Cardiovascular Prevention and Pharmacotherapy

Original Article

CHA₂DS₂-VASc Score Is Correlated with Cardiac Performance in Chronic Atrial Fibrillation: Doo Soo Jeon, Mi-Jeong Kim, Wonjik Lee, Dongjae Lee, Ik Jun Choi; Cardiovasc Prev Pharmacother. 2020;2(2):56-62. Published online April 30, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e9

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Abstract PDF: Background
The CHA₂DS₂-VASc score is a popular tool for risk prediction of thromboembolism in patients with atrial fibrillation (AF). Each component of the CHA₂DS₂-VASc scheme is an established risk factor for left ventricular diastolic dysfunction and heart failure (HF). In AF patients, HF is often adversely affecting to clinical outcomes including thromboembolism. We hypothesized that the CHA₂DS₂-VASc score reflects cardiac reserve and the risk of HF as well as the risk of stroke in patients with AF.
Methods
A total of 103 patients who had the diagnosis of chronic non-valvular AF patients with preserved ejection fraction (EF) were enrolled consecutively. CHA₂DS₂-VASc score was compared to exercise capacity (peak oxygen uptake, peak VO₂), B-type natriuretic peptide (BNP) and echocardiographic diastolic dysfunction index (early mitral to annular velocity, E/E′) ratio.
Results
Exercise capacity was correlated with age (β=−0.568, p<0.001), CHA₂DS₂-VASc score (β=−0.526, p<0.001), BNP (β=−0.449, p<0.001) and diastolic dysfunction (β=−0.534, p<0.001). Patients with CHA₂DS₂-VASc score ≥2 had a significantly less exercise capacity than those with CHA₂DS₂-VASc score <2 (p<0.001). Higher CHA₂DS₂-VASc score was associated with lower exercise capacity, more diastolic dysfunction and higher BNP (for trend p=0.001).
Conclusions
High CHA₂DS₂-VASc score is associated with poor exercise capacity in patients with AF. Diastolic dysfunction is thought to be the major mechanism of exercise limitation. CHA₂DS₂-VASc score might be useful for predicting overall cardiac reserve as well as stroke risk stratification in AF patients.

Review Article

Pregnancy at Late Maternal Age and Future Cardiovascular Health: Mi-Jeong Kim; Cardiovasc Prev Pharmacother. 2019;1(2):50-56. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e9

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Abstract PDF: Increasing numbers of women are delivering their first child at a later age. First pregnancy at a later age is, per se, a high-risk pregnancy. Pregnancy after 35 years is traditionally considered a late maternal age. The risks of obstetric complications including fetal and maternal complications are increased. Defective placenta syndrome, including hypertensive disorders, preterm birth, and intrauterine growth retardation, shares similar pathophysiologic mechanisms with endothelial dysfunction, although their clinical presentations differ. Recent medical advances have improved the medical performance of pregnancy-related cardiovascular disease (CVD). Recent evidence has shown that women with underlying defective placental syndrome or other pregnancy-related complications have an increased risk of unfavorable cardiovascular outcomes in later life. An increasing number of women delivering their first child at a later age have epidemiological characteristics that differ from those reported previously and for which data are limited data regarding the cardiovascular prognosis. Therefore, increased attention to public health and CVD prevention is required for women with complicated pregnancies.

Original Article

Preterm Labor and Later Maternal Cardiovascular Disease in General Population: Doubtful Relationship with Atherosclerosis: Mi-Jeong Kim, Hae Ok Jung, Sung Ha Chun, Hyeon Woo Yim, Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2019;1(2):71-78. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e10

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Abstract PDF: Background
The maternal cardiovascular system experiences an enormous challenge during pregnancy. A history of preterm labor suggestive of dysfunctional pregnancy might be associated with the maternal later life chronic cardiovascular disease (CVD). We evaluated the association between preterm labor and the late development of maternal atherosclerotic CVD using the national database of general population.
Methods
Data for 5,226 postmenopausal women aged ≥50 years were analyzed from the Korean National Health and Nutrition Examination Survey V, which had conducted from 2010 to 2012.
Results
The numbers of preterm labor and CVD (stroke, myocardial infarction, or angina pectoris) were 151 (3.0±0.3%) and 367 (6.6±0.4%), respectively. In a multivariate analysis, CVD was independently associated with age (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.8–2.0), the presence of hypertension (OR, 1.9; 95% CI,1.5–2.3), diabetes (OR, 2.3; 95% CI, 1.8–2.9), chronic kidney disease (OR, 1.8; 95% CI, 1.4–2.2) and low high-density lipoprotein cholesterol concentration (OR, 0.8; 95% CI, 0.7–0.9) were independently associated with CVD. A history of preterm labor was not associated with CVD (OR, 1.5; 95% CI, 0.6–3.8).
Conclusions
There was no significant association between preterm labor and atherosclerotic CVD in general population. A history of preterm labor is not likely to be a risk factor for later CVD in women.

Editorial

Welcome to the New Journal Cardiovascular Prevention and Pharmacotherapy: Mi-Jeong Kim, Jang-Whan Bae, Dae Ryong Kang; Cardiovasc Prev Pharmacother. 2019;1(1):1-2. Published online July 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e5

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