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Coronary calcium score (CCS) is a highly sensitive marker for estimating coronary artery calcification (CAC) and detecting coronary artery disease (CAD). Mean platelet volume (MPV (is a platelet indicator that represent platelet stimulation and production. The aim of the current study was to examine the association between MPV values and CAC. We examined 290 patients who underwent coronary computerized tomography (CT) exam between the years 2017 and 2020 in a tertiary care medical center. Only patients evaluated for chest pain were included. The Multi-Ethnic Study of Atherosclerosis (MESA) CAC calculator was used to categorize patients CCS by age, gender, and ethnicity to CAC severity percentiles (<50, 50-74, 75-89, ≥90). Thereafter, the association between CAC percentile and MPV on admission was evaluated. Out of 290 patients, 251 (87%) met the inclusion and exclusion criteria. There was a strong association between higher MPV and higher CAC percentile ( P  = .009). The 90th CAC percentile was associated with the highest prevalence of diabetes mellitus (DM), hypertension, dyslipidemia, and statin therapy ( P  = .002, .003, .001, and .001, respectively). In a multivariate analysis (including age, gender, DM, hypertension, statin therapy, and low-density lipoprotein level) MPV was found to be an independent predictor of CAC percentile (OR 1.55-2.65, P  < .001). Higher MPV was found to be an independent predictor for CAC severity. These findings could further help clinicians detect patients at risk for CAD using a simple and routine blood test.

Background: The effect of chronic benzodiazepine use on blood pressure has not been documented. We aimed to evaluate whether regular benzodiazepine use can be associated to the results of ambulatory blood pressure monitoring (ABPM)., Methods: A retrospective analysis of the ABPM database between 2009 and 2015 was performed. The study groups were divided according to benzodiazepine treatment at least 3 months before ABPM. Generalized estimating equation (GEE) model analysis was conducted to estimate the association between benzodiazepine treatment and ABPM test measurements. Multivariable COX regression survival analysis model for mortality and cardiovascular (CV) events was performed., Results: A total of 4,938 ABPM studies were included in final analysis, 670 ABPMs of benzodiazepine-treated patients, and 4,268 of untreated patients. The benzodiazepine-treated group was significantly older, with a predominance of female patients, comprised more diabetic patients and consumed more antihypertensive medications. Adjustment for age, gender, diabetes mellitus, and number of antihypertensive medications, showed an association between benzodiazepine treatment and significantly lower ABPM measurements. When the analysis was split into those ≥60 years old and the other <60 years old, regular benzodiazepine consumption was associated with lower ABPM measurements only among ≥60 years old. Multivariable Cox regression survival analysis showed that regular benzodiazepine consumption was not associated with increased mortality or CV events (mean follow-up period of 42.4 ± 19.8 and 42.1 ± 20.0 months, respectively)., Conclusions: Long-term use of benzodiazepines by ≥60 years old was independently associated with lower diastolic and systolic blood pressure in all parameters of ABPM, but not among younger patients.

Objective: The aim of the current study was to evaluate the effect of α blockers on the cardiac outcomes of hypertensive patients who underwent myocardial perfusion imaging (MPI)., Methods: A retrospective analysis of the nuclear cardiology laboratory database was performed. The study group included only hypertensive patients (n = 19 ,495). The cohort was divided into three groups - a reference group of no α-blocker therapy (n = 17 ,053), α blockers for benign prostatic hypertrophy (BPH) (n = 1164), and doxazosin for hypertension (HTN) (n = 1258). We used Cox proportional regression models to examine the patient cardiac outcomes (composite of cardiovascular mortality and myocardial infarction) adjusted for the myocardial perfusion study results. The mean age was 65 ± 11.1 years, 55% were men, and the average follow-up was 79.2 ± 37.3 months., Results: In univariate analysis, the doxazosin for HTN group had the highest rate of adverse cardiac events in comparison to the BPH and reference groups (14.1 vs. 11.3% and 8.9%, respectively, P < 0.001). After stratifying for the degree of reversibility of perfusion defect, only individuals with a moderate-to-severe perfusion defect in the doxazosin for HTN group had a significant increase in adverse cardiac events [hazard ratio 1.50 95% confidence interval (1.14-1.98)]., Conclusion: Our data show that doxazosin treatment for HTN is associated with adverse cardiac outcome only among patients with moderate-to-severe ischemia on myocardial perfusion imaging. Doxazosin and other α blockers appear to be safe in the vast majority of patients with a lesser degree of ischemia.

