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Life (Basel, Switzerland) Sep 2021This study summarized the relevant literature and aimed to determine the effect of exercise-based interventions after myocardial infarction in middle-aged and older... (Review)
Review
This study summarized the relevant literature and aimed to determine the effect of exercise-based interventions after myocardial infarction in middle-aged and older adults. Studies were identified and analyzed according to the PRISMA guidelines. The following electronic databases were used: Google Scholar, PubMed, Mendeley, Science Direct, and Scopus. The identified studies had to be longitudinal, be published in English, have taken place between 2010 and 2020, involve participants who had suffered myocardial infarction, and address different types of exercise-based interventions to be included. Of the 592 relevant studies identified, 20 were included in the qualitative analysis. After analyzing the results obtained, it could be concluded that different types of exercise-based interventions or their combination have a positive effect after myocardial infarction in middle-aged and elderly adults. It can also be suggested that the combination of a cycle ergometer and a treadmill may be the most effective exercise-based intervention. An adequate choice of intensity and volume is crucial, with the optimal duration of the experimental program and the type(s) of exercises adapted to participants after myocardial infarction.
PubMed: 34575077
DOI: 10.3390/life11090928 -
Pharmacotherapy Dec 2022To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).
MATERIALS AND METHODS
We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157).
RESULTS
A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m . Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59-1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points.
CONCLUSIONS
Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.
Topics: Humans; Diabetes Mellitus, Type 2; Glucagon-Like Peptide-1 Receptor; Myocardial Infarction; Renal Insufficiency, Chronic; Stroke
PubMed: 36271706
DOI: 10.1002/phar.2737 -
Lupus Mar 2023Systemic lupus erythematosus (SLE) is an autoimmune disease that typically affects women aged 16-55 years. Cardiovascular disease (CVD) is a well-recognized... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Systemic lupus erythematosus (SLE) is an autoimmune disease that typically affects women aged 16-55 years. Cardiovascular disease (CVD) is a well-recognized complication of SLE. This systematic literature review and meta-analysis evaluated the relative risk (RR; compared with non-SLE controls), absolute risk (AR; as incidence proportion, n/N), and incidence rate (IR) of CVD events (including stroke, myocardial infarction [MI], and CVD [composite or undefined]) in adult patients with SLE. The RR of CV risk factors (including hypertension, diabetes, and metabolic syndrome [MetS]) was also examined.
METHODS
PubMed and Embase were searched on September 10, 2020. Observational studies published between January 2010 and September 2020 that reported RR, AR, and/or IR of CVD events, or RR of CV risk factors, were eligible. Pooled risk estimates were calculated using a random-effects model.
RESULTS
Forty-six studies (16 cross-sectional, 15 retrospective cohort, 14 prospective cohort, and 1 case-control) were included in meta-analyses. Most studies were considered high quality (Critical Appraisal Skills Programme checklists). Compared with adults without SLE, patients with SLE had statistically significantly higher RRs (95% CIs) of stroke (2.51 [2.03-3.10]; 12 studies), MI (2.92 [2.45-3.48]; 11 studies), CVD (2.24 [1.94-2.59]; 8 studies), and hypertension (2.70 [1.48-4.92]; 7 studies). RRs of diabetes (1.24 [0.78-1.96]; 3 studies) and MetS (1.49 [0.95-2.33]; 7 studies) were elevated but not significant. RRs of stroke and MI were generally higher in younger versus older patients with SLE. In patients with SLE, the pooled estimate of AR (95% CI) was 0.03 (0.02-0.05), 0.01 (0.00-0.02), and 0.06 (0.03-0.10) for stroke (7 studies), MI (6 studies), and CVD (8 studies), respectively. The pooled estimate of IR per 1000 person-years (95% CI) was 4.72 (3.35-6.32), 2.81 (1.61-4.32), and 11.21 (8.48-14.32) for stroke (10 studies), MI (6 studies), and CVD (8 studies), respectively. Although heterogeneity (based on I value) was high in most analyses, sensitivity analyses confirmed the robustness of the pooled estimates.
CONCLUSIONS
This meta-analysis found an increased risk of stroke, MI, CVD, and hypertension in patients with SLE compared with the general population, despite substantial heterogeneity across the included studies.
