Lipoprotein-Associated Phospholipase A2 Bound on High-Density Lipoprotein Is Associated With Lower Risk for Cardiac Death in Stable Coronary Artery Disease Patients A 3-Year Follow-Up

ObjectivesThe aim of this study was to examine the prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) associated with high-density lipoprotein (HDL) (HDL-Lp-PLA2) in patients with stable coronary artery disease (CAD).BackgroundLp-PLA2 is a novel risk factor for cardiovascular disease. It has been postulated that the role of Lp-PLA2 in atherosclerosis may depend on the type of lipoprotein with which it is associated.MethodsTotal plasma Lp-PLA2 and HDL-Lp-PLA2 mass and activity, lipids, and C-reactive protein were measured in 524 consecutive patients with stable CAD who were followed for a median of 34 months. The primary endpoint was cardiac death, and the secondary endpoint was hospitalization for acute coronary syndromes, myocardial revascularization, arrhythmic event, or stroke.ResultsFollow-up data were obtained from 477 patients. One hundred twenty-three patients (25.8%) presented with cardiovascular events (24 cardiac deaths, 47 acute coronary syndromes, 28 revascularizations, 22 arrhythmic events, and 2 strokes). Total plasma Lp-PLA2 mass and activity were predictors of cardiac death (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.005 to 1.021; p = 0.002; and HR: 1.040; 95% CI: 1.005 to 1.076; p = 0.025, respectively) after adjustment for traditional risk factors for CAD. In contrast, HDL-Lp-PLA2 mass and activity were associated with lower risk for cardiac death (HR: 0.972; 95% CI: 0.952 to 0.993; p = 0.010; and HR: 0.689; 95% CI: 0.496 to 0.957; p = 0.026, respectively) after adjustment for traditional risk factors for CAD.ConclusionsTotal plasma Lp-PLA2 is a predictor of cardiac death, while HDL-Lp-PLA2 is associated with lower risk for cardiac death in patients with stable CAD, independently of other traditional cardiovascular risk factors

Long-term Effect of CPAP Treatment on Cardiovascular Events in Patients With Resistant Hypertension and Sleep Apnea. Data From the HIPARCO-2 Study

Background: There is some controversy about the effect of continuous positive airway pressure (CPAP) on the incidence of cardiovascular events (CVE). However, the incidence of CVE among patients with both obstructive sleep apnea (OSA) ans resistant hypertension (HR) has not been evaluated. Our objective was to analyze the long-term effect of CPAP treatment in patients with RH and OSA on the incidence of CVE. Methods: Multi-center, observational and prospective study of patients with moderate-severe OSA and RH. All the patients were followed up every 3-6 months and the CVE incidence was measured. Patients adherent to CPAP (at least 4h/day) were compared with those with not adherent or those who had not been prescribed CPAP. Results: Valid data were obtained from 163 patients with 64 CVE incidents. Treatment with CPAP was offered to 82%. After 58 months of follow-up, 58.3% of patients were adherent to CPAP. Patients not adherent to CPAP presented a non-significant increase in the total CVE incidence (HR:1.6; 95%CI: 0.96-2.7; p=0.07). A sensitivity analysis showed that patients not adherent to CPAP had a significant increase in the incidence of cerebrovascular events (HR: 3.1; CI95%: 1.07-15.1; p=0.041) and hypertensive crises (HR: 5.1; CI95%: 2.2-11.6; p=0.006), but the trend went in the opposite direction with respect to coronary events (HR: 0.22; CI95%: 0.05-1.02; p=0.053). Conclusions: In patients with RH and moderate-severe OSA, an uneffective treatment with CPAP showed a trend toward an increase in the incidence of CVE (particularly neurovascular events and hypertensive crises) without any changes with respect to coronary events

A case-control validation of Type D personality in Greek patients with stable coronary heart disease

BACKGROUND: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. METHODS: Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Cronbach's α coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA ≥10 and SI ≥10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. CONCLUSIONS: These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality

The efficacy of antihypertensiye drugs in chronic intermittent hypoxia conditions

