European Journal of Cardiovascular Medicine

Cardiovascular disease (CVD) is the primary cause of mortality in developed and developing societies. Identifying patients at high CVD risk is important but challenging. Measurement of classical risk factors is crucial for this assessment. Also, next to traditional factors such as lipids or lipoprotein levels, apolipoproteins or Lp(a) plasma levels may be important for such purposes. Moreover, the use of emerging biomarkers such as C-reactive protein is likely to gain importance in upcoming years in an attempt to better identify subgroups of patients that may be at increased cardiovascular risk. Our review will focus on novel tools that are, or will become available to identify patients at high CVD risk; and to discuss the potential usefulness of statins in these patients, with a particular focus on potent statin therapy.

Objective: The objective of this study was to characterise the main risk factors (RFs) for cardio- vascular disease and their correlation with sex and age in the Latvian population.Background: The significance of the data regarding the variation of different RFs for cardiovascular disease according to sex and age is controversial.Methods: Various RFs were analysed in 1400 outpatients (mean age, 55.2+14.4 years, 27.1% were men) depending on age and sex.Results: Male individuals had a larger waist circumference (WC) than did female patients (99.1+14.0 vs 92.2+14.7cm, p<0.001), higher diastolic blood pressure (DBP) (83.6+9.6 vs 81.8+9.6mmHg, p=0.002), and higher levels of blood glucose (5.81+1.59 vs 5.57+1.39mmol/l, p=0.006) and triglycerides (1.85+1.37 vs 1.56+1.04mmol/l, p<0.001), but lower levels of total cholesterol (5.42+1.25 vs 5.72+1.20mmol/l, p<0.001) and high-density lipoprotein-cholesterol (HDL-C) (1.23+0.34 vs1.48+0.37mmol/l, p<0.001). Compared with the younger age group (i.e., males, <45 years; females,<55 years), patients in the older age group had a significant (p<0.001 in all cases) larger WC, higher systolic blood pressure, higher DBP, higher blood glucose level, and a higher level low-density lipoprotein-cholesterol, but lower HDL-C level. Age significantly correlated with all RFs in the younger-patient subgroup as well as in the female subgroup.Conclusions: Analyses of cardiovascular RFs in different age subgroups of both sexes clearly showed the individual features of the risk profile. The new approach requires individual attention based on sex and age as well as in the management of risk. These data suggest that activities for reducing cardiovascular risk are needed in groups which are at relatively lower risk of cardiovascular disease: younger persons and in female subgroups.

Coronary angioplasty with stenting is a safe procedure in experienced hands. Anticipating and tackling complications is the key to successful coronary intervention. We present a 63-year-old man with unstable angina, who underwent angioplasty and stenting to left anterior descending artery. A dissection was noted at the distal end of the stent and this was covered with another stent. Following stenting another dissection was noted distal to the second stent and a third stent was deployed. Subsequently, there was no-flow and patient had a cardiac arrest from which he was resuscitated. Finally TIMI III flow was achieved and further in hospital course was uneventful. Dissection, no flow and cardiac arrest are the dreaded complications of angioplasty and all three occurred in this patient. Steps to prevent these complications and management options are discussed.

Differences in the prevalence, extent and severity of atherosclerotic lesions in the left coronary artery (LCA) versus the right coronary artery (RCA) have come to the fore, as they may influence the clinical presentation, complications and subsequent management of coronary artery disease. Data from descriptive epidemiological studies suggest a higher susceptibility of the LCA for athero- sclerosis in comparison to the RCA. Altered hemodynamics, as a result of the different forces exerted in LCA and RCA during the cardiac cycle, affect blood flow properties and favour the development of regions with low or oscillatory endothelial shear stress in the LCA, thereby promoting atherogenesis. Increased wall stress in the LCA, as well as the complex three-dimensional geometric configuration of the coronary arteries in combination with the divergent dynamic structural alterations they undergo during the cardiac cycle may also contribute to the above disparity in atherosclerosis susceptibility between RCA and LCA. Further analytical research in the above factors is warranted to elucidate the precise pathophysiologic mechanisms of coronary atherosclerosis.

Cardiovascular diseases (CVD), their well-established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance. However, potential causal mechanisms underlying their association still need to be elucidated. Several non-mutually exclusive hypotheses have been suggested to explain this association: a) mental disorders could increase vulnerability to CVD through poor health behaviour including smoking, unbalanced diet, the development of mental disorders; or c) mental disorders and CVD/CVRF could share risk factors such as common metabolic processes or common genes. Disentangling some of these mechanisms will require studying the temporal relationship of the appearance of CVD and mental disorders. Herein we review the existing epidemiological evidence of an association between these two types CoLaus/PsyCoLaus study cohort, a population-based in Lausanne, Switzerland designed to address some of these questions.