Cardiac mortality

Studied in the CAST (CardiacArrhythmia Suppression Trial, I and II) with findings of excessive cardiac mortality and no benefit on long-term survival compared to placebo... 

Oral hypoglycemic drugs have been associated with increased cardiac mortality as compared to treatment with diet alone or diet and insulin... 

Penninx BWJH, Beekman ATF, Honig A, et al. Depression and cardiac mortality Results from a community-based longitudinal study. Arch Gen Psychiatry 2001 58 221-227. 

Cilostazol is indicated for symptomatic relief of intermittent claudication (46,47). With recent attention focusing on new antiplatelet modalities in percutaneous coronary intervention, renewed interest in cilostazol has emerged. Although cilostazol has not been associated with the same increase in cardiac mortality noted with other PDE3 inhibitors used in patients with heart failure (such as milrinone), it is not recommended for use in patients with coexistent heart failure. 

In most cases, the reversal of symptomatic myocardiopathy has been achieved without drug toxicity (19,43). Davis and Porter (19) and Tsironi et al. (44) confirmed clinically the laboratory data of Link et al. (45) that DFO therapy reverses cardiac arrhythmias in some patients previously unresponsive to medical treatment. This may be attributed to removal of a toxic labile iron pool. They also mentioned improvement of left ventricular ejection fraction in seven of nine patients. It is important to note that oral chelators are less effective than DFO and are unable to prevent cardiac mortality in patients with established heart disease (46). 

Chaitman BR, Rosen AD, Williams DO, et al. Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial. Circulation 1997 96(7) 2162-2170. 

Study Procedure No. of patients FAJ, months or mean SD Death, n (%) Late cardiac mortality, n (%) Acute MI n (%) Ventricular fibrillation, n (%) Permanent pacing, n (%) Reintervention, n (%)... 

The question of the effect of ziprasidone on the QTC interval has been analysed in an extensive review (18). It is generally accepted that 440 ms is the upper limit of normality, and the authors concluded that ziprasidone clearly prolongs the QTC interval, but that the clinical consequences of this effect are uncertain, and that so far no direct association with torsade de pointes, sudden death, or increased cardiac mortality has been observed. However, they provided recommendations about its use. 

St Leger, A. S., Cochrane, A. L., Moore, F. (1979). Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. The Lancet, 1, 1017-1020. 

The importance of one of those lifestyle modifications, increased physical activity, was showcased at the 2004 meeting of the American College of Cardiology. Fitness in women was shown to be the most important factor in assessing cardiac mortality risk. Every increase in fitness, measured on a treadmill, was associated with a 9 percent decrease in all-cause mortality and a 13 percent drop in cardiac mortality. 

In the Polish Arrhythmia Trial (PAT) amiodarone reduced all-cause mortality from 10.7 to 6.9% compared with placebo and cardiac mortality from 10.7 to 6.2% (38). 

The authors of a study of the use of MRI scans to assess the subclinical effects of the anthracyclines concluded that increased MRI enhancement equal to or greater than 5 on day 3 compared with the baseline predicted significant reduction in ejection fraction at day 28 (32). In 1000 patients given doxorubicin chemotherapy and irradiation there were six cases of congestive heart failure and three cases of myocardial infarction there was a cumulative cardiac mortality of 0.4% in all anthracycUne-exposed patients (33). 

Flaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J Am CoU Cardiol 1992 20(3) 527-32. 

In the Canadian Study of Health and Aging, a population-based prospective study of people aged 65 years or more, 5-year follow-up of 837 subjects who reportedly used at least one antihypertensive or diuretic agent showed that the risk of all-cause and cardiac mortality was significantly higher among nifedipine users than... 

Senechal M, Dorent R, du Montcel ST, Ghossou JJ, Pavie A, PetitclercT, Dubois M, Isnard R, Gandjbakhch I. End-stage renal failure and cardiac mortality after heart transplantation. Clin Transplant 2004 18 1-6. 

Predictors for LVH and cardiac failure include age, hypertension, and hemoglobin concentration. In ESRD a Ig/dL fall in hemoglobin increases the relative risk of left ventricular dilation by 1.49, left ventricular systolic dysfunction by 1.55, and death by 1.25. " In patients on dialysis, large observational studies have clearly shown that anemia is associated with increased mortality rates and increased hospitaliza-tion. " In hemodialysis (HD) patients hematocrit levels of 33% to 36% (corresponding to hemoglobin concentration of 11 to 12g/dL) were associated with the lowest risk for all-cause and cardiac mortality,and these patients also had the lowest risk of hospitalization. " " A large randomized controlled trial has tested the hypothesis that normalization of anemia would have benefits in terms of... 

