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1.
Respir Med Case Rep ; 51: 102099, 2024.
Article in English | MEDLINE | ID: mdl-39282053

ABSTRACT

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and underdiagnosed condition, often presenting with variable symptoms, making it challenging to identify. This case report highlights the clinical relevance of CTEPH, emphasizing its misdiagnosis as asthma and the need for increased awareness in recognizing its atypical presentations. Objective: To present a case of CTEPH misdiagnosed as asthma, showcasing the importance of early identification and raising awareness about the underrepresentation of this disease. Case report: A 39-year-old male with a history of misdiagnosed asthma presented with progressive dyspnea. Despite treatment with inhalers, symptoms persisted. Further investigations revealed dilated pulmonary arteries, right ventricular dysfunction, and elevated pulmonary pressures. Subsequent examinations confirmed CTEPH, leading to referral for surgical thromboembolectomy. Postoperative assessments demonstrated significant improvements in hemodynamic parameters. Discussionconclusion: This case underscores the challenges in diagnosing CTEPH, especially when presenting as asthma. Heightened awareness among healthcare professionals is crucial for timely recognition, considering the potential for favorable outcomes with appropriate intervention. Recognition of CTEPH as a differential diagnosis for dyspnea, particularly in those with a history of pulmonary embolism, is essential for providing accurate diagnosis and timely intervention.

2.
Clin Cardiol ; 32(5): 244-50, 2009 May.
Article in English | MEDLINE | ID: mdl-19452486

ABSTRACT

BACKGROUND: Inflammatory marker and hemoglobin levels (eg biomarkers) considered separately, predict adverse events in selected populations. HYPOTHESIS: A multiple biomarker approach predicts adverse events in women referred for evaluation of ischemia. METHODS: We investigated associations between biomarkers (high sensitivity C-reactive protein, interleukin-6, serum amyloid-A, and hemoglobin levels) with adverse outcomes in women referred for coronary angiography for suspected ischemia in the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE). RESULTS: Among 595 women (mean age 58 years, ejection fraction [EF] 65%, majority without coronary stenosis >or= 50%) followed for 3.6 +/- 1.8 years (mean +/- SD), those without abnormal markers had fewer events (11.6%) compared to those with 1 (18.4%), 2 (20.9%), or 3 (37%) abnormal markers (p < 0.001 for trend). Women without abnormal markers had fewer deaths (1.6%) than women with 1 (6.1%), 2 (9.1%), or 3 (17%) abnormal markers (p < 0.001 for trend). Adding low hemoglobin was associated with higher adverse event and all-cause mortality rates. In multivariate analysis, as the number of abnormal biomarkers increased risk increased. Women with 3 or 4 abnormal biomarkers were approximately 10-20 times more likely to die (p < 0.05). Biomarkers added to the predictive information provided by the Framingham Risk Score. CONCLUSIONS: Among women undergoing coronary angiography for suspected ischemia, a multibiomarker approach predicted adverse events. Biomarkers added prognostic information beyond that obtained from traditional risk factors.


Subject(s)
Biomarkers/blood , Coronary Restenosis/drug therapy , Hemoglobins/analysis , Myocardial Ischemia/diagnosis , C-Reactive Protein/analysis , Confidence Intervals , Coronary Angiography , Coronary Restenosis/mortality , Female , Humans , Inflammation/blood , Inflammation/diagnosis , Interleukin-6/blood , Middle Aged , Multivariate Analysis , Myocardial Ischemia/drug therapy , Myocardial Ischemia/mortality , National Heart, Lung, and Blood Institute (U.S.) , Prognosis , Risk Factors , Serum Amyloid A Protein/analysis , Sex Factors , Stroke Volume , Syndrome , United States/epidemiology , Ventricular Function, Left
3.
Clin Cardiol ; 30(2): 69-74, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17326061

