1
|
Radhoe SP, Veenis JF, Linssen GCM, van der Lee C, Eurlings LWM, Kragten H, Al-Windy NYY, van der Spank A, Koudstaal S, Brunner-La Rocca HP, Brugts JJ. Diabetes and treatment of chronic heart failure in a large real-world heart failure population. ESC Heart Fail 2021; 9:353-362. [PMID: 34862765 PMCID: PMC8788034 DOI: 10.1002/ehf2.13743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Although diabetes mellitus (DM) is a common co‐morbidity in chronic heart failure (HF) patients, European data on concurrent HF and DM treatment are lacking. Therefore, we have studied the HF treatment of patients with and without DM. Additionally, with the recent breakthrough of sodium–glucose cotransporter 2 (SGLT2) inhibitors in the field of HF, we studied the potential impact of this new drug in a large cohort of HF patients. Methods and results A total of 7488 patients with chronic HF with a left ventricular ejection fraction <50% from 34 Dutch outpatient HF clinics between 2013 and 2016 were analysed on diabetic status and background HF therapy. Average age of the total population was 72.8 years (±11.7 years), and 64% of the patients were male. Diabetes was present in 29% of the patients (N = 2174). Diabetics had a worse renal function (mean estimated glomerular filtration rate 56 vs. 61 mL/min/1.73 m2, P < 0.001). Renin–angiotensin system inhibitors were less often prescribed in diabetics compared with non‐diabetics (79% vs. 82%, P = 0.001), while no significant differences regarding other guideline‐recommended HF drugs were found. Target doses of beta‐blockers (23% vs. 16%, P < 0.001), renin–angiotensin system inhibitors (47% vs. 43%, P = 0.009), and mineralocorticoid receptor antagonists (57% vs. 51%, P = 0.005) were more often prescribed in diabetics than non‐diabetics. Based on the latest trials on SGLT2 inhibitors, 31–64% of all HF patients would fulfil the eligibility or enrichment criteria (with vs. without N‐terminal prohormone BNP criterion). Conclusions In this large real‐world HF registry, a high prevalence of DM was observed and diabetics more often received guideline‐recommended target doses. Based on current evidence, the majority of patients would fulfil the enrichment criteria of SGLT2 trials in HF and the impact of this new drug class will be large.
Collapse
Affiliation(s)
- Sumant P Radhoe
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Jesse F Veenis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands
| | - Chris van der Lee
- Department of Cardiology, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | - Luc W M Eurlings
- Department of Cardiology, VieCuri Medisch Centrum, Venlo, The Netherlands
| | - Hans Kragten
- Department of Cardiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | | | | | - Stefan Koudstaal
- Department of Cardiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | | | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| |
Collapse
|
2
|
Uijl A, Veenis JF, Brunner-La Rocca HP, van Empel V, Linssen GCM, Asselbergs FW, van der Lee C, Eurlings LWM, Kragten H, Al-Windy NYY, van der Spank A, Koudstaal S, Brugts JJ, Hoes AW. Clinical profile and contemporary management of patients with heart failure with preserved ejection fraction: results from the CHECK-HF registry. Neth Heart J 2021; 29:370-376. [PMID: 33439465 PMCID: PMC8271056 DOI: 10.1007/s12471-020-01534-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Clinical management of heart failure with preserved ejection fraction (HFpEF) centres on treating comorbidities and is likely to vary between countries. Thus, to provide insight into the current management of HFpEF, studies from multiple countries are required. We evaluated the clinical profiles and current management of patients with HFpEF in the Netherlands. Methods We included 2153 patients with HFpEF (defined as a left ventricular ejection fraction ≥ 50%) from the CHECK-HF registry, which included patients from 2013 to 2016. Results Median age was 77 (IQR 15) years, 55% were women and the most frequent comorbidities were hypertension (51%), renal insufficiency (45%) and atrial fibrillation (AF, 38%). Patients between 65 and 80 years and those over 80 years had on average more comorbidities (up to 64% and 74%, respectively, with two or more comorbidities) than patients younger than 65 years (38% with two or more comorbidities, p-value < 0.001). Although no specific drugs are available for HFpEF, treating comorbidities is advised. Beta-blockers were most frequently prescribed (78%), followed by loop diuretics (74%), renin-angiotensin system (RAS) inhibitors (67%) and mineralocorticoid receptor antagonists (MRAs, 39%). Strongest predictors for loop-diuretic use were older age, higher New York Heart Association class and AF. Conclusion The medical HFpEF profile is determined by the underlying comorbidities, sex and age. Comorbidities are highly prevalent in HFpEF patients, especially in elderly HFpEF patients. Despite the lack of evidence, many HFpEF patients receive regular beta-blockers, RAS inhibitors and MRAs, often for the treatment of comorbidities. Supplementary Information The online version of this article (10.1007/s12471-020-01534-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A Uijl
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J F Veenis
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Thoraxcenter, Rotterdam, Rotterdam, The Netherlands.
