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Valentina Boyko

Publications and source records attributed to Valentina Boyko.

At least 55 records · Page 3Linked to original sources
PubMed2003

Predictors of cardiac and noncardiac mortality among 14,697 patients with coronary heart disease.

The decrease in mortality from ischemic heart disease during the last 25 years may partly reflect improvement in diagnosis and treatment of patients with coronary heart disease. These patients, therefore, are experiencing morbidity and mortality due to other causes. The aim of our study was to describe the incidence and causes of cardiac mortality (CM) and noncardiac mortality (NCM) and to identify predictive factors. A cohort of 14,697 patients with coronary heart disease was merged with the Central Population Registry to identify mortality records from 1990 to 1996. Among the 1,839 deaths, 1,055 (57.4%) were cardiac, 626 (34.0%) were noncardiac, and 158 deaths (8.6%) were due to unknown causes as classified in the International Classification of Diseases-Ninth Edition (ICD). The 3 most significant predictors were age for a 10-year increment (odds ratios 1.75 and 2.25 for CM and NCM, respectively), chronic obstructive pulmonary disease (odds ratios 1.67 and 1.71), and current smoking (odds ratios 1.29 and 1.66). A history of cancer was a predictor of NCM, but not of CM, whereas peripheral vascular disease predicted CM but not NCM. As the number of predictive factors increased from none to >or=5, the risk of NCM gradually increased from 1.9% to 15.5%. Similar predictors expose subjects with coronary disease to CM and NCM, but smoking plays a more pronounced role in the prediction of NCM, whereas past myocardial infarction, lower levels of high-density lipoprotein cholesterol, and peripheral vascular disease are mainly associated with CM. Because of the similarity of antecedent predictors, treatment of risk factors among patients with coronary heart disease should prove valuable for the prevention of all-cause mortality.

Age Factors↗
PubMed2003

Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes.

BACKGROUND: The aim of this study was to determine the frequency of prior cerebrovascular events (CE) among patients with an acute coronary syndrome (ACS) and to compare the clinical characteristics, clinical course, treatment, and outcomes of patients with ACS with and without a prior CE. METHODS AND RESULTS: We prospectively enrolled 10,484 patients with ACS in 103 hospitals in 25 countries across Europe and the Mediterranean basin. A prior CE was reported in 254 of 4338 patients (5.9%) with ST elevation, 420 of 5215 patients (8.1%) without ST elevation, and 92 of 663 patients (13.9%) with an undetermined electrocardiographic pattern. In general, patients with a prior CE were older, more likely to be females and nonsmokers, more commonly had prior myocardial infarction, heart failure, bypass surgery, and were more likely to have diabetes, hypertension, and renal failure. While in the hospital, they had more heart failure, and they were more likely to receive warfarin, digoxin, diuretics and calcium-channel blockers, and less likely to receive antiplatelet agents, beta-blockers, and statins. The inhospital mortality rates were 9.1% (with a prior CE) versus 6.4% (without a prior CE) for patients with ACS with ST elevation; 5.0% versus 2.0% for patients with ACS with non-ST elevation; and 14.1% versus 10.7% for patients with ACS with undetermined electrocardiographic results. The adjusted risk (95% CI) of inhospital death for patients with a prior CE was 1.12 (0.70, 1.81), 1.79 (1.06, 3.00), and 0.92 (0.44, 1.94) for ST-elevation ACS, non-ST-elevation ACS, and ACS with undetermined electrocardiogram, respectively. The P value for interaction between prior CE and the type of ACS on outcome was.10. CONCLUSIONS: Patients with a prior CE constitute 7.5% of patients with ACS and have high-risk features. A prior CE is associated with increased inhospital mortality, particularly in patients with with non-ST-elevation ACS.

Age Distribution↗
PubMed2003

Functional class in patients with heart failure is associated with the development of diabetes.