The authors would like to thank the Portuguese Fundacao para a Ciencia e a Tecnologia (FCT) and CEDOC (Chronic Diseases Research Centre, Lisbon, Portugal). Lucilia N. Diogo is supported by an FCT fellowship (SFRH/BD/48335/2008; PTDC/SAU-TOX/112264/2009).Sleep apnea/hypopnea disorders include centrally originated diseases and obstructive sleep apnea (OSA). This last condition is renowned as a frequent secondary cause of hypertension (HT). The mechanisms involved in the pathogenesis of HT can be summarized in relation to two main pathways: sympathetic nervous system stimulation mediated mainly by activation of carotid body (CB) chemoreflexes and/or asphyxia, and, by no means the least important, the systemic effects of chronic intermittent hypoxia (CIH). The use of animal models has revealed that CIH is the critical stimulus underlying sympathetic activity and hypertension, and that this effect requires the presence of functional arterial chemoreceptors, which are hyperactive in CIH. These models of CIH mimic the HT observed in humans and allow the study of CIH independently without the mechanical obstruction component. The effect of continuous positive airway pressure (CRAP), the gold standard treatment for OSA patients, to reduce blood pressure seems to be modest and concomitant antihypertensive therapy is still required. We focus this review on the efficacy of pharmacological interventions to revert HT associated with CIH conditions in both animal models and humans. First, we explore the experimental animal models, developed to mimic HT related to CIH, which have been used to investigate the effect of antihypertensive drugs (AHDs). Second, we review what is known about drug efficacy to reverse HT induced by CIH in animals. Moreover, findings in humans with OSA are cited to demonstrate the lack of strong evidence for the establishment of a first-line antihypertensive regimen for these patients. Indeed, specific therapeutic guidelines for the pharmacological treatment of HT in these patients are still lacking. Finally, we discuss the future perspectives concerning the non-pharmacological and pharmacological management of this particular type of HT.publishersversionpublishe

The prognostic significance of atrial arrhytmias recorded early after cardioversion for atrial fibrillation