ABSTRACT

BACKGROUND: Altered coronary reactivity is frequent in women with findings of myocardial ischemia without significant obstructive disease. This suggests a defect in coronary microvascular function. The adenosine-related component of this altered reactivity has been described in male and mixed gender populations, while the factors influencing this component of coronary reactivity in symptomatic women have received limited attention. Accordingly, the relationship between adenosine-related microvascular coronary reactivity and risk factors in symptomatic women evaluated for suspected ischemia remains uncertain. HYPOTHESIS: Abnormal coronary microvascular reactivity to adenosine is predicted by atherosclerosis risk factors in women. METHODS: As part of the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE), we investigated the relationship between risk factors and coronary microvascular reactivity as flow velocity reserve to intracoronary adenosine (CFVR(Ado)) in 210 women referred for angiography to evaluate suspected ischemia. RESULTS: Univariate analyses identified associations between CFVR(Ado) and multiple risk conditions; however, after adjusting for age, none remained significant. The best multivariable model using combinations of risk conditions to predict CFVR(Ado) yielded an R2 of only 0.18. CONCLUSIONS: Among women with suspected ischemia, risk factors account for <20% of observed variability in CFVR(Ado). Therefore, other as yet unidentified factors must primarily account for coronary microvascular reactivity to adenosine.


Subject(s)
Atherosclerosis/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/physiopathology , Myocardial Ischemia/diagnostic imaging , Adenosine , Atherosclerosis/epidemiology , Biomarkers/blood , Blood Flow Velocity , Coronary Angiography , Coronary Artery Disease/epidemiology , Female , Humans , Inflammation , Middle Aged , Myocardial Ischemia/epidemiology , Predictive Value of Tests , Risk Factors , Vasodilator Agents
4.
Pharmacotherapy ; 26(12): 1794-801, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17125440

ABSTRACT

STUDY OBJECTIVES: To determine the frequency and type of complementary and alternative medicine (CAM) use among healthy volunteers participating in research, and to investigate the potential for interactions between commonly used CAM modalities and various drugs. DESIGN: Prospective evaluation. SETTING: University general clinical research center. SUBJECTS: Sixty healthy adults participating in an ongoing drug study. MEASUREMENTS AND MAIN RESULTS: The clinical study database was queried to determine the use and type of existing and newly started CAM throughout the study period. Baseline characteristics were compared between users and nonusers of CAM to identify differences between them. Potential CAM-drug interactions were classified based on curated databases and primary literature sources. Of the 60 subjects enrolled, 30 (50%) used CAM during the study. Of these, 26 (87%) were using CAM at study entry. Baseline CAM users were on average 7 years older than nonusers (p=0.03) and had high-density lipoprotein cholesterol concentrations 10 mg/dl higher than those of nonusers (p=0.04). The group using CAM had more women and nonsmokers than the other group. Several potential CAM-drug interactions were identified. CONCLUSION: Because of high rates of CAM use (50% of the subjects were using biologically based CAM) and the many potential CAM-drug interactions, CAM use should be rigorously addressed in clinical practice and research. Failure to capture this information may have clinical repercussions through pharmacokinetic and pharmacodynamic interference of clinical response and clinical trial results. Clinicians and researchers may be able to identify those most likely to use CAM by their baseline characteristics; this would help target those patients and research subjects for more thorough assessment and follow-up.


Subject(s)
Clinical Trials as Topic/statistics & numerical data , Complementary Therapies/statistics & numerical data , Drug Interactions , Research Subjects , Adult , Age Factors , Confounding Factors, Epidemiologic , Female , Herb-Drug Interactions , Humans , Male , Minerals/administration & dosage , Plant Preparations/administration & dosage , Prospective Studies , Sex Factors , Vitamins/administration & dosage
5.
Pharmacotherapy ; 26(11): 1572-7, 2006 Nov.
Article in English | MEDLINE | ID: mdl-17064201

