The influenza vaccine reduced major cardiovascular events in patients with ACS. Therefore, it should be encouraged as a secondary prevention in this group of patients.
BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.
A large proportion of Asian hypercholesterolaemic patients on lipid-lowering drugs are not at recommended LDL-C levels and remain at risk for cardiovascular disease. Given the proven efficacy of lipid-lowering drugs in the reduction of LDL-C, there is room for further optimization of treatments to maximize benefits and improve outcomes.
Objective: To determine the association between splenectomy and pulmonary hypertension in patients with thalassaemia with anaemia. Design: Prospective cross-sectional study. Methods: 68 patients with thalassaemia, who had a haemoglobin concentration of less than 100 g/l, were recruited into this study. Echocardiography was performed before clinical data were reviewed. Pulmonary artery pressure was estimated by measuring the systolic transtricuspid pressure gradient from tricuspid regurgitation and adding it to the right atrial pressure, which was estimated by the response of the inferior vena cava to inspiration. Pulmonary hypertension was defined as systolic pulmonary artery pressure . 35 mm Hg. History of splenectomy and other clinical data were compared between patients with and without pulmonary hypertension. Results: 29 patients had pulmonary hypertension and 39 did not. Patients with pulmonary hypertension had significantly more nucleated red blood cells and higher platelet counts, and a higher prevalence of splenectomy (75.8% v 25.6%, odds ratio 9.1, 95% confidence interval 3.0 to 27.7). In multivariate analysis, splenectomy was the only factor significantly related to pulmonary hypertension. Conclusion: Splenectomy is a strong risk factor for pulmonary hypertension in patients with thalassaemia.H eart disease is a major cause of mortality and morbidity in patients with thalassaemia after the first decade of life, 1 despite improved prognosis with iron chelation. The common cardiac abnormalities that have been reported in patients with thalassaemia are cardiac hypertrophy, ventricular systolic dysfunction, pericarditis and pulmonary hypertension. Pulmonary hypertension is found in about 59-75% of patients with thalassaemia and can be the leading cause of heart failure in these patients.2 4 5 Factors affecting pulmonary artery pressure include high cardiac output caused by anaemia, left ventricular (LV) systolic dysfunction, chronic pulmonary haemosiderosis, recurrent respiratory tract infections, hypoxaemia and pulmonary fibrosis.5 6 Another proposed cause is the hypercoagulable state with thrombotic obstruction of the pulmonary arteries.7-9 Although most of the reported patients with thalassaemia with pulmonary hypertension were splenectomised, 2 5 6 non-splenectomised patients can also have pulmonary hypertension whereas some of them have normal pulmonary arterial pressure.2 The relationship between splenectomy and pulmonary hypertension in thalassaemia has not been clearly established. The purpose of this study was to explore this relationship. METHODS PatientsWe studied patients with thalassaemia with haemoglobin concentration less than 100 g/l who were being treated at the haematology outpatient clinic from January 2000 to December 2001. They were free from cardiac symptoms and had no evidence of clinical heart failure or signs of chronic liver disease. None were taking cardioactive drugs at the time of examination. We excluded patients with significant valvular heart disease, congenital heart diseas...
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