32 research outputs found
Effect of simvastatin on restenosis after percutaneous transluminal angioplasty of femoropopliteal arterial obstruction
No full textModulation of Lipoprotein(a) Atherogenicity by High Density Lipoprotein Cholesterol Levels in Middle-Aged Men With Symptomatic Coronary Artery Disease and Normal to Moderately Elevated Serum Cholesterol fn1fn1This study was supported by Bristol-Myers Squibb Co., Princeton, New Jersey (REGRESS main study) and by Grant 94.032 from the Dutch Heart Foundation, Den Haag, The Netherlands [lipoprotein(a) substudy].
No full textAbstractObjectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lumen changes in patients with symptomatic coronary artery disease (CAD) and normal to moderate hypercholesterolemia.Background. Recent conflicting reports have confirmed or refuted the association of lipoprotein(a) with clinical events or angiographically verified disease progression.Methods. The association between serum lipoprotein(a) and changes in coronary artery lumen was studied in 704 men entered into the Regression Growth Evaluation Statin Study (REGRESS), a double-blind, placebo-controlled, quantitative angiographic study that assessed the effect of 2 years of pravastatin treatment. The primary end points were changes in average mean segment diameter (MSD) and average minimal obstruction diameter (MOD). Pavastatin- and placebo-treated patients were classified as having progressing, regressing or stable CAD, and median lipoprotein(a) concentrations were compared. Bivariate and multivariate regression analyses were performed in the overall patient group and in high risk subgroups.Results. Pravastatin treatment did not affect serum apolipoprotein(a) levels. Median in-trial (sampled at 24 months) apolipoprotein(a) levels for regressing, stable and progressing CAD were, respectively, 130, 162 and 251 U/liter in placebo-treated patients and 143, 224 and 306 U/liter in pravastatin-treated patients. Predictors of MSD and MOD changes were baseline MSD and MOD, in-trial apolipoprotein(a), in-trial high density lipoprotein (HDL) cholesterol and baseline use of long-acting nitrates. The multivariate models predicted 14% of MSD changes and 12% of MOD changes; apolipoprotein(a) predicted only 2.6% and 4.8%, respectively. However, in patients with in-trial HDL cholesterol levels <0.7 mmol/liter, apolipoprotein(a) predicted up to 37% of the arteriographic changes.Conclusions. Serum lipoprotein(a) levels predict coronary artery lumen changes in normal to moderately hypercholesterolemic white men with CAD; its atherogenicity is marked in the presence of concomitant hypoalphalipoproteinemia
Heart rate variability, but not heart rate, is associated with handgrip strength and mortality in older Africans at very low cardiovascular risk: A population-based study
No full textA high heart rate and a low heart rate variability at rest are established predictors of various forms of functional impairment, morbidity, and mortality [1–6]. Two explanations can be given for these associations. On one hand, a high heart rate and a low heart rate variability are thought to reflect dysfunction of the flexible autonomic regulation of the heart rate in particular and of the body's functioning in general that arises during ageing [3–5]. On the other hand, a high heart rate and a low heart rate variability are brought about by cardiovascular risk factors, such as obesity, hyperlipidaemia, diabetes, hypertension, and physical inactivity [2,3,7–9]. Since research on heart rate and heart rate variability has almost exclusively been conducted in western populations with an affluent sedentary lifestyle and high prevalences of these risk factors, it has been difficult to determine whether or not heart rate and heart rate variability are associated with functional impairment, morbidity, and mortality independently of cardiovascular risk factors
130 Stromelysin promoter polymorphism is associated with the progression of coronary heart disease
No full textP4‐021: ASSOCIATION OF BLOOD PRESSURE LOWERING MEDICATION WITH VISIT‐TO‐VISIT BLOOD PRESSURE VARIABILITY AND COGNITIVE FUNCTION IN OLD AGE
No full textAssociation of indexed aortic dimensions with the presence and extent of coronary artery ectasia in patients with acute coronary syndrome
No full textBackground: Conflicting findings have been reported on the potential association between CAE and aortic dilatation. This study aimed to investigate the relationship between CAE extent and aortic dimensions in patients with acute coronary syndrome (ACS). Methods: This retrospective cohort study included 448 adult patients who underwent coronary angiography for ACS between 2004 and 2015. The cohort was divided into 224 patients with CAE and 224 control patients without CAE, matched for age, sex, and hypertension. Aortic dimensions at the annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta were measured using transthoracic echocardiography and indexed to body surface area (BSA). The extent of CAE was classified using the Markis and Markis-Harirkrishnan systems. Statistical analysis included ANOVA to assess differences in aortic dimensions and their correlation with CAE extent. Results: Patients with CAE had significantly larger non-indexed aortic dimensions compared to those without CAE (e.g., ascending aorta diameter: 35.2 ± 4.0 mm vs. 33.6 ± 3.7 mm, p < 0.0001). However, when indexed to BSA, these differences were not significant. No significant correlation was found between CAE extent and aortic dimensions (e.g., indexed ascending aorta: F = 1.161, p = 0.325). The incidence of bicuspid aortic valve was similar between both groups (0.9 % vs. 0.4 %, p = 0.554). Conclusion: In patients with ACS, there were no significant differences in indexed aortic diameters in those with and without CAE. Additionally, no correlation was found between CAE extent and aortic dimensions and the incidence of bicuspid aortic valve was comparable in both groups