| | - H P Brunner-La Rocca
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V van Empel
- Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - C van der Lee
- Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | | | - H Kragten
- Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | | | | | - S Koudstaal
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J J Brugts
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Thoraxcenter, Rotterdam, Rotterdam, The Netherlands
| | - A W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
3
|
Ponikowski P, Kirwan BA, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Göhring UM, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Butler J, Friede T, Jensen KH, Pocock S, Jankowska EA. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet 2020; 396:1895-1904. [PMID: 33197395 DOI: 10.1016/s0140-6736(20)32339-4] [Citation(s) in RCA: 376] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. METHODS AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin <100 μg/L, or 100-299 μg/L with transferrin saturation <20%), and had a left ventricular ejection fraction of less than 50%. Before hospital discharge, participants were randomly assigned (1:1) to receive intravenous ferric carboxymaltose or placebo for up to 24 weeks, dosed according to the extent of iron deficiency. To maintain masking of patients and study personnel, treatments were administered in black syringes by personnel not involved in any study assessments. The primary outcome was a composite of total hospitalisations for heart failure and cardiovascular death up to 52 weeks after randomisation, analysed in all patients who received at least one dose of study treatment and had at least one post-randomisation data point. Secondary outcomes were the composite of total cardiovascular hospitalisations and cardiovascular death; cardiovascular death; total heart failure hospitalisations; time to first heart failure hospitalisation or cardiovascular death; and days lost due to heart failure hospitalisations or cardiovascular death, all evaluated up to 52 weeks after randomisation. Safety was assessed in all patients for whom study treatment was started. A pre-COVID-19 sensitivity analysis on the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT02937454, and has now been completed. FINDINGS Between March 21, 2017, and July 30, 2019, 1525 patients were screened, of whom 1132 patients were randomly assigned to study groups. Study treatment was started in 1110 patients, and 1108 (558 in the carboxymaltose group and 550 in the placebo group) had at least one post-randomisation value. 293 primary events (57·2 per 100 patient-years) occurred in the ferric carboxymaltose group and 372 (72·5 per 100 patient-years) occurred in the placebo group (rate ratio [RR] 0·79, 95% CI 0·62-1·01, p=0·059). 370 total cardiovascular hospitalisations and cardiovascular deaths occurred in the ferric carboxymaltose group and 451 occurred in the placebo group (RR 0·80, 95% CI 0·64-1·00, p=0·050). There was no difference in cardiovascular death between the two groups (77 [14%] of 558 in the ferric carboxymaltose group vs 78 [14%] in the placebo group; hazard ratio [HR] 0·96, 95% CI 0·70-1·32, p=0·81). 217 total heart failure hospitalisations occurred in the ferric carboxymaltose group and 294 occurred in the placebo group (RR 0·74; 95% CI 0·58-0·94, p=0·013). The composite of first heart failure hospitalisation or cardiovascular death occurred in 181 (32%) patients in the ferric carboxymaltose group and 209 (38%) in the placebo group (HR 0·80, 95% CI 0·66-0·98, p=0·030). Fewer days were lost due to heart failure hospitalisations and cardiovascular death for patients assigned to ferric carboxymaltose compared with placebo (369 days per 100 patient-years vs 548 days per 100 patient-years; RR 0·67, 95% CI 0·47-0·97, p=0·035). Serious adverse events occurred in 250 (45%) of 559 patients in the ferric carboxymaltose group and 282 (51%) of 551 patients in the placebo group. INTERPRETATION In patients with iron deficiency, a left ventricular ejection fraction of less than 50%, and who were stabilised after an episode of acute heart failure, treatment with ferric carboxymaltose was safe and reduced the risk of heart failure hospitalisations, with no apparent effect on the risk of cardiovascular death. FUNDING Vifor Pharma.