PURPOSE: Recent reports suggest that decreased functional capacity in patients with heart failure may be associated with abnormalities in glucose metabolism. We followed patients with coronary artery disease who participated in the Bezafibrate Infarction Prevention study to determine the incidence of diabetes by baseline functional status during a 7.7-year follow-up. METHODS: The sample comprised 2616 nondiabetic patients aged 45 to 74 years with a fasting blood glucose level <7 mmol/L (126 mg/dL). They were divided into three groups by New York Heart Association (NYHA) criteria: class I (n = 1986 patients), class II (n = 518), and class III (n = 112). The detection of a fasting blood glucose level > or =7 mmol/L during follow-up was defined as the criterion for the development of diabetes. RESULTS: The study groups had similar demographic and clinical characteristics, except that patients with symptomatic heart failure (NYHA class II or III) were more likely to have angina. During follow-up, diabetes developed in 259 patients (13%) in NYHA class I, 76 (15%) in class II, and 22 (20%) in class III (P for trend = 0.05). At the last visit, patients in NYHA class III were twice as likely (17% [n = 19]) to have fasting blood glucose levels > or =7 mmol/L as those in NYHA class I (7.8% [n = 154]) or class II (8.7% [n = 45]) (P = 0.005). In a multivariate analysis, NYHA class III was associated with a 1.7-fold (95% confidence interval [CI]: 1.1 to 2.6) increase in the rate of development of diabetes, but NYHA class II was not (hazard ratio = 1.0; 95% CI: 0.8 to 1.3). CONCLUSION: Among patients with coronary artery disease, advanced heart failure (NYHA class III) is associated with a significantly increased risk of developing diabetes during a 6- to 9-year follow-up.

Age Distribution↗
PubMed2003

Acute coronary syndromes in patients with pre-existing moderate to severe valvular disease of the heart: lessons from the Euro-Heart Survey of acute coronary syndromes.

AIM: To determine the frequency of pre-existing valvular disease (VD) among patients with acute coronary syndromes (ACS) and to compare the clinical characteristics, clinical course, treatment, and outcomes of ACS patients with and without pre-existing VD. METHODS AND RESULTS: The Euro Heart Survey ACS prospectively enrolled 10,484 ACS patients in 103 hospitals in 25 countries across Europe and the Mediterranean basin. Of the 10,207 patients with data on VD status, 489 (4.8%) had a diagnosis of pre-existing VD: 3.7% of 4339 ST-segment-elevation-ACS patients, 5.2% of 5210 non-ST-segment-elevation-ACS patients, and 10.8% of 658 undetermined-electrocardiogram-ACS patients. Moderate/severe mitral regurgitation had been diagnosed in 54.0% (48.7% without and 5.3% with concomitant mitral stenosis), and moderate/severe aortic stenosis occurred in 31.7% (26.4% without and 5.3% with concomitant aortic regurgitation). Patients with pre-existing VD had worse baseline clinical and demographic characteristics, were more likely to present with heart failure and less likely to have typical angina, and had a more complicated in-hospital course (heart failure, atrial arrhythmias, and renal failure). They were more likely to receive inotropic agents, diuretics, amiodarone, and warfarin, and less likely to receive antiplatelet agents and beta-adrenergic blockers. As compared to patients without VD, the adjusted risk (95% confidence interval) of in-hospital death for VD patients was 1.55 (0.85, 2.80), 1.92 (1.03, 3.59), and 1.77 (0.75, 4.17) for ST-segment-elevation-ACS, non-ST-segment-elevation-ACS, and undetermined-electrocardiogram-ACS, respectively. CONCLUSIONS: Patients with ACS and pre-existing VD constitute about 5% of all ACS patients; they have high-risk features and poor prognosis. There is a need to better define their optimal treatment, in order to improve their prognosis.

Acute Disease↗
PubMed2003

Cardiac biomarkers and acute coronary syndromes--the Euro Heart Survey of Acute Coronary Syndromes Experience.

