Short Communication Cardiology 2014;129:203–206 DOI: 10.1159/000365139
Received: May 20, 2014 Accepted: June 6, 2014 Published online: October 17, 2014
Predictors of Coronary Artery Disease in Patients with Behçet’s Disease Ambarish Pandey a Jalaj Garg b Parasuram Krishnamoorthy d Chandrasekar Palaniswamy b Jay Doshi c Gregg Lanier b Hasan Ahmad b a
Division of Cardiology, Department of Medicine, University of Texas, Dallas, Tex., b Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, N.Y., c Division of Cardiology, Department of Medicine, Albert Einstein School of Medicine, Montefiore Medical Center, New York, N.Y., and d Department of Medicine, Mount Sinai Englewood Hospital and Medical Center, Englewood, N.J., USA
Abstract Background: Behçet’s disease (BD) is a multisystem vasculitis of unknown etiology. We aimed to determine the prevalence and predictors of coronary artery disease (CAD) in patients with BD. Methods: All adult patients diagnosed with BD from the National Inpatient Sample database using the International Classification of Diseases 9th revision (ICD-9 code 136.1) during 2009–2010 were included in the analysis. We analyzed the demographics, traditional risk factors, prevalence, and predictors of CAD in patients with BD using ICD9 codes. Results: The prevalence of BD among adults was 0.006% (n = 2,540) of all in-hospital admissions in the USA. The mean age was 43.9 years, with women (45 years) being older than men (40 years) (p < 0.001). Traditional risk factors prevalent in our study were hypertension (35%), hyperlipidemia (17.4%), diabetes mellitus (13.8%), smoking (13.1%), and obesity (7.2%). The prevalence of CAD was 12.1%. Hypertension (OR = 2.20, p = 0.03) and hyperlipidemia (OR = 2.34, p = 0.02) were found to be independent predictors of
© 2014 S. Karger AG, Basel 0008–6312/14/1294–0203$39.50/0 E-Mail [email protected] www.karger.com/crd
CAD in a multimodel regression analysis. Conclusion: In patients with BD, traditional risk factors associated with CAD were similar to what is expected in the overall population. However, the young age of patients with CAD in this population suggests an accelerated course of atherosclerosis in BD. © 2014 S. Karger AG, Basel
Introduction
Behçet’s disease (BD) is a multisystem autoimmune disorder characterized by recurrent oral and genital ulcers and uveitis, and it is associated with significant vascular complications like thrombophlebitis, aneurysm formation, and thromboembolic occlusions [1–3]. Cardiovascular (CV) involvement in subjects with BD has not been well studied. BD is known to be associated with microvascular inflammation, focal fibrinoid deposition, and fibroblast proliferation in small-caliber coronary arteries, resulting in coronary thrombosis and aneurysms [4]. This has been associated with clinical manifestations such as myocardial ischemia, pericarditis, valvular disorders, arrhythmias, myocarditis, and left ventricular dysfunction [4, 5]. Most of the studies describing these CV involveJalaj Garg, MD Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College 100 Woods Road, PMB 495, Valhalla, NY 10595 (USA) E-Mail garg.jalaj @ yahoo.com
Downloaded by: NYU Medical Center Library 198.143.38.97 - 7/28/2015 6:41:22 PM
Key Words Behçet’s disease · Atherosclerosis · Arrhythmias · Hypertension · Hyperlipidemia
Table 1. Baseline demographics of patients with BD
Variables
Total population (n = 2,540)
Males (n = 642; 25.27%)
Females (n = 1,898; 74.72%)
p valuesa
Age, years Length of stay, days Mortality Diabetes mellitus Hypertension Hyperlipidemia CAD Smoking Alcohol abuse Ventricular arrhythmias Atrial fibrillation/atrial flutter Obesity Premature ventricular contractions Sick sinus syndrome Bundle branch block Pulmonary artery aneurysm Anxiety Cocaine consumption
43.9 (0.63) 5.57 (0.42) 0.57 13.81 34.96 17.37 12.07 13.14 3.87 1.01 3.82 7.17 0.41 4.02 0.99 0.39 9.92 1.98
40.17 (1.19) 5.33 (0.63) – 8.49 34.09 12.59 11.31 20.39 10.77 0.88 5.53 7.11 0.86 1.59 0.88 0.84 2.34 2.61
45.12 (0.73) 5.65 (0.52) 0.76 15.62 35.26 18.99 12.33 10.68 1.53 1.06 3.24 7.19 0.25 4.84 1.03 0.24 12.48 1.77