Collapse
Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wroclaw, Poland; Center for Heart Diseases, University Hospital in Wrocław, Wroclaw, Poland.
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research, Nyon, Switzerland; London School of Hygiene & Tropical Medicine, University College London, London, UK
| | | | - Theresa McDonagh
- King's College Hospital, London, UK; School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Jarosław Drozdz
- Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Lodz, Poland
| | | | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andre Keren
- Hadassah Medical Center, Department of Cardiology, Jerusalem, Israel
| | | | - Hans Kragten
- Maastricht University Medical Center, Heerlen, Netherlands
| | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Córdoba, Argentina
| | - Marco Metra
- Department of Cardiology, University and Civil Hospital, Brescia, Italy
| | | | - José C Nicolau
- Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcus Ohlsson
- Department of Internal Medicine, Malmö University Hospital, Malmö, Sweden
| | | | | | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Zürich, Switzerland
| | - David Sim
- National Heart Center, Clinical Translational and Research Office, Singapore
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Beirut, Lebanon
| | - Peter van der Meer
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Clinical Cardiovascular Research Institute, Haifa, Israel
| | | | | | | | | | | | - Henry J Dargie
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Michael Motro
- Sheba Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Tim Friede
- University Medical Center Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Göttingen partner site, Göttingen, Germany
| | | | - Stuart Pocock
- Department of Clinical Research, SOCAR Research, Nyon, Switzerland
| | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wroclaw, Poland; Center for Heart Diseases, University Hospital in Wrocław, Wroclaw, Poland
| |
Collapse
|
4
|
Jepma P, Jorstad HT, Snaterse M, Ter Riet G, Kragten H, Lachman S, Minneboo M, Boekholdt SM, Peters RJ, Scholte Op Reimer W. Lifestyle modification in older versus younger patients with coronary artery disease. Heart 2020; 106:1066-1072. [PMID: 32179587 PMCID: PMC7361002 DOI: 10.1136/heartjnl-2019-316056] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/14/2023] Open
Abstract
Objective To compare the treatment effect on lifestyle-related risk factors (LRFs) in older (≥65 years) versus younger (<65 years) patients with coronary artery disease (CAD) in The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial. Methods The RESPONSE-2 trial was a community-based lifestyle intervention trial (n=824) comparing nurse-coordinated referral with a comprehensive set of three lifestyle interventions (physical activity, weight reduction and/or smoking cessation) to usual care. In the current analysis, our primary outcome was the proportion of patients with improvement at 12 months follow-up (n=711) in ≥1 LRF stratified by age. Results At baseline, older patients (n=245, mean age 69.2±3.9 years) had more adverse cardiovascular risk profiles and comorbidities than younger patients (n=579, mean age 53.7±6.6 years). There was no significant variation on the treatment effect according to age (p value treatment by age=0.45, OR 1.67, 95% CI 1.22 to 2.31). However, older patients were more likely to achieve ≥5% weight loss (OR old 5.58, 95% CI 2.77 to 11.26 vs OR young 1.57, 95% CI 0.98 to 2.49, p=0.003) and younger patients were more likely to show non-improved LRFs (OR old 0.38, 95% CI 0.22 to 0.67 vs OR young 0.88, 95% CI 0.61 to 1.26, p=0.01). Conclusion Despite more adverse cardiovascular risk profiles and comorbidities among older patients, nurse-coordinated referral to a community-based lifestyle intervention was at least as successful in improving LRFs in older as in younger patients. Higher age alone should not be a reason to withhold lifestyle interventions in patients with CAD.
