Relative risk of cardiovascular morbidity is increased in Chronic Kidney Disease (CKD). According to current KDIGO guideline
cardiovascular risk can be estimated from Glomerular Filtration Rate (GFR) and proteinuria.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
This study analyzed bleeding complications in 150 patients with acute coronary syndrome (ACS) who received antiplatelet and anticoagulant therapy, comparing outcomes in diabetic and non-diabetic patients. There was no statistically significant difference in major bleeding as defined by TIMI criteria between diabetic and non-diabetic patients or between those who received heparin alone versus heparin plus tirofiban. The most common site of bleeding was the cardiac catheterization access site. While GRACE and CRUSADE risk scores were higher in diabetics, indicating greater disease severity, rates of all TIMI bleeding and blood transfusions were similar between diabetic and non-diabetic patients.
Achieving Blood Pressure Goal: From Clinical Trial into Real-World DataSuharti Wairagya
Hypertension remains a major global health issue, with over 7 million deaths annually associated with it. Less than 50% of hypertensive patients receive therapy, and approximately 70% of treated patients do not reach blood pressure goals. Most guidelines recommend initiating treatment with two drugs when blood pressure is more than 20/10 mmHg above goal or for those at high cardiovascular risk. Clinical trials have shown that the amlodipine/valsartan combination effectively lowers blood pressure and helps more patients achieve goals compared to monotherapy. Real-world Indonesian studies found that amlodipine/valsartan combination therapy was effective at controlling blood pressure in the majority of uncontrolled hypertensive patients switched from monotherapy.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
1) A meta-analysis of 27 randomized trials found that treating anemia in chronic kidney disease patients with erythropoiesis-stimulating agents (ESAs) to achieve higher hemoglobin levels increased risks of stroke, worsening hypertension, and vascular access thrombosis compared to lower hemoglobin targets.
2) No significant differences were found between higher and lower hemoglobin targets for risks of death, cardiovascular events, or progression to kidney failure requiring dialysis.
3) While higher hemoglobin targets reduced need for blood transfusions, they increased use of intravenous iron therapy.
This document summarizes the results of the HOPE-3 Trial, which evaluated the effects of blood pressure lowering and statin use on cognitive and functional outcomes in older adults. The trial found that while both interventions reduced cardiovascular events, they did not significantly prevent cognitive or functional decline over 5.6 years. However, there were trends toward benefit of blood pressure lowering in those with the highest baseline blood pressure and longer duration of treatment. Rosuvastatin also had no adverse effects on cognition. In conclusion, the interventions were generally not effective at preventing cognitive or functional decline, but some subgroups may benefit.
Rivaroxaban has shown benefits beyond antiplatelet therapy alone in reducing cardiovascular events. The COMPASS trial found that in patients with chronic coronary artery disease or peripheral artery disease, rivaroxaban plus aspirin reduced the composite of cardiovascular death, stroke, and myocardial infarction by 24% compared to aspirin alone. It also reduced mortality by 18% and ischemic stroke by 42%. Patients with multiple risk factors such as diabetes, chronic kidney disease, or heart failure derived the greatest benefits. However, use of anticoagulants remains lower than guidelines recommend due to overestimation of bleeding risks and underestimation of thrombotic risk.
This study analyzed bleeding complications in 150 patients with acute coronary syndrome (ACS) who received antiplatelet and anticoagulant therapy, comparing outcomes in diabetic and non-diabetic patients. There was no statistically significant difference in major bleeding as defined by TIMI criteria between diabetic and non-diabetic patients or between those who received heparin alone versus heparin plus tirofiban. The most common site of bleeding was the cardiac catheterization access site. While GRACE and CRUSADE risk scores were higher in diabetics, indicating greater disease severity, rates of all TIMI bleeding and blood transfusions were similar between diabetic and non-diabetic patients.
Achieving Blood Pressure Goal: From Clinical Trial into Real-World DataSuharti Wairagya
Hypertension remains a major global health issue, with over 7 million deaths annually associated with it. Less than 50% of hypertensive patients receive therapy, and approximately 70% of treated patients do not reach blood pressure goals. Most guidelines recommend initiating treatment with two drugs when blood pressure is more than 20/10 mmHg above goal or for those at high cardiovascular risk. Clinical trials have shown that the amlodipine/valsartan combination effectively lowers blood pressure and helps more patients achieve goals compared to monotherapy. Real-world Indonesian studies found that amlodipine/valsartan combination therapy was effective at controlling blood pressure in the majority of uncontrolled hypertensive patients switched from monotherapy.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
1) A meta-analysis of 27 randomized trials found that treating anemia in chronic kidney disease patients with erythropoiesis-stimulating agents (ESAs) to achieve higher hemoglobin levels increased risks of stroke, worsening hypertension, and vascular access thrombosis compared to lower hemoglobin targets.
2) No significant differences were found between higher and lower hemoglobin targets for risks of death, cardiovascular events, or progression to kidney failure requiring dialysis.
3) While higher hemoglobin targets reduced need for blood transfusions, they increased use of intravenous iron therapy.
This document summarizes the results of the HOPE-3 Trial, which evaluated the effects of blood pressure lowering and statin use on cognitive and functional outcomes in older adults. The trial found that while both interventions reduced cardiovascular events, they did not significantly prevent cognitive or functional decline over 5.6 years. However, there were trends toward benefit of blood pressure lowering in those with the highest baseline blood pressure and longer duration of treatment. Rosuvastatin also had no adverse effects on cognition. In conclusion, the interventions were generally not effective at preventing cognitive or functional decline, but some subgroups may benefit.
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
This study examined 273 patients admitted with acute coronary syndrome (ACS) to Sohag University Hospital in Egypt. The researchers found:
1) The overall prevalence of low high-density lipoprotein cholesterol (HDL-C) was 73.3% among the patients.