UNLABELLED: AMIS: To examine the application of the redefinition of acute myocardial infarction (AMI) published on 4 September 2000. METHODS AND RESULTS: The Euro Heart Survey of Acute Coronary Syndromes (ACS) prospectively surveyed 10484 patients in 103 hospitals across 25 European and Mediterranean basin countries during 4 September 2000 to 15 May 2001. We evaluated the use of cardiac troponin assays and whether the diagnosis of unstable angina (UA) or AMI was in accordance with the results of biomarker assays (cardiac troponins, CK-MB mass, CK-MB%, or CK). Troponin assays were used in 6036 (63.3%) of the 9538 patients with available biomarker levels; of whom elevated troponin levels were recorded in 648 of 2307 (28.1%) patients with UA and in 2957 of 3729 (79.3%) patients with AMI. Of the 8871 patients with available creatine kinase values, levels above the upper limit of normal were recorded in 848 of 3625 (23.4%) patients with UA and in 3948 of 5246 (75.3%) patients with AMI. CONCLUSIONS: Cardiac troponin assays are still not universally available for the evaluation of ACS patients. A substantial proportion of ACS patients receive a diagnosis of UA or AMI, irrespective of the result of biomarker assays, indicating that the redefinition of AMI has not yet been universally adopted, and that additional efforts are warranted to ensure its appropriate implementation.

Angina, Unstable↗
PubMed2003

Prospective study of Chlamydia pneumoniae IgG and IgA seropositivity and risk of incident ischemic stroke.

BACKGROUND AND PURPOSE: Chlamydia pneumoniae infection or exposure to C. pneumoniae was implicated as a risk factor for ischemic stroke. Our aim was to evaluate prospectively the association between the presence of antibodies to C. pneumoniae (IgG and IgA) and the risk of incident ischemic stroke among patients with pre-existing vascular disease. METHODS: Sera were collected from 3,090 coronary heart disease patients enrolled in a secondary prevention trial. We measured baseline antibodies (IgG and IgA) in the sera of patients who developed subsequent ischemic strokes (cases, n = 134) during follow-up (mean 8.2 years), and in 134 age- and gender-matched pairs without subsequent stroke or myocardial infarction. RESULTS: The crude relative odds (95%CI) of incident ischemic strokes in seropositive patients at baseline (>1.1 relative value units) were 1.29 (95%CI, 0.69-2.47) for IgG and 1.31 (95% CI, 0.69-2.55) for IgA by matched-pair analyses, and 1.42 (95%CI, 0.69-2.98) for IgG and 1.57 (95%CI, 0.76-3.35) for IgA after adjustments for conventional risk factors and the inflammatory marker, soluble intercellular adhesion molecule-1. We explored the possibility that the risk of ischemic stroke may increase in parallel to increasing antibody titers, but did not demonstrate any significant association. CONCLUSIONS: Serological evidence for prior infection with C. pneumoniae did not emerge as an independent risk factor for incident ischemic stroke among patients at high risk due to pre-existing vascular disease.

Aged↗
PubMed2003

Long-term outcome of intravenous magnesium therapy in thrombolysis-ineligible acute myocardial infarction patients.

The aim of our study was to analyze the long-term survival and cardiac function in 194 consecutive, thrombolysis-ineligible acute myocardial infarction (AMI) patients receiving 48-hour intravenous magnesium sulfate (22 g) - 96 patients, compared with placebo - 98 patients. After a mean 4.8-year follow-up, all-cause mortality and cardiac mortality were significantly lower in the magnesium compared to the placebo group [(18 vs. 33 patients, p < 0.01) and (12 vs. 30 patients, p < 0.001), respectively]. Rest radionuclide ventriculography tests for left-ventricular ejection fraction (LVEF) were assessed in surviving patients up to completion of follow-up. Magnesium-treated patients had a significantly higher LVEF (0.51 +/- 0.10 vs. 0.44 +/- 0.14, p < 0.05) and a lower incidence of heart failure compared to placebo-treated patients (12 vs. 3 patients, p = 0.02). Beneficial effects of intravenous magnesium therapy in thrombolysis-ineligible AMI patients appeared to last for at least 4.8 years, concomitant with preserved LVEF, suggesting a favorable role for acute magnesium treatment in these patients.

