-
The European Respiratory Journal Jan 2023The impact of sex on the association of obstructive sleep apnoea (OSA) with recurrent cardiovascular events following acute coronary syndrome (ACS) remains uncertain....
BACKGROUND
The impact of sex on the association of obstructive sleep apnoea (OSA) with recurrent cardiovascular events following acute coronary syndrome (ACS) remains uncertain. This study sought to examine the association between OSA and long-term cardiovascular outcomes in women and men with ACS.
METHODS
In this prospective cohort study, we recruited 2160 ACS patients undergoing portable sleep monitoring between June 2015 and January 2020. The primary end-point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischaemia-driven revascularisation or hospitalisation for unstable angina or heart failure.
RESULTS
After exclusion of patients with failed sleep studies, central sleep apnoea, regular continuous positive airway pressure therapy and loss of follow-up, 1927 patients were enrolled. Among them, 298 (15.5%) were women and 1014 (52.6%) had OSA (apnoea-hypopnoea index ≥15 events·h). The prevalence of OSA was 43.0% and 54.4% in women and men, respectively. In 4339 person-years (median 2.9 years, interquartile range 1.5-3.6 years), the cumulative incidence of MACCE was significantly higher in OSA non-OSA groups in the overall population (22.4% 17.7%; adjusted hazard ratio (HR) 1.29, 95% CI 1.04-1.59; p=0.018). OSA was associated with greater risk of MACCE in women (28.1% 18.8%; adjusted HR 1.68, 95% CI 1.02-2.78; p=0.042), but not in men (21.6% 17.5%; adjusted HR 1.22, 95% CI 0.96-1.54; p=0.10). No significant interaction was noted between sex and OSA for MACCE (interaction p=0.32). The incremental risk in women was attributable to higher rates of hospitalisation for unstable angina and ischaemia-driven revascularisation.
CONCLUSIONS
In hospitalised ACS patients, OSA was associated with increased risk of subsequent events, particularly among women. Female patients with ACS should not be neglected for OSA screening and dedicated intervention studies focusing on women with ACS and comorbid OSA should be prioritised.
Topics: Male; Humans; Female; Acute Coronary Syndrome; Prospective Studies; Risk Factors; Sleep Apnea, Obstructive; Angina, Unstable
PubMed: 36104289
DOI: 10.1183/13993003.01110-2022 -
Cardiology 2022
Topics: Angina, Unstable; Clinical Trials as Topic; Humans; Myocardial Infarction
PubMed: 35468609
DOI: 10.1159/000524700 -
European Journal of Clinical... Dec 2022This study aims to compare the effects of ticagrelor and clopidogrel on platelet function, cardiovascular prognosis, and bleeding in patients with unstable angina...
PURPOSE
This study aims to compare the effects of ticagrelor and clopidogrel on platelet function, cardiovascular prognosis, and bleeding in patients with unstable angina pectoris.
METHODS
Patients with unstable angina pectoris undergoing percutaneous coronary intervention (PCI) were enrolled (January 2018-December 2019). In total, 212 patients were treated with ticagrelor (90 mg twice daily) and 210 patients were treated with clopidogrel (75 mg once daily). Thromboelastography and light transmission aggregometry were used to measure the platelet aggregation rate (PAR). High-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (CRP), and heart-type fatty acid-binding protein (h-FABP) were measured to assess myocardial injury after PCI. Cardiovascular prognosis and bleeding events were evaluated in hospital and 12 months after discharge.
RESULTS
The PAR was significantly slower with ticagrelor (P < 0.001). hs-TnT, NT-proBNP, CRP, and h-FABP increased after compared with before PCI in both groups (P < 0.05). hs-TnT (P < 0.001) and h-FABP (P < 0.001) increased more significantly with clopidogrel. The in-hospital and 12-month major adverse cardiovascular event (MACE) rates were not significantly different between the two groups. The in-hospital total bleeding event rate was higher with ticagrelor (P < 0.05). Minor bleeding and total bleeding were more frequent at the 12-month follow-up in the ticagrelor group (P < 0.05).