ABSTRACT

STUDY OBJECTIVES: To investigate whether atorvastatin decreases serum or leukocyte-produced CD40 ligand (CD40L) levels and whether these effects are dependent on reduction in low-density lipoprotein cholesterol (LDL) levels in people without overt dyslipidemia. DESIGN: Prospective pilot study. SETTING: University research center. SUBJECTS: Twenty-five normocholesterolemic volunteers (mean age 32 +/- 11 yrs; 15 women, 10 men) without cardiovascular disease. INTERVENTION: After a 2-week drug-free run-in period, subjects received atorvastatin 80 mg/day orally for 16 weeks. MEASUREMENTS AND MAIN RESULTS: All lipoprotein level measurements were performed with the subject in the fasting state. The CD40L concentrations were measured by immunofluorescence detection in serum and leukocyte culture supernates after 24-hour incubation, and treatment effect was analyzed. Baseline mean +/- SD total cholesterol, LDL, high-density lipoprotein cholesterol, and triglyceride levels were 179 +/- 33, 97 +/- 29, 62 +/- 20, and 102 +/- 69 mg/dl, respectively. Mean changes in each of these levels, respectively, after 16 weeks of atorvastatin were -34%, -59%, +3%, and -23%. The median serum CD40L level was lower at 16 weeks (2.3 ng/ml, interquartile range [IQR] 1.2-5.0 ng/ml) than at baseline (3.0 ng/ml, IQR 2.1-3.7 ng/ml), but the change was not significant (p=0.24). However, atorvastatin significantly lowered CD40L produced from leukocytes by 57% (21 pg/mg of protein [IQR 10-38 pg/mg] vs 49 pg/mg [IQR 21-149 pg/mg], p=0.045). Effects were independent of reduction in cholesterol levels. CONCLUSION: Although atorvastatin did not significantly lower serum CD40L levels, significant reduction in leukocyte production was seen independent of degree of LDL reduction. These pilot data suggest a potential benefit in normocholesterolemic individuals that should be further investigated, and that leukocyte CD40L concentrations should be considered in the drug response.


Subject(s)
Heptanoic Acids/pharmacology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Leukocytes/drug effects , Pyrroles/pharmacology , Adult , Atorvastatin , CD40 Ligand/blood , Cholesterol/blood , Female , Humans , Leukocytes/immunology , Male , Triglycerides/blood
6.
Cytokine ; 33(5): 258-63, 2006 Mar 07.
Article in English | MEDLINE | ID: mdl-16567110

ABSTRACT

Data exist linking elevated epithelial neutrophil activating peptide (ENA-78) concentrations with myriad inflammatory conditions. ENA-78 is encoded by the CXCL5 gene which has recently been shown to be polymorphic in nature (rs352046 and rs425535). No functional data on these polymorphisms exist. We investigated whether CXCL5 polymorphisms are associated with differences in plasma ENA-78 concentrations or leukocyte production of ENA-78 from cultured leukocytes in relatively healthy adults. We genotyped 114 adults for the above polymorphisms. Variant alleles at both loci were highly linked (D'=1, r2=0.94). The rs352046 variant allele was associated with significantly higher ENA-78 plasma concentrations. A genotype effect was also demonstrated for this polymorphism and leukocyte production of ENA-78. Both polymorphisms were predicted to have functional consequences by in silico analyses, with the rs352046 polymorphism found to occur at a transcription factor binding site for myeloid zinc finger proteins and the rs425535 polymorphism found to be located in an exon splicing enhancer site. Our findings add to the strength of CXCL5 as candidate gene in future disease-gene and pharmacogenetic association studies.


Subject(s)
Chemokines, CXC/chemistry , Chemokines, CXC/genetics , Leukocytes/metabolism , Polymorphism, Genetic , Adult , Alleles , Chemokine CXCL5 , Female , Genome , Genotype , Homozygote , Humans , Inflammation , Male , Middle Aged
7.
Pharmacotherapy ; 26(3): 333-40, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16503719

ABSTRACT

STUDY OBJECTIVE: To investigate the immunomodulatory effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) by determining whether atorvastatin alters the production of specific endothelium-derived immunoactive proteins and whether its treatment effects depend on its concentration and/or inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase. DESIGN: In vitro study using a multiplexing method for protein measurement. SETTING: University laboratory. MEASUREMENTS AND MAIN RESULTS: Human umbilical vein endothelial cells were cultured to approximately 80% confluence and treated with atorvastatin 1-50 microM alone or with mevalonate for 24 hours. Untreated cells served as controls. Culture-conditioned media were removed and multiplex assayed for protein content of epithelial neutrophil-activating peptide-78, interleukin-8, monocyte chemotactic protein-1, interleukin-6, interleukin-10, fibroblast growth factor, and granulocyte colony stimulating factor. Atorvastatin significantly reduced the production of epithelial neutrophil-activating peptide-78, interleukin-6, interleukin-8, and monocyte chemotactic protein-1 (p<0.001 to p<0.05) in a concentration-dependent manner without affecting basal production of interleukin-10, fibroblast growth factor, and granulocyte colony stimulating factor. The treatment effects of atorvastatin were reversed with concurrent mevalonate therapy. CONCLUSION: By inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase, atorvastatin lowered concentrations of several inflammatory molecules derived from basal-state endothelial cells in a concentration-dependent manner. The in vivo importance of these immunomodulatory effects needs further investigation.


