Transcript Troponin T - ResearchGate

Cardiovascular risk management in patients with psychosis
Ass Prof. Sven V Eriksson (Dep. of Clinical Science, Danderyd Hospital)
[email protected]
https://www.researchgate.net/profile/Sven_Eriksson4
Disclosures
No relevant disclosures after 1999
No membership of industy advisory boards
No shareholdings in pharmaceutical companies
My research since 2012 on vacations/weekends
Previous paid lectures 1990 -1999 from:
Astra Zeneca, MSD, Merck, Sanofi, Pfizer, Bayer, Bristol-Myers
Squibb, and Boehringer Ingelheim, Ortivus AB, HewlettPackard, Philips Medical System
Research Grants from Ástra Zeneca 1993 and
Bristol-Myers Squibb 1999 for producing ”Patient
simultors on CD”
Cardiovascular risk management in
patients with psychosis Mayo-KI 150911
How do we treat these patients today
Some new results never presented before!
Markers of increased risk (ESC 150830)
Can we do better in the future?
New controversial solutions
[email protected]
Special interests
Medical Statistics
PIL Prov- och intervjubaserat urval till
läkarprogrammet
Heart and the brain
Psychosocial variables in relation to various risk factors in
patients with stable angina. JIM 2000;247:240-8
Patient simulators
Work with the Ösby group, Fesmire Group
Writing scientific papers in the right order
First introduction ……
Riskfactor for cardiovascular disase
Do we need Markers of increased risk?
I beat
schizophreinia
I beat
schizophrenia
Cardiovascular risk factors and metabolic syndrome in people with established psychotic
illnesses: baseline data from the IMPaCT randomized controlled trial
Psychologicl Medicine 2015 September:45:12:2619-29.
Stockholm Psychosís
Study (n=1085)
Variables
IMPaCT study
England (n=450)
Smokers (%)
62 %
41 %
Weight (kgs)
90
87
Body Mass Index (kg/m2)
31
29
123 (31%)
129 (61 %)
5.9
5.8
2.1 ( %)
1.8 (40%)
5,2 (53 %)
5,4
3.0
3.5
HDL Cholesterol,
1.2 (47 %)
1.2
Waist circumference
106 (83 %)
102 (66 %)
21 %
5%
Systolic blood pressure
FPG: (> 5,6 mmol/L)
Tg (> 1,7 mmol/L)
Total Cholesterol, mmol/L
LDL Cholesterol,
Lipid lowering theraphy
IMPaCT study
Sweden (n=145)
Cardiovascular risk in a first-episode psychosis
sample: a ‘critical period’ for prevention?
Schizophr Res 2011;127:257-61
Variables
First-episode psychosis
Controls (n=145)
(n=56)
Smokers
26 (46%)
52 (36%)
80.1 (14.2)
81.5 (23.3)
25.8 (4.8)
26.5 (7.0)
Systolic blood pressure
126.1 (13.5)
116.3 (10.5)
Diastolic blood pressure
71.3 (1.6)
63.9 (10.6)
0 (0%)
2 (1%)
9 (16%)
18 (12%)
Total Cholesterol, mg /dl
171.8 (28.1)
164.4 (33.5)
HDL Cholesterol, mg /dl
48.2 (11.3)
51.2 (12.9)
Prevalence of Metabolic Syndrome,
n (%)
11 (19.6%)
24 (16.6%)
1 (0-5)
0 (0-9)
Weight (kgs)
Body Mass Index (kg/m2)
NHANES-defined Diabetes
Impaired Fasting Glucose (FPG:
100-125mg/dl)
10-year risk for developing
coronary heart disease, %
Prescription of Statin (%) in Men and Women
with/without Schizophrenia in Stockholm
40
35
30
25
20
15
10
5
0
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
Men
Schizop. Men
Women
Scizop Women
Prescription (%) of insulin in Stockholm in men and
women with and without schizophrenia
16
14
12
10
8
6
4
2
0
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
Men
Schizop. Men
Women
Scizop Women
Prescription of metformin (%) in Stockholm
18
16
14
12
10
8
6
4
2
0
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
Men
Schizop. Men
Women
Scizop Women
Markers of increased cardiovascular risk
Brain Natriuretic Peptide (BNP)
High sensitve CRP
Troponin T
Glucose
LDL Choleserol
Fasting glucose as a risk marker in men
Fasting glucose as a risk marker in women
Scatterplot of Glucose_1 against Glucose_0
22
20
18
Glucose_1
16
14
12
10
8
6
4
2
2
4
6
8
10
12
Glucose_0
14
16
18
20
Scatterplot of LDL_1 against LDL_0
Sven 150803 in Sven 150825 ESC 97v*1203c
LDL_1 = 0,8627+0,7385*x
8
7
6
LDL_1
5
4
3
2
1
0
-1
0
1
2
3
4
LDL_0
5
6
7
8
9
Natriuretic peptides
NT-proBNP as predictor of hospitalization in
5875 unselected pat. (262 Scizophrenia)
Rosenberg et al. Eur Heart J 2009;30:66-73
BNP Measurement in Patients with psychiatric disease
*Nakae Ichiro et al Int j Med 2005; Eriksson SV et al ESC, 2015
*Psychiatric disease (n=60)
Stockholm psychosis study (n=300)
Median interquartile range
Controls
25 + 56 pg/ml
90 + 320
44 (19 77)
13 + 11
BNP may be useful for detecting cardiac
complications
Risk of future Cardiovascular Events
Reasons for increased levels of Plasma BNP
Heart failure
Myocardial infarction
Left ventricular hypertrophy
Pulmonary embolism
Pulmonary hypertension (COP)
Renal failure
Ascitic cirrhosis
High age
Cardiac inflammation eg. Myocarditis/olanzapin
Psychosis??