CONCLUSION
Ticagrelor was more effective in suppressing the PAR than clopidogrel and reduced PCI-induced myocardial injury in patients with unstable angina pectoris. However, it increased in-hospital and 12-month bleeding events and had no benefit on in-hospital and 12-month MACEs.
Topics: Humans; Ticagrelor; Clopidogrel; Fatty Acid Binding Protein 3; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Treatment Outcome; Prognosis; Hemorrhage; Angina, Unstable
PubMed: 36245047
DOI: 10.1007/s00228-022-03401-3 -
Clinical Cardiology Oct 1990The pathophysiology of unstable angina has been better elucidated in the past five years and has led to more rational therapy. Coronary arteries in patients with... (Review)
Review
The pathophysiology of unstable angina has been better elucidated in the past five years and has led to more rational therapy. Coronary arteries in patients with unstable angina have atherosclerotic plaques which are often complex and are the site of platelet activation and fibrin deposition. Nitrates, one of the oldest therapies, are efficacious and act not only by dilating coronary vessels but by reducing preload and afterload. Beta blockers have a salutary effect by decreasing myocardial oxygen demand. Calcium channel blockers attenuate smooth muscle contraction and thereby act to decrease coronary artery spasm. Beta blockers and calcium channel blockers are equally efficacious in unstable angina. The antiplatelet agent, aspirin, has been shown to reduce fatal or non-fatal myocardial infarction and probably overall mortality. The use of heparin acutely for unstable angina has been demonstrated to decrease refractory angina and myocardial infarction, and acutely is probably better than aspirin. For patients with reduced ejection fractions (0.30-0.49), a prospective randomized trial has shown that coronary artery bypass graft surgery offers an improved three-year survival compared with medical therapy; however, surgery does not prevent myocardial infarction. Percutaneous transluminal coronary angioplasty may be a reasonable therapeutic alternative for some patients with single-vessel disease who are refractory to medical therapy but there are as yet no controlled trials of this question. To date a clinical benefit from thrombolytic therapy has not been demonstrated.
Topics: Angina, Unstable; Angioplasty, Balloon, Coronary; Humans
PubMed: 2257708
DOI: 10.1002/clc.4960131002 -
Einstein (Sao Paulo, Brazil) 2015Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation... (Review)
Review
Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high.
Topics: Acute Coronary Syndrome; Angina, Unstable; Anticoagulants; Cineangiography; Critical Care; Evidence-Based Medicine; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors
PubMed: 26466065
DOI: 10.1590/S1679-45082015RW3172 -
Cells Dec 2022Acute coronary syndrome (ACS) encompasses a spectrum of presentations including unstable angina, non-ST elevation myocardial infarction (NSTEMI) and ST-elevation...
Acute coronary syndrome (ACS) encompasses a spectrum of presentations including unstable angina, non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) [...].
Topics: Humans; Acute Coronary Syndrome; Angina, Unstable; Non-ST Elevated Myocardial Infarction; ST Elevation Myocardial Infarction; Biology
PubMed: 36552899
DOI: 10.3390/cells11244136 -
Postgraduate Medical Journal Mar 1988
Review
Topics: Angina Pectoris; Angina, Unstable; Coronary Thrombosis; Coronary Vessels; Fibrinolysis; Humans; Platelet Aggregation
PubMed: 3050942
DOI: 10.1136/pgmj.64.749.196 -
Texas Heart Institute Journal 2010In this, the 1st part of a 2-part review, we discuss how plaque rupture is the most common underlying pathophysiologic cause of unstable angina and... (Review)
Review
In this, the 1st part of a 2-part review, we discuss how plaque rupture is the most common underlying pathophysiologic cause of unstable angina and non-ST-segment-elevation myocardial infarction and how early risk stratification is vital in the timely diagnosis and treatment of acute coronary syndrome. Part 2 of this review (to be published in a later issue of this journal) will focus mainly on the various pharmacologic agents and treatment approaches (early invasive vs early conservative) to the management of unstable angina and non-ST-segment-elevation myocardial infarction.