Collapse
Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands .,Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Hans Kragten
- Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Sangeeta Lachman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ron J Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilma Scholte Op Reimer
- Achieve Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| |
Collapse
|
5
|
Ponikowski P, Kirwan BA, Anker SD, Dorobantu M, Drozdz J, Fabien V, Filippatos G, Haboubi T, Keren A, Khintibidze I, Kragten H, Martinez FA, McDonagh T, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Jankowska EA. Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure. Eur J Heart Fail 2019; 21:1651-1658. [PMID: 31883356 DOI: 10.1002/ejhf.1710] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Iron deficiency (ID) is a common co-morbidity in heart failure (HF), associated with impaired functional capacity, poor quality of life and increased morbidity and mortality. Treatment with intravenous (i.v.) ferric carboxymaltose (FCM) has shown improvements in functional capacity, symptoms and quality of life in stable HF patients with reduced ejection fraction. The effect of i.v. iron supplementation on morbidity and mortality in patients hospitalised for acute HF (AHF) and who have ID has yet to be established. The objective of the present article is to present the rationale and design of the AFFIRM-AHF trial (ClinicalTrials.gov NCT02937454) which will investigate the effect of i.v. FCM (vs. placebo) on recurrent HF hospitalisations and cardiovascular (CV) mortality in iron-deficient patients hospitalised for AHF. METHODS AFFIRM-AHF is a multicentre, randomised (1:1), double-blind, placebo-controlled trial which recruited 1100 patients hospitalised for AHF and who had iron deficiency ID defined as serum ferritin <100 ng/mL or 100-299 ng/mL if transferrin saturation <20%. Eligible patients were randomised (1:1) to either i.v. FCM or placebo and received the first dose of study treatment just prior to discharge for the index hospitalisation. Patients will be followed for 52 weeks. The primary outcome is the composite of recurrent HF hospitalisations and CV mortality. The main secondary outcomes include the composite of recurrent CV hospitalisations and CV mortality, recurrent HF hospitalisations and safety-related outcomes. CONCLUSION The AFFIRM-AHF trial will evaluate, compared to placebo, the effect of i.v. FCM on morbidity and mortality in iron-deficient patients hospitalised for AHF.
Collapse
Affiliation(s)
- Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland.,Center for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland.,London School of Hygiene and Tropical Medicine, University College London, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Jarosław Drozdz
- Klinika Kardiologii, Uniwersytet Medyczny w Łodzi, Lodz, Poland
| | | | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andre Keren
- Assuta Hashalom Heart Institute, Assuta Hospitals, Tel-Aviv, Israel
| | | | | | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Córdoba, Argentina
| | | | - Marco Metra
- Cardiology, University of Brescia and Civil Hospital, Brescia, Italy
| | | | - José C Nicolau
- Faculdade de Medicina FMUSP, Instituto do Coracao (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcus Ohlsson
- Department of Nephrology and Transplantation, Skane University Hospital Malmoe, Malmo, Sweden
| | | | | | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Zürich, Switzerland
| | - David Sim
- National Heart Centre, Clinical Translational and Research Office, Singapore, Singapore
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Beirut, Lebanon
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
6
|
Dudink EAMP, Peeters FECM, Altintas S, Heckman LIB, Haest RJ, Kragten H, Kietselaer BLJH, Wildberger J, Luermans JGLM, Weijs B, Crijns HJGM. Agatston score of the descending aorta is independently associated with coronary events in a low-risk population. Open Heart 2018; 5:e000893. [PMID: 30564374 PMCID: PMC6269642 DOI: 10.1136/openhrt-2018-000893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/03/2018] [Accepted: 11/10/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives A standard coronary artery calcium scan includes part of the aorta. This additional information is often not included in routine analyses. We aimed to determine the feasibility of assessing the Agatston score of the descending aorta calcification (DAC) on standard coronary calcium scans and the association of this score with coronary events in a low-risk study population. Methods Between January 2008 and March 2011, 390 consecutive patients who were referred for cardiac CT as part of work-up for pulmonary vein isolation (n=115) or assessment of presence of coronary artery disease (n=275) were included. At baseline, all patients were free of a history of cardiovascular disease. Two independent observers determined the Agatston score of the ascending aorta and descending aorta. Results A total of 16 patients (4.1%) developed coronary events (acute coronary syndrome (n=6) and symptomatic significant coronary artery disease requiring treatment (n=10)) during a follow-up of 67±12 months, with more events in patients with calcifications in the descending aorta than in those without (8.4% vs 3.7 %; p=0.08). Multivariable Cox regression, corrected for Framingham Risk Score (FRS) and coronary Agatston score (CAC), revealed that DAC was independently associated with coronary events (per 100 units; HR: 1.06, 95% CI 1.02 to 1.09; p=0.001). DAC furthermore increased the identification of patients that will experience a coronary event (area under the curve: 0.68 for FRS only, 0.75 for FRS+CAC and 0.78 for FRS+CAC+DAC). Conclusions The Agatston score of the descending aorta could be included in the standard analysis of cardiac CT scans of low-risk patients since it holds valuable information for the prediction of coronary events.