Background Atrial fibrillation (AF) has a high risk of recurrence after electrical cardioversion (CV)The purpose of our study was to investigate prognostic factors, such as heart rate (HR) and atnalarrhythmias, measured during Holter recording for 24 hours after CVMethods We prospectively studied 117 consecutive patients (pts) (mean age±S D 61 6 ±10,8 years)subjected to CV, who successfully converted to sinus rhythm All underwent echocardiography and 24hour Holter after CV The majority of pts (60,7%) folio wed-up for one yearResults Thirty-seven pts (31 6%) recurred to AF during the first year of follow-up (group I) Thirty-fourpts (29 1%) remained in sinus rhythm at one year (group II) During one month of follow-up, 22 pts(18,8%) recurred to AF (group III) and the rest remained in sinus rhythm (group IV) Age, gender,underlying disease, left atrium size, fractional shortening, duration of AF and the medication taken weresimilar between the two groups (All P-values=NS) Group I had more atrial premature complexes perhour (APC/h) compared with group II and more APC/h in the first and second six-hour segment of theHolter (P10 APC/h hadhigh specificity but low sensitivity (91 2% και 32 4% respectively) Group III had more atnal prematurecomplexes per hour (APC/h) compared with pts of group IV and more APC/h in the first and second sixhoursegment of the Holter (P=0 002, P=0 057 and P=0 013, respectively) Cut-off analysis showed thatpts with more than 32 APC/h had 10 times higher risk of AF recurrence (OR=10 4 with 95% C 1=2 3-47 4) (sensitivity=75% specificity=77%) Group III pts had higher maximum, average and minimumheart rate compared to group IV (P=0 0013, P=0 0221 and P=0 0331, respectively) Cut-off analysisrevealed that pts with maximum heart rate (Max HR) more than 90 5 bpm had 6 7 times higher risk of AFrecurrence (OR=6 68 with 95% C 1=1 3-34 9) (sensitivity=69% specrficity=78%) Pts with combinationof Max HR more than 90 5 bpm and more than 32 APC/h had 25 2 times higher risk of AF relapse(OR=25 2 with 95% C 1=1 8-352 5)Conclusions Simple 24hour Holter may help to identify pts at higher risk of AF recurrence after CV.Σκοπός Μελετήσαμε την προγνωστική άξια των κολπικών αρρυθμιών και της καρδιακήςσυχνότητας, που καταγράφονται με ενα Holter 24ωρης καταγραφής αμέσως μετά απο επιτυχήηλεκτρική καρδιοαναταξη, ως προς την υποτροπή της αρρυθμίαςΜέθοδοι Μελετήσαμε 117 διαδοχικούς ασθενείς (μέση ηλικία ± SD 61,6±10,8 ετη, 53,8%άνδρες), οι οποίοι υπεβλήθησαν σε επιτυχή ηλεκτρική καρδιοαναταξη για KM Σε όλους τουςασθενείς τοποθετήθηκε Holter 24ωρης καταγραφής μετά απο την ηλεκτρική καρδιοαναταξη Το60,7% των ασθενών παρακολουθήθηκε για ενα έτος Οι υπόλοιποι ασθενείς παρακολουθήθηκανγια ενα μήναΑποτελέσματα Τριαντα-επτα (31,6%) ασθενείς υποτροπίασαν σε KM κατά τη διάρκεια τουπρώτου έτους παρακολούθησης (ομάδα Ι) Τριαντα-τεσσερις ασθενείς (29,1%) παρέμειναν σεφλεβοκομβικο ρυθμό το πρώτο έτος (ομάδα Π) Εικοσι-δυο ασθενείς (18,8%) υποτροπίασαν σεKM κατά τη διάρκεια του πρώτου μήνα παρακολούθησης (ομάδα III) Οι υπόλοιποι ασθενείςπαρέμειναν σε φλεβοκομβικο ρυθμό τον πρώτο μήνα (ομάδα IV) Οι ασθενείς της ομάδας Ισυγκρινόμενη με την ομάδα II είχαν μεγαλύτερο αριθμό έκτακτων κολπικών συστολών ανα ωρα(APC/h) για το σύνολο της καταγραφής Holter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο(Ρ10 APC/h και η παρουσία SVT είχε υψηλήειδικότητα άλλα χαμηλή ευαισθησία (91,2% και 32,4% αντίστοιχα) Οι ασθενείς της ομάδας IIIσυγκρινόμενη με την ομάδα IV είχαν μεγαλύτερο αριθμό APC/h για το σύνολο της καταγραφήςHolter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο (Ρ=0,002, Ρ=0,057 και Ρ=0,013,αντίστοιχα) Οι ασθενείς της ομάδας III συγκρινόμενη με την ομάδα IV είχαν μεγαλύτερη μέγιστη(max HR), μέση και ελάχιστη καρδιακή συχνότητα (Ρ=0,0013 Ρ=0 0221 και Ρ=0 0331αντίστοιχα) Οι ασθενείς με max HR>90,5 bpm είχαν 6,6 μεγαλύτερο κίνδυνο υποτροπής της KM(OR=6,68 με 95% CI 1 3-34,9) τον πρώτο μήνα (ευαισθησια=69%, ειδικοτητα=78%) Οσυνδυασμός max HR>90,5 bpm και >32 APC/h είχε 25,2 μεγαλύτερη πιθανότητα υποτροπής τηςKM τον πρώτο μήνα (OR=25,2 με 95% C Ι 1,8-352,5)Συμπεράσματα Με ενα απλό Holter 24ωρου μπορούμε να αναγνωρίσουμε ασθενείς με υψηλόκίνδυνο υποτροπής της κολπικής μαρμαρυγής μετά απο την ηλεκτρική καρδιοαναταξη

Estimating the cost-effectiveness of screening a general population for cardiovascular risk with high-sensitivity troponin-I