Received: May 20, 2014 Accepted: June 6, 2014 Published online: October 17, 2014
Predictors of Coronary Artery Disease in Patients with Behçet’s Disease Ambarish Pandey a Jalaj Garg b Parasuram Krishnamoorthy d Chandrasekar Palaniswamy b Jay Doshi c Gregg Lanier b Hasan Ahmad b a
Division of Cardiology, Department of Medicine, University of Texas, Dallas, Tex., b Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, N.Y., c Division of Cardiology, Department of Medicine, Albert Einstein School of Medicine, Montefiore Medical Center, New York, N.Y., and d Department of Medicine, Mount Sinai Englewood Hospital and Medical Center, Englewood, N.J., USA
Abstract Background: Behçet’s disease (BD) is a multisystem vasculitis of unknown etiology. We aimed to determine the prevalence and predictors of coronary artery disease (CAD) in patients with BD. Methods: All adult patients diagnosed with BD from the National Inpatient Sample database using the International Classification of Diseases 9th revision (ICD-9 code 136.1) during 2009–2010 were included in the analysis. We analyzed the demographics, traditional risk factors, prevalence, and predictors of CAD in patients with BD using ICD9 codes. Results: The prevalence of BD among adults was 0.006% (n = 2,540) of all in-hospital admissions in the USA. The mean age was 43.9 years, with women (45 years) being older than men (40 years) (p < 0.001). Traditional risk factors prevalent in our study were hypertension (35%), hyperlipidemia (17.4%), diabetes mellitus (13.8%), smoking (13.1%), and obesity (7.2%). The prevalence of CAD was 12.1%. Hypertension (OR = 2.20, p = 0.03) and hyperlipidemia (OR = 2.34, p = 0.02) were found to be independent predictors of
© 2014 S. Karger AG, Basel 0008–6312/14/1294–0203$39.50/0 E-Mail [email protected] www.karger.com/crd
CAD in a multimodel regression analysis. Conclusion: In patients with BD, traditional risk factors associated with CAD were similar to what is expected in the overall population. However, the young age of patients with CAD in this population suggests an accelerated course of atherosclerosis in BD. © 2014 S. Karger AG, Basel
Introduction
Behçet’s disease (BD) is a multisystem autoimmune disorder characterized by recurrent oral and genital ulcers and uveitis, and it is associated with significant vascular complications like thrombophlebitis, aneurysm formation, and thromboembolic occlusions [1–3]. Cardiovascular (CV) involvement in subjects with BD has not been well studied. BD is known to be associated with microvascular inflammation, focal fibrinoid deposition, and fibroblast proliferation in small-caliber coronary arteries, resulting in coronary thrombosis and aneurysms [4]. This has been associated with clinical manifestations such as myocardial ischemia, pericarditis, valvular disorders, arrhythmias, myocarditis, and left ventricular dysfunction [4, 5]. Most of the studies describing these CV involveJalaj Garg, MD Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College 100 Woods Road, PMB 495, Valhalla, NY 10595 (USA) E-Mail garg.jalaj @ yahoo.com
Downloaded by: NYU Medical Center Library 198.143.38.97 - 7/28/2015 6:41:22 PM
Key Words Behçet’s disease · Atherosclerosis · Arrhythmias · Hypertension · Hyperlipidemia
Table 1. Baseline demographics of patients with BD
Variables
Total population (n = 2,540)
Males (n = 642; 25.27%)
Females (n = 1,898; 74.72%)
p valuesa
Age, years Length of stay, days Mortality Diabetes mellitus Hypertension Hyperlipidemia CAD Smoking Alcohol abuse Ventricular arrhythmias Atrial fibrillation/atrial flutter Obesity Premature ventricular contractions Sick sinus syndrome Bundle branch block Pulmonary artery aneurysm Anxiety Cocaine consumption
43.9 (0.63) 5.57 (0.42) 0.57 13.81 34.96 17.37 12.07 13.14 3.87 1.01 3.82 7.17 0.41 4.02 0.99 0.39 9.92 1.98
40.17 (1.19) 5.33 (0.63) – 8.49 34.09 12.59 11.31 20.39 10.77 0.88 5.53 7.11 0.86 1.59 0.88 0.84 2.34 2.61
45.12 (0.73) 5.65 (0.52) 0.76 15.62 35.26 18.99 12.33 10.68 1.53 1.06 3.24 7.19 0.25 4.84 1.03 0.24 12.48 1.77