Subject(s)
Endothelial Cells/drug effects , Heptanoic Acids/pharmacology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Immunologic Factors/pharmacology , Pyrroles/pharmacology , Atorvastatin , Cells, Cultured , Chemokine CCL2/metabolism , Chemokine CXCL5 , Chemokines, CXC/metabolism , Endothelial Cells/metabolism , Fibroblast Growth Factors/metabolism , Granulocyte Colony-Stimulating Factor/metabolism , Humans , Interleukin-6/metabolism , Interleukin-8/metabolism , Mevalonic Acid/pharmacology
8.
J Am Coll Cardiol ; 47(3 Suppl): S36-43, 2006 Feb 07.
Article in English | MEDLINE | ID: mdl-16458169

ABSTRACT

OBJECTIVES: Our objective was to determine the prognostic value of estimated metabolic equivalents (METs) based on self-reported functional capacity by the Duke Activity Status Index (DASI) in symptomatic women. BACKGROUND: Functional capacity is an important component affecting the predictive value of exercise testing, yet current guidelines offer limited assistance regarding identification of functional impairment and choice of pharmacologic stress testing. METHODS: A total of 914 women underwent clinically indicated coronary angiography and completed the 12-item DASI questionnaire; a subgroup of 251 women also underwent exercise testing. Cox proportional hazards modeling was used to estimate five-year death or myocardial infarction by DASI scores. In a secondary analysis, additional events included unstable angina, heart failure, or stroke at five years. RESULTS: Average DASI-estimated functional capacity was 5.7 +/- 4.2 METs and, for exercising women, 6.0 +/- 2.6 METs. In the 914 women, event-free survival ranged from 83% to 95% in subgroups with < or =4.7 to >9.9 METs (p = 0.009); 67% of the events occurred in women scoring < or =4.7 METs (p = 0.003). Event rates were similar by exercise and DASI MET values. In women with DASI-estimated METs < or =4.7 (n = 75), ischemia occurred less (39% vs. 64%, p < 0.0001), and exercise testing results were more often indeterminate (<85% predicted maximum heart rate = 37% vs. 6%, p = 0.001) as compared to women achieving >4.7 METs. CONCLUSIONS: Among women with suspected myocardial ischemia, functional impairment estimated by the DASI correlates with indeterminate exercise test results and is associated with an adverse prognosis. Use of the DASI before exercise testing can risk stratify symptomatic women and may improve the identification of higher-risk, functionally impaired subjects that would benefit from pharmacologic stress imaging and targeted risk management.


Subject(s)
Myocardial Ischemia/physiopathology , Adult , Aged , Coronary Angiography , Exercise Test , Female , Humans , Middle Aged , Myocardial Ischemia/diagnosis , Myocardial Ischemia/mortality , Prognosis , Proportional Hazards Models , Risk Assessment , Survival Analysis
9.
J Am Coll Cardiol ; 47(3 Suppl): S4-S20, 2006 Feb 07.
Article in English | MEDLINE | ID: mdl-16458170

ABSTRACT

Despite a dramatic decline in mortality over the past three decades, coronary heart disease is the leading cause of death and disability in the U.S. Importantly, recent advances in the field of cardiovascular medicine have not led to significant declines in case fatality rates for women when compared to the dramatic declines realized for men. The current review highlights gender-specific issues in ischemic heart disease presentation, evaluation, and outcomes with a special focus on the results published from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. We will present recent evidence on traditional and novel risk markers (e.g., high sensitivity C-reactive protein) as well as gender-specific differences in symptoms and diagnostic approaches. An overview of currently available diagnostic test evidence (including exercise electrocardiography and stress echocardiography and single-photon emission computed tomographic imaging) in symptomatic women will be presented as well as data using innovative imaging techniques such as magnetic resonance subendocardial perfusion, and spectroscopic imaging will also be discussed.