Topics: Adult; Humans; Female; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Lupus Erythematosus, Systemic; Cardiovascular Diseases; Myocardial Infarction; Risk Factors; Hypertension; Stroke; Diabetes Mellitus
PubMed: 36547368
DOI: 10.1177/09612033221147471 -
Archives of Gerontology and Geriatrics Nov 2023The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of... (Review)
Review
AIMS
The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of guideline-recommended cardioprotective medications following myocardial infarction (MI) in people who are frail.
DATA SOURCES
Ovid Medline, PubMed and Cochrane were searched from inception to October 2022 for studies that reported prescribing of one or more cardioprotective medication classes post-MI or acute coronary syndromes in people with frailty.
STUDY SELECTION
We included observational studies that reported prescribing of cardioprotective medications post-MI stratified by frailty status.
RESULTS
Overall, 16 cohort studies published from 2013 to 2022 that used seven different frailty scales were included. Prescribing of all cardioprotective medication classes following MI was lower in frail compared to non-frail people, with absolute rates of prescribing varying substantially across studies. Median prescribing in frail and non-frail people, respectively, was 88.9% (IQR 81.5-96.2) and 93.1% (IQR 92.0-98.9) for aspirin; 68.1% (IQR 61.9-91.2) and 86.7% (IQR 79.5-92.8) for P2Y12-inhibitors; 83.1% (IQR 76.9-91.3) and 94.0% (IQR 87.1-95.9) for lipid-lowering therapy; 67.9% (IQR 60.6-74.0) and 74.7% (IQR 71.3-84.5) for angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; and 74.1% (IQR 69.2-79) and 77.6% (IQR 71.8-85.9) for beta-blockers.
CONCLUSION
People who were frail were less likely to be prescribed guideline recommended medication classes post-MI than those who were non-frail. Further research is needed into treatment benefits and risks in frail people to avoid unnecessarily withholding treatment in this high-risk population, while also minimising potential for medication related harm.
Topics: Humans; Aged; Frailty; Myocardial Infarction; Acute Coronary Syndrome; Angiotensin-Converting Enzyme Inhibitors; Risk Factors
PubMed: 37356114
DOI: 10.1016/j.archger.2023.105106 -
BMC Cardiovascular Disorders Oct 2023The prognostic significance of serum uric acid (SUA) in individuals who have experienced myocardial infarction (MI) remains a subject of academic debate. Thus, the aim... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The prognostic significance of serum uric acid (SUA) in individuals who have experienced myocardial infarction (MI) remains a subject of academic debate. Thus, the aim of this study was to examine the occurrence of immediate and long-term adverse outcomes in individuals with elevated levels of uric acid (UA) following a diagnosis of MI.
METHOD
This study conducted a literature search from PubMed, Embase, Web of Science, Medline, Cochrane Library, Emcrae, and Scopus to perform a systematic review and meta-analysis of the prognostic impact of MI with a hyper SUA to assess short-term (30-day or in-hospital) and long-term mortality, the incidence of major adverse cardiovascular events (MACE), and its adverse event rate in relation to SUA. The literature search was conducted up until April 2023. A random effects model and risk ratio (RR) were used as epidemiological indicators. For indicators with low disease rates, treatment intensity was reduced and RR was considered equivalent to odds ratio (OR). Hazard Ratio (HR), RR, and OR extracted from the data were simultaneously subjected to multivariable adjustment for confounding factors. In addition, P values for all original hypotheses were extracted and a meta-analysis was conducted. High SUA was defined as SUA levels equal to or greater than 420 μmol/L (7.0 mg/dL) for males and equal to or greater than 357 μmol/L (6.0 mg/dL) for females. The quality of the literature was evaluated using the Newcastle-Ottawa Scale (NOS).
RESULTS
This comprehensive study included a total of 41 investigations, involving a large sample size of 225,600 individuals who had experienced MI. The findings from the meta-analysis reveal that patients diagnosed with hyperuricemia have significantly increased rates of short-term mortality (RR = 2.14, 95% CI = 1.86, 2.48) and short-term incidence of MACE (RR = 1.94, 95% CI = 1.65-2.11). Furthermore, long-term adverse outcomes, including all-cause mortality (RR = 1.46, 95% CI = 1.40-1.51) and incidence of MACE (RR = 1.43, 95% CI = 1.35-1.52), were also found to be higher in this specific patient population.