2) Patients with low HDL-C had higher rates of in-hospital mortality (12% vs 11%) and congestive heart failure (18% vs 5.5%) compared to those with satisfactory HDL-C.
3) Low HDL-C was more common in women and was associated with insignificantly higher in-hospital mortality and congestive heart failure in women, but not in men.
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
The study evaluated the efficacy and safety of combining LDL cholesterol lowering (rosuvastatin 10 mg) and blood pressure lowering (candesartan 16-12.5 mg and hydrochlorothiazide 12.5 mg) therapies versus placebo in 12,705 participants without cardiovascular disease but with risk factors. The combined therapy group experienced significantly fewer cardiovascular events (29% risk reduction) and fewer secondary outcomes (28% risk reduction) compared to the dual placebo group. The number needed to treat over 5.6 years was 72 to prevent one primary outcome and 63 to prevent one secondary outcome. While statistically significant differences were observed, the overall clinical benefit was modest given the event rates in both groups.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Marc Penn, MD, PhD, FACC - Trials and Tribulations of Assessing CVD Risk in ...Cleveland HeartLab, Inc.
This document discusses the importance of assessing cardiovascular risk through inflammatory markers in addition to traditional lipid markers. It provides evidence that atherosclerosis is driven by inflammation and markers like hsCRP and MPO can help identify patients at higher risk of events. The document also discusses how statins work through multiple anti-inflammatory pathways beyond just lowering lipids. A multimarker inflammation approach is presented as a way to better stratify risk and identify high-risk patients within populations that may otherwise appear low risk based on traditional metrics alone.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
- The document summarizes research on cilostazol for the treatment of intermittent claudication from peripheral artery disease.
- Studies showed cilostazol significantly improved treadmill walking distance and quality of life measures compared to placebo over 6 months.
- The long-term CASTLE study of over 1400 patients found cilostazol did not increase cardiovascular risk over 3 years and may reduce stroke risk compared to placebo.
Cardiovascular disease is a major risk for those with diabetes.
1) Studies like the Framingham Heart Study and UKPDS found diabetes to be a significant risk factor for cardiovascular mortality and events like heart attacks.
2) Having diabetes poses similar risks as having a heart attack, with endothelial dysfunction, dyslipidemia, and other factors increasing cardiovascular risks.
3) Lifestyle changes like diet, exercise, weight loss and optimal control of blood pressure, cholesterol and blood sugars can help prevent premature cardiovascular events for those with diabetes.
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
- Statins may increase the risk of developing diabetes through pathways that reduce insulin sensitivity and insulin secretion. The JUPITER trial found a small increased risk of physician-reported diabetes with rosuvastatin use.
- Individual statins have variable effects on diabetes risk, with some studies finding atorvastatin and simvastatin association and others not finding rosuvastatin association. Higher intensity statin use was linked to greater diabetes risk than moderate-dose use.
- For patients with risk factors for both cardiovascular disease and diabetes, the cardiovascular benefits of statins often outweigh the risks of developing diabetes, but close monitoring of blood glucose is recommended. Risks and benefits should be weighed individually
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Statins have been shown to reduce cardiovascular risk in patients with chronic kidney disease (CKD), though the evidence is stronger for earlier stages of CKD. Several large trials found simvastatin reduced major atherosclerotic events and mortality in patients with CKD stages 3-5, including those on dialysis. Guidelines recommend considering statins for primary prevention of cardiovascular disease in CKD as in those without CKD. Dosage adjustments are recommended for some statins in more severe CKD due to increased risk of adverse effects, though trials found simvastatin, atorvastatin, and pravastatin can be used at standard doses even in stage 3 CKD without excess risk when monitored closely.
- The study aimed to determine the prevalence of peripheral vascular disease (PVD) in patients with chronic kidney disease (CKD) using ankle brachial index (ABI) measurements.
- ABI was measured on 72 CKD patients, and 20 patients (27.8%) had an ABI <0.9 indicating PVD.
- PVD prevalence was highest (34.7%) in patients with stage 5 CKD. Overall, the study found a significant prevalence of PVD among CKD patients based on ABI measurements.
This randomized controlled trial involved 4444 patients with coronary heart disease who were assigned to either simvastatin or placebo treatment. Over the median 5.4 year follow-up period, simvastatin treatment reduced total mortality by 30% compared to placebo. Specifically, 256 patients died in the placebo group compared to 182 in the simvastatin group, representing a relative risk of death of 0.70 for those receiving simvastatin. Simvastatin also reduced major coronary events such as heart attacks and procedures by 34% compared to placebo. This study provides evidence that long-term cholesterol lowering with simvastatin improves survival rates for patients with coronary heart disease.
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
This study examined 273 patients admitted with acute coronary syndrome (ACS) to Sohag University Hospital in Egypt. The researchers found:
1) The overall prevalence of low high-density lipoprotein cholesterol (HDL-C) was 73.3% among the patients.
2) Patients with low HDL-C had higher rates of in-hospital mortality (12% vs 11%) and congestive heart failure (18% vs 5.5%) compared to those with satisfactory HDL-C.
3) Low HDL-C was more common in women and was associated with insignificantly higher in-hospital mortality and congestive heart failure in women, but not in men.
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
The study evaluated the efficacy and safety of combining LDL cholesterol lowering (rosuvastatin 10 mg) and blood pressure lowering (candesartan 16-12.5 mg and hydrochlorothiazide 12.5 mg) therapies versus placebo in 12,705 participants without cardiovascular disease but with risk factors. The combined therapy group experienced significantly fewer cardiovascular events (29% risk reduction) and fewer secondary outcomes (28% risk reduction) compared to the dual placebo group. The number needed to treat over 5.6 years was 72 to prevent one primary outcome and 63 to prevent one secondary outcome. While statistically significant differences were observed, the overall clinical benefit was modest given the event rates in both groups.