B-Mode Ultrasound Assessment of Pravastatin Treatment Effect on Carotid and Femoral Artery Walls and Its Correlations With Coronary Arteriographic Findings: A Report of the Regression Growth Evaluation Statin Study (REGRESS)
No full textAbstractObjectives. In this B-mode ultrasound study we assessed pravastatin treatment effects on carotid and femoral artery walls and investigated the correlations between the state and evolution of peripheral and coronary atherosclerosis.Background. The Regression Growth Evaluation Statin Study (REGRESS) was an 11-center, 2-year, double-blind, placebo-controlled, prospective study of 885 men with coronary artery disease (CAD) (total cholesterol 4 to 8 mmol/liter). The study primarily investigated pravastatin treatment effects on the coronary lumen. This report focuses on the 255 patients who participated in the REGRESS ultrasound study.Methods. Carotid and femoral artery walls were imaged at baseline and at 6, 12, 18 and 24 months. Pravastatin treatment effect was defined as the difference in progression of the combined intima-media thicknesses (IMT) between treatment groups.Results. Pravastatin treatment effects were highly significant (combined IMT: p = 0.0085; combined far wall IMT: p < 0.0001; common femoral artery far wall IMT: p = 0.004). Correlations between the IMTs of the arterial wall segments ranged from −0.17 to 0.81. Baseline correlations between IMT and percent coronary lumen stenoses ranged from 0.23 to 0.36. Baseline IMT correlated with the mean coronary segment diameter (r = −0.32, p = 0.001) and minimal coronary obstruction diameter (r = −0.27, p = 0.005). There were no individual correlations between IMT and coronary lumen variables (p > 0.30).Conclusions. Pravastatin treatment effects on carotid and femoral artery walls were observed. B-mode ultrasound imaging studies of peripheral arterial walls could not describe the state and evolution of the coronary lumen in the individual patient, but proved to be a highly suitable tool for the assessment of antiatherosclerotic properties of agents
Secondary prevention with folic acid: effects on clinical outcomes
No full textAbstractObjectivesWe sought to conduct a randomized trial with folic acid 0.5 mg/day in a patient population with stable coronary artery disease (CAD).BackgroundFolic acid has favorable effects on vascular endothelium and lowers plasma homocysteine levels. In addition, homocysteine appears to be an independent risk factor for atherosclerotic disease. However, the value of folic acid in secondary prevention had seldom been tested.MethodsIn this open-label study, 593 patients were included; 300 were randomized to folic acid and 293 served as controls. Mean follow-up time was 24 months. At baseline all patients had been on statin therapy for a mean of 3.2 years.ResultsIn patients treated with folic acid, plasma homocysteine levels decreased by 18%, from 12.0 ± 4.8 to 9.4 ± 3.5 μmol/l, whereas these levels remained unaffected in the control group (p < 0.001 between groups). The primary end point (all-cause mortality and a composite of vascular events) was encountered in 31 (10.3%) patients in the folic acid group and in 28 (9.6%) patients in the control group (relative risk 1.05; 95% confidence interval: 0.63 to 1.75). In a multifactorial survival model with adjustments for clinical factors, the most predictive laboratory parameters were, in order of significance, levels of creatinine clearance, plasma fibrinogen, and homocysteine.ConclusionsWithin two years, folic acid does not seem to reduce clinical end points in patients with stable coronary artery disease (CAD) while on statin treatment. Homocysteine might therefore merely be a modifiable marker of disease. Thus, low-dose folic acid supplementation should be treated with reservation, until more trial outcomes become available
Flood Vulnerability Models and Household Flood Damage Mitigation Measures: An Econometric Analysis of Survey Data
No full textFlood events are expected to increase in their frequency and severity, which results in higher flood risk without additional adaptation measures. The information gained from flood risk models is essential in effective disaster risk management. However, vulnerability estimations are often a large driver of uncertainty, and flood damage is rarely estimated due to a lack of empirical damage data from flood events. This study uses a unique data set with experienced damages and the implementation of flood damage mitigation (FDM) measures on the household level, collected after the flood event in the Netherlands in 2021. Flood damage models that control for several hazard, exposure, and vulnerability indicators are estimated and allow for additional input in flood risk models. Previous estimates of the effectiveness of FDM measures are prone to a selection bias, as households that do, and do not implement FDM measures systematically differ in their risk profiles. By using an instrumental variable-estimation, this study overcomes this selection bias and finds significant reductions in flood damage due to FDM measures. These reductions can be incorporated in multivariate flood vulnerability estimations, which indicate that FDM measures significantly reduce flood damage. Providing information on flood hazard, as well as implementing early warning systems, is crucial for ensuring effective flood risk management.Hydraulic Structures and Flood Ris
803-2 Genetic predictive factors for restenosis after percutaneous transluminal coronary angioplasty
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