Collapse
Affiliation(s)
- Elton A M P Dudink
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Frederique E C M Peeters
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Sibel Altintas
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Rutger J Haest
- Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands
| | - Hans Kragten
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Bas L J H Kietselaer
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joachim Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Bob Weijs
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| |
Collapse
|
7
|
Sanders P, Anand R, Kowal R, Piorkowski C, Sohail MR, Kragten H, Moya A, Stromberg K, Rogers JD. INSERTION OF A MINIATURIZED INSERTABLE CARDIAC MONITOR OUTSIDE THE TRADITIONAL HOSPITAL SETTING: RESULTS FROM THE RIO 2 INTERNATIONAL STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Kragten H, Höppener P, Gielis A, de Booij M. Pectus excavatum severity underestimated due to lack of objective measures in radiological reports. BMJ Case Rep 2016; 2016:bcr-2015-213904. [PMID: 27217048 DOI: 10.1136/bcr-2015-213904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
During a routine physical examination, the degree of pectus excavatum (PE) is not always appreciated as the external appearance does not always reflect the severity of the deformity. In the patient in this case report, the severity had been underestimated for 33 years. The physicians, having requested standard two-view chest radiographs, had relied solely on the radiological reports, where the PE had been ambiguously described as 'moderate' or 'substantial'. In patients where PE has been observed, it is essential that an objective numeric measure of severity, using the Haller index, is included in radiological reports.
Collapse
Affiliation(s)
- Hans Kragten
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Paul Höppener
- Department of Research, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Albert Gielis
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Machiel de Booij
- Department of Radiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| |
Collapse
|
9
|
Jankowska EA, Kirwan BA, Kosiborod M, Butler J, Anker SD, McDonagh T, Dorobantu M, Drozdz J, Filippatos G, Keren A, Khintibidze I, Kragten H, Martinez FA, Metra M, Milicic D, Nicolau JC, Ohlsson M, Parkhomenko A, Pascual-Figal DA, Ruschitzka F, Sim D, Skouri H, van der Meer P, Lewis BS, Comin-Colet J, von Haehling S, Cohen-Solal A, Danchin N, Doehner W, Dargie HJ, Motro M, Friede T, Fabien V, Dorigotti F, Pocock S, Ponikowski P. The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study. Eur Heart J 2011; 42:3011-3020. [PMID: 34080008 PMCID: PMC8370759 DOI: 10.1093/eurheartj/ehab234] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 01/24/2023] Open
Abstract
AIMS Patients with heart failure (HF) and iron deficiency experience poor health-related quality of life (HRQoL). We evaluated the impact of intravenous (IV) ferric carboxymaltose (FCM) vs. placebo on HRQoL for the AFFIRM-AHF population. METHODS AND RESULTS The baseline 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), which was completed for 1058 (535 and 523) patients in the FCM and placebo groups, respectively, was administered prior to randomization and at Weeks 2, 4, 6, 12, 24, 36, and 52. The baseline KCCQ-12 overall summary score (OSS) mean ± standard error was 38.7 ± 0.9 (FCM group) and 37.1 ± 0.8 (placebo group); corresponding values for the clinical summary score (CSS) were 40.9 ± 0.9 and 40.1 ± 0.9. At Week 2, changes in OSS and CSS were similar for FCM and placebo. From Week 4 to Week 24, patients assigned to FCM had significantly greater improvements in OSS and CSS scores vs. placebo [adjusted mean difference (95% confidence interval, CI) at Week 4: 2.9 (0.5-5.3, P = 0.018) for OSS and 2.8 (0.3-5.3, P = 0.029) for CSS; adjusted mean difference (95% CI) at Week 24: 3.0 (0.3-5.6, P = 0.028) for OSS and 2.9 (0.2-5.6, P = 0.035) for CSS]. At Week 52, the treatment effect had attenuated but remained in favour of FCM. CONCLUSION In iron-deficient patients with HF and left ventricular ejection fraction <50% who had stabilized after an episode of acute HF, treatment with IV FCM, compared with placebo, results in clinically meaningful beneficial effects on HRQoL as early as 4 weeks after treatment initiation, lasting up to Week 24.