HDL-cholesterol concentrations are inversely associated with CVD.When we consider cardiovascular mortality in women in terms of HDL.Causes of low HDL cholesterol.Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile.associations of HDL-C and HDL-P with cIMT and CHD.MESA (Multi-Ethnic Study of therosclerosis. Functional Versus Dysfunctional HDL. High concentrations of HDL - cholesterol are associated with high all-cause mortality in men and women.Improvement of HDL function without necessarily raising HDL-C
Marc Penn, MD, PhD, FACC - Trials and Tribulations of Assessing CVD Risk in ...Cleveland HeartLab, Inc.
This document discusses the importance of assessing cardiovascular risk through inflammatory markers in addition to traditional lipid markers. It provides evidence that atherosclerosis is driven by inflammation and markers like hsCRP and MPO can help identify patients at higher risk of events. The document also discusses how statins work through multiple anti-inflammatory pathways beyond just lowering lipids. A multimarker inflammation approach is presented as a way to better stratify risk and identify high-risk patients within populations that may otherwise appear low risk based on traditional metrics alone.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This Journal publishes original research work that contributes significantly to further the scientific knowledge in pharmacy.
- The document summarizes research on cilostazol for the treatment of intermittent claudication from peripheral artery disease.
- Studies showed cilostazol significantly improved treadmill walking distance and quality of life measures compared to placebo over 6 months.
- The long-term CASTLE study of over 1400 patients found cilostazol did not increase cardiovascular risk over 3 years and may reduce stroke risk compared to placebo.
Cardiovascular disease is a major risk for those with diabetes.
1) Studies like the Framingham Heart Study and UKPDS found diabetes to be a significant risk factor for cardiovascular mortality and events like heart attacks.
2) Having diabetes poses similar risks as having a heart attack, with endothelial dysfunction, dyslipidemia, and other factors increasing cardiovascular risks.
3) Lifestyle changes like diet, exercise, weight loss and optimal control of blood pressure, cholesterol and blood sugars can help prevent premature cardiovascular events for those with diabetes.
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
- Statins may increase the risk of developing diabetes through pathways that reduce insulin sensitivity and insulin secretion. The JUPITER trial found a small increased risk of physician-reported diabetes with rosuvastatin use.
- Individual statins have variable effects on diabetes risk, with some studies finding atorvastatin and simvastatin association and others not finding rosuvastatin association. Higher intensity statin use was linked to greater diabetes risk than moderate-dose use.
- For patients with risk factors for both cardiovascular disease and diabetes, the cardiovascular benefits of statins often outweigh the risks of developing diabetes, but close monitoring of blood glucose is recommended. Risks and benefits should be weighed individually
Cardiovascular disease is very common in patients with chronic kidney disease.
- CVD is the leading cause of death in patients with CKD, even in early stages of kidney disease and those with low levels of albuminuria. Reduced kidney function and increased albuminuria are associated with higher risk of CVD events and mortality.
- The prevalence of CVD is extremely high in patients on dialysis, with over 70% of dialysis patients having CVD. CVD is responsible for about 40% of all deaths in dialysis patients.
- Both traditional CVD risk factors like hypertension and diabetes as well as nontraditional risk factors related to CKD contribute to the elevated CVD risk in this population. Targeting modifiable
Statins have been shown to reduce cardiovascular risk in patients with chronic kidney disease (CKD), though the evidence is stronger for earlier stages of CKD. Several large trials found simvastatin reduced major atherosclerotic events and mortality in patients with CKD stages 3-5, including those on dialysis. Guidelines recommend considering statins for primary prevention of cardiovascular disease in CKD as in those without CKD. Dosage adjustments are recommended for some statins in more severe CKD due to increased risk of adverse effects, though trials found simvastatin, atorvastatin, and pravastatin can be used at standard doses even in stage 3 CKD without excess risk when monitored closely.
- The study aimed to determine the prevalence of peripheral vascular disease (PVD) in patients with chronic kidney disease (CKD) using ankle brachial index (ABI) measurements.
- ABI was measured on 72 CKD patients, and 20 patients (27.8%) had an ABI <0.9 indicating PVD.
- PVD prevalence was highest (34.7%) in patients with stage 5 CKD. Overall, the study found a significant prevalence of PVD among CKD patients based on ABI measurements.
This randomized controlled trial involved 4444 patients with coronary heart disease who were assigned to either simvastatin or placebo treatment. Over the median 5.4 year follow-up period, simvastatin treatment reduced total mortality by 30% compared to placebo. Specifically, 256 patients died in the placebo group compared to 182 in the simvastatin group, representing a relative risk of death of 0.70 for those receiving simvastatin. Simvastatin also reduced major coronary events such as heart attacks and procedures by 34% compared to placebo. This study provides evidence that long-term cholesterol lowering with simvastatin improves survival rates for patients with coronary heart disease.
1) The study examined predictors of ischemia and outcomes in 169 Egyptian patients with diabetes referred for nuclear perfusion imaging over 2 years of follow up.
2) Significant relationships were found between higher summed stress scores and outcomes of sudden cardiac death, myocardial infarction, and heart failure. Higher summed rest scores also significantly predicted several adverse outcomes.
3) Degree of typical chest pain, transient left ventricular dilation, lung uptake on imaging, and extent of ischemia (summed difference score) were independent predictors of myocardial infarction. Transient left ventricular dilation was the strongest predictor of sudden cardiac death.
