Background: Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery byp...Background: Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown. Methods: We studied 1351 patients enrolled in the Post- CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low- dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow- up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention(< 1 drink), light(1- 6 drinks), moderate(7- 13 drinks), and heavier(≥ 14 drinks). Results: During follow- up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events(hazard ratio 0.7, 95% CI 0.4- 1.1) and less angiographic progression(odds ratio 0.7, 95% CI 0.5- 1.1), although neither of these effects were statistically significant. High- density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers. Conclusion: We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.展开更多
Aims: To analyse measures of clinical data, functional capacity, left ventricu lar function and neurohormonal activation for the ability to predict mortality a nd morbidity in patients after a hospitalisation for hear...Aims: To analyse measures of clinical data, functional capacity, left ventricu lar function and neurohormonal activation for the ability to predict mortality a nd morbidity in patients after a hospitalisation for heart failure. Methods: In a prospective study, patients 60 years or above with systolic heart failure NYHA II-IV were followed for at least 18 months. At study start, a physical examina tion, echocardiography, blood samples and measurements of quality of life(QoL) b y Nottingham Health Profile were obtained. Data on mortality and readmission rat es were collected. Results: 208 patients, 58%men, with a mean age of 76 years, and an ejection fraction of 0.34 were included and followed for a mean of 1122 d ays. In all, 74(36%) patients died and 171(82%) were readmitted. By univariate analysis, readmissions were predicted by poor QoL(169±118 vs. 83±100, p< 0.00 1), age, creatinine, haemoglobin(p< 0.01 all) and diabetes(p< 0.1). By multivari ate analyses, QoL at study start was the only independent predictor of readmissi ons(χ2=25.2, p< 0.001). Mortality was univariately associated with QoL(183±117 vs. 142±115, p< 0.05) and in multivariate analyses to traditional variables: a ge, male gender, systolic function, BNP and serum creatinine(χ2=48.9, p< 0.001) . Conclusions: Measurements representing different aspects of the heart failure syndrome can easily be obtained to stratify long-term risks of mortality and mo rbidity in hospitalised heart failure patients. Poor QoL was a univariate predic tor for mortality and a strong multivariate predictor for the important outcome of readmission, pointing to the need for a simple assessment of QoL.展开更多
文摘Background: Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown. Methods: We studied 1351 patients enrolled in the Post- CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low- dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow- up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention(< 1 drink), light(1- 6 drinks), moderate(7- 13 drinks), and heavier(≥ 14 drinks). Results: During follow- up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events(hazard ratio 0.7, 95% CI 0.4- 1.1) and less angiographic progression(odds ratio 0.7, 95% CI 0.5- 1.1), although neither of these effects were statistically significant. High- density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers. Conclusion: We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
文摘Aims: To analyse measures of clinical data, functional capacity, left ventricu lar function and neurohormonal activation for the ability to predict mortality a nd morbidity in patients after a hospitalisation for heart failure. Methods: In a prospective study, patients 60 years or above with systolic heart failure NYHA II-IV were followed for at least 18 months. At study start, a physical examina tion, echocardiography, blood samples and measurements of quality of life(QoL) b y Nottingham Health Profile were obtained. Data on mortality and readmission rat es were collected. Results: 208 patients, 58%men, with a mean age of 76 years, and an ejection fraction of 0.34 were included and followed for a mean of 1122 d ays. In all, 74(36%) patients died and 171(82%) were readmitted. By univariate analysis, readmissions were predicted by poor QoL(169±118 vs. 83±100, p< 0.00 1), age, creatinine, haemoglobin(p< 0.01 all) and diabetes(p< 0.1). By multivari ate analyses, QoL at study start was the only independent predictor of readmissi ons(χ2=25.2, p< 0.001). Mortality was univariately associated with QoL(183±117 vs. 142±115, p< 0.05) and in multivariate analyses to traditional variables: a ge, male gender, systolic function, BNP and serum creatinine(χ2=48.9, p< 0.001) . Conclusions: Measurements representing different aspects of the heart failure syndrome can easily be obtained to stratify long-term risks of mortality and mo rbidity in hospitalised heart failure patients. Poor QoL was a univariate predic tor for mortality and a strong multivariate predictor for the important outcome of readmission, pointing to the need for a simple assessment of QoL.
