Coronary Artery Disease: Thomas RJ

Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Anonymous00090. · No affiliation provided · J Cardiopulm Rehabil Prev. · Pubmed #17885506 No free full text.

This publication has no abstract.

Thomas RJ. · No affiliation provided · J Cardiopulm Rehabil. · Pubmed #14646789 No free full text.

This publication has no abstract.

Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F. · Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Foundation, Rochester, MN 55905, USA. · Lancet. · Pubmed #16920472 No free full text.

Abstract: BACKGROUND: Studies of the association between obesity, and total mortality and cardiovascular events in patients with coronary artery disease (CAD) have shown contradictory results. We undertook a systematic review to determine the extent and nature of this association. METHODS: We selected cohort studies that provided risk estimates for total mortality, with or without cardiovascular events, on the basis of bodyweight or obesity measures in patients with CAD, and with at least 6 months' follow-up. CAD was defined as history of percutaneous coronary intervention, coronary artery bypass graft, or myocardial infarction. We obtained risk estimates for five predetermined bodyweight groups: low, normal weight (reference), overweight, obese, and severely obese. FINDINGS: We found 40 studies with 250,152 patients that had a mean follow-up of 3.8 years. Patients with a low body-mass index (BMI) (ie, <20) had an increased relative risk (RR) for total mortality (RR=1.37 [95% CI 1.32-1.43), and cardiovascular mortality (1.45 [1.16-1.81]), overweight (BMI 25-29.9) had the lowest risk for total mortality (0.87 [0.81-0.94]) and cardiovascular mortality (0.88 [0.75-1.02]) compared with those for people with a normal BMI. Obese patients (BMI 30-35) had no increased risk for total mortality (0.93 [0.85-1.03]) or cardiovascular mortality (0.97 [0.82-1.15]). Patients with severe obesity (> or =35) did not have increased total mortality (1.10 [0.87-1.41]) but they had the highest risk for cardiovascular mortality (1.88 [1.05-3.34]). INTERPRETATION: The better outcomes for cardiovascular and total mortality seen in the overweight and mildly obese groups could not be explained by adjustment for confounding factors. These findings could be explained by the lack of discriminatory power of BMI to differentiate between body fat and lean mass.

Squires RW, Montero-Gomez A, Allison TG, Thomas RJ. · Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. · J Cardiopulm Rehabil Prev. · Pubmed #18496316 No free full text.

Abstract: PURPOSE: Randomized-clinical trials have demonstrated the benefits of disease management for patients with coronary disease. It is not known if long-term disease management in routine clinical practice provided by cardiac rehabilitation (CR) program staff is possible. The goal of this study was to evaluate the feasibility and clinical benefits of a 3-year disease-management program in the setting of an outpatient CR facility. METHODS: Consecutive patients (n = 503) referred to CR and who were available for long-term follow-up served as subjects. After a phase II CR program, disease managers assessed secondary-prevention goals every 3 to 6 months via face-to-face meetings with each patient. Outcome measures included use of cardioprotective medications, coronary risk factors, amount of habitual exercise training, and all-cause mortality. RESULTS: At 3 years, aspirin usage was 91%, statin usage 91%, beta-blocker usage 78%, and angiotensin-converting enzyme inhibitor usage 76%. Low-density lipoprotein cholesterol was 90 +/- 23 mg/dL, systolic blood pressure was 126 +/- 19 mm Hg, and body mass index was 29.0 +/- 5.1 kg/m2. Exercise training averaged 139 +/- 123 minutes per week. Annual mortality was 1.9%. There were no differences (P > .05) in medication usage or low-density lipoprotein cholesterol for men versus women, or for age below 65 years versus age 65 years or greater. CONCLUSIONS: Long-term disease management of patients with coronary disease in routine clinical practice by CR program staff is feasible and effective in achieving and maintaining secondary-prevention goals. Overweight remains a prevalent and persistent risk factor. We advocate expansion of CR programs into long-term coronary disease-management programs.

Bunch TJ, White RD, Lopez-Jimenez F, Thomas RJ. · Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. · Resuscitation. · Pubmed #18308453 No free full text.