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document summarizes end organ damage that can result from hypertension. It discusses how hypertension can damage the brain, eyes, heart, kidneys, and arteries. It provides definitions for hypertension, assessments for target organ damage, and lists routine lab tests for evaluating hypertension patients. Specific types of end organ damage are outlined such as retinopathy, coronary heart disease, renal failure, and atherosclerosis. Hypertensive emergencies that require rapid blood pressure reduction are also defined.
Hemorheological indexes, living habits, medical history and genetics factor are primary risk factors in Coronary Heart Disease (CHD). In the present study the relation of all factors to the severity of CHD was examined. The data of 282 patients (mean age: 60±9 years) diagnosed with CHD and 229 healthy controls (mean age: 59±7 years) from Wenzhou Medical University were analyzed.
This study estimated the prevalence of chronic kidney disease (CKD) among 132 patients attending a diabetes clinic in Jamaica. Approximately 86% of patients had CKD based on estimated glomerular filtration rate (eGFR) below 60 or albuminuria of 30 mg/g or higher. Over 20% had moderate albuminuria and 62% had severe albuminuria. Based on risk categories from the KDIGO guidelines, 51% were at high risk and 17% at very high risk of adverse outcomes like mortality, cardiovascular disease, and kidney failure. The high prevalence of CKD and risk of adverse outcomes shows the need for further studies on preventing CKD in diabetes patients in developing countries.
This study compared the effects of levosimendan, dobutamine, and vasodilator therapy on ongoing myocardial injury in patients with acute decompensated heart failure. The study found that while all treatments were associated with decreases in cardiac troponin I levels and improvements in hemodynamic and functional indicators, levosimendan treatment showed the most pronounced improvements, especially in left ventricular ejection fraction and systolic pulmonary artery pressure. However, none of the treatments significantly reduced cardiac troponin I levels compared to each other. The study demonstrated beneficial effects of short-term use of levosimendan, dobutamine, and nitroglycerin on ongoing myocardial injury in acute decompensated heart failure.
Metabolic syndrome (MetS) predicts cardiovascular and cerebrovascular events over 20 years of follow-up. A study of 529 asymptomatic patients with MetS at baseline found they experienced 199 cardiovascular adverse events, compared to 120 events for 278 healthy controls, with an odds ratio of 2.3. Multivariate analysis identified MetS, BMI, C-reactive protein levels, and preclinical atherosclerosis as independent predictors of cardiovascular events over the 20 year period. Subclinical atherosclerosis was more prevalent in patients with MetS compared to controls. MetS significantly increased the risk of total cardiovascular, cerebrovascular, myocardial infarction and angina events over the long term follow-up period.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay
This document summarizes the key points from a lipidology conference presentation. It discusses recent guidelines and studies on cholesterol treatment, including more aggressive LDL lowering to under 70mg/dl for patients with cardiovascular disease. New tools for general cardiovascular risk prediction were presented. Treatment with high-dose statins was found to significantly reduce stroke recurrence and other outcomes for patients who had a stroke or TIA within the past 1-6 months. Immediate withdrawal of statins after acute stroke was associated with increased risks.
Dyslipidemia -Assessment and management based on evidence SYEDRAZA56411
This document provides a summary of a presentation on dyslipidemia assessment and management. It discusses several key points:
1. International guidelines recommend intensive statin therapy to manage cardiovascular disease risk in patients with dyslipidemia.
2. Randomized trials like JUPITER showed that rosuvastatin reduced major cardiovascular events in individuals with elevated CRP levels despite normal lipid levels, supporting early prevention.
3. Guidelines worldwide advise lowering LDL-C based on cardiovascular risk, with intensive statin therapy recommended for high-risk patients to achieve LDL-C reduction of 50% or more.
The study to measure the level of serum annexin V in patients with renal hype...inventionjournals
ABSTRACT : Renovascular hypertension reflects the causal relation between anatomically evident arterial occlusive disease and elevated blood pressure. The coexistence of renal arterial vascular disease and hypertension roughly defines this type of nonessential hypertension. The aim of this study was to measure the level of serum Anti-Annexin V antibodies in patients with renal hypertension. Methods. This study was conducted on 115 patients, diagnosed with renal hypertension and hypertension. Informed consents were obtained from the patients and the study was approved by the Kharkiv National Medical University ethics committee. Ten healthy age and sex matched volunteers were included as a control group. All patients and controls were subjected to the following full history taking and thorough clinical examination. Routine laboratory testing included a complete blood count, and erythrocyte sedimentation rate (ESR) and kidney function tests (blood urea nitrogen and serum creatinine). Immunological tests for antinuclear antibody (ANA) and anticentromere antibodies (ACA) was performed by the indirect immunofluorescence technique. AntiScl-70 (anti-topoisomerase antibodies) and anticardiolipin antibodies (ACA: IgG and IgM) were tested using the ELISA technique. The anti-annexin V antibodies titre used the ZYMUTEST anti-Annexin IgG ELISA kit. [Hyphen-BioMed, France.]: to measure the IgG isotype of auto-antibodies to annexin V in human serum. Results. Anti-annexin V antibodies were present in 75% of patients (mean 83.46 ± 22.44 AU/mL) vs. 0% in the controls (mean 3.94 ± 4.5 AU/mL). Comparison between patients and controls as regards levels of anti-annexin V showed a highly significant difference (P < 0.001). Furthermore, correlation of anti-annexin V titres with the disease activity score in the patient group showed a statistically significant positive correlation (r = 0.51, P < 0.05).In addition, the anti-annexin V antibody titres in this study showed a highly significant positive correlation with ACL antibodies (r = 0.74, P < 0.001). Patients with antiphospholipid syndrome (APS) have been known to have a higher frequency of anti-annexin V antibodies, and thrombotic events have been reported more frequently in patients with positive anti-annexin V antibodies. Furthermore, inhibition of annexin V binding to negatively charged phospholipids may be an additional pathogenic mechanism of APS.
diabetes Orientation Talk The dealing with diabetic complications pptxGovindRankawat1
When and how to screen Diabetic Kidney Disease (DKD) And what is the role of Urine Albumin Creatinine Ratio (UACR)
All patients with type 2 diabetes must be screened for diabetic nephropathy at the time of diagnosis.
