Studies have shown an increased risk of coronary artery disease (CAD) in the human immunodeficiency virus (HIV) population. Epicardial fat (EF) quality may be linked to this increased risk. In our study, we evaluated the associations between EF density, a qualitative characteristic of fat, and inflammatory markers, cardiovascular risk factors, HIV-related parameters, and CAD. Our study was cross-sectional, nested in the Canadian HIV and Aging Cohort Study, a large prospective cohort that includes participants living with HIV (PLHIV) and healthy controls. Participants underwent cardiac computed tomography angiography to measure volume and density of EF, coronary artery calcium score, coronary plaque, and low attenuation plaque volume. Association between EF density, cardiovascular risk factors, HIV parameters, and CAD were evaluated using adjusted regression analysis. A total of 177 PLHIV and 83 healthy controls were included in this study. EF density was similar between the two groups (−77.4 ± 5.6 HU for PLHIV and −77.0 ± 5.6 HU for uninfected controls, P = .162). Multivariable models showed positive association between EF density and coronary calcium score (odds ratio, 1.07, P = .023). Among the soluble biomarkers measured in our study, adjusted analyses showed that IL2Rα, tumor necrosis factor alpha and luteizing hormone were significantly associated with EF density. Our study showed that an increase in EF density was associated with a higher coronary calcium score and with inflammatory markers in a population that includes PLHIV.
Background: Canadian data on intracranial hemorrhage (ICH) associated with oral anticoagulation is limited. Objectives: Primary study outcomes were baseline hematoma volumes and in-hospital mortality in patients with ICH associated with direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Second-ary outcomes included the use of four-factor prothrombin complex concentrate (4f-PCC). Methods: Retrospective cohort study of patients with ICH associated with oral anticoagulation in three ter-tiary care hospitals in Montreal, Canada, between 2011 and 2018. Results: Twenty-nine patients were receiving DOACs and 114 patients were under VKAs. Median baseline hematoma volumes were similar, 14.8 ml [5.7–42.8] in the DOAC group and 15.6 ml [5.9–38.1] in the VKA group (p = 0.91). In-hospital mortality rate was 34.5% in the DOAC group and 48.2% in the VKA group (p = 0.26). Only 17 patients (58.6%) in the DOAC group received 4f-PCC. Conclusion: Our study did not demonstrate significant differences in outcomes of ICH associated with DOACs versus VKAs. Management approaches were variable. RésuméContexte: Il existe peu de données canadiennes sur l’hémorragie intracrânienne (HIC) associée à la prise d’anticoagulants par voie orale. Objectifs: Les critères d’évaluation principaux de l’étude sont le volume initial de l’hématome et la mortalité à l’hôpital chez des patients présentant une HIC associée à la prise d’anticoagulants oraux directs (AOD) par rapport à la prise d’antagonistes de la vitamine K (AVK). Les critères d’évaluation secondaires comprennent l’utilisation d’un concentré de complexe prothrombique à quatre facteurs (4f-PCC pour four-factor prothrombin complex concentrate). Méthodologie: Étude de cohorte rétrospective portant sur des patients présentant une HIC associée à la prise d’anticoagulants oraux dans trois hôpitaux de soins tertiaires de Montréal (Canada) entre 2011 et 2018. Résultats: Au total, 29 patients prenaient des AOD et 114 des AVK. Les volumes médians des hématomes au départ sont semblables, soit de 14,8 ml (de 5,7 à 42,8) dans le groupe des AOD et de 15,6 ml (de 5,9 à 38,1) dans le groupe des AVK (p = 0,91). Le taux de mortalité à l’hôpital est de 34,5 % pour le groupe des AOD et de 48,2 % pour celui des AVK (p = 0,26). Seuls 17 patients (58,6 %) du groupe des AOD ont reçu le 4f-PCC. Conclusion: Notre étude ne montre aucune différence importante dans les résultats concernant l’HIC associée à la prise d’AOD par rapport à la prise d’AVK. Les méthodes de prise en charge sont variables.
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