Abstract: AIM: Studies have shown an association between obesity and total mortality among people with and without coronary artery disease. This study reviews outcomes among obese survivors of ventricular fibrillation in out-of-hospital cardiac arrest. METHODS: All survivors of ventricular fibrillation in out-of-hospital cardiac arrest who presented in Rochester, MN from November 1990 to September 2006 were included and classified by body weight. Implantable cardioverter defibrillator shocks administered were determined by review of subsequent device interrogations. RESULTS: Among a study population of 226, 99 (44%) survived to hospital discharge with neurological recovery. Data to calculate body mass index were available in 213 cases (95%). There was no significant difference in the relative distribution of body weight between hospital survivors and non-survivors, nor in cardioverter defibrillator implantation rates. Mean follow-up was 5.8+/-4.4 years; 5-year survival was 80+/-5%, lower among underweight and normal compared with heavier individuals. The 5-year survival free of implantable cardioverter defibrillator shocks was 61+/-7%, with no weight-based difference in shocks. CONCLUSION: There was no apparent weight-based influence on resuscitation survival after ventricular fibrillation in out-of-hospital cardiac arrest. People of normal or low weight had a lower long-term survival and represent at population high risk from primarily non-cardiac diseases.

Romero-Corral A, Somers VK, Sierra-Johnson J, Jensen MD, Thomas RJ, Squires RW, Allison TG, Korinek J, Lopez-Jimenez F. · Division of Cardiovascular Diseases, Department of Internal Medicine, Gonda 5-368, 200 First Street SW, Rochester, MN 55905, USA. · Eur Heart J. · Pubmed #17626030 links to  free full text

Abstract: BACKGROUND: Emerging evidence suggests that a mildly elevated body mass index (BMI), is related to improved survival and fewer cardiovascular events in patients with coronary artery disease (CAD). We hypothesize that these results are related to the poor diagnostic performance of BMI to detect adiposity, especially in the intermediate BMI ranges. METHODS AND RESULTS: A cross-sectional study of 95 patients with CAD referred to phase II cardiac rehabilitation. Body fat (BF)% was estimated by air displacement plethysmography. Height, weight, BMI and waist circumference were measured the same day. We calculated the correlation between BMI and both, BF% and lean mass and assessed the diagnostic performance of BMI to detect obesity defined as a BF% > 25% in men and > 35% in women. Although BMI had a good correlation with BF% (rho = 0.66, P < 0.0001), it also had a good correlation with lean mass (rho = 0.41, P < 0.0001), and BMI failed to discriminate between both (P-value = 0.72). A BMI >or= 30 kg/m2 had a good specificity (95%; 95% CI, 83-100) but a poor sensitivity (43%; 95% CI, 32-54) while a BMI >or= 25 kg/m2 had a good sensitivity (91%; 95% CI, 84-97) but a poor specificity (65%; 95% CI, 42-88) to detect BF%-obesity. CONCLUSIONS: In patients with CAD, BMI does not discriminate between BF% and lean mass, and a BMI < 30 kg/m(2) is a poor index to diagnose obesity. These findings may explain the controversial findings that link mild elevations of BMI to better survival and fewer cardiovascular events in patients with CAD. Body composition techniques to accurately diagnose obesity in patients with CAD might be necessary.

Powell BD, Bybee KA, Valeti U, Thomas RJ, Kopecky SL, Mullany CJ, Wright RS. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA. · Am J Cardiol. · Pubmed #17350365 No free full text.

Abstract: Statin therapy has recently been shown to decrease adverse perioperative events in patients undergoing vascular surgery. The potential beneficial effect of lipid-lowering therapy in patients undergoing coronary artery bypass grafting (CABG) is not well known. This was an observational analysis of 4,739 patients who underwent first-time isolated CABG at a single institution from 1995 to 2001. Patients were categorized into 2 groups based on treatment with a lipid-lowering agent within 30 days before surgery. Univariate and multivariate analyses were used to determine the association between lipid-lowering therapy and survival to hospital discharge. Patients in the lipid-lowering group (n = 2,334) tended to be younger (mean age 66 +/- 10 vs 68 +/- 10 years), were more likely to be diabetic (31% vs 28%), and on beta blockers (77% vs 70%) than patients in the nonlipid-lowering group (n = 2,405). In-hospital mortality was significantly lower in the lipid-lowering group than in the nonlipid-lowering therapy group (1.4% vs 2.2%, odds ratio 0.62, 95% confidence interval 0.40 to 0.96, p = 0.03). A multivariable model demonstrated a loss of statistical significance for the effect of lipid-lowering therapy on in-hospital mortality (adjusted odds ratio 0.83, 95% confidence interval 0.5 to 1.37, p = 0.46). In conclusion, preoperative use of lipid-lowering therapy in patients undergoing CABG appears safe and is associated with improved survival to hospital discharge compared with patients not receiving lipid-lowering therapy. However, patient risk factors and other cardioprotective medication use associated with the use of preoperative lipid-lowering therapy appear to explain the association with improved survival.