Smoking prevalence in coronary patients from EuroAspire III Romania

OBJECTIVE

Evaluating smoking incidence, the compliance to smoking cessation recommendation and benefits of quitting smoking in coronary patients included in EuroAspire III Romania survey.

MATERIALS AND METHODS

We evaluated the acute cardiovascular events (MACE) incidence in 530 consecutive coronary patients (> or = 18 years and < 80 years at the time ofidentification) with first or recurrent clinical diagnosis or treatments for coronary heart disease, retrospectively identified from diagnostic registers or hospital discharge lists. The coronary events for hospital admission were: elective or emergency coronary artery by-pass graft (CABG), elective or emergency percutaneous transluminal coronary angioplasty (PTCA), acute myocardial infarction (AMI) and unstable angina (UA). The starting date for identification was not less than 6 months and not more than 3 years prior to the expected date ofinterview. Patients were divided in three groups according to their condition of smoker (smoking at interview moment), ex-smoker (quitting smoking prior to interview moment) and no smoker (never smoking).

RESULTS

Smoking incidence before hospital admission for coronary event was 68.3% and 10% after hospital discharge. Prior the coronary event, percentage of male smokers (77.15%) predominated by female smokers (42.64%) - p<0.05, OR=4.54. Male smokers (67.25%) were more compliant to smoking cessation recommendation compared to females (32.35%) - p=0.04, OR=2.16; there was no significant difference between the two sexes concerning smoking incidence at interview moment (p>0.05). Patients who continued smoking after hospital discharged presented an increased frequency of MACE compared to non smokers (p=0.043, OR=1.98). Also, patients who continued smoking till hospitalization for coronary event, presented a higher risk compared to non smokers concerning re-intervention by PTCA (p=0.017, OR=4.28) and AMI incidence (p=0.01, OR=4.89). The MACE incidence was higher in active smokers versus passive smokers, but there was no significant differences between the two groups (p>0.05).

CONCLUSION

Majority of coronary patients renounced smoking after their first experience with cardiovascular events, a small part continued smoking. Patients who continued smoking after the acute event had higher incidence of MACE compared to non-smokers or ex-smokers (p<0.05). Also, MACE incidence was higher in active smokers versus passive but the difference was not significant between the two groups (p>0.05).

Environmental factors and cardiovascular risk in young individuals

Normal endothelial function alters physiologically with aging. Intervention of environmental factors precipitates and accelerates endothelial dysfunction progression, correlated with cardiovascular risk.

AIM

To study the impact of environmental factors (smoking, nutritional habits, stress, physical activity) on the imbalance of the endothelial commuting threshold.

METHODS

The questionnaire method was applied in order to identify and quantify the presence of environmental factors; an anthropometrical physical exam was performed; metabolic profile (insulin resistance HOMA-IR, lipid parameters) was assessed. Arterial elasticity was assessed with Complior (Artech Medical).

RESULTS

The studied lot (n=80, 21.16 +/- 2.43 years) comprised young medicine students and showed a high incidence of: smoking (31.25%), unhealthy nutritional habits (60%), stress (60%), sedentary lifestyle (25%). The odds for endothelial function alteration were significant only in subjects who associated stress and smoking (OR=8.18, p=0.0006); in the same group, there was noticed the tendency for metabolic profile alteration, meaning insulin resistance (OR=1.19, p=ns). The association stress-smoking did not significantly influence the unhealthy nutritional habits (p=ns, OR=2.39), lipoprotein anomalies (TC > or = 190 mg/dL: p=ns, OR=0.98; LDL > or = 130 mg/dL: p=ns, OR=3.53), or the sedentary lifestyle (p=ns, OR=0.80).

CONCLUSIONS

The main environmental factors which determine endothelial function imbalance in young ages are smoking and occupational stress. It is a positive stress which does not lead to significant metabolic anomalies or lifestyle changes. Though, this kind of stress leads to an unhealthy behavior: smoking. The association stress-smoking is essential in endothelial function alteration in young subjects. Primary cardiovascular prevention must focus drastically on unhealthy behaviors correction to reduce cardiovascular risk in young individuals.

Lifestyle, cardio-metabolic risk and arterial stiffness

HDL-cholesterol plays a key role defining the functional state of the arteries and the relation to cardiovascular risk.

AIM

To assess the degree of arterial stiffness in asymptomatic subjects with and without cardiovascular risk, depending on lipidic parameters behavior and on the insulin resistance state.

METHODS

Arterial stiffness was assessed using the carotid-radial pulse wave velocity (PWV-CR) measured with Complior; cardiovascular risk was calculated using the SCORE chart; metabolic risk was quantified by assessing fasting lipidic (TC, TG, HDL, LDL) and glycemic parameters (HOMA-IR >1 defines the insulin resistance state).

RESULTS

58 asymptomatic subjects, 57.62 +/- 14.40 years: 46.55% with (SCORE > or = 5%) and 53.45% without (SCORE < 5%) cardiovascular risk. In subjects with SCORE < 5% and low HDL (< 40 mg/dL), PWV-CR is influenced by the TG/HDL ratio (R2=0.27, p=0.04); LDL < 115 mg/dL has a powerful influence on PWV-CR (R2=0.58, p=0.02); the association of lipidic alterations is predictive for increased PWV-CR (> or = 9.5 m/s) (R2=0.85, p=0.008). In subjects with SCORE > or = 5%, protective HDL level (> or = 40 mg/dL) and HOMA-IR > 1, PWV-CR is strongly related to the insulin resistance state (R2=0.74, p=0.02), also to the association with LDL levels (R2=0.92, p=0.01).

CONCLUSIONS

The association between low HDL levels and other lipidic alterations in asymptomatic subjects with low cardiovascular risk influences the degree of arterial stiffness. Increased HDL levels and the presence of insulin resistance syndrome in high risk asymptomatic subjects are predictive for arterial stiffness. This prediction is amplified by LDL association to the metabolic state of the insulin resistance syndrome. It is necessary to establish target levels for HDL and TG in the cardiovascular disease prevention guidelines.

Assessment of treatment with orotate magnesium in early postoperative period of patients with cardiac insufficiency and coronary artery by-pass grafts (ATOMIC)

The benefit of the treatment with magnesium orotate (magnerot) was assessed in a randomised, single blind and placebo controlled study. Respecting the inclusion criteria were selected 32 patients with ischemia chronic failure in early postoperative period after CABG. The main improvements induced by magnesium orotate are the increase in exercise capacity (distance ambulated during 6 minutes walk test and ergospirometric parameters) and the reduction of ventricular premature beats. The treatment was well tolerated and the adverse reactions were not significant. The study strongly suggests the benefit of magnesium orotate added to classical antiischemic therapy in the complex management of coronary patients after CABG.

The value of echocardiography in the early diagnosis of myocardial impairment due to connective tissue diseases

The study comprised 14 patients with systemic lupus erythematosus (SLE) and 12 patients with diffuse scleroderma. Echocardiography ascertained 5 cases of congestive and 1 case of restrictive cardiomyopathy among the patients with SLE, as well as 6 cases with restrictive cardiomyopathy among those with scleroderma. The authors specify two important echocardiographic variables: the E-septum distance and the septal and wall motion after amyl-nitrite test, which reveal the intrinsic contractile properties of the myocardium, allowing an early diagnosis of myocardial impairment, as well as the selection of patients for an efficient treatment with vasodilator drugs.