Aged↗
PubMed2003

Functional capacity impairment in patients with coronary artery disease: prevalence, risk factors and prognosis.

BACKGROUND: Some patients developing heart failure and functional capacity impairment have no history of myocardial infarction (MI), and stable angina pectoris is their principal clinical manifestation of coronary artery disease (CAD). The present study was aimed to evaluate the outcome of CAD-related functional capacity impairment in patients with and without a history of MI over a 7.7-year follow-up. METHODS: The study sample comprised 14,283 coronary patients aged 45-74 years, screened for participation in the Bezafibrate Infarction Prevention study. The presence of NYHA functional class II was defined as mild functional capacity impairment and the presence of NYHA functional class III-IV was defined as advanced functional capacity impairment. RESULTS: The patients were divided in two groups: (1) those with a history of MI, 10,307 patients, who formed three subgroups: NYHA I 7,551 patients (73.3%); NYHA II 2,176 patients (21.1%); NYHA III + IV 580 patients (5.6%), and (2) those without a history of MI, 3,976 patients, who also formed three subgroups: NYHA I 2,744 patients (69.0%); NYHA 981 patients (24.7%); NYHA III + IV 251 patients (6.3%). Multivariate analysis identified a history of MI as a consistent predictor of increased all-cause and cardiac mortality for patients with NYHA I, II and III + IV subgroups with escalating significance for patients with advanced functional capacity impairment: hazard ratios of 1.55 (95% CI 1.36-1.75), 1.56 (95% CI 1.30-1.86) and 1.72 (95% CI 1.24-2.40) for all-cause and 1.93 (95% CI 1.60-2.33), 1.73 (95% 1.35-2.20) and 3.22 (95% CI 1.87-5.54) for cardiac mortality, respectively. CONCLUSIONS: The prevalence of low functional capacity is similar among coronary patients with and without a history of MI, but their long-term survival differs substantially in favor of the latter. Therefore, two different types of CAD-related advanced functional capacity impairments (post-MI and non-post-MI) can be distinguished.

Aged↗
PubMed2002

Is there an association between hypertension and cancer mortality?

BACKGROUND: Because of suggestions that hypertension may increase the long-term risk of cancer, we assessed the relation between hypertension and malignancy. METHODS: We conducted a MEDLINE search of English-language articles published between January 1966 and January 2000 using the terms hypertension or blood pressure, and neoplasm or cancer or malignancy. We reviewed prospective studies that reported cancer incidence or mortality in hypertensive and nonhypertensive patients, case-control studies that reported the prevalence of hypertension in cancer patients and controls, and references from identified articles. RESULTS: We identified 10 longitudinal studies that evaluated the association between blood pressure and cancer mortality in 47 119 subjects. Subjects with hypertension experienced an increased rate of cancer mortality during durations of follow-up ranging 9 to 20 years, with an age- and smoking-adjusted pooled odds ratio of 1.23 (95% confidence interval [CI]: 1.11 to 1.36). In 13 case-control studies, including 6964 cases of renal cell cancer and 9181 controls, the adjusted odds ratio for renal cell cancer among hypertensive patients, relative to normotensive counterparts, was 1.75 (95% CI: 1.61 to 1.90). No clear association was found between hypertension and cancer of other sites. CONCLUSION: Hypertension was associated with an increased risk of mortality from cancer, particularly renal cell carcinoma.

Carcinoma, Renal Cell↗
PubMed2002

Soluble intercellular adhesion molecule-1 and long-term risk of acute coronary events in patients with chronic coronary heart disease. Data from the Bezafibrate Infarction Prevention (BIP) Study.

