PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Common chronic health problems and life satisfaction among Macao elderly people

Aim:Most elderly people live with one or more health problems and their quality of life is affected.This study aimed to compare life satisfaction of elderly people living with common chronic medical illness compared with those without these health conditions in order to identify conditions that most affect life satisfaction of elderly people living in the community.Method:The data was collected by a questionnaire survey of 529 elderly living in community dwellings of Macao using a single measure of life satisfaction and self-reported common chronic medical illness diagnosed by a physician.A purposeful stratified random sampling method was used.Independent sample t-tests were conducted to compare participants who had a health condition to those without a health condition.Results:Respondents who indicated the lowest life satisfaction were those with fracture after the age of 60,eye illness,chronic bronchitis/emphysema,and metabolic arthritis/arthritis.For men,prostate problems was also significantly related to low life satisfaction.Conclusion:Lowest life satisfaction was reported among Macao elderly people living with mobility related chronic medical illness.Policies and practices should pay more attention to mobility related health problems or issues of elderly people,such as eye health and neuromuscular weaknesses.

Circulating tumor cells and drug history in primary breast cancer patients

Aim:Different types of chronic medication may affect breast cancer prognosis.Circulating tumor cells(CTCs)play an important role in cancer metastasis formation.There is no evidence of how chronic medication affects CTCs and breast cancer prognosis.The aim of this study was to evaluate association between chronic medication and CTCs in patients with primary breast cancer.Methods:This study involved 414 patients with stage I-III primary breast cancer.Chronic drug history was collected from patients’medical records and included all drugs that were prescribed for patients over at least the last 6 months prior to CTCs evaluation.CTCs were detected using a quantitative real-time polymerase chain reaction(qRT-PCR)-based method at the time of breast surgery.Results:There was no association between CTCs,including their different subpopulations and chronic medication.Chronic medication using angiotensin-converting-enzyme inhibitors(ACEi),metformin,and insulin were associated with inferior disease-free survival(HR=0.49,95%CI 0.26-0.94,P=0.007 for ACEi;HR=0.27,95%CI 0.08-0.91,P<0.001 for metformin;and HR=0.12,95%CI 0.01-2.91,P<0.001 for insulin)and this was most pronounced in patients with epithelial to mesenchymal transition(CTC_EMT)phenotype.In multivariate analysis,chronic administration of metformin and/or insulin was an independent predictor of inferior outcome.Conclusion:Our findings show that there was no association between chronically used medication and CTCs in primary breast cancer patients.However,administration of ACEi,metformin,and/or insulin could negatively affect prognosis of patients with CTC_EMT.