CONCLUSION
Patients diagnosed with MI and elevated SUA levels exhibit a heightened incidence of MACE during their hospital stay. Furthermore, these individuals also experience elevated rates of in-hospital mortality and mortality within one year of hospitalization. However, it is important to note that further randomized controlled trials are necessary to validate and authenticate these findings.
Topics: Male; Female; Humans; Uric Acid; Myocardial Infarction; Prognosis; Hospitalization; Length of Stay
PubMed: 37848854
DOI: 10.1186/s12872-023-03523-1 -
Scientific Reports Oct 2023The older adult is an influential group experiencing acute myocardial infarction, delaying treatment and causing a high mortality rate. Factors related to their delay... (Meta-Analysis)
Meta-Analysis
The older adult is an influential group experiencing acute myocardial infarction, delaying treatment and causing a high mortality rate. Factors related to their delay differ from other age groups, and their specific characteristics are barriers to recognizing their symptoms and learning new information. Therefore, specific innovative methods related to their limitations and needs should be considered when developing interventions promoting on-time treatment. This study aims to review intervention details and their effects on knowledge, belief, decision-making, rate of calling 911, and mortality among community-dwelling older adults at risk or after a first myocardial infarction compared to receiving usual care or no intervention. The 12 databases were searched unlimitedly until July 30, 2022. The two researchers independently reviewed the articles, and the third reviewer broke the tight when disagreement was found. Data were extracted, kinds of interventions were grouped, and intervention details were summarized narratively. Finally, the selected outcomes were analyzed by meta-analysis using a fixed and a random-effects model. Eleven articles were for final review. Interventions were categorized into eight groups: direct mail, community-based, multi-group health education, innovation methods, tailored education, structured education, tricked intervention promoting memory and concern, and nurse-based case management. Finally, the meta-analysis found that only innovative methods could increase the rate of calling 911 and taking aspirin (Odd ratio = 2.55; 95% CI = 1.01-6.44). In contrast, there were no statistically significant differences in the rate of affecting time to first unplanned readmission or death and time delay to the emergency room. Results recommended that effective and specific interventions must be developed and strengthened to promote older adults surviving acute myocardial infarction.Clinical Trial Registration Number: PROSPERO CRD42021247136.
Topics: Aged; Humans; Myocardial Infarction
PubMed: 37898637
DOI: 10.1038/s41598-023-45695-y -
Life (Basel, Switzerland) Jan 2024Coronavirus disease 2019 (COVID-19) was a global pandemic with high mortality and morbidity that led to an increased health burden all over the world. Although the virus... (Review)
Review
Coronavirus disease 2019 (COVID-19) was a global pandemic with high mortality and morbidity that led to an increased health burden all over the world. Although the virus mostly affects the pulmonary tract, cardiovascular implications are often observed among COVID-19 patients and are predictive of poor outcomes. Increased values of myocardial biomarkers such as troponin I or NT-proBNP were proven to be risk factors for respiratory failure. Although the risk of acute coronary syndromes (ACSs) was greater in the acute phase of COVID-19, there were lower rates of hospitalization for ACSs, due to patients' hesitation in presenting at the hospital. Hospitalized ACSs patients with COVID-19 infection had a prolonged symptom-to-first-medical-contact time, and longer door-to-balloon time. The mechanisms of myocardial injury in COVID-19 patients are still not entirely clear; however, the most frequently implicated factors include the downregulation of ACE2 receptors, endothelial dysfunction, pro-coagulant status, and increased levels of pro-inflammatory cytokines. The aim of this paper is to evaluate the long-term outcomes and prognosis of COVID-19 survivors that presented an acute myocardial infarction, by reviewing existing data. The importance of the association between this infectious disease and myocardial infarction arises from the increased mortality of patients with SARS-CoV-2 infection and AMI (10-76%, compared with 4.6% for NSTEMI patients and 7% for STEMI patients without COVID-19). The literature review showed an increased risk of cardiovascular events in COVID-19 survivors compared with the general population, even after the acute phase of the disease, with poorer long-term outcomes.
PubMed: 38398712
DOI: 10.3390/life14020202 -
Diagnostics (Basel, Switzerland) Feb 2022The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the... (Review)
Review
The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI.
