ST-elevation myocardial infarction risk in the very elderly

Campos, André; Placido-Sposito, Andrea; Freitas, Wladimir M.; Moura, Filipe A.; Guariento, Maria Elena; Nadruz, Wilson; Moriguchi, Emílio Hideyuki; Spósito, Andrei C.

doi:10.1016/j.bbacli.2016.09.001

Cited by 6 publications

(7 citation statements)

References 30 publications

(25 reference statements)

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“…In our study, despite high waist diameter, steroid replacement did not increase classic cardiovascular risk factors. This finding is in accordance with other authors that did not find an increase in adipocytokines in patients with adrenal insufficiency under corticotherapy [36]. However, recent studies suggested that testosterone treatment of older men was associated with progression of noncalcified atherosclerotic plaque [37].…”

Section: Discussionsupporting

confidence: 93%

Classic cardiovascular risk factors improve in very elderly hypopituitary patients treated on standard hormone replacement in long term follow- up

Rosa

Soares

Rodrigues

et al. 2021

Clin Diabetes Endocrinol

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Background Hypopituitarism in the elderly population is an underdiagnosed condition and may increase comorbidities related to glucose metabolism, dyslipidemia, and cardiovascular risk factors. Optimization of hormone replacement that considers alterations in clearance rates of hormones, interaction with other medications, and evaluation of the risk-benefit ratio of treatment is a big challenge for clinical practice. Objectives This study aimed to evaluate classic cardiovascular risk factors in hypopituitary septuagenarians and octagenarians by diagnosis and after long-term hormone replacement. Methods This is a retrospective observational study, with patients recruited and selected from a registry in a tertiary medical center. We included patients aged 70–99 years with hypopituitarism, evaluated hormonal and biochemical parameters, and cardiovascular risk scores were calculated by diagnosis and compared after long-term follow-up. All patients gave informed consent. Patient data were compared to a sex and age-matched control group, with long-term geriatric follow-up, without endocrine diseases. Results Thirty-five patients were included, 16 patients aged 70–75 years (72.61), 12 patients 76–80 years (72.28), 7 patients 81–99 years (89.28). Pituitary macroadenomas were the main cause of hypopituitarism, mean maximal diameter 3.4 cm (2.9–4.3), and invasive craniopharyngiomas. At the moment of diagnosis, most patients were overweight, and abdominal adiposity was observed in 76.9% of women and 36.4% of men, primarily in octagenarians and nonagenarians. Comorbidities were frequent; 85.7% presented hypertension, 37.1% diabetes, 53.1% low HDL, 51.5% hypertriglyceridemia. Most patients presented more than two combined pituitary deficiencies; hypogonadism in 88.6%, central hypothyroidism in 82.9%, GH deficiency in 65.7%, and adrenal insufficiency in 25.7%. Analysis of cardiovascular risk prediction in the total cohort showed that 57.1% of patients presented a reduction in the General Cardiovascular Disease (CVD) Risk Prediction Score and 45.7% in atherosclerotic CVD risk estimated by ACC/AHA 2013 Pooled Cohort Equation, despite being submitted to conventional hormone replacement, during the mean follow-up of 14.5 years. This reduction was not observed in the control group. Discussion and conclusion In this study, aged hypopituitary patients presented a reduction in estimated general CVD risk during long-term follow-up, despite replacement with corticosteroids, levothyroxine, or gonadal steroids. Early diagnosis and treatment of hypopituitarism in the elderly remain challenging. Larger studies should be performed to assess the risk-benefit ratio of hormone replacement on the metabolic profile in septuagenarian and octogenarian patients.

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Section: Discussionsupporting

confidence: 93%

Classic cardiovascular risk factors improve in very elderly hypopituitary patients treated on standard hormone replacement in long term follow- up

Rosa

Soares

Rodrigues

et al. 2021

Clin Diabetes Endocrinol

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“…In Brazil, HF has become a leading cause of hospitalization while acute myocardial infarction (AMI) has become the main cause of death. [ 2 , 3 ]…”

Section: Introductionmentioning

confidence: 99%

Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America

et al. 2018

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BackgroundIn high-income temperate countries, the number of hospitalizations for heart failure (HF) and acute myocardial infarction (AMI) increases during the winter. This finding has not been fully investigated in low- and middle-income countries with tropical and subtropical climates. We investigated the seasonality of hospitalizations for HF and AMI in Sao Paulo (Brazil), the largest city in Latin America.MethodsThis was a retrospective study using data for 76,474 hospitalizations for HF and 54,561 hospitalizations for AMI obtained from public hospitals, from January 2008 to April 2015. The average number of hospitalizations for HF and AMI per month during winter was compared to each of the other seasons. The autoregressive integrated moving average (ARIMA) model was used to test the association between temperature and hospitalization rates.FindingsThe highest average number of hospital admissions for HF and AMI per month occurred during winter, with an increase of up to 30% for HF and 16% for AMI when compared to summer, the season with lowest figures for both diseases (respectively, HF: 996 vs. 767 per month, p<0.001; and AMI: 678 vs. 586 per month, p<0.001). Monthly average temperatures were moderately lower during winter than other seasons and they were not associated with hospitalizations for HF and AMI.InterpretationThe winter season was associated with a greater number of hospitalizations for both HF and AMI. This increase was not associated with seasonal oscillations in temperature, which were modest. Our study suggests that the prevention of cardiovascular disease decompensation should be emphasized during winter even in low to middle-income countries with tropical and subtropical climates.

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“…Whereas genetic factors have been rather a subject of clinical investigation now, several non-genetic characteristics (e.g. gender and age) are well known to affect the risk of myocardial infarction (20,21). To in-vestigate the possibility that the association of two TP53 SNPs with myocardial infarction is dependent on one gender, we performed two independent sub-analyses limited to either men or women.…”

Section: Discussionmentioning

confidence: 99%

TP53 rs1042522 and rs8064946 variants in myocardial infarction

Hakobjanyan¹,

Stahelova²,

Mrázek³

et al. 2019

BLL

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OBJECTIVE: This study investigated the hypothesis that the single nucleotide polymorphisms (SNPs) of TP53 gene are related to a risk of myocardial infarction. METHODS: The coding SNP at codon 72 (rs1042522) and non-coding rs8064946 SNP were genotyped by polymerase chain reaction with sequence specifi c primers in 205 Czech patients with myocardial infarction and 148 Czech control subjects. RESULTS: The distribution of both SNPs was in agreement with the Hardy-Weinberg equilibrium and was similar to other European populations. Our power analysis showed 96 % of probability to detect an odd ratio equal to 2. Neither rs1042522 nor rs8064946 were associated with the risk of myocardial infarction. The haplotypes combined of rs1042522 and rs8064946 were not associated with myocardial infarction in the present study. CONCLUSION: The TP53 SNPs are not strongly associated with genetic predisposition to myocardial infarction

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ST-elevation myocardial infarction risk in the very elderly

Cited by 6 publications

References 30 publications

Classic cardiovascular risk factors improve in very elderly hypopituitary patients treated on standard hormone replacement in long term follow- up

Classic cardiovascular risk factors improve in very elderly hypopituitary patients treated on standard hormone replacement in long term follow- up

Increased hospitalizations for decompensated heart failure and acute myocardial infarction during mild winters: A seven-year experience in the public health system of the largest city in Latin America

TP53 rs1042522 and rs8064946 variants in myocardial infarction

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