Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension

Rendina, Domenico; Ippolito, R.; Filippo, Gianpaolo De; Muscariello, Riccardo; Palma, D. De; Bonis, Silvana De; Cola, Michele Schiano di; Benvenuto, D.; Galderisi, Maurizio; Strazzullo, Pasquale; Galletti, Ferruccio

doi:10.1007/s11739-016-1527-2

Cited by 4 publications

(2 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As a result, MetS is a powerful prognosticator for stroke and CV diseases [ 5 , 11 , 42 – 44 ], both in the general population [ 42 , 43 ] and in some specific settings of patients such as those with arterial hypertension [ 12 ] and/or type 2 diabetes mellitus [ 44 ]. Furthermore, it has been associated with silent myocardial ischemia independent of essential hypertension [ 45 ]. However, exact information in regard to the prognostic role of MetS in patients with RA/AS/PsA is still lacking.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome

Cioffi

Viapiana

Tarantini³

et al. 2020

Intern Emerg Med

View full text Add to dashboard Cite

Systemic chronic inflammation may favor the onset of metabolic syndrome (MetS) which represents a risk factor for CV events. Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are disorders with high prevalence of MetS. We assessed the factors associated with MetS and its prognostic role in non-selected RA/AS/PsA patients. Between March 2014 and April 2016, 458 patients (228 RA, 134 PsA, 96 AS) selected for a primary prevention program for cardiovascular diseases were analyzed. Primary and co-primary end points were a composite of all-cause death/all-cause hospitalization and CV death/CV hospitalization, respectively. MetS was diagnosed according to the IDF Task Force on Epidemiology and Prevention. Patients were divided into MetS + (73 = 16%) and MetS − (385 = 84%). At multivariate logistic analysis, cancer, moderate/high disease activity, higher LV mass (LVM) and degree of LV diastolic dysfunction were independently associated with MetS. At 36-month follow-up, the event rate for primary/co-primary end point was 52/15% in MetS + vs 23/7% in MetS − (both p < 0.001). At multivariate Cox regression analysis, MetS was related to primary end point (HR 1.52 [CI 1.01–2.47], p = 0.04) together with higher LVM, disease duration and higher prevalence of biologic DMARDs refractoriness, and to co-primary end point (HR 2.05 [CI 1.16–3.60], p = 0.01) together with older age and higher LVM. The RA/AS/PsA phenotype MetS + is a subject with moderate/high disease activity, LV structural and functional abnormalities at increased risk for cancer. MetS + identifies RA/AS/PsA patients at higher risk for CV and non-CV events, independently of traditional CV risk factors analyzed individually and traditional indexes of inflammation.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome

Cioffi

Viapiana

Tarantini³

et al. 2020

Intern Emerg Med

View full text Add to dashboard Cite

show abstract

“…Так, якщо класична ішемія, асоційована зі стенокардією, виникає під час навантаження, супроводжується зростанням частоти серцевих скорочень (ЧСС) і триває декілька хвилин, то ББІМ частіше виникає на фоні підвищеної активації парасимпатичної нервової системи, включаючи відпочинок і сон, асоційована з нижчою ЧСС і триває від декількох хвилин до кількох годин, хоча чіткого зв'язку між ЧСС і «тихою» ішемією не встановлено. Факторами ризику виникнення ББІМ, окрім ЦД, є ожиріння, чоловіча стать, гіперхолестеринемія, гіпертригліцеридемія, артеріальна гіпертензія [7,10,11].…”

Section: вступunclassified

Silent Myocardial Ischemia in Patients With Acute Coronary Syndrome and Diabetes Mellitus

Myhovych,

Kovalchuk,

Bahan

et al. 2023

Act. Probl. of the Modern Med.

View full text Add to dashboard Cite

ST-segment elevation myocardial infarction, stenting of the infarct-related coronary artery, silent (painless) myocardial ischemia, diabetes mellitus, 24-hour electrocardiographic monitoring. Introduction. Currently, approximately 422 million people in the world have diabetes mellitus, and over 1.3 million individuals in Ukraine are diagnosed with diabetes mellitus. Diabetic neuropathy is known to contribute to the development of atypical and painless variants of ischemic heart disease in individuals with diabetes. This poses a challenge for timely diagnosis and obscures the course of ischemic heart disease, as the prevalence of silent myocardial ischemia is significantly high in these patients. Therefore, the aim of this study is to investigate the occurrence of myocardial ischemia episodes in patients with ST-elevation myocardial infarction within the first day following stenting of the infarct-related coronary artery. Furthermore, we aimed to demonstrate the painless nature of these episodes in the presence of type 2 diabetes mellitus through a clinical case presentation. Materials and methods. 30 patients with ST-segment elevation myocardial infarction were examined, and 24-hour electrocardiographic monitoring was performed during the first day after the infarct-related coronary artery stenting. Results. Episodes of transient myocardial ischemia were registered in 50% of people. We found that the majority of episodes (80%) were painless. In the presence of diabetes mellitus, only episodes of painless myocardial ischemia were noted that is supported by the example of a clinical case. The study highlighted the informativeness of 24-hour electrocardiographic monitoring in identifying episodes of myocardial ischemia, particularly in its painless variant. The results demonstrate that patients with ST-elevation myocardial infarction (STEMI) experience episodes of transient myocardial ischemia within the first day after coronary artery stenting, with a majority of these episodes being painless. Furthermore, in the presence of diabetes mellitus, ischemic episodes tend to be painless. Therefore, 24-hour electrocardiographic monitoring serves as a valuable method for the detection of myocardial ischemia.

show abstract

The benefit of angiotensin AT1 receptor blockers for early treatment of hypertensive patients

et al. 2017

View full text Add to dashboard Cite

ESC guidelines for management of arterial hypertension allow one to choose among five classes of antihypertensive drugs indiscriminately. They are based on the principle that in the management of hypertensive patients, it is fundamental to reduce blood pressure (BP), independently of the utilized drug. However, it has been demonstrated that the renin-angiotensin system (RAS) plays a relevant role in the hypertensive-derived development and progression of organ damage. Thus, antihypertensive drugs interfering with the RAS should be preferred in preventing and reducing target organ damage. The availability of two classes of drugs, ACE-inhibitors and angiotensin AT1 receptor blockers (ARBs), both interfering with the RAS, makes the choice between them difficult. Both pharmacological strategies offer an effective BP control, and a substantial improvement of prognosis in different associated pathologies. Regarding cardiovascular prevention, ACE-inhibitors have an extensive scientific literature regarding utility in high-risk patients. Nevertheless, there is evidence to support the concept that in the early phases of organ tissue damage, the RAS is activated, but the ACE pathway producing angiotensin II is not always employed. Accordingly, ACE-inhibitors appear to be less effective, whereas ARBs have a greater beneficial action in the initial stages of atherosclerotic disease. Moreover, patients undergoing ARBs therapy show a substantially lower risk of therapy discontinuation when compared to those treated with ACE-inhibitors, because of a better tolerability. In conclusion, ACE-inhibitors should be used in patients who have already developed organ damage, but tolerate this drug well, while ARBs should be the first choice in naïve hypertensive patients without organ damage or at the initial stages of disease.

show abstract

Risk factors for silent myocardial ischemia in patients with well-controlled essential hypertension

Cited by 4 publications

References 53 publications

Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome

Clinical profile and outcome of patients with chronic inflammatory arthritis and metabolic syndrome

Silent Myocardial Ischemia in Patients With Acute Coronary Syndrome and Diabetes Mellitus

The benefit of angiotensin AT1 receptor blockers for early treatment of hypertensive patients

Contact Info

Product

Resources

About