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Asian ethnicity, persistent smoking predict poor prognosis in CAD patients

19 Oct 2019

Despite currently recommended preventive measures, premature coronary artery disease (CAD) remains an aggressive disease, characterized by high rates of recurrent events and mortality, a study has shown. Asian ethnicity and persistent smoking are the strongest predictors of a first recurrent event.

The authors prospectively enrolled and followed 880 patients with acute or stable obstructive CAD (mean age, 40.1±5.7 years). Majority were men, smokers and had a family history of CAD or hypercholesterolaemia. The primary endpoints were all-cause death, myocardial infarction (MI), ischaemic stroke and refractory angina requiring coronary revascularization.

Of the patients, 91.2 percent underwent coronary revascularization at baseline presentation, primarily for acute MI (78.8 percent). Over a 20-year follow-up, a total of 399 ischaemic events occurred in 264 patients, and a second recurrent event occurred in more than a third of the patients (36 percent).

The most common first recurrent event was MI (131 of 264 patients), which was mainly associated with new coronary lesions (17.3 percent vs 7.8 percent; p=0.01; hazard ratio [HR], 1.45, 95 percent CI, 1.09–1.93 for new vs initial culprit lesion). All-cause death occurred in 55 patients (6.3 percent) at a median time of 8.4 years.

The following factors were strongly associated with a first recurrent event: ethnic origin (sub-Saharan African vs Caucasian: adjusted HR, 1.95, 1.13–3.35; p=0.02), inflammatory disease (adjusted HR, 1.58, 1.05–2.36; p=0.03) and persistent smoking (adjusted HR, 2.32, 1.63–3.28; p<0.01). After considering all recurrent events, the same factors and Asian ethnicity correlated with poor prognosis, with persistent smoking having the greatest impact.

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Most Read Articles
01 Nov 2019
Women with hypertensive disorders of pregnancy, especially pre-eclampsia, are at heightened risk of developing cardiovascular disorder and chronic hypertension, with the risk becoming apparent soon after pregnancy, a study has found.
Roshini Claire Anthony, 29 May 2019

Gestational diabetes and abnormal glucose levels in pregnancy, as determined with an oral glucose challenge test (OGCT) at 24–28 weeks gestation, could signal a future risk of cardiovascular disease (CVD)*, according to a recent study.

07 Jul 2019
Plasma creatinine kinase activity, measure during early pregnancy, influences blood pressure during pregnancy and contributes to severe gestational hypertension diagnosed before 34 weeks of gestation, according to a recent study. There is no association between creatinine kinase and other hypertensive disorders during pregnancy.
Pank Jit Sin, 16 Oct 2019
While a diagnosis of cancer is often met with concern and devastation, the same is barely true for heart failure. However, the mortality rate for those suffering from heart failure is worse than some common cancers, such as prostate and breast cancers.