OBJECTIVES: The goal of this study was to assess soluble intercellular adhesion molecule-1 (sICAM-1) level as a predictor of future acute coronary events in patients with chronic coronary heart disease (CHD). BACKGROUND: Increased sICAM-1 concentration has been shown to be associated with the incidence of CHD in healthy persons. Its significance in patients with CHD has been scarcely investigated. METHODS: We designed a prospective, nested case-control study. Sera were collected from patients with CHD enrolled in a secondary prevention trial that evaluated the efficacy of bezafibrate in reducing coronary events. We measured baseline sICAM-1 concentration in the sera of patients who developed subsequent cardiovascular events (cases: n = 136) during follow-up (mean: 6.2 years) and in age- and gender-matched controls (without events: n = 136). RESULTS: Baseline serum concentrations of sICAM-1 were significantly higher in cases versus controls (375 vs. 350 ng/ml; p < 0.05). Each 100 ng/ml increase in sICAM-1 concentration was associated with 1.27 (95% confidence interval [CI]: 1.00 to 1.63) higher relative odds of coronary events. Soluble ICAM-1 concentration in the highest quartile (>394 ng/ml) was associated with significantly higher odds of coronary events (compared with the lowest quartile), even after multivariate adjustment (2.31, 95% CI: 1.02 to 5.50). After adding fibrinogen and total white blood cell count to the multivariate model, the relative odds were 2.12 (95% CI: 0.88 to 5.35) and 2.70 (95% CI: 1.10 to 7.05), respectively. CONCLUSIONS: Elevated sICAM-1 concentration in CHD patients is associated with increased risk of future coronary events independent of other traditional risk factors.

Bezafibrate↗
PubMed2002

Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis.

Unlike thrombolytic agents, there are conflicting data regarding the time-dependent effect of aspirin treatment on outcome in acute myocardial infarction (AMI). We sought to evaluate the impact of timing of aspirin administration (before vs after thrombolysis) on mortality of patients with AMI. Our study included 1,200 patients with ST elevation AMI treated with thrombolysis. Early (n = 364) versus late (n = 836) users were defined as those receiving emergency aspirin before versus after initiation of thrombolysis, respectively. Time (median) from symptom onset to initiation of aspirin treatment was significantly shorter in early versus late users (1.6 vs 3.5 hours; p <0.001). There were no significant differences between the 2 groups with respect to baseline clinical characteristics. Early aspirin users were more likely to develop reischemia, to be treated with beta blockers, to be referred to coronary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery. Early users experienced lower mortality at 7 days (2.5% vs 6.0%, p = 0.01), 30 days (3.3% vs 7.3%, p = 0.008), and 1 year (5.0% vs 10.6%, p = 0.002) than late users. This survival benefit persisted for patients with and without previous aspirin therapy or revascularization and after adjustment for baseline characteristics and therapies at 7 days (odds ratio 0.36, 95% confidence interval 0.15 to 0.79), at 30 days (odds ratio 0.39, 95% confidence interval 0.17 to 0.82), and at 1 year (odds ratio 0.41, 95% confidence interval 0.21 to 0.74). Our study proposes a time-dependent benefit from aspirin in patients with AMI treated with thrombolysis.

Aged↗
PubMed2002

Does participation in a long-term clinical trial lead to survival gain for patients with coronary artery disease?

PURPOSE: Little is known about the advantages and disadvantages of participation in a clinical trial for patients with coronary heart disease. We hypothesized that participation itself in a long-term clinical trial with regular clinical evaluation and adjustment of treatments might lead to survival gain among patients with coronary artery disease who agreed or refused to participate in the Bezafibrate Infarction Prevention study. SUBJECTS AND METHODS: The study was performed in 18 university hospitals. There were 3502 patients who fulfilled the inclusion criteria. Among them, 3122 patients signed informed consent and were included in the study ("participants"), whereas 380 declined to participate ("nonparticipants"). For all participants, routine visits to the clinics were scheduled bimonthly for study medication distribution and compliance assessment, and every 4 months for clinical evaluation and management. Nonparticipants continued with community-based treatment and were followed only for mortality. RESULTS: The two groups were similar with regard to age, sex, and the prevalence of most cardiovascular diseases, risk factors, and medications, except that participants were more likely to have presented with an anginal syndrome (1788 [57%] vs. 190 [50%]) and to have symptomatic heart failure (754 [25%] vs. 66 [18%]). During follow-up (mean [+/- SD], 7.7 +/- 0.8 years), 475 patients died. All-cause mortality was similar in participants (n = 423 [13.6%]) and nonparticipants (n = 52 [13.7%]). In a multivariate analysis, participation in the clinical trial was not associated with all-cause mortality (hazard ratio [HR] = 0.96; 95% confidence interval [CI]: 0.70 to 1.30) or cardiac mortality (HR = 1.12; 95% CI: 0.72 to 1.74). CONCLUSION: Participation in a long-term clinical trial in a country with readily accessible community-based medicine may not lead to survival gain in patients with coronary artery disease.

