 in women and 10.3, 11.2 and 14.5 in men, respectively. Pre-diabetes mellitus and diabetes mellitus were not independently associated with incident AP; however, key predictors of AP were male sex, low-density lipoprotein-cholesterol, triglycerides, systolic blood pressure, antihypertensive medication and difficulty performing at least one instrumental activity of daily living (all p < 0.05 to p < 0.01). In our cohort of older adult participants, while the incidence of AP is greater in those with diabetes mellitus, neither diabetes mellitus nor pre-diabetes mellitus independently predicted incident angina pectoris.
Collapse
Affiliation(s)
- Njambi Mathenge
- Division of Cardiology, Massachusetts
General Hospital, Boston, MA, USA
| | - Wenjun Fan
- Division of Cardiology, School of
Medicine, University of California, Irvine, Irvine, CA, USA
| | - Nathan D Wong
- Division of Cardiology, School of
Medicine, University of California, Irvine, Irvine, CA, USA
| | - Calvin Hirsch
- Division of Cardiovascular Medicine,
School of Medicine, University of California, Davis, Davis, CA, USA
| | | | - Ezra A Amsterdam
- Division of Cardiovascular Medicine,
School of Medicine, University of California, Davis, Davis, CA, USA
| | - Bruce Koch
- Medical Affairs, Gilead Sciences, Foster
City, CA, USA
| | - Rico Calara
- Medical Affairs, Gilead Sciences, Foster
City, CA, USA
| | - Julius M Gardin
- Division of Cardiology, Department of
Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
- Julius M Gardin, Division of Cardiology,
Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange
Avenue, Room I-510, Newark, NJ 07103, USA.
| |
Collapse
|
9
|
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5190] [Impact Index Per Article: 1038.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
10
|
Characteristics, treatment and quality of life of stable coronary artery disease patients with or without angina: Insights from the START study. PLoS One 2018; 13:e0199770. [PMID: 30001355 PMCID: PMC6042700 DOI: 10.1371/journal.pone.0199770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/13/2018] [Indexed: 01/09/2023] Open
Abstract
Data on contemporary management patterns of angina in patients with stable coronary artery disease (CAD) are scarce. We sought to describe the current presentation, management, and quality of life of stable CAD patients with or without angina, using the data from the START (STable Coronary Artery Diseases RegisTry) study. START was a prospective, observational, nationwide study aimed to evaluate the presentation, management, treatment and quality of life of stable CAD presenting to cardiologists during outpatient visits or discharged from cardiology wards. Among the 5070 consecutive stable CAD patients enrolled in 183 participating centers over a 3-month period, 3714 (73.2%) had no angina and 1356 (26.8%) presented with angina. Patients with angina underwent more frequently coronary angiography (92.7% vs 84.9%; p<0.0001) and other diagnostic imaging procedures compared to those without angina. In addition, patients with angina received more frequently different combinations of first line therapies and angina relief drugs compared to patients without angina. The quality of life, assessed with the EQ 5D-5L questionnaire, did not differ between the two groups, with the exception of the 'pain or worry' domain that was higher in patients with compared to those without angina (p<0.0001). Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina. Our findings highlight the need for disseminating best-practice patterns and improving guidelines adherence for the management of angina even among cardiologists.
Collapse
|
11
|
Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4425] [Impact Index Per Article: 737.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
12
|
Fanaroff AC, James SK, Weisz G, Prather K, Anstrom KJ, Mark DB, Ben-Yehuda O, Alexander KP, Stone GW, Ohman EM. Ranolazine After Incomplete Percutaneous Coronary Revascularization in Patients With Versus Without Diabetes Mellitus: RIVER-PCI Trial. J Am Coll Cardiol 2017; 69:2304-2313. [PMID: 28473136 DOI: 10.1016/j.jacc.2017.02.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic angina is more common in patients with diabetes mellitus (DM) with poor glucose control. Ranolazine both treats chronic angina and improves glucose control. OBJECTIVES This study sought to examine ranolazine's antianginal effect in relation to glucose control. METHODS The authors performed a secondary analysis of the RIVER-PCI (Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention) trial, a clinical trial in which 2,604 patients with chronic angina and incomplete revascularization following percutaneous coronary intervention were randomized to ranolazine versus placebo. Mixed-effects models were used to compare the effects of ranolazine versus placebo on glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-up. Interaction between baseline HbA1c and ranolazine's effect on Seattle Angina Questionnaire angina frequency at 6 and 12 months was tested. RESULTS Overall, 961 patients (36.9%) had DM at baseline. Compared with placebo, ranolazine significantly decreased HbA1c by 0.42 ± 0.08% (adjusted mean difference ± SE) and 0.44 ± 0.08% from baseline to 6 and 12 months, respectively, in DM patients, and by 0.19 ± 0.02% and 0.20 ± 0.02% at 6 and 12 months, respectively, in non-DM patients. Compared with placebo, ranolazine significantly reduced Seattle Angina Questionnaire angina frequency at 6 months among DM patients but not at 12 months. The reductions in angina frequency were numerically greater among patients with baseline HbA1c ≥7.5% than those with HbA1c <7.5% (interaction p = 0.07). CONCLUSIONS In patients with DM and chronic angina with incomplete revascularization after percutaneous coronary intervention, ranolazine's effect on glucose control and angina at 6 months was proportionate to baseline HbA1c, but the effect on angina dissipated by 12 months.
