• Aarup Horton posted an update 6 months ago

    Atherosclerosis has been linked to cognitive decline in late life; however, the impact of cardiovascular risk factors (CVRFs) and subclinical atherosclerosis on brain metabolism at earlier stages remains unexplored.

    This study sought to determine the association between brain metabolism, subclinical atherosclerosis, and CVRFs in middle-aged asymptomatic individuals.

    This study included 547 asymptomatic middle-aged participants (50 ± 4 years, 82% men) from the PESA (Progression of Early Subclinical Atherosclerosis) study with evidence of subclinical atherosclerosis. Participants underwent

    F-fluorodeoxyglucose (FDG)-positron emission tomography. Global brain FDG uptake and voxel-wise analyses were used to evaluate the associations of cerebral metabolism with CVRFs and atherosclerotic plaque burden in carotids and femorals assessed by 3-dimensional vascular ultrasound.

    Global FDG uptake showed an inverse correlation with 30-year Framingham Risk Score (FRS) (β =-0.15, p<0.001). This association was mmatic middle-aged individuals, cardiovascular risk is associated with brain hypometabolism, with hypertension being the modifiable CVRF showing the strongest association. Subclinical carotid plaque burden is also linked to reduced brain metabolism independently of CVRFs. Cerebral areas showing hypometabolism include those known to be affected in dementia. These data reinforce the need to control CVRFs early in life in order to potentially reduce the brain’s midlife vulnerability to future cognitive dysfunction.

    Diabetes mellitus (DM) increases the risk of embolism in nonvalvular atrial fibrillation (NVAF).Theassociation between pre-diabetes and risk of ischemic stroke has not been studied separately in this population.

    The purpose of this study was to evaluate whether pre-diabetes is associated with increased risk of stroke and death in patients with NVAF.

    We conducted a historical cohort study using the Clalit Health Services electronic medical records. The study population included all members aged≥25 years, with a first diagnosis of NVAF between January 1, 2010, and December 31, 2016. We compared 3 groups of individuals those with pre-diabetes, those with diabetes, and normoglycemic patients.

    A total of 44,451 cases were identified. The median age was 75 years, and 52.5% were women. During a mean follow-up of 38months, the incidence rates of stroke (per 100 person-years) were 1.14 in normoglycemic individuals, 1.40 in those with pre-diabetes, and 2.15 in those with diabetes. In both univariate and multivariate analyses, pre-diabetes was associated with an increased risk of stroke compared with normoglycemic persons (adjusted hazard ratio 1.19; 95% confidence interval 1.01 to 1.4) even after adjustment for CHA

    DS

    -Vasc risk factors and use of anticoagulants, while diabetes conferred an even higher risk (vs. normoglycemia (adjHR 1.56; 95%CI 1.37 to 1.79). The risk for mortality was higher for individuals with diabetes (adjHR 1.47; 95%CI 1.41 to 1.54) but not for those with pre-diabetes (adjHR 0.98; 95%CI 0.92 to 1.03).

    In this cohort of patients with incident NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors.

    In this cohort of patients with incident NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors.

    Postural orthostatic tachycardia syndrome (POTS) is a complex, multifaceted disorder that impairs functional status and quality of life. Current pharmacological treatments are limited.

    This study investigated the effect of ivabradine (selective blocker of the I

    channel in the sinoatrial node) on heart rate, quality of life (QOL), and plasma norepinephrine (NE) levels in patients with hyperadrenergic POTS defined by plasma NE >600 pg/ml and abnormal tilt table test.

    In total, 22 patients with hyperadrenergic POTS as the predominant subtype completed a randomized, double-blinded, placebo-controlled, crossover trial with ivabradine. Patients were randomized to start either ivabradine or placebo for 1month, and then were crossed over to the other treatment for 1month. Heart rate, QOL, and plasma NE levels were measured at baseline and at the end of each treatment month.

    The average age was 33.9 ± 11.7 years, 95.5% were women (n=21), and 86.4% were White (n=23). selleck There was a significant reduction in heart rate between placebo and ivabradine (p<0.001). Patients reported significant improvements in QOL with RAND 36-Item Health Survey 1.0 for physical functioning (p=0.008) and social functioning (p=0.021). There was a strong trend in reduction of NE levels upon standing with ivabradine (p=0.056). Patients did not experience any significant side-effects, such as bradycardia or hypotension, with ivabradine.

    Ivabradine is safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS as the predominant subtype.

    Ivabradine is safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS as the predominant subtype.

    Type 2 myocardial infarction (MI) patients may have different characteristics and outcomes when compared with type 1 MI.

    The purpose of this study was to compare patients with type 1 MI to those with type 2 MI in the United States.

    Using the Nationwide Readmissions Database, MI patients were categorized over the 3months following the introduction of an International Classification of Diseases-10th Revision code specific for type 2 MI. Baseline characteristics and inpatient and post-discharge outcomes among both cohorts were compared.

    There were 216,657 patients with type 1 MI, 37,765 patients with type 2 MI, and 1,525 patients with both type 1 and 2 MI. Patients with type 2 MI were older (71 years vs. 69 years; p<0.001), were more likely to be women (47.3% vs. 40%; p<0.001), and had higher prevalence of heart failure (27.9% vs. 10.9%; p<0.001), kidney disease (35.7% vs. 25.7%; p<0.001), and atrial fibrillation (31% vs. 21%; p<0.001). Rates of coronary angiography (10.9% vs. 57.3%; p<0.

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