Aged↗
PubMed2002

Combined coronary and mitral annulus calcium detection in the non-invasive diagnosis of coronary artery disease in patients with systemic hypertension.

BACKGROUND: Although the presence of coronary calcium (CC) on fast spiral computed tomography (FSCT) is a powerful predictor of coronary artery disease (CAD), both the specificity and positive predictive value (PPV) of CC in CAD diagnosis are modest. Since previous studies have shown an association between mitral annular calcification (MAC) and coronary atherosclerosis, we aimed to investigate whether combined coronary and MAC detection could improve the non-invasive diagnosis of CAD. DESIGN AND METHODS: Our study comprised 522 patients (284 men and 238 women, age ranged from 52-80 years, mean 65 +/- 6 years) who underwent FSCT of the coronaries as well as echo-Doppler examination. Among them, 97 patients had prior diagnosis of prevalent proven CAD (CAD group) while 425 patients were without clinically manifested CAD (the No CAD group). RESULTS: The prevalence of CC in the CAD group was 95 versus 68% in the No CAD group (P = 0.001). The prevalence of MAC in CAD group was 63 versus 51% in No CAD group (P = 0.03). Sensitivity and negative predictive value (NPV) of CC as a predictor of CAD were 95 and 96% respectively, but specificity and PPV were low: 32 and 24% respectively. Sensitivity and NPV of MAC as predictors of CAD were 63 and 85% respectively; specificity and PPV, 49 and 22% respectively. Using of combined CC and MAC evaluation in the prediction led to some specificity improvement at the expense of a similar sensitivity reduction, without a considerable gain in the total accuracy of the method. CONCLUSIONS: Coronary calcium detection on FSCT in hypertensive patients yields excellent sensitivity and NPV but relatively low specificity and PPV for clinically manifested CAD. Mitral annular calcification assessment yields a low sensitivity and specificity and its addition to CC evaluation does not improve non-invasive diagnosis of CAD.

Aged↗
PubMed2002

Outcome of myocardial infarction in patients treated with aspirin is enhanced by pre-hospital administration.

OBJECTIVE: Reducing time to reperfusion therapy is one of the goals in the management of acute myocardial infarction (AMI). We assessed the association between timing of aspirin administration and outcome of patients with AMI. PATIENTS: We studied 922 consecutive AMI patients with ST-segment elevation in Killip class I-III on admission. Patients were divided into two groups based upon the timing of emergency aspirin administration: before (early aspirin users) or after (late aspirin users) hospital admission. RESULTS: Early aspirin users (n = 338; 37%) were younger, less likely to be women, and more likely to smoke (p < 0.006) than late users (n = 584; 63%). Other baseline and clinical characteristics were similar. Early aspirin users were more likely to be treated with thrombolysis or primary percutaneous transluminal coronary angioplasty. Compared with late users, early aspirin users had significantly lower in-hospital complications and lower mortality rates at 7 (2.4 vs. 7.3%, p = 0.002) and 30 days (4.9 vs. 11.1%, p = 0.001). By multivariate adjustment, pre-hospital aspirin was an independent determinant of survival at 7 (odds ratio 0.43; 95% confidence interval 0.18-0.92) and at 30 days (odds ratio, 0.60; 95% confidence interval 0.32-1.08). Survival benefit associated with aspirin persisted for subgroups treated or not with reperfusion therapy. CONCLUSIONS: Outcome of AMI patients treated with aspirin is improved by pre-hospital administration. Our findings suggest that emergency pre-hospital aspirin might facilitate early reperfusion.

