Improved angiographic findings in a high risk acute coronary syndrome patient after modest weight reduction, regular exercise and medication: A case report and literature review
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Sep 20, 2012
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Abstract
A 55-year-old, morbidly obese man body weight (BW) of 104 kg, body mass index (BMI) of 30.5 kg/m2 with known history of type 2 diabetes mellitus, hypertension, dyslipidemia and primary hypothyroidism, presented with acute chest pain and heart failure in 2007. Frank pulmonary edema and cardiomegaly were documented from admission chest film (Figure 1). The electrocardiogram (ECG) (Figure 2) showed sinus tachycardia, left atrial enlargement, tall R in V2 with ST depression in V2-4, Q wave and mild ST segment elevation in inferior leads.
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Veerakul G, Kitkungvan T, Bhatia N. Improved angiographic findings in a high risk acute coronary syndrome patient after modest weight reduction, regular exercise and medication: A case report and literature review. BKK Med J [Internet]. 2012 Sep. 20 [cited 2024 Nov. 13];4(1):50. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/217972
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Case Report
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References
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Wijns W, Kolh P, Danchin N, et al. Guidelines on myo cardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio Thoracic Surgery (EACTS). Eur Heart J 2010;31:2501-55.
Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/ Non-ST Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collab oration With the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Am Coll Cardiol 2011;57;1920-59.
Serruys PW, Morice MC, Kappetein AP, et al. Percuta neous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-72.
De Gonzales B, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010;363:2211-9.
Zheng W, McLerran DF, Rolland B, et al. Association between body mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364:719-29.
Park YW, Zhu S, Palaniappan L, et al. The metabolic syndrome: prevalence and associated risk factor findings in the U.S. population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2003;163:427-36.
Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55.
Juhan-Vague I, Alessi MC, Mavri A, et al. Plasminogen activator inhibitor-1 inflammation, obesity, insulin resis tance and vascular risk. J Thromb Haemost 2003;1:1575-9.
Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992;16:397-415
Grundy SM, Cleeman JI, Daniels SR, et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.
Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for health care professionals from the American Heart Association. Circulation 2001;104:1694-1740.
Segasothy M, Phillips PA. Vegetarian diet; panacea for modern lifestyle disease? Q J Med 1999;92:531-44.
Linke A, Erbs S, Hambrecht R. Effects of exercise training upon endothelial function in patients with cardiovascular disease. Front Biosci 2008;13:424-32.
Thompson PD, Buchner D, Pina IL, et al. For the American Heart Association. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003;107:3109-16.
Leon AS, Franklin BA, Costa F, et al. Cardiac reha bilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111:369-76.
Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guideline for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart Lung, and Blood Institute. Circulation 2006;113:2363-72.
Vecchia CL, Decarli A, Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology 1998;9:208-10
Singh RB, Rastogi SS, Veram R, et al. An Indian experi ment with nutritional modulation in acute myocardial infarction. Am J Cardiol 1992;69:879-85.
Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-7.
Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary athero sclerosis: Results of the NHLBI type II coronary inter vention study. Circulation 1984;69:313-24.
MAAS Investigators. Effects of simvastatin on coronary atheroma. Lancet 1994;344:633-38.
Blankenhorn DH, Nessim SA, Johnson RL, et al. Beneficial effects of combine colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass graft. JAMA 1987;257:3233-40.
Ornish DM, Scherwitz LW, Brown SE, et al. Can lifestyle changes reverse atherosclerosis? Lancet 1990; 336:129-33.
Gould KL, Ornish D, Kirkeeide R, et al. Improve stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol 1992; 69:845-53.
Brown GB, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid lowering therapy in men with high level of apolipoprotein B. New Engl J Med 1990;323:1289-98.
Kane JP, Malloy MJ, Ports TA, et al. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990;264:3007-12.
Schuler G, Hambrecht R, Schlierf G, et al. Myocardial perfusion and regression of coronary artery disease in patients on a regimen of intensive physical exercise and low fat diet. J Am Coll Cardiol 1992;19:34-42
Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low fat diet: effects on progression of coronary artery disease. Circulation 1992;86:1-11.
Blankenhorn DH, Azren S, Kramsch DM, et al. Coronary angiographic changes with lovastatin therapy. Ann Intern Med 1993;119:969-76.
Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994;89:975-90.
Scandinavian Simvastatin Survival Study (4S). Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet 1994; 344:1383-89.
Shepherd J, Cobbe SM, Ford I, et al. For the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New Engl J Med 1995;333:1301-07.
Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol. N Engl J Med 1996;335:1001-9.
The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardio vascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Eng J Med 1998;339:1349-57.
Pedersen TR, Faergerman O, Kastelein JJ, et al. High-dose atorvastatin vs. usual dose simvastatin for secondary prevention after myocardial infarction; the IDEAL study: a randomized control trial. JAMA 2005; 294:2437-45.
Jensen LO, Thayssen P, Pedersen KE, et al. Regression of Coronary Atherosclerosis by Simvastatin: A Serial Intravascular Ultrasound Study. Circulation 2004;110: 265-70.
