Coronary artery disease is the leading cause of death in the United Sates and other developed counties. Air pollution, especially pollutants from mobile sources, is associated with cardiac and respiratory hospitalization and mortality, although the biological mode of action is still unknown. Previous epidemiologic studies have largely been conducted in major metropolitan areas. To elucidate the underlying biology in a less urban environment, we combined environmental data with existing clinical and genomic information from more than 9,300 cardiac catheterization patients (CATHGEN). This study examines the prevalence of chronic clinical conditions among 2,254 CATHGEN patients living within Durham, Wake, and Orange counties, North Carolina. Due to small numbers, we excluded 64 patients whose reported race was neither white nor black. Using the latitude and longitude of each patient's address, we computed the residence's distance to the nearest primary or secondary roadway and assigned their residence to one of six traffic exposure zones. Associations were examined using generalized additive models (R 2.13.0 package mgvc 1.7-6) adjusting for sex, race, and a smooth function of age that allowed for overdispersion from the binomial. Results for continuous exposure variables are expressed in interquartile ranges. In the defined metropolitan area, half of the CATHGEN patients lived between 332 m (0.21 miles) and 1479 m (0.92 miles) of a primary or secondary roadway. Only 53 patients lived within 200 m of a high-speed, high-volume roadway (zone 5) or a major roadway with extended traffic delays (zone 6), but 584 lived within 200m of a low-speed arterial characterized by a transit route (zone 4). In this cohort, we observed that chronic obstructive pulmonary disease was associated with residence in zone 4 (odds ratio = 1.67, 95% CI 1.18-2.35) or in zone 5 (5.05, 2.66-9.58). Peripheral vascular disease showed an inverse exponential association with distance to a primary or secondary roadway (OR = 1.26, 95% CI 1.12-1.41 for an IQR increment in distance). These analyses demonstrate the power of CATHGEN to detect modest air pollution associations in a less urban area. In the future, we will incorporate the wealth of available clinical and genomic information to elucidate the biological modes of action underlying these associations.
Background/Introduction Cardiovascular (CV) disease represents the leading cause of death and disability in developed countries with elevated LDL-C among the main risk factors for CV events. Purpose We conducted a study to describe the clinical profile of patients initiating evolocumab in real-world clinical practice, specifically hospital cardiology units in Spain. Methods Retrospective, observational, serial chart review of consecutive hyperlipidemic patients (≥18 years) who initiated evolocumab in 31 Spanish hospital cardiology units from February-2016 to May-2017. Relevant patients characteristics and clinical data were collected from medical records at 12 weeks pre- and 12±4 weeks post-evolocumab initiation. Baseline values correspond to data collected up to 12 weeks prior to initiation of evolocumab. Results 186 patients were enrolled: 72.0% men, mean (SD) age 60.3 (9.8) years, mean (SD) body mass index 28.5 (4.3) kg/m2. CV history and CV risk factors at evolocumab initiation are summarised below (Figure). Half of all patients were statin intolerant and almost all (94.1%) were secondary prevention. At baseline, half (51.1%) of all patients were receiving ezetimibe and 44.1% were receiving high-intensity statins. At baseline, mean (SD) LDL-C was 144.0 (49.0) mg/dL; 38.7% of patients had LDL-C 100-<130 mg/dL, 28.0% had LDL-C 130-<160 mg/dl, 12.4% had LDL-C ≥160 mg/dL, 12.9% had LDL-C ≥190 mg/dL. Mean (SD) baseline HDL-C was 47.7 (13.0) mg/dL. After 12 weeks of evolocumab treatment, mean (SD) LDL-C was reduced by 57.6% (21.6) to 62.2% (44.1) mg/dL (p<0.0001; LDL-C reductions of 57.5% [23.2]/57.6% [21.6] in patients with/without FH and 46.0% [21.5]/58.5% [22.1] in primary/secondary prevention patients, respectively). At week 12, 64.9% patients reached LDL-C levels <70 mg/dL, and 49.1% <50 mg/dL, while statin use remained stable (data not shown). Only 3.2% (n=6) patients discontinued evolocumab (voluntary withdrawal, mostly). Baseline CV history and CV risk factors Conclusions In Spanish Cardiology Units, evolocumab was typically prescribed in patients with FH and/or atherosclerotic cardiovascular disease, aligned with 2016 ESC/EAS guidelines recommendation on PCSK9i usage. Patients tended to have LDL-C levels above the recommended thresholds with LDL- levels markedly reduced after 12 (± 4) weeks of evolocumab treatment. Acknowledgement/Funding This work was supported by Amgen.
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