Aged↗
PubMed2002

Soluble intercellular adhesion molecule-1 and risk of future ischemic stroke: a nested case-control study from the Bezafibrate Infarction Prevention (BIP) study cohort.

BACKGROUND AND PURPOSE: Inflammation is considered to be involved in the pathogenesis of ischemic stroke. Our purpose was to assess the role of soluble intercellular adhesion molecule-1 (sICAM-1) concentration, a marker of inflammation, in predicting future ischemic stroke among patients at risk because of chronic coronary heart disease. METHODS: We obtained baseline serum samples from patients with chronic coronary heart disease enrolled in the Bezafibrate Infarction Prevention trial (n=3090), which assessed the efficacy of bezafibrate in secondary prevention. Using a prospective nested case-control design, we measured baseline sICAM-1 concentration in sera of patients who developed ischemic stroke during a mean follow-up of 8.2 years (cases, n=134) and in age- and sex-matched controls without any subsequent cardiovascular events (n=134). RESULTS: Baseline serum concentrations of sICAM-1 were significantly higher in cases compared with controls (379 versus 350 ng/mL, P<0.05). sICAM-1 concentration at the highest quartile (>394 ng/mL) was associated with significantly higher relative odds of ischemic stroke compared with the lower concentrations after adjustment for potential confounding variables (relative odds, 2.1; 95% CI, 1.1 to 4.3). After fibrinogen and total white blood cell count were added to the multivariable model, the relative odds were 2.1 (95% CI, 1.1 to 4.2) and 2.2 (95% CI, 1.1 to 4.8), respectively. The risk associated with raised concentrations of sICAM-1 seemed to be highest for large disabling strokes of cardioembolic origin. CONCLUSIONS: Elevated concentrations of sICAM-1, a marker of inflammation, are associated with increased risk of ischemic stroke, independent of other traditional cerebrovascular risk factors and of plasma fibrinogen, among patients at increased risk because of manifest coronary heart disease.

Bezafibrate↗
PubMed2002

Severity of angina pectoris and risk of ischemic stroke.

BACKGROUND AND PURPOSE: Ischemic stroke and coronary heart disease (CHD) share risk factors and pathogenic process, ie, atherosclerosis and thrombosis. We examined the relationship between severity of angina pectoris and its accompanying characteristics and the risk of incident ischemic stroke. METHODS: We traced 3122 patients with stable CHD, included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. CHD was documented by a history of myocardial infarction > or =6 months and < 5 years before enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing. Severity of angina pectoris was assessed according to the Canadian Cardiovascular Society angina classification, and heart failure functional class according to the New York Heart Association (NYHA) classification. Patients with severe heart failure or unstable angina on enrollment were excluded. RESULTS: During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The cumulative rate of ischemic stroke increased in a dose-response manner from 4.7% in patients with no angina to 5.7%, 8.4%, and 12.9% in patients with angina classes 1, 2, and 3, respectively (P<0.001). Patients with NYHA functional class 1 had a 5.5% rate of ischemic stroke versus 7.3% and 9.6% in patients with classes 2 and 3, respectively (P=0.05). In a Cox proportional-hazard model adjusting for conventional risk factors and potential confounders, the hazard ratio associated with angina class 1 was 1.20 (95% CI, 0.83 to 1.74); class 2, 1.66 (95% CI, 1.12 to 2.45); and class 3, 2.35 (95% CI, 1.08 to 5.13), as compared with patients with no angina. Hazard ratios of ischemic stroke associated with conventional risk factors were 1.55 for a 10-year age increment, 2.16 for diabetes mellitus, 1.81 for current smoking, and 1.29 for a 20 mm Hg increase in systolic blood pressure. CONCLUSIONS: Severity of angina pectoris in patients with stable CHD predicts an increased risk of subsequent ischemic stroke. The association between angina class and incident ischemic stroke is independent of traditional vascular risk factors.

Aged↗