Nissen SE, Nichols SJ, Sipahi I, et al. Effect of Intensive compared with moderate lipid lowering therapy on progression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-65.
Nicholls SJ, Ballantyne CM, Barter PJ, et al. Effect of Two Intensive Statin Regimens on Progression of Coronary Disease. N Engl J Med 2011;365:2078-87.
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Force of the European Society of cardiology and Other Societies on cardiovascular Disease prevention in clinical Practice. Eur Heart J 2012;33:1635-701
Wijns W, Kolh P, Danchin N, et al. Guidelines on myo cardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio Thoracic Surgery (EACTS). Eur Heart J 2010;31:2501-55.
Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/ Non-ST Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collab oration With the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Am Coll Cardiol 2011;57;1920-59.
Serruys PW, Morice MC, Kappetein AP, et al. Percuta neous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-72.
De Gonzales B, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010;363:2211-9.
Zheng W, McLerran DF, Rolland B, et al. Association between body mass index and risk of death in more than 1 million Asians. N Engl J Med 2011;364:719-29.
Park YW, Zhu S, Palaniappan L, et al. The metabolic syndrome: prevalence and associated risk factor findings in the U.S. population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2003;163:427-36.
Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55.
Juhan-Vague I, Alessi MC, Mavri A, et al. Plasminogen activator inhibitor-1 inflammation, obesity, insulin resis tance and vascular risk. J Thromb Haemost 2003;1:1575-9.
Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992;16:397-415
Grundy SM, Cleeman JI, Daniels SR, et al. American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.
Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for health care professionals from the American Heart Association. Circulation 2001;104:1694-1740.
Segasothy M, Phillips PA. Vegetarian diet; panacea for modern lifestyle disease? Q J Med 1999;92:531-44.
Linke A, Erbs S, Hambrecht R. Effects of exercise training upon endothelial function in patients with cardiovascular disease. Front Biosci 2008;13:424-32.
Thompson PD, Buchner D, Pina IL, et al. For the American Heart Association. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003;107:3109-16.
Leon AS, Franklin BA, Costa F, et al. Cardiac reha bilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111:369-76.
Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guideline for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart Lung, and Blood Institute. Circulation 2006;113:2363-72.
Vecchia CL, Decarli A, Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology 1998;9:208-10
Singh RB, Rastogi SS, Veram R, et al. An Indian experi ment with nutritional modulation in acute myocardial infarction. Am J Cardiol 1992;69:879-85.
Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-7.
Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary athero sclerosis: Results of the NHLBI type II coronary inter vention study. Circulation 1984;69:313-24.
MAAS Investigators. Effects of simvastatin on coronary atheroma. Lancet 1994;344:633-38.
Blankenhorn DH, Nessim SA, Johnson RL, et al. Beneficial effects of combine colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass graft. JAMA 1987;257:3233-40.
Ornish DM, Scherwitz LW, Brown SE, et al. Can lifestyle changes reverse atherosclerosis? Lancet 1990; 336:129-33.
Gould KL, Ornish D, Kirkeeide R, et al. Improve stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol 1992; 69:845-53.
Brown GB, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid lowering therapy in men with high level of apolipoprotein B. New Engl J Med 1990;323:1289-98.
Kane JP, Malloy MJ, Ports TA, et al. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA 1990;264:3007-12.
Schuler G, Hambrecht R, Schlierf G, et al. Myocardial perfusion and regression of coronary artery disease in patients on a regimen of intensive physical exercise and low fat diet. J Am Coll Cardiol 1992;19:34-42
Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low fat diet: effects on progression of coronary artery disease. Circulation 1992;86:1-11.
Blankenhorn DH, Azren S, Kramsch DM, et al. Coronary angiographic changes with lovastatin therapy. Ann Intern Med 1993;119:969-76.
Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994;89:975-90.
Scandinavian Simvastatin Survival Study (4S). Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet 1994; 344:1383-89.
Shepherd J, Cobbe SM, Ford I, et al. For the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New Engl J Med 1995;333:1301-07.
Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol. N Engl J Med 1996;335:1001-9.
The Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) Study Group. Prevention of cardio vascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Eng J Med 1998;339:1349-57.
Pedersen TR, Faergerman O, Kastelein JJ, et al. High-dose atorvastatin vs. usual dose simvastatin for secondary prevention after myocardial infarction; the IDEAL study: a randomized control trial. JAMA 2005; 294:2437-45.
Jensen LO, Thayssen P, Pedersen KE, et al. Regression of Coronary Atherosclerosis by Simvastatin: A Serial Intravascular Ultrasound Study. Circulation 2004;110: 265-70.
Nissen SE, Nichols SJ, Sipahi I, et al. Effect of Intensive compared with moderate lipid lowering therapy on progression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006;295:1556-65.
Nicholls SJ, Ballantyne CM, Barter PJ, et al. Effect of Two Intensive Statin Regimens on Progression of Coronary Disease. N Engl J Med 2011;365:2078-87.
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Force of the European Society of cardiology and Other Societies on cardiovascular Disease prevention in clinical Practice. Eur Heart J 2012;33:1635-701