Collapse
Affiliation(s)
- Alexander C Fanaroff
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Stefan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Giora Weisz
- Division of Cardiology, Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Kristi Prather
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Daniel B Mark
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Karen P Alexander
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
| | - Gregg W Stone
- Division of Cardiology, Columbia University, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - E Magnus Ohman
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
13
|
Bakhshi M, Rezaei R, Baharvand M, Bakhtiari S. Frequency of craniofacial pain in patients with ischemic heart disease. J Clin Exp Dent 2017; 9:e91-e95. [PMID: 28149470 PMCID: PMC5268115 DOI: 10.4317/jced.53078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Referred craniofacial pain of cardiac origin might be the only symptom of ischemic heart accidents. This study aimed to determine the frequency of craniofacial pain in patients with ischemic heart disease. Material and Methods This cross-sectional study was accomplished on 296 patients who met the criteria of having ischemic heart disease. Data regarding demographics, medical history and referred craniofacial pain were recorded in data forms. In addition, patients underwent oral examination to preclude any source of dental origin. Chi-square test, Student’s t-test and backward regression model were used to analyze the data by means of SPSS software version 21. P<0.05 was considered significant. Results A total of 296 patients were studied comprising of 211 men (71%) and 85 women (29%) with the mean age of 55.8. Craniofacial pain was experienced by 53 patients out of 296, 35 (66%) of whom were male and 18 (34%) were female. None of the patients experienced craniofacial pain solely. The most common sites of craniofacial pain were occipital and posterior neck (52.8%), head (43.3%), throat and anterior neck (41.5%) respectively. We found no relationship between craniofacial pain of cardiac origin with age, diabetes, hypertension, and family history. On the other hand, there was a significant relationship between hyperlipidemia and smoking with craniofacial pain of cardiac origin. Conclusions Radiating pain to face and head can be expected quite commonly during a cardiac ischemic event. Dental practitioners should be thoroughly aware of this symptomatology to prevent misdirected dental treatment and delay of medical care. Key words:Craniofacial pain, ischemic heart disease, myocardial infarction, angina pectoris, referred pain.
Collapse
Affiliation(s)
- Mahin Bakhshi
- Associate Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Rezaei
- Resident of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Bakhtiari
- Associate Professor, Dept. of Oral Medicine, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Methanolic seed extract of Vitis vinifera ameliorates oxidative stress, inflammation and ATPase dysfunction in infarcted and non-infarcted heart of streptozotocin-nicotinamide induced male diabetic rats. Int J Cardiol 2016; 222:850-865. [PMID: 27522389 DOI: 10.1016/j.ijcard.2016.07.250] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 07/21/2016] [Accepted: 07/30/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We hypothesized that consumption of Vitis vinifera seed by diabetics could help to ameliorate myocardial damage. Therefore, in this study, we investigated effects of V. vinifera seed methanolic extract (VVSME) on parameters related to myocardial damage in diabetes with or without myocardial infarction (MI). METHODS Streptozotocin-nicotinamide induced diabetic rats received oral VVSME for 28days. MI was induced by intraperitoneal injection of isoproterenol on last two days. Prior to sacrifice, blood was collected and fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile and insulin levels were measured. Levels of serum cardiac injury marker (troponin-I and CK-MB) were determined and histopathological changes in the heart were observed following harvesting. Levels of oxidative stress (LPO, SOD, CAT, GPx and RAGE), inflammation (NF-κB, TNF-α, IL-1β and IL-6) and cardiac ATPases (Na(+)/K(+)-ATPase and Ca(2+)-ATPase) were determined in heart homogenates. LC-MS was used to identify constituents in the extracts. RESULTS Consumption of VVSME by diabetic rats with or without MI improved the metabolic profiles while decreased the cardiac injury marker levels with lesser myocardial damage observed. Additionally, VVSME consumption reduced the levels of LPO, RAGE, TNF-α, Iκκβ, NF-κβ, IL-1β and IL-6 while increased the levels of SOD, CAT, GPx, Na(+)/K(+)-ATPase and Ca(2+)-ATPase in the infarcted and non-infarcted heart of diabetic rats (p<0.05). LC-MS analysis revealed 17 major compounds in VVSME which might be responsible for the observed effects. CONCLUSIONS Consumption of VVSME by diabetics helps to ameliorate damage to the infarcted and non-infarcted myocardium by decreasing oxidative stress, inflammation and cardiac ATPases dysfunctions.
Collapse
|