Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would...Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would not affect overall survival outcomes or coronary artery disease prevalence in a community population followed by a large cardiovascular practice. Methods Data was retrospectively collected for 5 years and 8 months (1/1/2004to 10/8/2009) from the electronic medical record at a large cardiovascular practice at a university. Only patients ≥ age 50 were included in our analysis Results The baseline characteristics of the 8060 study subjects. For the entire study population the mean age was 65 +/– 10 years, 71% were women. On multivariable logistic regression analysis, calcium supplementation was not an independent predictor of all-cause death, nor was calcium supplementation an independent predictor of the diagnosis of coronary artery disease. Survival analysis showed no survival differences for patients on calcium supplements (p = NS). Hazard ratios using the Cox proportional hazards model were calculated, showing that calcium supplementation was not an independent predictor of reduced survival. Conclusion This study suggests that there was no association between calcium supplementation and coronary artery disease as well as overall survival in a large retrospective cohort of patients greater than 50 with high rates of significant cardiovascular risk factors.展开更多
Background: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. Much attention has been focused on planning at hospital disc...Background: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. Much attention has been focused on planning at hospital discharge;however longer-term patient compliance is not well described. Hypothesis: A follow-up multidisciplinary educational program improves disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following hospital discharge. Methods: Using a prospective, randomized, controlled design, patients undergoing CABG completed surveys over a year period, assessing disease understanding and motivation. Four to six weeks after CABG, intervention subjects completed a one-time educational program with a multidisciplinary team. The primary endpoint was a composite score of reduced risk factors, medication use, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (Intervention = 49, Control = 49). The composite score was not different between groups (I = 12.8 ± 4.5 points, C = 12.7 ± 4.9 points, p = 0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes were not influenced by the intervention. Medication prescribing declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use are robust at hospital discharge but the latter declines with time and was not improved by our intervention. These findings are concerning and warrant further study.展开更多
Fish oils containing omega-3 fatty acids (OM3FA) are widely prescribed in the management of dyslipidemia. An asso-ciation between OM3FA and reduced risk of atrial fibrillation (AF) has been proposed. We examined the i...Fish oils containing omega-3 fatty acids (OM3FA) are widely prescribed in the management of dyslipidemia. An asso-ciation between OM3FA and reduced risk of atrial fibrillation (AF) has been proposed. We examined the impact of OM3FA exposure on the risk of developing AF in patients with cardiovascular disease. Data was obtained from elec-tronic medical records of patients seen by our cardiology service between 2005 and 2007. Patients were excluded if AF developed prior to, or on the day of, OM3FA exposure. A total of 11,360 subjects were eligible for analyses. Subjects exposed to OM3FA were at higher risk for AF. Nearly all AF risk factors were significantly more prevalent in the OM3FA exposed group. As expected, those prescribed OM3FA were also more likely to be prescribed statins, ACE in-hibitors, aspirin, and beta blockers. AF occurred in 8.5% (221/2600) of OM3FA exposed subjects and 23.5% (2054/8760) of those not exposed. After controlling for AF risk factors, OM3FA exposed subjects were 74% less likely to develop AF than those not exposed to OM3FA (odds ratio 0.26, 95%CI 0.22-0.30, p < 0.0001). After controlling for risk factors for AF, OM3FA use is significantly associated with a reduced risk for AF in patients with cardiovascular disease. Potential mechanisms which may explain the ability of OM3FAs to reduce AF include its anti-inflammatory and anti-arrhythmic properties. The optimal dose of OM3FA to prevent AF is unknown and warrants prospective as-sessment in a randomized controlled trial of OM3FAs powered to detect significant differences in AF.展开更多
文摘Purpose The goal of this study was to examine the association of calcium supplements with coronary artery disease and survival. Our initial hypothesis was that when adjusted for risk factors, calcium supplements would not affect overall survival outcomes or coronary artery disease prevalence in a community population followed by a large cardiovascular practice. Methods Data was retrospectively collected for 5 years and 8 months (1/1/2004to 10/8/2009) from the electronic medical record at a large cardiovascular practice at a university. Only patients ≥ age 50 were included in our analysis Results The baseline characteristics of the 8060 study subjects. For the entire study population the mean age was 65 +/– 10 years, 71% were women. On multivariable logistic regression analysis, calcium supplementation was not an independent predictor of all-cause death, nor was calcium supplementation an independent predictor of the diagnosis of coronary artery disease. Survival analysis showed no survival differences for patients on calcium supplements (p = NS). Hazard ratios using the Cox proportional hazards model were calculated, showing that calcium supplementation was not an independent predictor of reduced survival. Conclusion This study suggests that there was no association between calcium supplementation and coronary artery disease as well as overall survival in a large retrospective cohort of patients greater than 50 with high rates of significant cardiovascular risk factors.
文摘Background: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. Much attention has been focused on planning at hospital discharge;however longer-term patient compliance is not well described. Hypothesis: A follow-up multidisciplinary educational program improves disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following hospital discharge. Methods: Using a prospective, randomized, controlled design, patients undergoing CABG completed surveys over a year period, assessing disease understanding and motivation. Four to six weeks after CABG, intervention subjects completed a one-time educational program with a multidisciplinary team. The primary endpoint was a composite score of reduced risk factors, medication use, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (Intervention = 49, Control = 49). The composite score was not different between groups (I = 12.8 ± 4.5 points, C = 12.7 ± 4.9 points, p = 0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes were not influenced by the intervention. Medication prescribing declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use are robust at hospital discharge but the latter declines with time and was not improved by our intervention. These findings are concerning and warrant further study.
文摘Fish oils containing omega-3 fatty acids (OM3FA) are widely prescribed in the management of dyslipidemia. An asso-ciation between OM3FA and reduced risk of atrial fibrillation (AF) has been proposed. We examined the impact of OM3FA exposure on the risk of developing AF in patients with cardiovascular disease. Data was obtained from elec-tronic medical records of patients seen by our cardiology service between 2005 and 2007. Patients were excluded if AF developed prior to, or on the day of, OM3FA exposure. A total of 11,360 subjects were eligible for analyses. Subjects exposed to OM3FA were at higher risk for AF. Nearly all AF risk factors were significantly more prevalent in the OM3FA exposed group. As expected, those prescribed OM3FA were also more likely to be prescribed statins, ACE in-hibitors, aspirin, and beta blockers. AF occurred in 8.5% (221/2600) of OM3FA exposed subjects and 23.5% (2054/8760) of those not exposed. After controlling for AF risk factors, OM3FA exposed subjects were 74% less likely to develop AF than those not exposed to OM3FA (odds ratio 0.26, 95%CI 0.22-0.30, p < 0.0001). After controlling for risk factors for AF, OM3FA use is significantly associated with a reduced risk for AF in patients with cardiovascular disease. Potential mechanisms which may explain the ability of OM3FAs to reduce AF include its anti-inflammatory and anti-arrhythmic properties. The optimal dose of OM3FA to prevent AF is unknown and warrants prospective as-sessment in a randomized controlled trial of OM3FAs powered to detect significant differences in AF.
