Novena Heart Centre

Third Annual Cardiovascular Symposium – Old Problems, New Solutions

admin — Wed, 28 Apr 2010 04:09:30 +0000

Low HDL-C predicts subclinical atherosclerosis in asymptomatic South East Asian patients without known cardiovascular disease

drake — Fri, 12 Feb 2010 13:35:15 +0000

We assessed the association between low HDL-C and subclinical atherosclerosis in asymptomatic individuals without known cardiovascular (CV) disease. 276 patients underwent B-Mode carotid ultrasound. Mean carotid artery intima-media thickness (CIMT) was measured. Subclinical atherosclerosis was defined as a mean CIMT >1.0mm. In a logistic regression analysis, HDL-C (OR = 0.94; 95% CI = 0.90 to 0.98; p < 0.01) was an independent predictor of subclinical atherosclerosis, as were age (OR = 1.06; 95% CI = 1.01 to 1.11; p = 0.01) and SBP (OR = 1.03; 95% CI = 1.00 to 1.06; p = 0.02). For every 1mg/dl decrease in HDL-C, the risk of developing subclinical atherosclerosis increased by 6%. In an asymptomatic South East Asian population, a low HDL-C was the only lipid parameter associated with development of subclinical atherosclerosis.

For further reading, you can download the full article here.

Screening for suclinical atherosclerosis with B-mode Carotid ultrasound improves risk stratification in asymptomatic South East Asian patients without known cardiovascular disease

drake — Fri, 12 Feb 2010 13:30:05 +0000

Impact of Diabetes Mellitus on Survival in South East Asian Patients with Congestive Heart Failure due to Left Ventricular Systolic Dysfunction

admin — Sun, 07 Feb 2010 20:19:21 +0000

By Raymond Lee, Chan SP, Wong J, Lau D, Ho KT, Kenneth Ng

Abstract

Objective

We assessed the impact of diabetes mellitus on survival in South East Asian patients with congestive heart failure.

Methods

1668 consecutive patients with chronic heart failure (age 65±13 years, ejection fraction 28±12%, 67% male) were followed up for 36±12months. 837 patients (50.2%) were diabetic and 1076 patients (65%) had ischemic cardiomyopathy. Primary outcome measure was 17 all-cause mortality. Secondary outcome measures were heart failure readmission and the composite end-point.

Results

There were 223 (13.4%) deaths and 112 (7%) heart failure readmissions. Ischemic cardiomyopathy, renal failure, hypertension, 19 cerebrovascular disease, peripheral vascular disease, and hyperlipidemia were more prevalent in diabetics (all pb0.01). All-cause mortality 20 (17.3% vs 9.4%), heart failure readmission (8.1% vs 5.3%) and the composite end-point (21.9% vs 12.6%) occurred more frequently in 21 diabetics (all pb0.05). Diabetes was an independent predictor of all-cause mortality (OR=1.70, p=0.01), as were ischemic cardiomyopathy 22 (OR=1.85, p=0.01), hypertension (OR=1.78, p=0.01), GFR (OR=0.98, pb0.01), and beta-blocker use (OR=0.55, pb0.01).

Conclusions

In spite of advances in heart failure treatment, the presence of diabetes mellitus significantly worsens survival in South East Asian patients with congestive heart failure.

Keywords: Diabetes mellitus; Congestive heart failure; Death; Readmission; South East Asian population

For further reading, you can download the full article here.

Bromocriptine Use and the Risk of Valvular Heart Disease

admin — Sun, 07 Feb 2010 20:17:36 +0000

By Tan L, Kenneth Ng, Au WL, Raymond Lee, Chan YH et al

Abstract

It has been reported that patients on pergolide and carbergoline have an increased risk of developing valvular heart disease. It is uncertain if bromocriptine, an ergot-derived dopamine agonist (DA) with partial 5-HT_2B activity, is associated with a similar risk. We assessed the frequency of valvular heart disease in Parkinson’s disease (PD) patients on bromocriptine compared to pergolide and a control group of PD patients who had not been treated on any DA. Seventy-two PD patients on bromocriptine, 21 patients on pergolide, and 47 control PD patients were recruited. Transthoracic echocardiographic studies were performed and reviewed by a blinded cardiologist. The risk for the bromocriptine group to develop any abnormal valvular regurgitation was 3.32 (adjusted OR, 95% CI: 1.11–9.92, P = 0.03) compared to controls, whereas the risk for the pergolide group was 3.66 (adjusted OR, 95% CI: 1.22–10.97, P = 0.02). When cumulative dose of bromocriptine was analyzed by quartiles, patients with a greater exposure to bromocriptine had significantly higher risk of developing both mild and moderate severe regurgitations (P for trend, 0.005 and 0.019, respectively). This study demonstrated that bromocriptine use was associated with an increased risk of developing valvular heart disease, which occurred in a cumulative dose-dependent manner.

Key words: bromocriptine; valvular heart disease; 5-HT2 serotonin receptors; ergotamines; pergolide; dopamine agonists

For further reading, you can download the full article here.