Collapse
Affiliation(s)
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Chemin de Chantemerle 18, 1260 Nyon, Switzerland,London School of Hygiene and Tropical Medicine, University College London, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornhall Rd, Kansas City, MO 64111, USA
| | - Javed Butler
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Stefan D Anker
- Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Theresa McDonagh
- King’s College Hospital, Denmark Hill, Brixton, London SE5 9RS, UK,King’s College London, Strand, London WC2R 2LS, UK
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Calea Floreasca 8, Bucharest 014461, Romania
| | - Jarosław Drozdz
- Department Cardiology, Medical University of Lodz, al. Tadeusza Kościuszki 4, 90-149 Lodz, Poland
| | - Gerasimos Filippatos
- Department of Cardiology, Heart Failure Unit, National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attiko, Athens 157 72, Greece
| | - Andre Keren
- Assuta Hashalom, Assuta Hospitals, HaBarzel St 20, Tel Aviv-Yafo, Israel
| | | | - Hans Kragten
- Maastricht University Medical Center, P. Debyelaan 25, 6229 Maastricht, Netherlands
| | - Felipe A Martinez
- Universidad Nacional de Córdoba, International Society of Cardiovascular Pharmacotherapy, Av. Haya de la Torre s/n, Argentina
| | - Marco Metra
- Department of Cardiology, University and Civil Hospital, Piazzale Spedali Civilli, 1, 25123 Brescia, Italy
| | - Davor Milicic
- University Hospital Center Zagreb, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - José C Nicolau
- Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, Sao Paulo-SP, 05403-900, Brazil
| | - Marcus Ohlsson
- Department of Internal Medicine, Skane University Hospital Malmo, Carl-Bertil Laurells gata 9, 214 28 Malmo, Sweden
| | - Alexander Parkhomenko
- The M.D. Strazhesko Institute of Cardiology, Narodnoho Opolchennya St, 5, Kyiv 03680, Ukraine
| | - Domingo A Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Frank Ruschitzka
- UniversitätsSpietal Zürich, Klinik für Kardiologie, Rämistrasse 100, 8006 Zürich, Switzerland
| | - David Sim
- National Heart Center, Clinical Translational and Research Office, 5 Hospital Dr, Singapore 169609
| | - Hadi Skouri
- American University of Beirut, Medical Center Beirut, Maamari Street - Hamra, 1107 2020 Beirut, Lebanon
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9713 Groningen, The Netherlands
| | - Basil S Lewis
- Lady Davies Carmel Medical Center, Clinical Cardiovascular Research Institute, 21 Ehud Street, Haifa, Haifa District, Israel
| | - Josep Comin-Colet
- Department of Cardiology, University Hospital Bellvitge and IDIBELL, University of Barcelona, Gran Via de l’Hospitalet, 199 08908, Hospitalet de Llobregat, Barcelona, Spain
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany,German Center for Cardiovascular Research (DZHK), partner site Göttingen, 37099 Göttingen, Germany
| | - Alain Cohen-Solal
- Hospital Lariboisière, INSERM, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Nicolas Danchin
- European Hospital Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France
| | - Wolfram Doehner
- BCRT—Berlin Institute of Health Center for Regenerative Therapies, Föhrer Str. 15, 13353; Department of Cardiology (Virchow Campus), Charité- Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353; and German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Potsdamer Straße 58, 10785 Berlin, Germany
| | - Henry J Dargie
- Robertson Center for Biostatistics, University of Glasgow, Boyd Orr Building University Avenue, Glasgow G12 8QQ, UK
| | - Michael Motro
- Sheba Medical Center, Tel-Aviv University, Sackler School of Medicine, 6997801 Tel Aviv, Israel
| | - Tim Friede
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, 37099 Göttingen, Germany,Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Vincent Fabien
- Vifor Pharma Ltd, Flughofstrasse 61, P.O. Box 8152, Glattbrugg, Switzerland
| | - Fabio Dorigotti
- Vifor Pharma Ltd, Flughofstrasse 61, P.O. Box 8152, Glattbrugg, Switzerland
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, University College London, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wrocław Medical University, Borowska 213, 50-556 Wroclaw, Poland,Center for Heart Diseases, University Hospital in Wrocław, Borowska 213, 50-556 Wroclaw, Poland
| |
Collapse
|
10
|
Jorstad HT, von Birgelen C, Alings M, Liem A, van Dantzig JM, Jaarsma W, Lok D, Kragten H, de Vries K, de Milliano P, Withagen A, Tijssen J, Peters R. IMPROVEMENT OF RISK FACTOR CONTROL AFTER AN ACUTE CORONARY SYNDROME BY A NURSE COORDINATED PREVENTION PROGRAM: RESULTS FROM A RANDOMIZED TRIAL. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
11
|
Abstract
Pectus excavatum is usually considered meaningless and without clinical significance. The following case may put a different complexion on the matter. A healthy 59-year-old male patient complained of progressive heart palpitations, fatigue and postural dyspnoea; bending over caused a clear increase of dyspnoea. At repeated examinations no overt abnormality or explanation was found, except a supraventricular arrhythmia and a nodal tachycardia. In the years to follow the symptoms led to considerable physical impairments. Finally, the patient himself, after searching the web, came up with a possible cause: his pectus excavatum. A lateral chest x-ray with the patient bending over and a lateral computed tomography of the thorax revealed an impression of the heart by the sternum. Ten years after the patient's signs and symptoms first appeared, a modified Ravitch procedure was carried out, after which the physical condition of the patient improved rapidly.