Subject(s)
Myocardial Ischemia , Female , Heart Function Tests , Humans , Myocardial Ischemia/diagnosis , Myocardial Ischemia/epidemiology , Myocardial Ischemia/physiopathology , Risk Factors , Sex Factors
10.
J Am Coll Cardiol ; 47(3 Suppl): S44-9, 2006 Feb 07.
Article in English | MEDLINE | ID: mdl-16458171

ABSTRACT

OBJECTIVES: We investigated the relationship between coronary vascular reactivity and functional capacity as assessed from the Duke Activity Status Index (DASI) in a cohort of women evaluated for suspected ischemia. BACKGROUND: Reduced functional capacity and impaired vascular reactivity are associated with poor prognosis, but an association between vascular reactivity and functional capacity is unknown. METHODS: A total of 190 women enrolled in the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE) study had baseline clinical assessment and coronary artery flow velocity response to adenosine (CFVR(ado)). We compared these results with self-reported DASI metabolic equivalents (METs). RESULTS: Mean age was 55 +/- 11 years (range 21 to 83 years), and only 18% had coronary stenosis > or =50%. Women with a CFVR(ado) <2.5 (n = 98) had mean DASI of 15.1 +/- 13.6, compared to women (n = 92) with CFVR(ado) > or =2.5, whose mean DASI was 21.0 +/- 15.2 (p = 0.004). This relationship was maintained after adjusting for age and presence of coronary artery disease. CFVR(ado) of > or =2.5 was associated with a DASI of >20 (odds ratio 3.03, 95% confidence interval 1.56 to 5.90, p = 0.001). CONCLUSIONS: Women with reduced CFVR(ado) were significantly more likely to have reduced functional capacity. Impairment in coronary vascular function and reduced levels of activity may both play a role in the poorer prognosis observed in the WISE study women; however, the relationship between the two is still unclear.


Subject(s)
Coronary Vessels/physiology , Myocardial Ischemia/physiopathology , Adenosine/pharmacology , Adult , Aged , Aged, 80 and over , Blood Flow Velocity/drug effects , Coronary Vessels/diagnostic imaging , Coronary Vessels/drug effects , Female , Humans , Middle Aged , Prognosis , Ultrasonography , Vasodilator Agents/pharmacology
11.
Am Heart J ; 150(5): 900-6, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16290958

ABSTRACT

BACKGROUND: Measurement of C-reactive protein (CRP), a marker of inflammation, is recommended to improve cardiovascular disease (CVD) risk stratification. However, no studies have collectively evaluated how inflammatory markers cluster empirically and relate to angiographic coronary artery disease and CVD events. METHODS: From the WISE study, 580 women with fasting plasma samples of inflammatory markers (interleukin [IL]-6, IL-18, tumor necrosis factor alpha, transforming growth factor beta, CRP, serum amyloid A [SAA], and intercellular adhesion molecules) were analyzed over a median of 4.7 years follow-up. All women were referred for coronary angiography (1996-2000) to evaluate suspected myocardial ischemia. RESULTS: In factor analysis, a "proinflammation" factor (cluster) loaded on IL-6, CRP, and SAA (r = 0.63-0.87); a "proinflammation and anti-inflammation" cluster loaded on IL-18 and tumor necrosis factor alpha (r = 0.72, 0.77); and an "immunosuppressive" factor loaded singly on transforming growth factor beta (r = 0.96). No cluster was independently associated with angiographic coronary artery disease. However, quartile increases of the "proinflammation" cluster (IL-6, CRP, and SAA) yielded death rates of 2.6%, 7.2%, 13.1%, 26.6%, respectively (P < .0001). Women with > or = 2 of 3 proinflammation markers in the upper quartile had an adjusted relative risk of death of 4.21 (95% CI 1.91-9.25), a higher conferred risk than any single marker alone, all of which were roughly equally predictive. CONCLUSIONS: Although IL-6, CRP, and SAA all predict CVD risk in women, development of global measures of inflammation and simply counting the number of markers with high levels improve CVD risk stratification. In addition, results indicate that the adverse impact of inflammation may be largely through other mechanisms than promotion of atherogenesis (ie, destabilization of vulnerable plaques).


