Association of epistaxis with atherosclerotic cardiovascular disease

Abstract

Objectives/Hypothesis To investigate the association between epistaxis and atherosclerotic cardiovascular disease. Study Design Case‐control cohort study. Methods This study included patients from the tertiary‐care ear, nose, and throat department at the University Hospital of Zurich between December 1, 2016 and June 1, 2017. We assessed the cardiovascular risk profiles in a group of 41 patients presenting with epistaxis, and a group of 41 matched controls, focusing on a surrogate parameter for atherosclerosis: the carotid intima‐media thickness (CIMT). Results With a mean of 1.06 mm (standard deviation [SD] = 0.17), CIMT values were on average 26% higher in epistaxis patients than in their controls, with a mean of 0.84 mm (SD = 0.14; P < .001). Occurrence of severe epistaxis was also associated with lower ankle–brachial index values at 0.96 (SD = 0.12) versus 1.05 (SD = 0.17) (P < .001) and significantly higher QRISK2 relative risks (an algorithm for predicting cardiovascular risk) than found in the control group (1.81, SD = 0.97 vs. 1.35, SD = 0.28; P = .028). A binary logistic regression model, adjusted for possible confounders, showed an odds ratio of 2.5 for the occurrence of epistaxis per increase in CIMT of 0.1 mm in the study population (95% confidence interval: 1.56‐4.11; P < .001). Conclusions The occurrence of severe epistaxis was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease. Accordingly, patients affected by epistaxis should be regarded as at an elevated cardiovascular risk, which indicates the need for appropriate further medical assessment and preventive measures. Level of Evidence 3b Trial registration Clinical trials NCT03092973 Laryngoscope, 129:783–787, 2019

Assessment of Serum Levels of Selenium and Zinc in Children with Epilepsy

“…Regarding the clinical characteristics of the patients; we showed that the mean age of the study patients was 27.25± 13.92 years, ranged from 12 to 70 years. These results were in similar to Rahmanzadeh-Shahi et al, (2018); who showed that the mean age of patients with epistaxis was 40.22 ± 2.07), but it was lower than Lou and Lou, (2019) and Kunz et al, (2018); who showed that the mean age was 72.4 ± 5.1 years and 74.2 ± 13.6 years respectively. Moreover, Brown et Our work showed that right-sided epistaxis occurred in 45%, then bilateral epistaxis (30%), and lastly the left-sided epistaxis (25%).…”

Nasal Packs for Epistaxis: Predictors of Success

“…Instead, a history of IHD and normal haemoglobin on admission were found to be independent predictors of re‐bleeding following pack removal. Strong association between severe epistaxis and IHD has been previously described 11 . The findings of this study suggest a lower chance of pack success in those with a history of IHD but further research is needed to determine if a causative relationship exists.…”

Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension

“…However, the reduction of elastic fibres with subsequent collagen accumulation leads to arterial stiffening and intima-media thickening, which are independent predictors of incident hypertension in prospective community-based studies 22 . Kunz et al 23 mentioned that it is crucial to identify individuals with an increased atherosclerotic burden before such life-threatening events take place. The occurrence of severe epistaxis in his study was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease by analysing the carotid intima-media thickness by means of an ultrasonographic study 23 .…”

“…Kunz et al 23 mentioned that it is crucial to identify individuals with an increased atherosclerotic burden before such life-threatening events take place. The occurrence of severe epistaxis in his study was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease by analysing the carotid intima-media thickness by means of an ultrasonographic study 23 .…”