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Article: CHA2DS2-VASc Score as a Predictor of Adverse Outcomes after Ischemic Stroke in Patients without Atrial Fibrillation.

Aker, Amir / Volis, Ina / Saliba, Walid / Naoum, Ibrahim / Zafrir, Barak

The Israel Medical Association journal : IMAJ

2024 Volume 26, Issue 3, Page(s) 143–148

Abstract: Background: Ischemic stroke is associated with increased risk of morbidity and mortality in future vascular events.: Objectives: To investigate whether CHA2DS2-VASc scores aid in risk stratification of middle-aged patients without atrial fibrillation ...

Abstract	Background: Ischemic stroke is associated with increased risk of morbidity and mortality in future vascular events. Objectives: To investigate whether CHA2DS2-VASc scores aid in risk stratification of middle-aged patients without atrial fibrillation (AF) experiencing ischemic stroke. Methods: We analyzed data of 2628 patients, aged 40-65 years with no known AF who presented with acute ischemic stroke between January 2020 and February 2022. We explored the association between CHA2DS2-VASc scores categorized by subgroups (score 2-3, 4-5, or 6-7) with major adverse cardiac and cerebrovascular events (MACCE) including recurrent stroke, myocardial infarction, coronary revascularization, or all-cause death during a median follow-up of 19.9 months. Results: Mean age was 57 years (30% women); half were defined as low socioeconomic status. Co-morbidities included hypertension, diabetes, obesity, and smoking in 40-60% of the patients. The incidence rate of MACCE per 100 person-years was 6.7, 12.2, and 21.2 in those with score 2-3, 4-5, and 6-7, respectively. In a multivariate cox regression model, compared to patients with score 2-3 (reference group), those with score 4-5 and 6-7 had an adjusted hazard ratio (95% confidence interval [95%CI]) for MACCE of 1.74 (95%CI 1.41-2.14) and 2.87 (95%CI 2.10-3.93), respectively. The discriminative capacity of CHA2DS2-VASc score for overall MACCE was modest (area under curve 0.63; 95%CI 0.60-0.66), although better for myocardial infarction 0.69 (95% CI 0.61-0.77). Conclusions: CHA2DS2-VASc score may predict future MACCE in middle-aged patients with ischemic stroke and no history of AF.
MeSH term(s)	Middle Aged ; Humans ; Female ; Male ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Stroke/epidemiology ; Stroke/etiology ; Ischemic Stroke/complications ; Risk Assessment ; Myocardial Infarction/complications ; Risk Factors
Language	English
Publishing date	2024-03-16
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 5470: Show issues

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Article ; Online: Pulsed-Field Ablation of AV Nodal Re-Entrant Tachycardia: Are We Shooting the AV Node?

Nakagawa, Hiroshi / Sugawara, Masafumi / Saliba, Walid I / Hussein, Ayman A

JACC. Clinical electrophysiology

2023 Volume 10, Issue 1, Page(s) 93–95

MeSH term(s)	Humans ; Atrioventricular Node/surgery ; Tachycardia, Atrioventricular Nodal Reentry/surgery ; Heart Block ; Tachycardia, Supraventricular
Language	English
Publishing date	2023-11-29
Publishing country	United States
Document type	Editorial
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2023.10.020
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Article ; Online: Lipoprotein(a) testing in clinical practice: real-life data from a large healthcare provider.

Zafrir, Barak / Aker, Amir / Saliba, Walid

European journal of preventive cardiology

2022 Volume 29, Issue 14, Page(s) e331–e333

MeSH term(s)	Humans ; Lipoprotein(a) ; Health Personnel
Chemical Substances	Lipoprotein(a)
Language	English
Publishing date	2022-06-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2626011-6
ISSN	2047-4881 ; 2047-4873
ISSN (online)	2047-4881
ISSN	2047-4873
DOI	10.1093/eurjpc/zwac124
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Zs.A 4686: Show issues

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Article ; Online: Extreme lipoprotein(a) in clinical practice: A cross sectional study.

Zafrir, Barak / Aker, Amir / Saliba, Walid

International journal of cardiology. Cardiovascular risk and prevention

2023 Volume 16, Page(s) 200173

Abstract: Introduction: Measurement of lipoprotein(a) [Lp(a)] is recommended once in a lifetime to identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to analyze the clinical features of patients with extreme Lp(a).: ... ...