Patients with type 1 diabetes should be screened five years after diagnosis and at puberty. If the initial test reveals negative result then the test has to be repeated annually for both type 1 and type 2 diabetes.
Early Diabetic kidney disease expressed as Microalbuminuria (if urinary albumin excretion is 30 - 300 mg/24 h.
Random urine samples should be used and the results of albumin measurement in spot collection may be expressed as urinary albumin concentration (mg/dL) or as urinary albumin to creatinine ratio (mg/g or mg/mmol).
This method is often found to be the easiest to carry out in an office setting, generally provides accurate information, and is therefore preferred;
Background and Aim: Many studies have found association between Red Cell Distribution Width (RDW) values and hypertension, dipping pattern, and end-organ damage. RDW values are affected by blood vitamin B12, iron, and folic acid levels, parameters that were not assessed in the previous studies. The aim of our study was to evaluate the relation between RDW and hypertension, dipper pattern, and end-organ damage independently from vitamin B12, folic acid, and ferritin levels in newly diagnosed hypertensive patients.
- The document discusses the evidence for lipid lowering therapy in patients with chronic kidney disease (CKD). It summarizes data from major trials showing proportional reductions in major vascular events with reductions in LDL cholesterol.
- For patients at high risk of atherosclerotic events like those with diabetes or known heart disease, statin therapy may provide similar benefits regardless of kidney function, though the evidence is less clear for patients on dialysis or with mild CKD.
- Ongoing trials like SHARP and AURORA aim to provide more evidence on the risks and benefits of statin therapy in patients with CKD or on dialysis.
Comparative Study of Hscrp in Chronic Kidney Diseaseiosrphr_editor
Chronic kidney disease (CKD) is a global threat to health mainly in developing countries because therapy is expensive and lifelong. over 1 million people worldwide are on dialysis or with a functioning graft. Early detection of Chronic kidney disease (CKD) and its consequent complications can prevent its grave complications . It causes not only significant morbidity but also it causes high mortality. Because of increase in incidence of Diabetes mellitus, hypertension, obesity and an aging population there is increase in progression of chronic kidney disease to end stage renal disease (ESRD). . Cardiovascular disease (CVD) is the major cause of mortality in haemodialysis patients and so it has become imperative to have a screening programme at all levels to detect CKD at an early stage and to initiate specific therapy to reduce the progression of renal disease and also the burden of ESRD (1). High sensitive C-Reactive protein (Hs CRP) assay is useful for sensitive detection of inflammatory state (2,3). This study aims at estimating Hs CRP as a marker of inflammation in CKD patients...
This document provides a summary of articles across various medical specialties discussed in the April 2015 edition of the UTSW Journal Watch. In the Hepatology section, an article is summarized that finds corticosteroids may be safely used in patients with severe alcoholic hepatitis who present with an upper GI bleed after bleeding is controlled. In Pulmonary/Critical Care, a summary is provided of a trial finding no difference in mortality between early goal-directed therapy and usual care for treating septic shock. The study suggests protocols for goals of care are less important than early antibiotics and fluids. In Nephrology, a meta-analysis summary indicates preoperative use of renin-angiotensin system inhibitors may be linked to
1) Multiple lines of evidence from meta-analyses, prospective cohort studies, and randomized controlled trials establish that LDL causes atherosclerotic cardiovascular disease (ASCVD).
2) The risk of atherosclerosis and need for treatment depends on LDL levels and increases with age from childhood through older age. Lowering LDL, including to very low levels, reduces ASCVD risk and can regress atherosclerotic plaques.
3) Intensive LDL lowering through combination therapy such as statins plus ezetimibe or PCSK9 inhibitors provides additional cardiovascular benefit beyond statin therapy alone, including in those already at very low LDL levels. The greatest risk reduction occurs in high-risk groups.
Instability and rupture of atherosclerotic plaques result in acute coronary syndrome.
LDL-C is usually related to ASCVD.
Statin medications are first-line therapy for LDL-C lowering Post ACS.
Rosuvastatin 20mg and 40 mg significantly increase HDL-C levels compared with Atorvastatin 80 mg
Similar to International Journal of Nephrology & Therapeutics (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
2. SRL Nephrology & Therapeutics
SCIRES Literature - Volume 3 Issue 1 - www.scireslit.com Page - 002
Abbreviations
ACR: Urinary Albumin/Creatinine Ratio; CKD: Chronic Kidney
Disease; GFR-EPI: estimated Glomerular Filtration Rate published by
CKD-Epidemiology Collaboration; hsTnT: High Sensitive Troponin
T; HbA1c: Hemoglobin A1c; non–HDL-C: difference between total
cholesterol and HDL-cholesterol; Scr: Serum Creatinine; TPCR:
Urinary Total Protein/Creatinine
Introduction
Cardiovascular mortality risk is increased in all stages of chronic
kidney disease [1-4]. Although cardiac troponin is the first choice in
the diagnosis of acute myocardial infarction, proper interpretation
of slightly elevated troponin is challenging, because high sensitive
troponin T tests applied since ~2009 detect even the smallest cardiac
damage. Recent clinical studies proved that high sensitive troponin
level depends on GFR, and it increases with the impairment of renal
function. According to the current KDIGO 2013 guideline [5],
automatedreportingofestimatedGlomerularFiltrationRate(GFR)in
laboratories established the classification of Chronic Kidney Disease
(CKD). However, recognition of chronic kidney disease in early stage
is often based on albuminuria or proteinuria [6-15]. According to
KDIGO 2013 guideline for the assessment of cardiovascular risk in
chronic kidney disease GFR- and proteinuria-based renal score is
recommended.