PubMed: 35204567
DOI: 10.3390/diagnostics12020476 -
Cureus Nov 2023Autonomic responses elicited by myocardial infarction vary depending on the site of injury, but accurate assessment using heart rate variability during the acute phase... (Review)
Review
Autonomic responses elicited by myocardial infarction vary depending on the site of injury, but accurate assessment using heart rate variability during the acute phase is limited. We systematically searched PubMed without language restrictions throughout July 2023. We reviewed studies reporting autonomic indices separately for anterior and inferior infarcts, followed by a meta-analysis of those reporting the standard deviation of the inter-beat interval between normal sinus beats during the initial 24 hours after the onset of symptoms. Six studies were included, comprising 341 patients (165 anterior, 176 inferior infarcts), all with satisfactory scores on the Newcastle-Ottawa quality scale. The estimated average of the standardized mean difference (based on the random-effects model) was -0.722 (95% confidence intervals: -0.943 to -0.501), which differed from zero (z=-6.416, p<0.0001). This finding indicates sympathetic and vagal dominance during acute anterior and inferior infarcts, respectively, with excessive responses likely contributing to early arrhythmogenesis. Despite the amelioration of autonomic dysfunction by revascularization, infarct location should be considered when commencing β-adrenergic receptor blockade, especially after delayed procedures.
PubMed: 38106761
DOI: 10.7759/cureus.48893 -
Alternative Therapies in Health and... Apr 2024An acute myocardial infarction (AMI) is a serious, life-threatening disease. Practitioners of traditional Chinese medicine (TCM) commonly use the Tongxinluo (TXL)...
CONTEXT
An acute myocardial infarction (AMI) is a serious, life-threatening disease. Practitioners of traditional Chinese medicine (TCM) commonly use the Tongxinluo (TXL) capsule, a Chinese patent medicine, to treat AMIs. The benefits of TXL capsules for AMIs remain unknown.
OBJECTIVE
The systematic review and meta-analysis intended to investigate the effects of TXL capsules for AMI patients.
DESIGN
The research team conducted a comprehensive literature search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to February 2023. The team used the search terms acute myocardial infarction, myocardial infarction, TXL Capsule Therapy, and TXL Capsule. The team also performed a meta-analysis and evaluated the features of the included studies using the Cochrane Collaboration tool for assessing the risk of bias.
SETTING
The study took place at the Second Affiliated Hospital at Heilongjiang University of Chinese Medicine in Harbin City, Heilongjiang Province, China.
OUTCOME MEASURES
The research team: (1) evaluated the studies' quality using the Cochrane Collaboration tool for assessing the risk of bias; (2) analyzed the curative effect of the TXL capsules for AMI; (3) explored the effects of the TXL capsules on left ventricular end-diastolic dimension (LVEDD), left ventricular end systolic diameter (LVESD), and left ventricular ejection fraction (LVEF); and (4) explored the effects of the TXL capsules on creatine kinase isoenzyme (CK-MB) peak time, CK-MB peak value, and cardiac index.
RESULTS
The literature search found ten studies. Compared with routine treatment alone, a combination of routine treatment and TXL capsules significantly improved the curative effects (odds ratio = 3.48; 95% CI: 2.34, 5.17; P < .00001) Compared with the control groups, the TXL capsule groups' LVESD and LVEF were significantly lower, with MD=-0.23; 95% CI: -0.37, -0.10; and P = .0007 and MD=-0.43; 95% CI: -0.61, -0.25; and P < .00001, respectively, and its LVEDD was significantly higher, with MD=5.27; 95% CI: 4.33, 6.21; and P < .00001. For myocardial enzymes, the TXL capsule groups' creatine kinase isoenzyme (CK-MB) peak values and cardiac indexes were significantly lower than those of the control groups, with MD=-53.11; 95% CI: -55.26, -50.97; and P < .00001 and MD=-1.87; 95% CI: -2.03, -1.70; and P < .00001, respectively.
CONCLUSIONS
The meta-analysis showed that the TXL capsule can bring greater therapeutic benefits for AMI patients in combination with routine treatment. The current study was a meta-analysis, and the field needs more well-designed studies.
PubMed: 38581311
DOI: No ID Found