Comorbidity

IJCS

Original Article

Exploring Risk Factors, Comorbidities, and Multiple Drug Therapy in Coronary Artery Disease Patients

Ketan Inamdar et al. Harshada Kajave Akash Shete Jayant Pawar … Anmaria Thomas Madhur Kulkarni

Abstract

Background:

Coronary artery disease (CAD) continues to be a predominant global cause of morbidity and mortality, with rising prevalence in developing nations like India, emphasizing the need to address risk factors, multimorbidity, and polypharmacy to implement effective lifestyle interventions and drug therapies to enhance patient outcomes.

Objectives:

To evaluate the risk factors, comorbidities, and multiple drug therapy patterns among patients diagnosed with CAD in a tertiary care setting.

Methods:

This prospective observational study used medical records to collect data on demographics, comorbidities, lifestyle factors, and medications. Descriptive statistics summarized findings, and Chi-square tests assessed associations between gender, risk factors, and CAD. The significance level adopted in the statistical analysis was 5%.

Results:

Out of 300 patients enrolled, 69.3% were male, and the highest disease prevalence was noted in the 66–75 age group. Hypertension was the most common comorbidity (71%), followed by diabetes mellitus (DM) (50%). Poor diet was the leading lifestyle risk factor (25.3%), followed by smoking (21%). A significant association existed between gender and CAD type (p = 0.002), with females showing higher angina prevalence and males showing more myocardial infarction (MI). For CAD management, aspirin (92.6%) and enoxaparin (59.3%) were most frequently prescribed, followed by atorvastatin (53.6%) and nicorandil (52%). For comorbidity management, beta-blockers (59.6%) and insulin (48.7%) were commonly prescribed. Increased use of ticagrelor and dapagliflozin was observed, indicating a greater alignment with evidence-based guideline recommendations.

Conclusion:

This study highlights the burden of multimorbidity and polypharmacy among CAD patients in India, emphasizing the need for individualized, evidence-based therapy.

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IJCS

Case Report

Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

Esmeralci Ferreira et al. Valerio Fuks Rodolfo Staico Roberto Esporcatte … Andréa Araujo Brandão Denilson Campos Albuquerque

Introduction

Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks.^– Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions and controversies about the effectiveness of this treatment are quite broad, especially when associated with the use of new devices. In this clinical case study, with an 18-month follow-up, we describe the development of knowledge regarding this technique and its evidence basis.

[…]

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IJCS

Viewpoint

Exercise Training: A Hero that Can Fight two Pandemics at Once

Renata Rodrigues Teixeira de Castro et al. João Giffoni da Silveira Neto Roberta Rodrigues Teixeira de Castro

The sedentarism pandemic

The WHO recommends that adults aged 18 years and older should accumulate at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or a combination of both per week. People who do not meet these requirements are considered sedentary. The health benefits of physical exercise include lower risks of cardiovascular disease, hypertension, diabetes, obesity, dementia and breast and colon cancer.^– Despite all these benefits, sedentarism is a pandemic, affecting 27.5% of people globally.

Sedentarism increases the risk of the world´s major non-communicable diseases. I-Min Lee et al., estimated that physical inactivity is responsible for 6% of the burden of coronary artery disease, 7% of type 2 diabetes, 10% of breast cancer and colon cancers. Thus, inactivity is considered responsible for 9% of premature mortality, globally. Actually, sedentarism kills more people annually than the COVID-19 infection.

[…]

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IJCS

Viewpoint

Coronavirus Disease (COVID-19) Pandemic: An Opportunity Window to Implement Home-Based Cardiac Rehabilitation

Renata Rodrigues Teixeira de Castro

The World Health Organization declared that the new coronavirus outbreak is a public health emergency of pandemic proportions. The outbreak has caused various governments to take protective measures such as lockdown of cities, travel bans, prohibition of group gatherings and public events, and social distancing. Many health and exercise training facilities were closed, as well as cardiac rehabilitation services. These restrictions are disrupting people’s daily activities.

Although staying at home can contain virus spread, it will certainly reduce regular physical activity and increase sedentary behavior, which can increase the risk of development and worsening of chronic conditions.^– Therefore, there is a strong evidence for continuing physical activity at home even during the pandemic situation.

[…]

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IJCS

Editorial

Psoriatic March, Skin Inflammation and Cardiovascular Events – Two Plaques for one Syndrome

José Laerte Boechat

Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. Unfortunately, this is still the view among many doctors.

In this issue, Campos et al., published an interesting observational study on cardiovascular (CV) risk factors and risk measurement in patients with psoriatic arthritis, which allow us, in this editorial, to put the spotlight on some points of great interest in this area.

[…]

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IJCS

Original Article

Determinants of Arterial Stiffness and Vascular Aging in the Older Adult

Telmo Pereira et al. Tatiana Costa

Abstract

Background:

Arterial stiffness (AS) is recognized as an important and independent risk factor for cardiovascular diseases (CVD).

Objective:

This study was aimed at identifying the main determinants of AS in the elderly.

Design and Methods:

This was an observational, cross-sectional study of elderly participants. Blood pressure (BP) and parameters of arterial function were measured using a validated device. Clinical and demographic data, global cardiovascular risk, health-related quality of life, dietary profile and cognition data were evaluated. Blood samples were collected for biochemical profiling of the participants. Handgrip strength test was performed. Student’s t-test and the χ² or Fisher exact tests were used for between-group comparisons as adequate. Correlational analysis was performed with the Pearson correlation coefficients and linear regression analysis. A two-tailed p < 0.05 was considered significant.

Results:

Fifty-four participants (81.8 ± 8.8 years; 65-94 years) were included in the study. Central BP was 132.7 ± 23.7 mmHg and 51.5 ± 15.7 mmHg, respectively, for aortic systolic and pulse pressures. Mean pulse wave velocity (PWV) was 12.9 ± 2.1 m/s and augmentation index 30.1 ± 12.9%. The proportion of participants with abnormal AS (increased PWV) was 27.8%. Participants with abnormal AS had higher brachial and central BP, higher BMI and higher abdominal fat. Functionality and nutritional status were worse in participants with abnormal AS. Regression analysis indicated age, brachial and central BP and vascular resistance as main determinants of AS.

Conclusions:

Abnormal AS is a common finding in the elderly and is highly associated with hypertension, functional decline and impairment of kidney function.

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IJCS

Review Article

Impact of Obesity and Bariatric Surgery in the Outcome of Patients with Heart Failure

Ricardo Mourilhe-Rocha et al. Nathália Felix Araujo Salvino

Abstract

Currently, the association between obesity and heart failure (HF) is increasingly known. Patients with advanced obesity who suffer from HF without an identifiable cause can be diagnosed as having obesity-associated cardiomyopathy. Although data suggest that obesity may reduce mortality in HF, weight loss, especially in the presence of morbid obesity, reduces symptoms and improves the quality of life of those patients.

Bariatric surgery is the major treatment available for sustained weight loss in morbid obesity. Observational studies have demonstrated an improvement in ventricular structure and function of morbidly obese patients with HF who underwent that procedure.

Thus, despite the risks, bariatric surgery should be considered for patients with HF, because of its potential for reducing associated comorbidities and improving quality of life and functional capacity, in addition to making eligible for heart transplantation those excluded due to high body mass index.

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IJCS

Brief Communication

The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation

Turgut Karabag et al. Belma Kalayci Bahar Sahin Elif Coskun … Mustafa Umut Somuncu Mustafa Ozan Cakir

Abstract

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient’s lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs 4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods.

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