The first aim of this study was to evaluate whether renal score
is enough to estimate cardiovascular risk in CKD for a long run.
Therefore, in Study A we retrospectively evaluated renal scores,
GFR, proteinuria and the effect of proteinuria on the efficacy of lipid
lowering therapy during a four-year period.
The second aim was to prove whether high sensitive troponin T
(hsTnT) has an incremental value to predict cardiovascular risk. For
this we evaluated hsTnT at different stages of CKD and correlation
with clinical cardiovascular score (Study B). As the permanently
elevated hsTnT is common in CKD, correct evaluation of cardiac
state is a crucial task at emergency departments, nephrology or
cardiac centers.
Subjects and Methods
Study A
First in a retrospective study we reviewed the clinical and
laboratory data of 400 patients, who were followed regularly at the
Nephrology Outpatient Centre, University of Debrecen in a four-
year period (2009-2012) without acute cardiac events. To calculate
Framingham clinical cardiovascular scores and renal scores, we could
enroll only 20 patients who had a complete medical history (Table 1)
and all laboratory results (serum creatinine, GFR, urinary protein (or
albumin), creatinine from the first morning urine, serum cholesterol,
LDL-C, HDL-C, triglyceride and HbA1c in diabetes mellitus) each
year (2009-2012). At the beginning of Study A median age of the 20
patients (15 men, 5 women) was 65 years (38-88 years). The clinical
score indicating the risk of cardiovascular mortality was estimated
from the parameters of the Framingham study [16,17]. The patient’s
history and traditional cardiovascular risk markers were taken into
account as it is detailed in Table 1 (age, BMI, blood pressure, cardiac
events, myocardial infarction, stroke, blood lipids, hyperglycemia,
diabetes mellitus, HbA1c). Renal score was estimated from the
glomerular filtration rate (GFR-EPI) and urinary protein/creatinine
or albumin/creatinine ratio (Table 2). The patients were sorted into
four groups of severity based on renal scores (1: low, 2: moderate,
3: high, 4: extremely high cardiovascular risk). The advantage of
GFR-EPI formula is the reliability up to 90 ml/min/1.73 m2
; it was
calculated as Levey et al published for adults in 2009 [14]:
Female if Scr <62 µmol/ L: eGFR=144×(Scr/61.6)–0,329
×(0.993) age
Female if Scr >62 µmol/ L: eGFR=144×(Scr/61.6)–1,209
×(0.993) age
Male if Scr <80 µmol/ L: eGFR=141×(Scr/79.2)–0,411
×(0.993) age
Male if Scr >80 µmol/ L: eGFR=141×(Scr/79.2)–1,209
×(0.993)age
Fasting blood samples were collected in Becton-Dickinson
vacuum tubes with a gel separator. After centrifugation (1800 g, 10
min) clinical biochemical tests were performed on a Cobas-6000
analyzer (Roche Diagnostics Ltd, Mannheim). Serum cholesterol and
triglyceride were determined by enzymatic assay, HDL-cholesterol
Abstract
Relative risk of cardiovascular morbidity is increased in Chronic Kidney Disease (CKD). According to current KDIGO guideline
cardiovascular risk can be estimated from Glomerular Filtration Rate (GFR) and proteinuria.
Aims: First aim was to evaluate renal score, is it enough to estimate cardiovascular risk in CKD. Then we checked whether high
sensitive Troponin T (hsTnT) has an incremental value to predict cardiovascular risk in CKD.
Methods: Clinical cardiovascular score was established according to the Framingham study: age, BMI, blood pressure, lipids, patient
history (diabetes mellitus, myocardial infarction, stroke). Renal severity scores (1-4) were determined from GFR and urinary albumin/
creatinine or protein/creatinine. Biochemical parameters were determined by Cobas 6000.
Results: Results in Study A (n:20) Mean of GFR decreased (66 ± 12 vs. 47 ± 16 ml/min/1.73 m2
) and renal score impaired (2.5 ±
1.1 vs. 3 ± 0.9) during four years. Clinical cardiovascular score was proportional to the renal score: clinical score was 21.8 ± 9.8 at renal
score <3.5 and 29.2 ± 6.7 at renal score >3.5 (p:0.09). Proteinuria has prognostic value in lipid lowering therapy: atherogenic non-HDL
was reducible from 3.62 ± 0.75 to 2.92 ± 0.63 mmol/ L without proteinuria. In Study B (n:21) mean of clinical cardiovascular score was
21.5 ± 2.1 at moderate renal damage and 27.4 ± 9.2 at severe renal damage. Mean of hsTnT was also lower (14.8 ± 11.3) at renal scores
1-2 compared to hsTnT (32.8 ± 20.9 ng/ L) at renal scores 3-4. Individual hsTnT correlated with clinical scores (R = 0.655, P < 0.001).
Conclusions: Impairment of renal score indicates higher cardiovascular risk. Permanent moderate elevation of hsTnT refers to
increased cardiovascular risk, which has incremental value in the treatment of CKD.