Subject(s)
Myocardial Ischemia/immunology , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/blood , Cardiovascular Diseases/complications , Cardiovascular Diseases/immunology , Female , Humans , Inflammation/blood , Inflammation/complications , Inflammation Mediators/blood , Middle Aged , Myocardial Ischemia/blood , Myocardial Ischemia/complications , Risk Factors , Syndrome
12.
Clin Cardiol ; 28(7): 321-8, 2005 Jul.
Article in English | MEDLINE | ID: mdl-16075824

ABSTRACT

BACKGROUND: The INternational VErapamil SR-Trandolapril Study (INVEST), a prospective, randomized, antihypertensive trial, found that two different medication regimens produced similar blood pressure (BP) control with equivalent cardiovascular (CV) outcomes (death from any cause, nonfatal myocardial infarction [MI], or nonfatal stroke). HYPOTHESIS: The study was undertaken to investigate whether differences exist by global regions in demographics, treatment, and outcomes in the INVEST trial. METHODS: Data were analyzed for 22,576 patients with stable coronary artery disease (CAD) enrolled in INVEST. We investigated differences in patient characteristics, treatment approaches, BP control, and clinical outcomes by creating three global regions based on geographical location: Northern Americas (NA), Caribbean (CA), and Eurasia (EA). RESULTS: We observed significant regional differences in patient characteristics, treatment patterns, BP control, and CV outcomes. At baseline, patients from NA were older and had greater body mass index, higher rates of diabetes, peripheral vascular disease, and coronary revascularization, but lower rates of MI or left ventricular hypertrophy than patients in CA and EA. At 24 months, there were regional differences in both study and nonstudy antihypertensive drug use. Despite having higher mean baseline BP, patients from CA and EA achieved lower mean systolic BP throughout study follow-up. Furthermore, patients from both CA and EA had lower rates of all-cause mortality, fatal or nonfatal MI, fatal or nonfatal stroke, and newly diagnosed diabetes than patients from NA. CONCLUSIONS: In INVEST, regional differences in medication utilization, BP control, and CV outcomes were identified. These disparities warrant further investigation to define appropriate care for patients with hypertension and stable CAD from an international public health perspective.


Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Coronary Artery Disease/drug therapy , Hypertension/drug therapy , Indoles/therapeutic use , Verapamil/therapeutic use , Aged , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Body Mass Index , Calcium Channel Blockers/therapeutic use , Coronary Artery Disease/complications , Female , Follow-Up Studies , Humans , Hypertension/complications , Male , Middle Aged , Prospective Studies , Treatment Outcome
13.
JAMA ; 292(10): 1179-87, 2004 Sep 08.
Article in English | MEDLINE | ID: mdl-15353530

ABSTRACT

CONTEXT: Individual contributions of obesity and physical fitness (physical activity and functional capacity) to risk of coronary heart disease in women remain unclear. OBJECTIVE: To investigate the relationships of measures of obesity (body mass index [BMI], waist circumference, waist-hip ratio, and waist-height ratio) and physical fitness (self-reported Duke Activity Status Index [DASI] and Postmenopausal Estrogen-Progestin Intervention questionnaire [PEPI-Q] scores) with coronary artery disease (CAD) risk factors, angiographic CAD, and adverse cardiovascular (CV) events in women evaluated for suspected myocardial ischemia. DESIGN, SETTING, AND PARTICIPANTS: The National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) is a multicenter prospective cohort study. From 1996-2000, 936 women were enrolled at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (mean follow-up, 3.9 [SD, 1.8] years) for adverse outcomes. MAIN OUTCOME MEASURES: Prevalence of obstructive CAD (any angiographic stenosis >or=50%) and incidence of adverse CV events (all-cause death or hospitalization for nonfatal myocardial infarction, stroke, congestive heart failure, unstable angina, or other vascular events) during follow-up. RESULTS: Of 906 women (mean age, 58 [SD, 12] years) with complete data, 19% were of nonwhite race, 76% were overweight (BMI >or=25), 70% had low functional capacity (DASI scores <25, equivalent to

Subject(s)
Body Mass Index , Cardiovascular Diseases/epidemiology , Coronary Artery Disease/epidemiology , Physical Fitness , Coronary Angiography , Female , Follow-Up Studies , Humans , Middle Aged , Myocardial Ischemia/diagnostic imaging , Obesity/complications , Proportional Hazards Models , Risk Factors
14.
J Am Coll Cardiol ; 43(11): 2009-14, 2004 Jun 02.
Article in English | MEDLINE | ID: mdl-15172405

