MedPageToday.com
Published: Apr 15, 2013
By Chris Kaiser , Cardiology Editor, MedPage Today
Periodontal disease and its treatment are predictors of stroke. Also, comorbidities that increase Afib risk, antiplatelet agents in STEMI, and peptides in Afib.
Caring for Teeth Protects Against Stroke
The amount of dental care and periodontal disease was significantly correlated to incident stroke (IR) risk, a nationwide, population-based study found.
Compared with controls (IR 0.32/year) who had neither periodontal disease nor treatment for it, the IR for other cohorts (all P<00.001) was:
- 0.14%/year for those who regularly had their teeth cleaned
- 0.39%/year for those who had extensive treatment or tooth extraction
- 0.48%/ year for those with untreated periodontal disease
In the adjusted model, those who had regular cleanings had a significantly lower risk of stroke (HR 0.75) compared with controls, but so did those who received extensive treatment (HR 0.95), reported Dachen Chu, MD, PhD, from Taipei City Hospital, Taiwan, and colleagues.
The highest risk of stroke was in the individuals who had untreated periodontal disease (HR 1.15), especially among the youngest (20 to 44) age group (HR 2.17), they wrote in the latest issue of Stroke: Journal of the American Heart Association.
The retrospective study spanned the years 2000 to 2010 and included 510,762 individuals with periodontal disease and 208,674 controls.
Other Conditions Add to Afib Death Risk
A Swedish epidemiological study identified disease conditions significantly associated with first-time hospitalization for atrial fibrillation and all-cause death.
Of the 272,186 patients with incident atrial fibrillation (mean age 72, 44% women), neoplasm, chronic renal failure, and COPD were most associated with increased all-cause mortality compared with controls without Afib, according to Tommy Andersson, MD, of Orebro University Hospital in Sweden, and colleagues.
The researchers noted that none of these comorbid conditions are “included in the scoring schemes used to asses thromboembolic risk,” according to the study published in the latest edition of the European Heart Journal.
In addition, the risk of death was higher for women in all age categories, but especially among those younger than 65.
Prasugrel Equals Ticagrelor in STEMI
Prasugrel (Effient) proved noninferior to ticagrelor (Brilinta) in inhibiting platelet activity 2 hours after the loading dose in ST-segment elevation myocardial infarction (STEMI) patients.
But in the primary percutaneous coronary intervention setting, it took at least 4 hours for the drugs to achieve effective platelet inhibition — and then for only 56% of those on prasugrel and 40% of those on ticagrelor, according to Guido Parodi, MD, of Careggi Hospital in Florence, Italy, and colleagues.
They identified morphine use (OR 5.29) and baseline platelet reactivity units (OR 1.014) as independent predictors of high residual platelet reactivity, according to the study published online in the Journal of the American College of Cardiology.
“Our data revealed a wide variability of drug response suggesting that the gastrointestinal absorption of orally administered drugs may be limited or delayed in STEMI patients because of multiple reasons including reduced or delayed drug adsorption in patients with hemodynamic disarrangement, systemic vasoconstriction, adrenergic activation, and at high risk of vomit,” they concluded.
Peptide Predicts Stroke Risk in Afib
High levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with atrial fibrillation are associated with worse outcomes, an analysis of the ARISTOTLE trial found.
The annual rate of stroke in 14,892 patients ranged from 0.74% in the lowest quartile of NT-proBNP levels to 2.21% in the highest quartile, resulting in a hazard ratio of of 2.35, according to Ziad Hijazi MD,of Uppsala University in Sweden, and colleagues.
Also, the C-statistic improved from 0.62 to 0.65 for stroke when NT-proBNP levels were added to the CHA2DS2VASc score and from 0.59 to 0.69 for cardiac death, they wrote in the Journal of the American College of Cardiology.
The researchers emphasized that high levels of NT-proBNP were common, occurring in three-quarters of this patient population who also had at least one risk factor for stroke.