Troponin T
Increased Troponin T is not = cardiac injury
Satterplot of Troponin T against age and waist
3D Scatterplot of Age_0 against trop ok and Waist_0
Troponin T and BNP in patients with Psychosis
Scatteerplot of Troponin T against BNP
Spearman R = 0.15 p<0.001
35
Troponin T
30
25
20
15
10
5
0
-5-1000
0
1000
2000
3000
BNP
4000
5000
6000
C-Reactive Protein (CRP)
CRP as a marker of cardiovascular disease in patients
with a schizophrenia spectrum disorder treated in
routine medical practice
CRP in Stockholm Psychosis Study
Scatterplot CRP levels aginst BMI
55
50
45
BMI
40
35
30
25
20
15
-10,00
0,00
10,00
20,00
CRP
30,00
40,00
50,00
New lipid lowering therapy
Gastric Bypass
How to treat cardiovascular risk factors in patients
with psychosis in the future?
Markedly incressed use of high intensity statin treatment
Better treatment of hypertension
Smoke restriction for personell working with these patients
Screening with BNP and Troponin T to identify patients with
reduced heart function ?
Use of new lipid lowering theraphy
Gastric By-pass
Acknowledgements
Urban Ösby, Martin Schalling,
[email protected]
Snabbtest
Proprotein Convertase Subtilisin/Kexin
type 9 (PCSK9)
What are C-reactive proteins ?
C-reactive protein (CRP) is an
acute phase reactant made in
the liver.
Preserved through evolution
from Limulus polyhemus to man.
Named for its “capacity to
precipitate the somatic Cpolysaccharide of Streptococcus
pneumoniae”
Scatterplot CRP levels aginst BMI
55
50
45
BMI
40
35
30
25
20
15
-10,00
0,00
10,00
20,00
CRP
30,00
40,00
50,00
Risk of future Cardiovascular Events
Cumulative incidence of schizophrenia (top) and the combined endpoint of schizophrenia and
schizophrenia-like psychosis (bottom) as a function of age by quartiles of C-reactive protein
(CRP).
Wium-Andersen M K et al. Schizophr Bull
2013;schbul.sbt120
© The Author 2013. Published by Oxford University Press on behalf of the Maryland Psychiatric
Research Center. All rights reserved. For permissions, please email:
[email protected]
CRP levels in).Ctr, nonpsychiatric controls Ctr (N = 228) 0.991+1.15;
Scz, schizophrenia (N = 295) 1.85+2.00; Bp, Bipolar disorder (N = 192)
1.32+1.80. Schizophreia Research 2013;143,:198–202
How to treat cardiovascular risk factors in patients
with psychosis in the future?
Markedly incressed use of high intensity statin treatment
Better treatment of hypertensio
Smoke restriction for people personell working with these
patients
Screening with BNP and Troponin T to identify patients with
reduced heart function ?
Gastric By-pass
Use of new lipid lowering theraphy
Use of more effective drugs for weight loss
Cumulative incidence of schizophrenia (top) and the combined endpoint of schizophrenia and
schizophrenia-like psychosis (bottom) as a function of age by quartiles of C-reactive protein
(CRP).
Wium-Andersen M K et al. Schizophr Bull
2013;schbul.sbt120
© The Author 2013. Published by Oxford University Press on behalf of the Maryland Psychiatric
Research Center. All rights reserved. For permissions, please email:
[email protected]
CRP as a marker of cardiovascular disease in patients with a
schizophrenia treated in routine medical practice.
Marinar AS et al European Psychiatry 2011
Factors influencing Normal CRP levels
Gender
Body Mass Index
Ethnicity
Exercise
Alcohol Consumption
Infection
Factors influencing Normal CRP levels
Gender
Body Mass Index
Ethnicity
Exercise
Alcohol Consumption
Infection
Diseases CRP are related to
Atrial fibrillation?!
Stroke
Periodontal Disease
Rheumatic fever
Rheumatoid arthritis
Cancer
Diabetes
Alzheimer’s disease
Systemic lupus erythematosus (SLE)
Schizophrenia?
Troponin T
Chest pain common in
patients with
Routine test at the
emergency
department
Recommended ongoing monitoring Clozapine
induced myocarditis/cardiomyopathy 2012:
• BP- admission at week 6, week 18, 6 months
• ECG - 6 months and annually thereafter
• ECHO - 6 months, then thereafter if clinically indicated
• Troponin & CRP – Pre, first 4 weeks, week 6, week 18, at 6
months monthly unless clinically indicated
• CK-MB and NT-proBNP also advised should myocarditis be
suspected.
On onsafe
area