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For the high-risk chronic kidney disease population, coronary artery calcium is an independent predictor of cardiovascular risk, but how much it adds to traditional risk factors appears debatable.
An analysis of 1,541 participants in the Chronic Renal Insufficiency Cohort (CRIC) followed an average of 5.9 years showed that each standard deviation increase in coronary artery calcium was associated with a roughly 40% higher likelihood of any cardiovascular disease, of MI, and of heart failure after accounting for factors including age, sex, activity, cholesterol, blood pressure, diabetes, smoking, BMI, troponin T level, and other measures.
However, the increase in the C statistic was only 0.02 for predicting cardiovascular disease over use of all the above-mentioned established and novel cardiovascular disease risk factors, the researchers reported in JAMA Cardiology.
'Drip and Ship' vs 'Mothership'
A strategy of giving ischemic stroke patients IV thrombolysis within 4.5 hours of symptom onset before transport to a center where mechanical thrombectomy can be performed within a 6-hour window yielded similar odds of good functional outcomes at 3 months compared with transport straight to a thrombectomy-capable center, researchers reported online in JAMA Neurology.
However, an accompanying editorial questioned generalizability in determining whether time to thrombolysis versus time to thrombectomy is most important.
"This study involved only two urban centers located not very far apart that had excellent time-honed cooperation. Most spoke-and-hub relationships in the U.S. and Europe involve more centers, and distances between centers are often much longer," the editorial noted.
See the full MedPage Today story here.
Active Elders
Exercise -- it's not just for young, healthy hearts. Adults with heart disease in their 70s, 80s, and beyond benefit from physical activity for both heart health and daily life, according to an American Heart Association scientific statement published in Circulation.
The statement recommended periodic and standardized monitoring of physical activity in this older secondary prevention group and put emphasis on cardiac rehabilitation when appropriate and individualized guidance on increasing daily physical activities that are important to them, such as climbing stairs or doing basic household tasks.
Staying active can ease heart disease symptoms, preserve strength and balance, and cut down on frailty that particularly affects older heart patients, the statement noted.
"Many healthcare providers are focused only on the medical management of diseases, such as heart failure, heart attacks, valvular heart disease and strokes, without directly focusing on helping patients maximize their physical function," Daniel Forman, MD, of the University of Pittsburgh Medical Center and chair of the statement writing panel, said in a press release.
"Emphasizing physical function as a fundamental part of therapy can improve older patients' quality of life and their ability to carry out activities of daily living," he added. "Patients in their 70s, 80s and older can benefit."
In Other News
Over-the-counter NSAIDs were associated with cardiac arrest in a study from European Heart Journal: Cardiovascular Pharmacotherapy.