Topics: Acute Coronary Syndrome; Angina, Unstable; Health Status Indicators; Heart Function Tests; Humans; Myocardial Infarction; Predictive Value of Tests; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 20401284
DOI: No ID Found -
Experimental Biology and Medicine... Sep 2021Oxidative stress and inflammation are closely related to atherosclerotic cardiovascular disease. It is established that hydrogen has significant protective effects on...
Oxidative stress and inflammation are closely related to atherosclerotic cardiovascular disease. It is established that hydrogen has significant protective effects on many diseases as a potential antioxidative and anti-inflammatory agent. The purpose of this study is to evaluate the effect of hydrogen on unstable angina An atherosclerosis model was constructed by ox-LDL-induced injury of human umbilical vein endothelial cells and testing indicated hydrogen inhibited ox-LDL-induced oxidative stress and inflammatory response by down-regulating LOX-1/NF-kB signaling pathway. Subsequently, the attenuating effect of hydrogen-rich water intake on unstable angina was further confirmed in clinic. Forty hospitalized subjects with unstable angina were enrolled and consumed either 1000-1200 mL/d hydrogen-rich water or the same amount of placebo pure water in addition to conventional drugs for three months. Clinical analysis showed hydrogen-rich water intake relieved angina symptoms in unstable angina patients. Serum analysis showed that hydrogen-rich water addition resulted in more effective reductions of total-cholesterol, low-density lipoprotein-cholesterol, and apolipoprotein B levels compared with conventional treatment. These results support that hydrogen as adjuvant treatment has a beneficial effect on unstable angina.
Topics: Angina, Unstable; Anti-Inflammatory Agents; Antioxidants; Atherosclerosis; Cells, Cultured; Human Umbilical Vein Endothelial Cells; Humans; Hydrogen; Inflammation; Lipoproteins, LDL; Oxidative Stress; Signal Transduction
PubMed: 33899541
DOI: 10.1177/15353702211009138 -
The American Journal of Cardiology Nov 1992Unstable angina pectoris may be manifested as new-onset angina, a change in the anginal pattern, pain at rest with associated electrocardiographic (ECG) changes, or... (Review)
Review
Unstable angina pectoris may be manifested as new-onset angina, a change in the anginal pattern, pain at rest with associated electrocardiographic (ECG) changes, or postinfarction angina. Of these, pain at rest with ischemic ECG changes is known to be associated with the poorest prognosis. The pathogenesis of unstable angina pectoris involves a combination of a fixed atherosclerotic obstruction and a dynamic component related to coronary vasoconstriction, thrombus formation, or both. Long-acting nitrates, inhibitors of platelet aggregation, beta blockers, and calcium antagonists are among the agents that have been shown to be effective in the medical management of unstable angina. A study now in progress is evaluating the routine use of thrombolytic therapy for this indication. Although alleviation of symptoms and prevention of death and myocardial infarction are important therapeutic goals, the overall efficacy of a particular medical therapy can best be assessed by objective evaluation of its ability to control ischemia, using such techniques as exercise scintigraphy and ambulatory ECG monitoring. Cardiac catheterization and revascularization are indicated for patients with unstable angina who continue to experience symptoms or who show evidence of silent ischemia despite medical therapy. A study is under way to determine the advisability of routine revascularization of such patients. Revascularization will provide symptomatic relief in most patients with unstable angina and may prolong survival and improve left ventricular function in certain subsets.
Topics: Angina, Unstable; Humans; Myocardial Revascularization; Treatment Outcome
PubMed: 1449097
DOI: 10.1016/0002-9149(92)90023-r