Abstract Aims  To estimate the cost-effectiveness of using the cardiac specific marker high-sensitivity troponin-I (hsTnI) for assessing cardiovascular disease (CVD) risk in a general population. Methods and results  A discrete-event simulation model was developed from a societal perspective of a low-risk (Germany) and a high-risk (Kazakhstan) country. The model compared a Screen&amp;Prevent strategy guided by hsTnI against a do-nothing strategy. Risk functions were derived from published data of a prospective cohort study [Nord-Trøndelag Health (HUNT) Study]. The model assessed the number of CVD events and deaths, healthy life years, direct and indirect costs in PPP 2018 Dollar, and quality-adjusted life years (QALY) over a time horizon of 10 years. Screen&amp;Prevent reduced the number of CVD events per 1000 subjects by 5.1 and 5.0, equal to a number-needed-to-screen of 195 and 191 in Kazakhstan and Germany. Screen&amp;Prevent was cost saving in Kazakhstan and cost-effective in Germany with an incremental-cost-effectiveness ratio of $6755 ($2294; $24 054) per QALY gained at an opportunity-cost based willingness-to-pay threshold of$27 373. Varying input variables in univariate and probabilistic sensitivity analyses confirmed the robustness of the analysis. Conclusion  Assessing the cardiovascular risk with hsTnI in a general population and subsequently referring those at high risk to preventive means would very likely be cost-effective or cost-saving by avoiding CVD events and associated direct and indirect costs. This conclusion is retained even if only the direct costs or only the costs for screening and prevention are considered. Future studies should evaluate the incremental cost-effectiveness of hsTnI-guided assessment strategies against established risk algorithms. </jats:sec

Εκτίμηση επαγγελματικού κινδύνου για θερμική καταπόνηση εργαζομένων. Μελέτη περίπτωσης στη διάρκεια θερινής περιόδου 2021 στο λιμένα Πειραιά

Οι επικρατούσες συνθήκες κατά τη διάρκεια των θερινών μηνών και ειδικότερα οι υψηλές θερμοκρασίες επηρεάζουν, εκτός του γενικού πληθυσμού και μεγάλο μέρος των εργαζομένων που εργάζονται κυρίως σε εξωτερικούς χώρους. Ο σκοπός της παρούσας Διπλωματικής εργασίας είναι ο ποσοτικός υπολογισμός της θερμικής καταπόνησης των εργαζομένων με βάση τον δείκτη WBGT (ΘΥΒΜΑΣ), από δεδομένα που ελήφθησαν από 3 μετεωρολογικούς σταθμούς στην ευρύτερη περιοχή του λιμένα Πειραιά. Ο δείκτης WBGT θα υπολογιστεί ανά ώρα για τη διάρκεια των καλοκαιρινών μηνών (Ιούνιος-Ιούλιος-Αύγουστος) του 2021 και θα εξαχθούν συμπεράσματα σχετικά με τα πιο επιβαρυμένα διαστήματα και για τυχόν μέτρα που πάρθηκαν από τους εργοδότες τα συγκεκριμένα διαστήματα.The weather conditions during the summer months and especially the temperature affect, in addition to the general population, a large part of the workers who work mainly outdoors. The purpose of this Diploma Thesis is the quantitative calculation of the thermal stress of the employees based on the WBGT index, from data received from 3 meteorological stations in the wider area of the port of Piraeus. The WBGT index will be calculated per hour for the duration of the summer months (June-July-August) of 2021

The potential of novel peptides in the management of children with Congenital Heart Disease: Above and beyond the BNP

Congenital Heart Disease (CHD) constitutes a common cause of major congenital abnormalities with prevalence around 8.2 per 1000 live births in Europe. Despite the important advances in the diagnosis, treatment and management of CHD patients throughout the years, it remains a challenge how to better manage the children with CHD using the biomarkers. However, in the last decade, B-type Natriuretic Peptide (BNP) and less often Adrenomedullin (ADM) and Urotensin II (UT II) have become the focus of research, in view of the improvement in the management of patients with CHD. Moreover, despite crescent evidences supporting the use of BNP as diagnostic and prognostic marker in children with CHD, its use remains limited and guidelines/expert consensus recommendations are lacking. Adrenomedullin (ADM) and Urotensin II (UT II) are two potent vasoactive peptides that might play a role in the development of pulmonary hypertension. Future studies are needed to explore the role of both peptides as biomarkers of pulmonary hypertension and their prognostic significance on the development of pulmonary hypertension in CHD patients. © 2016 Elsevier Ireland Lt

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