Collapse
Affiliation(s)
- Ron Winkens
- Maastricht University, Integrated Care And General Practice, PO Box 5800, Maastricht, 6202 AZ, Netherlands
| | | | | | | | | |
Collapse
|
12
|
Elderen TV, Maes S, Seegers G, Kragten H, Wely LRV. Effects of a post-hospitalization group health education programme for patients with coronary heart disease. Psychol Health 2007; 9:317-330. [DOI: 10.1080/08870449408407490] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Therese Van Elderen
- a Health Psychology , University of Leiden , Wassenaarseweg 52, 2333 , AK Leiden , The Netherlands
| | - Stan Maes
- a Health Psychology , University of Leiden , Wassenaarseweg 52, 2333 , AK Leiden , The Netherlands
| | - Gerard Seegers
- a Health Psychology , University of Leiden , Wassenaarseweg 52, 2333 , AK Leiden , The Netherlands
| | - Hans Kragten
- b De Wever Hospital , H. Dunontstraat 5, 6419 PC , Heerlen , The Netherlands
| | - Lucy Relik-Van Wely
- c Diaronessen Hospital , dr Theodor Fliednerstraat 1, 5631 BM , Eindhoven , The Netherlands
| |
Collapse
|
13
|
Gorissen C, Baumgarten R, de Groot M, van Haren E, Kragten H, Leers M. Analytical and clinical performance of three natriuretic peptide tests in the emergency room. Clin Chem Lab Med 2007; 45:678-84. [PMID: 17484634 DOI: 10.1515/cclm.2007.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the analytical and diagnostic utility of B-type natriuretic peptide (BNP) and the N-terminus of this prohormone, N-terminal pro-BNP (NT-pro-BNP) testing in the emergency department to identify acute congestive heart failure (CHF). METHODS A blood sample taken from patients presenting to the emergency department with acute dyspnoea (n=80) was analyzed for natriuretic peptides using three different assays [Triage BNP (Biosite), Centaur BNP (Bayer) and Elecsys NT-pro-BNP (Roche)]. A cardiologist and a pulmonologist, blinded to the actual natriuretic peptide levels, reviewed all test results (including echocardiography, etc.) retrospectively and made a diagnosis of dyspnoea due to CHF or not. RESULTS Analytical testing showed good correlation and coefficients of variation of less than 10% for all three assays. Cardiac-related dyspnoea was found in 40 patients (50%). NT-proBNP and BNP values were significantly elevated in these patients. For identifying patients with CHF, BNP and NT-proBNP scored equally well (area under the receiver operating characteristic curve of 0.78, 0.77 and 0.78 for the Biosite, Roche and Bayer assays, respectively). CONCLUSIONS In general, the different assays tested for BNP and NT-pro-BNP correlate very well in patients with suspected CHF and may aid in the risk stratification process in emergency departments. However, the value must always be interpreted in conjunction with other clinical information. It should also be considered that renal impairment can affect the results.