Keywords: Cardiovascular mortality; Glomerular filtration rate; Proteinuria; Renal score; Troponin
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and LDL-cholesterol were measured by homogenous enzymatic
assay. For monitoring the efficacy of lipid lowering therapy, non-
HDL-C the sum of atherogenic lipoproteins was calculated from the
difference of total cholesterol and HDL-cholesterol. We considered
non-HDL-C<3.3 mmol/L as the target value in chronic kidney
disease. Urinary protein, albumin and creatinine were determined
from the first morning urine. Urinary albumin was analyzed by
immunoturbidimetry, urinary total protein was measured by
turbidimetric assay. To compensate diurnal variation, first morning
urinary albumin/creatinine and protein/creatinine were taken into
consideration. Urinary and serum creatinine was determined by
kinetic Jaffe method.
In Study A during a four-year period (2009-2012) 50% of the
patients was treated with atorvastatin (10-40 mg/ day), 25% received
simvastatin (10-40 mg/ day), and 25% were treated with ezetimibe
(20-40 mg/ day).
Study B
We enrolled 21 CKD patients (19 men, 2 women); their median
Table 1: Clinical score as a basic marker of cardiovascular risk was calculated from parameters of the Framingham study [16,17].
Age (years) <40 40-60 60-70 >70
score 1 2 3 4
Hypertension
duration (years) <5 5-10 >10
<140 Hgmm 1 2 3
140-160 Hgmm 4 5 6
>160 Hgmm 7 8 9
Diabetes mellitus
duration (years) <5 5-10 >10
HbA1c= 6.5-7.5 2 4 6
HbA1c >7.5 4 6 8
Cardiac event
Acute myocardial infarction, stroke 10
Cholesterol
level (mmol/L) <4.5 4.5-5 >5
score 0 3 6
Triglyceride (mmol/L) <1.7 1.7-2.5
score 0 3
LDL-C (mmol/L) <2.5 2.5-3 >3
score 0 3 6
HDL-C (mmol/L) >1 male, >1.3 female <1 male, <1.3 female
score 0 3
Body mass index 23-25 25-30 >30
score 2 4 6
Cardiac symptoms
2 scores/symptom
chest pain
oedema
palpitation
fatigue
asphyxia
arrhythmia
cardiac
decompensation
Abbreviations: HbA1c: Hemoglobin A1c; LDL-C: Low Density Lipoprotein; HDL-C: High Density Lipoprotein
Table 2: Renal score based on GFR and proteinuria shows relative risk of cardiovascular mortality in chronic kidney disease [6,7].
Relative risk of cardiovascular mortality in
CKD on the base of GFR and proteinuria
Stages of albuminuria or proteinuria (mg/ mmol)
A1: normal
ACR <3
A2: moderate
ACR: 3-30, or
TPCR: 15-50
A3: severe
ACR >30, or
TPCR: 51-350
A3n: nephrotic
TPCR >350
GFR stages (ml/min/
1.73 m2
)
G1: normal, or elevated >90 Low Moderate High Extremely High
G2: mild decrease 60-89 Low Moderate High Extremely High
G3a: mild-moderate decrease 45-59 Moderate High Extremely High Extremely High
G3b: moderate-severe decrease 30-44 High Extremely High Extremely High Extremely High
G4: severe decrease 15-29 Extremely High Extremely High Extremely High Extremely High
G5: end-stage renal failure <15 Extremely High Extremely High Extremely High Extremely High
Low risk: 1 (relative risk: 1-1.49), moderate risk: 2 (relative risk: 1.5-2.29), high risk: 3 (relative risk: 2.3-3.69), extremely high risk: 4 (relative risk
>3.7)
ACR: urinary Albumin/Creatinine (mg/mmol), GFR: Glomerular Filtration Rate, TPCR: urinary Total Protein/Creatinine (mg/ mmol).
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age was 67 years (32-89 years). They were monitored regularly at the
Nephrology Outpatient Centre and had no previous acute cardiac
event. We enrolled patients who had complete medical history and
laboratory results to calculate clinical cardiovascular score and renal
score. Their hsTnT was determined from a fasting serum sample by
chemiluminescent immunoassay on Cobas 6000 analyzer.
Ethics approval
The work is conforming to the guiding principle of the
Declaration of Helsinki; the patients gave informed consent for the
study approved by the Institutional Committee on Human Research,
Debrecen (RKEBI/IKEBI 3764-2012).
Statistical Analysis
Statistical calculations were done using the SPSS package version
22 (IBM, Somers, NY). In the retrospective Study A we analyzed the
changes of the renal score, GFR, proteinuria and non-HDL with time
by Friedman’s test. The average yearly changes of GFR and non-HDL
demonstrated normal distribution, so one-sample t-test could be
applied to test whether the changes were significant. The change rates
of the groups with and without proteinuria were compared using two-
sample t-test. In Study B we compared troponin T levels and clinical
scores between the groups with mild vs. severe renal damage by Welch
test, since the variances of the groups were significantly different by
Levene’s test. We tested whether the troponin T level and the renal
score were independent predictors of the clinical cardiovascular score
using stepwise forward linear regression analysis.
Results
In the retrospective Study A during a four-year period (2009-
2012) we observed significant impairment of the GFR (P < 10-6
)
and renal score (P < 10-4
; Friedman test for all patients). While the
individual GFR values decreased 0-15 ml/min/1.73 m2
in a year,
urinary protein/creatinine fluctuated. During the four-year period,
considerable impairment of renal function was observed in three
patients: proteinuria increased and GFR decreased to the value of <30
ml/min/1.73 m2
. The mean of GFR decreased from 66 ± 12 to 47 ± 16
ml/min/1.73 m2
in four years. In most cases the decrease of GFR was
followed by progressing proteinuria. The clinical cardiovascular score
was proportional to the renal score: mean of clinical score was 21.8
± 9.8 at renal score <3.5 and 29.2 ± 6.7 at renal score >3.5 (p:0.09).
Our results denote that impairment of renal score based on GFR and
proteinuria indicates higher cardiovascular risk.