The aim of this investigation was to find a time segment in which average blood pressure (BP) has the best correlation with 24-hour BP control. A total of 240 patients with full ambulatory BP monitoring (ABPM) were included; 120 had controlled BP (systolic BP [SBP] ≤135 mm Hg and diastolic BP [DBP] ≤85 mm Hg) and 120 had uncontrolled BP (SBP >135 mm Hg and/or DBP >85 mm Hg). Each ABPM was divided into 6- and 8-hour segments. Evaluation for correlation between mean BP for each time segment and 24-hour BP control was performed using receiver operating characteristic curve analysis and Youden's index for threshold with the best sensitivity and specificity. The mean BP in the following segments showed the highest area under the curve (AUC) compared with average controlled 24-hour BP: SBP 2 am to 8 am (AUC, 0.918; threshold value of 133.5 mm Hg, sensitivity-0.752 and specificity-0.904); SBP 2 pm to 10 pm (AUC, 0.911; threshold value of 138.5 mm Hg, sensitivity-0.803 and specificity-0.878); and SBP 6 am to 2 pm (AUC, 0.903; threshold value of 140.5 mm Hg, sensitivity-0.778 and specificity-0.888). The time segment 2 pm to 10 pm was shown to have good correlation with 24-hour BP control (AUC >0.9; sensitivity and specificity >80%). This time segment might replace full ABPM as a screening measure for BP control or as abbreviated ABPM for patients with difficulty in performing full ABPM., (© 2013 Wiley Periodicals, Inc.)

Background: Hypertension is associated with involvement of target organs which varies among the different ethnic groups. The multiplicity of the population in Israel offers an opportunity for evaluating target organ damage in hypertensive patients of different ethnic origins., Methods and Results: Data were collected from the computerized medical files of hypertensive patients in primary care clinics. The analysis was done on 576 hypertensive patients: 138 Bedouins (Arab residents), 141 Sephardic Jews (immigrants from North Africa and the Middle East), 152 Asian-Indian Jews (immigrants from India) and 145 Ashkenazi Jews (immigrants from Europe and North and South America). In multivariable logistic regressions adjusted for known risk factors and ethnicity, the prevalence of cerebrovascular disease was the highest among the Asian-Indian Jews (OR=3.09, p value=0.009). Renal damage was highest among the Bedouins (OR=4.54, p value<0.0001) and Asian-Indian Jews (OR=2.88, p value=0.005). The differences in the prevalence of renal damage among the various ethnic groups were even more pronounced among patients without diabetes (OR=8.31, p value<0.0001 in Bedouins and OR=7.46, p value=0.001 in Asian-Indian Jews). The prevalence of ischemic heart disease did not differ significantly among the four ethnic groups., Conclusions: The prevalence of cerebrovascular and renal diseases are both significantly associated with ethnic origin of Asian-Indian Jews and Bedouins. However, the multivariate analysis shows that the prevalence of ischemic heart disease is not associated with ethnicity.

The article presents case reports of two patients who exhibited extremely high Agatston calcium scores with mild coronary stenoses. In case 1, a woman who had Type II diabetes mellitus, hypertension, and renal failure was diagnosed with mild and non-obstructive coronary stenoses. In case 2, a man who had Type II diabetes mellitus, hypertension, and coronary heart disease was diagnosed with non-significant coronary stenoses in the left system, with limited significant lesions in the right.