Abstract	Introduction: Measurement of lipoprotein(a) [Lp(a)] is recommended once in a lifetime to identify individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to analyze the clinical features of patients with extreme Lp(a). Methods: Cross-sectional, case-control study of a single healthcare organization between 2015 and 2021. Individuals with extreme Lp(a) > 430 nmol/L (53 of 3900 tested patients) were compared to age- and sex-matched controls with normal range Lp(a). Results: Mean patient age was 58 ± 14 years (49% women). Myocardial infarction (47.2% vs. 18.9%), coronary artery disease (CAD) (62.3% vs. 28.3%), and peripheral artery disease (PAD) or stroke (22.6% vs. 11.3%) were more prevalent in patients with extreme than normal range Lp(a). The adjusted odds ratio [95% confidence interval (CI)] associated with extreme compared to normal range Lp(a) was 2.50 (1.20-5.21) for myocardial infarction, 2.20 (1.20-4.05) for CAD, and 2.75 (0.88-8.64) for PAD or stroke. A high-intensity statin plus ezetimibe combination was issued by 33% and 20% of CAD patients with extreme and normal range Lp(a), respectively. In patients with CAD, low density lipoprotein cholesterol (LDL-C) <55 mg/dL was achieved in 36% of those with extreme Lp(a) and 47% of those with normal range Lp(a). Conclusions: Extremely elevated Lp(a) levels are associated with an approximately 2.5-fold increased risk of ASCVD compared with normal range Lp(a) levels. Although lipid-lowering treatment is more intense in CAD patients with extreme Lp(a), combination therapies are underused, and attainment rates of LDL-C goals are suboptimal.
Language	English
Publishing date	2023-01-13
Publishing country	Netherlands
Document type	Journal Article
ISSN	2772-4875
ISSN (online)	2772-4875
DOI	10.1016/j.ijcrp.2023.200173
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Article: Remnant cholesterol and risk of myocardial infarction in patients with coronary artery disease undergoing revascularization.

Zafrir, Barak / Khoury, Razi / Saliba, Walid

Journal of clinical lipidology

2023 Volume 17, Issue 3, Page(s) 332–341

Abstract: Background: Despite substantial reduction in low-density lipoprotein cholesterol (LDL-C), patients develop recurrent cardiovascular events. Remnant cholesterol (RC), the cholesterol content of triglyceride-rich lipoproteins, is a potential contributor ... ...

Abstract	Background: Despite substantial reduction in low-density lipoprotein cholesterol (LDL-C), patients develop recurrent cardiovascular events. Remnant cholesterol (RC), the cholesterol content of triglyceride-rich lipoproteins, is a potential contributor to this residual risk. Objectives: To investigate the association between RC and risk for myocardial infarction (MI) in patients with coronary artery disease, and examine whether the predictive value of RC is retained beyond non-high-density lipoprotein cholesterol (non-HDL-C). Methods: Data on 9451 patients undergoing coronary revascularization in a single center. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus LDL-C (estimated using Martin-Hopkins equation). Cox-regression models were used to estimate the association between RC and risk for MI. Discordance analyses were performed to examine the correlation between RC and non-HDL-C (or LDL-C) in relation to MI risk. Results: Mean age was 65±11 years; 67% presented with acute coronary syndrome. During median follow-up of 9.6 years, 1690 patients developed MI. After multivariable adjustment including lipid-lowering therapies and non-HDL-C, RC was associated with higher MI risk: hazard ratio (95% confidence interval): 1.36 (1.20-1.56) and 1.58 (1.35-1.85) in those with RC levels ≥75th (32.6 mg/dL) and ≥90th (41.8 mg/dL) percentile, compared to RC <50th percentile (25.5 mg/dL). When RC and non-HDL-C (or LDL-C) levels were discordant, the level of RC better reflected the risk for MI. Conclusions: Elevated RC is a risk factor for MI independent of lipid-lowering therapies and non-HDL-C, providing further support that RC may serve as a residual cardiovascular risk marker and potential treatment target in patients with coronary artery disease.
MeSH term(s)	Humans ; Middle Aged ; Aged ; Coronary Artery Disease/complications ; Coronary Artery Disease/surgery ; Cholesterol, LDL ; Cholesterol ; Myocardial Infarction/complications ; Triglycerides ; Cholesterol, HDL ; Risk Factors
Chemical Substances	Cholesterol, LDL ; Cholesterol (97C5T2UQ7J) ; Triglycerides ; Cholesterol, HDL
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2365061-8
ISSN	1876-4789 ; 1933-2874
ISSN (online)	1876-4789
ISSN	1933-2874
DOI	10.1016/j.jacl.2023.03.009
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Guideline-Directed Low-Density Lipoprotein Cholesterol Management After Acute Ischemic Stroke: Findings from a National Health Care Service.

Zafrir, Barak / Aker, Amir / Naoum, Ibrahim / Saliba, Walid

The American journal of cardiology

2023 Volume 203, Page(s) 332–338

Abstract: Patients with ischemic stroke are at high risk for future cardiovascular events and should be treated intensively with lipid-modifying agents. Combination lipid-lowering therapies are often needed to achieve updated guideline-directed treatment goals. ... ...

