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Optimal Control of all Modifiable Vascular Risk Factors Among Patients With Atherosclerotic Disease. A Real-Life Study. Curr Probl Cardiol 2023; 48:101530. [PMID: 36481390 DOI: 10.1016/j.cpcardiol.2022.101530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
The effects of maintaining all classical, vascular risk factors on target among patients with stabilized atherosclerotic cardiovascular disease (ASCVD) are uncertain. Factores de Riesgo y ENfermedad Arterial (FRENA) was a prospective registry of consecutive outpatients with coronary, cerebrovascular, or peripheral artery disease. We analyzed the incidence of recurrent events and mortality according to sustained, optimal control of principal risk factors including the following: LDL cholesterol, glucose, blood pressure, and smoking. As of December 2018, 4285 stable outpatients were eligible for this study. Over a median follow-up of 21 months, 664 (15%) maintained all risk factors on target (Group 1), while 3621 (85%) did not (Group 2). During follow-up, no differences in recurrent major adverse cardiovascular events (MACEs) or death were observed between groups. On multivariable analysis, patients with previous known dyslipidemia (hazard ratio [HR]: 95% confidence interval (95% CI): ([HR]: 1.20 [95% CI, 1.03-1.40]), polyvascular disease ([HR]: 1.98 [95% CI, 1.69-2.32]), insulin therapy ([HR]: 1.56 [95% CI, 1.24-1.95]) and associated conditions ([HR]: 1.47 [95% CI, 1.24-1.74]) were associated with a higher risk for subsequent MACE. The presence of associated medical conditions was also strongly associated with all-cause death ([HR]: 3.49 [95% CI, 2.35-5.19]). Only a minority of patients with atherosclerotic cardiovascular disease achieved sustained optimal control for all principal risk factors although without discernible clinical, therapeutic benefit. The findings of the present study provide some insights into what factors may be used to guide physicians in adapting intensive, multifactorial therapy to the individual patient in clinical practice.
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Xu J, Fan Y, Zhou R, Shao J, Guo H, Chen Y, Wang Q, Dong Z, Li M, Chen Y, Wang S, Jiang T, Liu Y, Lin W. The interaction of persistent antiphospholipid antibodies positivity and cigarette smoking is associated with an increased risk of cardiovascular events: Cross-sectional and longitudinal analysis. Int J Cardiol 2023; 374:108-114. [PMID: 36496037 DOI: 10.1016/j.ijcard.2022.12.008] [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: 09/29/2022] [Revised: 11/15/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The antiphospholipid antibody (aPL)-positivity was suggested as a nontraditional risk of coronary artery disease (CAD) and it was associated with cigarette smoking. The co-occurrence of them was usually reported in individuals with cardiovascular diseases. This study was to demonstrate their interaction on the increasing risk of cardiovascular events. METHODS AND RESULTS A total of 826 consecutive male individuals who underwent coronary angiography (CAG) /percutaneous coronary intervention (PCI) were prospectively followed and classified into three groups based on different smoking statuses. The current smoking subjects had the highest occurrence of aPL-positivity, including aCL IgM (20.1%) and aβ2GP1 IgM (15.5%). IgM isotype positivity was an independent risk factor of CAD in the multivariate model, OR: 2.70 (1.52-4.80) for aCL IgM and OR:2.50 (1.35-4.63) for aβ2GP1 IgM.The interaction of current smoking and IgM isotype positivity was significantly associated with increased risk of CAD, OR: 8.75(4.59-16.66) for aCL IgM and OR: 8.78(4.28-17.98) for aβ2GP1 IgM. During about 3 years of follow-up, the smoking patients carrying persistent aPL positivity had the highest cumulative incidence of recurrent myocardial infarction and in-stent restenosis after CAD. CONCLUSION The interaction of current smoking and IgM isotype positivity was significantly associated with the increased risk of CAD, including positive aCL IgM and aβ2GP1 IgM. Cigarette smoking elevated the risk of subsequent cardiovascular events in the presence of IgM isotype positivity, including recurrent myocardial infarction and in-stent restenosis.
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Affiliation(s)
- Jinzhong Xu
- Department of Clinical Pharmacy, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Yuncao Fan
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Renfang Zhou
- Department of Clinical Laboratory, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Jianzhi Shao
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Haihui Guo
- Department of Clinical Pharmacy, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Yunpeng Chen
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Qizeng Wang
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Zhibing Dong
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Mengjia Li
- Department of Clinical Laboratory, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Ying Chen
- Department of Clinical Laboratory, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Shuangshuang Wang
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Tian Jiang
- Center Laboratory, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Wenhui Lin
- Department of Cardiovascular Medicine, Affiliated Wenling Hospital, Wenzhou Medical University, Wenling, Zhejiang, China.
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Sánchez-Bacaicoa C, Galán J, Guijarro C, Rico-Martín S, Monreal M, Calderón-García JF, Aguilar-Cortés E, Sánchez Muñoz-Torrero JF. Sustained low-density lipoprotein-cholesterol <70 mg/dl is associated with improved cardiovascular outcomes in the clinical setting. Eur J Clin Invest 2022; 52:e13732. [PMID: 34908162 DOI: 10.1111/eci.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Clinical trials have shown that intensive low-density lipoprotein cholesterol (LDL-C) lowering improves cardiovascular outcomes among patients with atherosclerotic cardiovascular disease (ASCVD), but data are limited in real clinical practice, particularly for patients with ASCVD informing different territories. METHODS FRENA was a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We compared the incidence of recurrent events in patients with sustained LDL-C levels <70 mg/dl compared with those with ≥70 mg/dl. RESULTS As of December 2018, 1182 patients were eligible for this study. Among them, 172 (14.5%) had mean LDL-C levels ≤70 mg/dl, and 1010 (85.5%) had <70 mg/dl. Their clinical characteristics at baseline were similar. During 5 years of follow-up, 252 patients (21%) suffered major adverse cardiovascular events (MACE). The incidence rates of MACE were 3.42 events per 100 patient-years (95% confidence interval [95% CI] 2.17-5.14) in patients with levels <70 mg/dl and 5.57 (95% CI, 4.87-6.34) in those with ≥70 mg/dl; the rate ratio was 0.61 (95% CI, 0.39-0.92), p = 0.019. On multivariable analysis, patients with LDL-C levels <70 mg/dl were at lower risk for MACE (hazard ratio [HR]: 0.61 [95% CI, 0.39-0.93] p < 0.05). MACE reduction was driven by a decrease in coronary and peripheral events with no significant effect on stroke. CONCLUSIONS Long-term sustained LDL-C <70 mg/dl in the clinical practice is associated with reduction in cardiovascular and peripheral vascular events with no apparent effect on stroke.
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Affiliation(s)
| | - Javier Galán
- Department of Internal Medicine, Hospital San Pedro Alcántara, Cáceres, Spain
| | - Carlos Guijarro
- Department of Medical Specialties and Public Heatlh, Alcorcon University Hospital. Rey Juan Carlos University, Madrid, Spain
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Julián F Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
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