Collapse
Affiliation(s)
- Cecile Gorissen
- Department of Emergency Medicine, Atrium Medical Centre, Heerlen, The Netherlands
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Dunselman P, Liem AH, Verdel G, Kragten H, Bosma A, Bernink P. Addition of felodipine to metoprolol vs replacement of metoprolol by felodipine in patients with angina pectoris despite adequate beta-blockade. Results of the Felodipine ER and Metoprolol CR in Angina (FEMINA) Study. Working Group on Cardiovascular Research, The Netherlands (WCN). Eur Heart J 1997; 18:1755-64. [PMID: 9402450 DOI: 10.1093/oxfordjournals.eurheartj.a015170] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS The study aimed to compare the addition of felodipine to metoprolol, and of the replacement of metoprolol by felodipine, with continuation of metoprolol, in patients with angina pectoris despite optimal beta-blockade. METHODS AND RESULTS The study was double-blind, parallel, randomized and controlled, and comprised 363 patients from 27 outpatient cardiology clinics in the Netherlands. The patients had angina and positive bicycle exercise tests despite optimal beta-blockade (resting heart rate < 65 beats.min-1). Randomization was to three treatment groups: continuation of metoprolol (control), addition of felodipine to metoprolol, and replacement of metoprolol by felodipine. Exercise tests were repeated after 2 and 5 weeks. The main outcome measure was: exercise result after 5 weeks, compared with baseline, between-group comparison of changes vs control. There were no significant differences in exercise duration and onset of chest pain vs control. The addition of felodipine increased time until 1 mm ST depression (43 s, 95% confidence interval 20-65 s), and decreased both ST depression at highest comparable work load (0.46 mm, 95% confidence interval 0.19-0.72), and maximal ST depression (0.49 mm, 95% confidence interval 0.23-0.74). Exercise results after replacement of metoprolol by felodipine were not different from control, apart from a significant increase in rate pressure product. Significantly more patients experienced adverse events in the felodipine monotherapy group. CONCLUSION Combination of metoprolol and felodipine is to be preferred to felodipine monotherapy in patients who have signs and symptoms of myocardial ischaemia despite optimal beta-blockade.
Collapse
|
16
|
Kool M, Lustermans F, Kragten H, Struijker Boudier H, Hoeks A, Reneman R, Rila H, Hoogendam I, Van Bortel L. Does lowering of cholesterol levels influence functional properties of large arteries? Eur J Clin Pharmacol 1995; 48:217-23. [PMID: 7589044 DOI: 10.1007/bf00198301] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hypercholesterolaemia is a risk factor for atherosclerosis and induces endothelial dysfunction. Endothelial dysfunction may increase vascular tone and arterial stiffness and as a consequence may decrease arterial distensibility (DC) and arterial compliance (CC). It is hypothesized that lipid-lowering therapy may enhance DC and CC. Therefore, the present study investigates the effect of lipid-lowering therapy with pravastatin on the haemodynamics, DC and CC of the elastic common carotid artery (CCA), and the muscular femoral (FA) and brachial (BA) arteries in patients with primary hypercholesterolaemia. After an 8-week placebo run-in period with a low-cholesterol diet, 19 patients with total cholesterol concentrations of between 6.5 and 9.0 mmol.l-1 and triglyceride concentrations < 4 mmol.l-1 entered a double-blind placebo controlled crossover study. Patients received pravastatin 40 mg o.d. or placebo, each for 8 weeks. Throughout the study the lipid-lowering diet was continued. With pravastatin, total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides were decreased (total cholesterol 26%, LDL-C 35%, triglycerides 16%), while high-density lipoprotein cholesterol (HDL-C) was not changed. Other laboratory values remained within the normal range. Blood pressure, heart rate, cardiac function and systemic vascular resistance were not influenced by pravastatin. Compared to placebo, diameter, distensibility and compliance of all arteries were not statistically significantly changed with pravastatin. These data suggest that, in patients with mild to moderate primary hypercholesterolaemia, short-term lowering of plasma cholesterol does not alter the haemodynamics and vessel wall properties of large arteries.
Collapse
Affiliation(s)
- M Kool
- Department of Pharmacology, Cardiovascular Research Institute Maastricht, University of Limburg, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Kragten H. Handbook of Chemical Equilibria in Analytical Chemistry, Ellis Horwood Series in Analytical Chemistry. Anal Chim Acta 1986. [DOI: 10.1016/s0003-2670(00)81823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|