Brodie BR, Hansen C, Stuckey TD et al. Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after the onset of symptoms. J Am Coll Cardiol 2006 47 289. 

Townsend R. Cardiac mortality in chronic kidney disease A clearer perspective. Ann Intern Med 2002 137 615—616. 

Ganesh SK, et al. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001 12 2131-2138. 

Baroreflex sensitivity (BRS) is a measure of the reflex bradycardia that follows an increase in systemic blood pressure. This reflex is mediated by arterial baroreceptors and may be measured after injection of phenylephrine or after spontaneous rises in blood pressure (64). Correlation between the two different tests is poor (69) and measures of baroreflex sensitivity are only moderately reproducible (70). Data on the ability of BRS to predict sudden death are conflicting. In the ATRAMI study in 1284 patients post-MI, HRV, and BRS were assessed at discharge (71). Depressed HRV and BRS carried a significant risk of cardiac mortality when both parameters were depressed the risk increased further. Thus, ATRAMI demonstrated that since BRS adds to the prognostic value of HRV, the two measures are complimentary rather than redundant. However, in another study of 700 post-MI patients, HRV or BRS was not predictive of SCD (60). BRS also does not appear useful for risk stratification in patients with nonischemic cardiomyopathy (63). 

La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic tone and reflexes after myocardial infarction) investigators. Lancet 1998 351(9101) 478-84. 

Gossel TA. Aspirin s roie in reducing cardiac mortality. US Pharmacist 1988,13 34-38. 

The Cardiac Arrhythmia Suppression Trial (CAST) highlighted the importance and awareness of proarrhythmia. The main finding of CAST was that, despite elimination of complex ventricular ectopy after myocardial infarction, mortality was significantly higher in patients treated with encainide or flecainide. Others have reported that the overall risk of cardiac mortality is higher, presumably due to proarrhythmia, in patients treated with Type la antiarrhythmics for atrial fibrillation who have con-... 

Cardiovascular Effects. A number of studies in humans and animals have examined the effects of zinc on serum cholesterol and triglycerides. These data are discussed below under Other Systemic Effects. However, no studies regarding the direct relationship between excessive zinc intake and cardiac mortality were located. No effects on electrocardiographic results were found in a group of elderly subjects (>65 years of age) taking zinc supplements of up to 2 mg zinc/kg/day (Hale et al. 1988) or 0.71 mg zinc/kg/day (Czerwinski et al. 1974). There was also no effect on the frequency of cardiovascular disease (heart attack, heart failure, hypertension, or angina) in elderly subjects (>67 years of age) taking up to 2 mg zinc/kg/day (Hale et al. 1988). 

Another class of vasoactive agents with demonstrated benefit in secondary MI prevention are the angiotensin-con-verting enzyme (ACE) inhibitors. Several large trials of angiotensin receptor blockers as secondary prevention agents are now also underway. Most of the evidence for benefit from ACE inhibitors has centered on patients with heart failure (59). An exception to this was the Heart Outcomes Prevention Evaluation (HOPE) trial, which excluded patients with ejection fractions <40%, and involved 9297 patients (60). There was a 25% reduction in cardiac mortality in patients receiving the ACE inhibitor ramipril. 

The DART results (10) were of interest not only because there was a decline in total and cardiac mortality in only 4 mo, but also because the difference in total MI was modest and there was a nonsignificant increase in nonfatal MI. This suggested that the primary effect of eating oily fish was on... 

The SMQs consist of different adverse event terms with the objective to describe a common medical concept. In an attempt to increase the sensitivity of the assessment, it is quite common to combine search terms for medically closely related concepts, that is, to use a composite endpoint for the assessment of risks. A typical example of a composite safety endpoint is the major adverse cardiovascular events (MACE) criterion. This endpoint consists of myocardial infarction, stroke, and cardiovascular death. While this approach is very appealing at a first glance, great caution should be applied when using these composite endpoints. As in the case of MACE, the individual components of the composite do not necessarily have the same medical importance. Therefore, the results of the individual components of the composite should always be reported in addition to the overall result. This is particularly important if equivalence or noninferiority of the overall risk is to be claimed, and then it would also be interesting to know whether a treatment reduces the risk of stroke at the expense of an increased risk of cardiac mortality. 

---