ABSTRACT

OBJECTIVES: This study was designed to investigate the relationship between hemoglobin level (Hgb) and adverse cardiovascular outcomes in women with suspected ischemia. BACKGROUND: Low Hgb levels correlate with increased cardiovascular morbidity and mortality in patients presenting with acute myocardial infarction (MI) or congestive heart failure (CHF). However, the prognostic significance of Hgb in women with suspected ischemia is unclear. METHODS: As part of the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE), we prospectively studied 936 women referred for coronary angiography to evaluate suspected ischemia. We compared Hgb levels with cardiovascular risk factors, core lab interpreted angiograms, inflammatory markers, and adverse cardiovascular outcomes. RESULTS: Of women enrolled, 864 (mean age 58.4 +/-11.6 years) had complete Hgb, angiogram, and follow-up (mean 3.3 +/- 1.7 years) data. The mean Hgb was 12.9 g/dl (range 7.7 to 16.4 g/dl) and 184 women (21%) were anemic (Hgb <12 g/dl). Anemic women had higher creatinine and were more likely to be nonwhite and have a history of diabetes, hypertension, and CHF (p < 0.05). However, we found no difference in EF or severity of coronary artery disease. Anemic women had a higher risk of death from any cause (10.3% vs. 5.4%; p = 0.02) and total adverse outcomes (26% vs. 16%, p < 0.01). In a multivariable model, decreasing Hgb was associated with significantly higher risk of adverse outcomes (hazard ratio = 1.20, p = 0.002). Also, anemic women had shorter survival time free of adverse outcome (p < 0.001). CONCLUSIONS: Our findings extend previous reports, linking lower hemoglobin levels with higher risk for adverse cardiovascular outcomes, to women evaluated for suspected ischemia in the absence of acute MI or CHF.


Subject(s)
Angina Pectoris , Heart Failure/blood , Hemoglobins/metabolism , Myocardial Infarction/blood , Adolescent , Adult , Aged , Aged, 80 and over , Biomarkers , Coronary Angiography , Female , Follow-Up Studies , Heart Failure/diagnostic imaging , Heart Failure/mortality , Heart Failure/pathology , Humans , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/mortality , Myocardial Infarction/pathology , Predictive Value of Tests , Prospective Studies , Survival Analysis , United States/epidemiology
16.
Circulation ; 109(6): 722-5, 2004 Feb 17.
Article in English | MEDLINE | ID: mdl-14970106

ABSTRACT

BACKGROUND: Coronary vascular dysfunction has been linked to atherosclerosis and adverse cardiovascular outcomes in men, but these relationships have not been firmly established in women. METHODS AND RESULTS: As part of the Women's Ischemia Syndrome Evaluation (WISE) sponsored by the National Heart, Lung, and Blood Institute, 163 women referred for clinically indicated coronary angiography underwent coronary reactivity assessment with quantitative coronary angiography and intracoronary Doppler flow before and after intracoronary administration of acetylcholine, adenosine, and nitroglycerin and were then followed up for clinical outcomes. History of hypertension was present in 61%, dyslipidemia in 54%, diabetes in 26%, and current tobacco use in 21% of women enrolled. Seventy-five percent had no or only mild epicardial coronary artery disease (CAD). Over a median follow-up of 48 months, events occurred in 58 women. On bivariate analysis, women with an event had significantly less change in coronary cross-sectional area (DeltaCSA) in response to acetylcholine (P=0.0006) and nitroglycerin (P=0.04). In addition, women with abnormal coronary dilator response to acetylcholine had less time free from cardiovascular events (P=0.004). In multivariable analysis, after controlling for age, hypertension, diabetes, dyslipidemia, tobacco use, and CAD severity, %DeltaCSA with acetylcholine (P=0.001) independently predicted events. When the outcome was restricted to only death, myocardial infarction, congestive heart failure, and stroke, %DeltaCSA with acetylcholine remained a significant predictor (P=0.006). CONCLUSIONS: In women in this study, impaired coronary vasomotor response to acetylcholine was independently linked to adverse cardiovascular outcomes regardless of CAD severity.


Subject(s)
Cardiovascular Diseases/diagnosis , Coronary Vessels/physiopathology , Vasodilator Agents , Acetylcholine , Adenosine , Cardiovascular Diseases/epidemiology , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Circulation , Disease-Free Survival , Female , Follow-Up Studies , Humans , Laser-Doppler Flowmetry , Middle Aged , Myocardial Ischemia/diagnostic imaging , Nitroglycerin , Prognosis , Prospective Studies , Risk Factors , Syndrome , Vasodilation
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