Efficacy of lipid lowering therapy also depended on proteinuria:
the atherogenic non-HDL-cholesterol (non-HDL-C) decreased
significantly in the 11 patients without proteinuria (P < 0.05, two-
sample t-test), but it was not reducible in the 9 patients with
proteinuria (Figure 1). Mean value of non-HDL-C decreased from
3.62 ± 0.75 to 2.92 ± 0.63 mmol/ L without proteinuria, and remained
3.5 ± 1.2 mmol/L with significant proteinuria in spite of lipid lowering
therapy (target value of non-HDL-C<3.3 mmol/ L).
In Study B (n:21) we investigated whether high sensitive Troponin
T (hsTnT) has an incremental value to predict cardiovascular risk in
CKD. Both cardiac hsTnT level (Welch test: P = 0.02) and clinical
cardiovascular score (P = 0.017) were significantly higher at severe
kidney damage (renal scores 3 or 4) than at mild kidney damage
(renal scores 1 or 2), (Figure 2). Mean of hsTnT was higher (32.8 ±
20.9 ng/L) at severe renal damage than at mild renal damage (14.8
± 11.3). The upper limit of reference range is hsTnT<14 ng/L (99
percentile value). Mean of clinical cardiovascular score was also
higher (27.4 ± 9.2) at severe renal damage than at mild renal damage
(21.5 ± 2.1), (Figure 2).
The correlation between clinical cardiovascular score and hsTnT
(R = 0.655, p < 0.001) indicates that permanent moderate elevation
of hsTnT has incremental value in predicting cardiovascular risk in
CKD (Figure 3).
Discussion
Our retrospective study detected the impairment of renal score
in a four-year period. The results support that clinical cardiovascular
score is proportional to renal score and it indicates the diagnostic
Figure 1: The efficacy of lipid lowering therapy depends on proteinuria: atherogenic non-HDL was successfully decreased in the group (n:11) without proteinuria
(P < 0.05, two-sample t-test), while change in non-HDL-C was Not Significant (NS) in patients (n:9) with proteinuria during four years long lipid lowering therapy
in Study-A.
SEE: Standard Error of the Estimate
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Figure 2: Both high sensitive troponin T (P = 0.020, Welch test) and clinical cardiovascular score (P = 0.017) were significantly higher at severe kidney damage
(renal scores 3 or 4) than at mild kidney damage (renal scores 1 or 2). Study-B, n:21.
Upper limit of the reference range is 14 ng/ L for hsTnT.
Figure 3: Clinical cardiovascular score (based on Framingham study) correlates with high sensitive troponin T level in chronic kidney disease (R = 0.655, P <
0.001). Study-B, n:21.
merit of the combined renal score for the estimation of Framingham-
based cardiovascular risk-assessment. In chronic kidney disease, for
the estimation of cardiovascular mortality risk both the glomerular
filtration rate and albumin/proteinuria should be monitored.
Permanent proteinuria alone implies an elevated cardiovascular
risk, and it indicates the progression of vascular damage. In case of
diabetes mellitus urinary albumin is recommended as a first, more
sensitive test. Even the first grade of albuminuria (3-30 mg/ mmol
urinary albumin/creatinine) indicates high risk of cardiovascular
morbidity, if GFR is decreased to as low as 45-59 ml/min/1.73 m2
(Table 2). It is in accordance with the opinion of Astor, et al. [18],
who established that 10 ml/min/1,73 m2
decrease in GFR at GFR<60
ml/min/1.73 m2
is associated with 1.29 and doubling of albuminuria
with 1.06 relative risk of cardiovascular mortality.
Among the cardiovascular lipid markers non-HDL-C decreased
in response to lipid lowering therapy only in those patients who did
not have proteinuria. The results indicate that proteinuria may be a
predictor of non-successful lipid-lowering therapy. These findings
underline the importance of monitoring proteinuria and GFR not
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only in kidney failure, but in other cardiovascular diseases as well.
One limitation of our study might be the different concentration of
the first morning urine samples, which might cause a scattering in
proteinuria, even if it was normalized to urinary creatinine. Another
limitation was the low number of cases, which was due to the fact that
to calculate Framingham clinical cardiovascular and renal scores, we
could only enroll the patients who had a complete medical history
and all laboratory results. However, the four-year follow-up proved
the utility of renal score in the estimation of cardiovascular risk.
Our results confirm that slightly elevated cardiac troponin is
common in CKD. Although a permanent slight elevation of cardiac
troponin is considered generally as a consequence of decreased
GFR [19-22], we found a moderate correlation between non-renal
clinical cardiovascular score and hsTnT. According to our results
permanently elevated troponin can be considered as a marker
of increased cardiovascular risk. Our opinion agrees with recent
publications in CKD [23-26]. If the renal score shows a rapid
impairment, it probably indicates the progression of vascular or
myocardial damage, which can be detected early by high sensitive
troponin T. Elevation of troponin depends on GFR and at end-stage
renal impairment it correlates with cardiac events and total mortality
[26]. It agrees with our opinion that in CKD hsTnT is predominantly
a marker of cardiovascular risk. Individual troponin T measured
in balanced conditions may have importance at the emergency
unit when a patient has atypical complaints and slightly elevated
troponin. For the differentiation between acute and chronic cardiac
damage, repeated troponin testing is proposed. The recent guidelines
recommended comparison of 0/1-hour or 0/3-hour values of hsTnT
with a test-specific cutoff, and it yields reliable evaluation [27,28]. The
permanent slight elevation of hsTnT can be considered as increased
cardiovascular risk. Elevated baseline troponin has an incremental
prognostic value [29] beside GFR and albumin/proteinuria in the
diagnosis and treatment of chronic kidney disease.
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