Mortality from ischaemic heart disease: sex-specific effects of transferrin saturation, serum iron, and total iron binding capacity. The HUNT studyMørkedal, Bjørn; Laugsand, Lars E; Romundstad, Pål R; Vatten, Lars J
doi: 10.1177/1741826710390134pmid: 21450624
Background: We assessed sex-specific associations of iron status with ischaemic heart disease (IHD) mortality and explored whether the strength of the associations changed during follow-up.Design: Prospective cohort study.Methods: During 11.4 years of follow-up, IHD mortality was studied in 28,154 men and 32,644 women without known myocardial infarction or stroke at baseline.Results: During follow-up, 1,034 men and women died from IHD. Compared to being in the highest quartile of transferrin saturation, the multivariate adjusted hazard ratio associated with being in the lowest quartile was 1.3 (95% CI 1.0–1.6) in men and 1.4 (95% CI 1.0–1.9) in women. The corresponding hazard ratios for serum iron were 1.5 (95% CI 1.1–1.9) in men and 1.1 (95% CI 0.8–1.4) in women, and for total iron binding capacity (TIBC), the hazard ratio of being in the highest compared to the lowest quartile was 0.9 (95% CI 0.8–1.2) in men and 1.5 (95% CI 1.1–2.0) in women. Associations with iron status were stronger in the early than in later stages of follow-up.Conclusions: The results suggest that low iron status may be a late sign of IHD pathology or that unknown prevalent disease at baseline could influence the associations.
A national survey on aspirin patterns of use and persistence in community outpatients in ItalyFilippi, Alessandro; Bianchi, Cosetta; Parazzini, Fabio; Cricelli, Claudio; Sessa, Emiliano; Mazzaglia, Giampiero
doi: 10.1177/1741826710397850pmid: 21450601
Background: Aspirin is recommended as preventive therapy in patients with cardiovascular diseases (CVD), diabetes mellitus, and high cardiovascular risk due to multiple risk factors. However, the benefits of aspirin might be affected by its inappropriate use. Real-life information on aspirin use is therefore needed as an audit tool aimed to maximize the benefits and minimize the risks.Design: Retrospective cross-sectional and cohort study.Methods: Primary care data were obtained from 400 Italian general practitioners (GPs) providing information to the Health Search/CDS Longitudinal Patients Database. Prevalence of use was assessed in individuals aged 18 years and older, registered in the GP’s list at the beginning of the observation period (year 2005). As potential correlates of aspirin use, clinical and demographic variables were also recorded. Logistic regression analysis was conducted to assess the relationship between such covariates and aspirin use. Persistence to aspirin treatment was examined among newly prescribed aspirin users during the years 2000–04.Results: On a total sample of 540,984 patients, 45,271 (8.3%) were prescribed at least once with aspirin. On 35,473 patients with previous CVD, 51.7% were treated with aspirin, whereas only 15.2% of 151,526 eligible patients free of CVD received an aspirin prescription. In primary prevention, prevalence of aspirin use was significantly associated with the increased number of cardiovascular risk factors either among diabetic (p < 0.001) or non-diabetic (p < 0.001) patients. A negative association has been observed among patients with contraindication to aspirin use. Only 23.4% of patients at 1 year and 12.2% at 2 years remained persistent with aspirin use, although most of first-time users reported an intermittent use.Conclusion: Underuse and discontinuation of aspirin treatment is common among eligible patients. Increased cardiovascular risk only partially influences aspirin management. An effort aimed to improve appropriate aspirin use is likely to provide major benefits.
Effects of statins on coronary and peripheral endothelial function in humans: a systematic review and meta-analysis of randomized controlled trialsReriani, Martin K; Dunlay, Shannon M; Gupta, Bhanu; West, Colin P; Rihal, Charanjit S; Lerman, Lilach O; Lerman, Amir
doi: 10.1177/1741826711398430pmid: 21450596
Objective: The purpose of this study was to quantify the effect of statins on peripheral and coronary endothelial function in patients with and without established cardiovascular disease.Background: Early atherosclerosis is characterized by endothelial dysfunction, a known prognostic factor for cardiovascular disease.Methods and results: The search included MEDLINE, Cochrane Library, Scopus, and EMBASE to identify studies up to 1 December 2009. Eligible studies were randomized controlled trials on the effects of statins compared with placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Forty-six eligible trials enrolled a total of 2706 patients: 866 (32%) were women and 432 (16%) had established cardiovascular disease. Meta-analysis using random-effects models showed treatment with statins significantly improved endothelial function [standardized mean difference (SMD) 0.66, 95% CI 0.46–0.85, p < 0.001]. Subgroup analyses demonstrated statistically significant improvement in endothelial function assessed both peripherally by flow-mediated dilatation (SMD 0.68, 95% CI 0.46–0.90, p < 0.001) and venous occlusion plethysmography (SMD 0.59, 95% CI 0.06–1.13, p = 0.03) and centrally in the coronary circulation by infusion of acetylcholine (SMD 1.58, 95% CI 0.31–2.84, p = 0.01). Significant heterogeneity observed across studies was explained in part by the type of endothelial function measurement, statin type and dose, and study population differences. Exclusion of outlier studies did not significantly alter the results.Conclusion: Statin therapy is associated with significant improvement in both peripheral and coronary endothelial function. The current study supports a role for statin therapy in patients with endothelial dysfunction.
Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarctionBøhmer, Ellen; Kristiansen, Ivar Sønbø; Arnesen, Harald; Halvorsen, Sigrun
doi: 10.1177/1741826711398425pmid: 21450598
The NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction showed an improved clinical outcome with early transfer for percutaneous coronary intervention (PCI) compared to a more conservative approach after thrombolysis. The aim of this substudy was to compare the 12-month quality-adjusted life years (QALYs) and costs of these alternative strategies. Methods: Patients with ST-elevation myocardial infarction <6 h duration and >90 min expected delay to PCI, received full-dose tenecteplase and were randomized to either early or late invasive strategy (n = 266). Detailed quality of life and resource use data were registered prospectively for a period of 12 months. Health outcomes were measured as quality of life using a generic instrument (15D). Quality of life scores were translated into QALYs. Unit costs were based on hospital accounts, fee schedules, and market prices. Results: After 12 months of follow-up, patients in the early invasive group had 0.008 (95% CI −0.027 to 0.043) more QALYs compared to the late invasive group. The mean total costs were €18,201 in the early versus €17,643 in the late invasive group, with a mean difference of €558 (95% CI −2258 to 3484). Cost/QALY was €69,750 while cost/avoided clinical endpoint was €5636. Conclusion: Early and late invasive strategies after thrombolysis resulted in similar quality of life and similar costs in ST-elevation myocardial infarction patients living far from a PCI centre (NCT00161005).
Policymakers’ perceptions of cardiovascular health in EuropeGyberg, Viveca; Rydén, Lars
doi: 10.1177/1741826710397487pmid: 21450603
Background: Prevention of cardiovascular disease at population level has proven to be both possible and successful. The European Heart Health Charter (EHHC) outlines goals for successful cardiovascular (CV) prevention both in individuals and at a national level. The objective of this study was to explore key European health policymakers’ perceptions of their country’s proximity to the EHHC-targets and their views on obstacles to domestic CV health and on the actions needed to improve it.Design: Questionnaire, descriptive.Method: The questionnaire was distributed to health policy leaders (n = 116) within the Ministries of Health, public health institutes, cardiac societies and heart foundations in 32 European countries, assessing previous knowledge, goal fulfilment of the EHHC, perceived obstacles to CV health, actions deemed to be important to improve the CV situation, and measures to promote CV health.Results: The response rate was 68%. The general consensus was that the national CV situations were far from attaining the EHHC targets. How different health policy leaders rated the proximity to specific targets and measures did, however, not necessarily reflect the actual situation. There was a polarisation between the health policy leaders regarding obstacles to CV health and what actions are needed to improve it. There were small differences between the four professional groups and regions of the extent measures were believed to be used.Conclusion: Discrepant views on the CV situation and on the actions needed to improve it, underline the importance of information assessing the national situation and the necessity of a dialogue between organisations and policymakers responsible for CV disease throughout Europe.
The effect of pain-free treadmill training on fibrinogen, haematocrit, and lipid profile in patients with claudicationMika, Piotr; Wilk, Boguslaw; Mika, Anna; Marchewka, Anna; Niżankowski, Rafał
doi: 10.1177/1741826710389421pmid: 21450630
Objective: To assess the effect of pain-free treadmill training on changes of plasma fibrinogen, haematocrit, lipid profile, and walking ability in patients with claudication.Design: Randomized control trial.Methods: Sixty-eight patients with peripheral obstructive arterial disease and intermittent claudication (Fontaine stage II) were randomly assigned into the treadmill training (repetitive intervals to onset of claudication pain, three times a week) or a control group (no change in physical activity) over 3 months. Both groups performed treadmill test to assess pain-free walking time (PFWT) and maximal walking time (MWT) and had blood analyses [for haematocrit, fibrinogen, triglycerides, and cholesterol: total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)] done at baseline and after 6 and 12 weeks of the study.Results: Total and LDL cholesterol levels in the training group decreased (p < 0.05) by 14.8% and 20,5%, respectively. Significant (p < 0.05) HDL cholesterol increased (14.6%) and triglycerides decreased (19%) in the training group but changes of all these lipids were insignificant in the control group over the 3 months. Haematocrit and fibrinogen changes were insignificant in both groups. PFWT was prolonged by 109% and MWT increased by 54% in the training group (p < 0.01), but not in the control group.Conclusion: The improvement in walking time over 3 months of pain-free treadmill training parallels with progressive normalization of lipid profiles in patients with claudication.