Patients with chronic gastrointestinal ischemia have a higher cardiovascular disease risk and mortality

Sana, Aria; Noord, Désirée van; Mensink, Peter; Kooij, Stephanie; Dijk, Kim van; Bravenboer, Bert; Lieverse, Aloysius G.; Sijbrands, Eric J.G.; Langendonk, Janneke G.; Kuipers, Ernst J.

doi:10.1016/j.atherosclerosis.2012.07.007

Cited by 11 publications

(9 citation statements)

References 31 publications

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“…Mortality at the 24-month follow-up was 36.6% in the atherosclerotic CMI population and 10.8% among patients without CMI. A previous study comparing mortality in patients with atherosclerotic CMI with the expected mortality in the general population, using age- and sex-specific mortality rates, reported an increased standardized mortality risk of 3.55 in patients with CMI, supporting the findings of the current study ( 24 ). The higher mortality in atherosclerotic CMI could be due to the systemic nature of atherosclerosis because atherosclerosis also affects other vascular beds.…”

Section: Discussionsupporting

confidence: 90%

The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center

Terlouw

Verbeten

Noord

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI. METHODS: A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers' well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment. RESULTS: This study included 358 patients, 75 had a ≥50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2–13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6–11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5–3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2–2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3–19.6] vs male patients 6.5 [95% CI 3.4–12.5]) and increased with age. CMI was more prevalent in the presence of a ≥70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%). DISCUSSION: The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ≥70% atherosclerotic single-vessel superior mesenteric artery stenosis.

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Section: Discussionsupporting

confidence: 90%

The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center

Terlouw

Verbeten

Noord

et al. 2020

Clin Transl Gastroenterol

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“…Our data confirm that weight loss is the only predictive clinical symptom in the prediction model. In accordance with the guidelines stating that patients with CMI have atherosclerotic involvement in other locations, 26 , 27 our score chart incorporated the presence of CVD as a predictor of CMI. Finally, the guidelines recommend considering the diagnosis of CMI in patients with otherwise unexplained abdominal symptoms and occlusive disease of two or three mesenteric arteries.…”

Section: Discussionmentioning

confidence: 99%

Validation of a score chart to predict the risk of chronic mesenteric ischemia and development of an updated score chart

et al. 2019

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Background and objectiveThe objective of this article is to externally validate and update a recently published score chart for chronic mesenteric ischemia (CMI).MethodsA multicenter prospective cohort analysis was conducted of 666 CMI-suspected patients referred to two Dutch specialized CMI centers. Multidisciplinary consultation resulted in expert-based consensus diagnosis after which CMI consensus patients were treated. A definitive diagnosis of CMI was established if successful treatment resulted in durable symptom relief. The absolute CMI risk was calculated and discriminative ability of the original chart was assessed by the c-statistic in the validation cohort. Thereafter the original score chart was updated based on the performance in the combined original and validation cohort with inclusion of celiac artery (CA) stenosis cause.ResultsIn 8% of low-risk patients, 39% of intermediate-risk patients and 94% of high-risk patients of the validation cohort, CMI was diagnosed. Discriminative ability of the original model was acceptable (c-statistic 0.79). The total score of the updated chart ranged from 0 to 28 points (low risk 19% absolute CMI risk, intermediate risk 45%, and high risk 92%). The discriminative ability of the updated chart was slightly better (c-statistic 0.80).ConclusionThe CMI prediction model performs and discriminates well in the validation cohort. The updated score chart has excellent discriminative ability and is useful in clinical decision making.

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“…Moreover, some gastrointestinal disorders may increase patients’ risk of cardiovascular disease as well. For example, patients with chronic gastrointestinal ischemia have an increased CVDs’ risk and excess mortality5. Furthermore, the pathophysiological mechanisms between the two organs would supply realistic treatment for CVDs and GIDs6.…”

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confidence: 99%

Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

Zhou

Qin

Guo

et al. 2016

Sci Rep

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Though cardiovascular diseases (CVDs) and gastrointestinal disorders (GIDs) are different diseases associated with different organs, they are highly correlated clinically. Importantly, in Traditional Chinese Medicine (TCM), similar treatment strategies have been applied in both diseases. However, the etiological mechanisms underlying them remain unclear. Here, an integrated systems pharmacology approach is presented for illustrating the molecular correlations between CVDs and GIDs. Firstly, we identified pairs of genes that are associated with CVDs and GIDs and found that these genes are functionally related. Then, the association between 115 heart meridian (HM) herbs and 163 stomach meridian (SM) herbs and their combination application in Chinese patent medicine was investigated, implying that both CVDs and GIDs can be treated by the same strategy. Exemplified by a classical formula Sanhe Decoration (SHD) treating chronic gastritis, we applied systems-based analysis to introduce a drug-target-pathway-organ network that clarifies mechanisms of different diseases being treated by the same strategy. The results indicate that SHD regulated several pathological processes involved in both CVDs and GIDs. We experimentally confirmed the predictions implied by the effect of SHD for myocardial ischemia. The systems pharmacology suggests a novel integrated strategy for rational drug development for complex associated diseases.Over the past decade, there has been a marked increase in our understanding that there are higher prevalence rates of gastrointestinal disease (GIDs) in patients with cardiovascular disease (CVDs) 1,2 with similar dysfunctional phenotypes, such as rib pain, stomach pain, nausea and vomiting. However, the underlying co-occurrence mechanisms of CVDs and GIDs are unclear, thereby hampering development of drugs for both diseases in humans 3 . In modern Western medicine, usually, it has been observed that cardiovascular diseases have an etiological relationship with gastrointestinal disorders. Several studies have reported that the risk of cardiovascular disease in patients with gastrointestinal disease appears to be far greater than in the general population 4 . Moreover, some gastrointestinal disorders may increase patients' risk of cardiovascular disease as well. For example, patients with chronic gastrointestinal ischemia have an increased CVDs' risk and excess mortality 5 . Furthermore, the pathophysiological mechanisms between the two organs would supply realistic treatment for CVDs and GIDs 6 . For example, Iranian traditional physicians have introduced several remedies for heart-stomach association ailments in a previous study 7 . In addition, novel studies demonstrated the close relationship between gastroesophageal reflux disease (GERD) and the development of atrial fibrillation (AF), notably, acid-suppressive therapy is an effective strategy for the management of AF and may help to minimize the use of anti-arrhythmic agents 8,9 .

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Patients with chronic gastrointestinal ischemia have a higher cardiovascular disease risk and mortality

Abstract: Patients with atherosclerotic CGI have an increased estimated CVD risk, and severe excess mortality. Secondary cardiovascular prevention therapy should be advocated in patients with CGI.

Cited by 11 publications

References 31 publications

The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center

The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center

Validation of a score chart to predict the risk of chronic mesenteric ischemia and development of an updated score chart

Systems Pharmacology Dissection of the Integrated Treatment for Cardiovascular and Gastrointestinal Disorders by Traditional Chinese Medicine

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