Abstract	Patients with ischemic stroke are at high risk for future cardiovascular events and should be treated intensively with lipid-modifying agents. Combination lipid-lowering therapies are often needed to achieve updated guideline-directed treatment goals. However, real-world data on intensification of lipid-lowering therapies and attainment of low-density lipoprotein cholesterol (LDL-C) targets early after ischemic stroke are limited. We extracted data from the largest healthcare provider in Israel on patients hospitalized with acute ischemic stroke between January 2020 and February 2022. Included were 3,027 patients surviving ≥1 year after stroke, with documented LDL-C levels and lipid-lowering medications at 2 time periods (0 to 3 months and 6 to 12 months after discharge). Participants were classified according to preexisting stroke and/or coronary artery disease. The use of combination lipid-lowering therapy (ezetimibe and/or proprotein convertase subtilisin/kexin type 9 [monoclonal antibodies] inhibitor plus statin) in the study population increased between the 2 timepoints from 3.6% to 5.1%, reaching 10.5% in those with previous coronary artery disease and stroke. LDL-C levels <70 and <55 mg/100 ml were attained by 42.3% and 22.9% of patients early after hospitalization, and in 49.5% and 27.1% during 6 to 12 months after hospitalization, respectively. Attainment of guideline-recommended LDL-C goals was higher in patients treated with combination lipid-lowering therapies and in those with preexisting cardiovascular disease. In conclusion, despite the advances in drug development and the availability of several mechanisms to lower cholesterol levels, the attainment of guideline-recommended LDL-C targets after acute ischemic stroke is suboptimal. Intensification of treatment with combination lipid-lowering therapies after hospitalization is uncommonly performed in clinical practice, even in those with preexisting cardiovascular disease.
MeSH term(s)	Humans ; Cholesterol, LDL ; Ischemic Stroke/drug therapy ; Cardiovascular Diseases/drug therapy ; Hypercholesterolemia/drug therapy ; Coronary Artery Disease/drug therapy ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Stroke/drug therapy ; Ezetimibe ; Delivery of Health Care ; Anticholesteremic Agents/therapeutic use
Chemical Substances	Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Ezetimibe (EOR26LQQ24) ; Anticholesteremic Agents
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2023.07.032
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Ui IV Zs.73: Show issues

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Article: Inhaled corticosteroids and COVID-19 outcomes in asthma: the Israeli experience.

Adir, Yochai / Fireman Klein, Einat / Saliba, Walid

ERJ open research

2022 Volume 8, Issue 1

Abstract: The use of ICS is safe and people living with #asthma should continue to take their prescribed medication as usual during the #COVID19 ... ...

Abstract	The use of ICS is safe and people living with #asthma should continue to take their prescribed medication as usual during the #COVID19 pandemic
Language	English
Publishing date	2022-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2827830-6
ISSN	2312-0541
ISSN	2312-0541
DOI	10.1183/23120541.00014-2022
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Article ; Online: Sudden Sensorineural Hearing Loss and COVID-19 Vaccination Revisited-An Ongoing Conversation-Reply.

Yanir, Yoav / Doweck, Ilana / Saliba, Walid

JAMA otolaryngology-- head & neck surgery

2022 Volume 148, Issue 8, Page(s) 795

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-06-30
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701825-8
ISSN	2168-619X ; 2168-6181
ISSN (online)	2168-619X
ISSN	2168-6181
DOI	10.1001/jamaoto.2022.1571
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Ul II Zs.87: Show issues

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Article ; Online: Inhaled corticosteroids and COVID-19 outcomes in asthma

Yochai Adir / Einat Fireman Klein / Walid Saliba

ERJ Open Research, Vol 8, Iss

the Israeli experience

2022 Volume 1

Keywords	Medicine ; R
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	European Respiratory Society
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Emerging Clinical Features of Acute Mastoiditis in Israel: A Registry Based Cohort.

Samuel, Orit / Saliba, Walid / Stein, Nili / Shiner, Yotam / Cohen-Kerem, Raanan

The Pediatric infectious disease journal

2024

Abstract: Background and objectives: Acute mastoiditis (AM) is a severe infection in the young population, with possible life-threatening complications. This study aimed to characterize AM presentation, symptoms and signs, complications, and management, over a ... ...

Abstract	Background and objectives: Acute mastoiditis (AM) is a severe infection in the young population, with possible life-threatening complications. This study aimed to characterize AM presentation, symptoms and signs, complications, and management, over a period of 10 years. Methods: This large-scale population-based cohort studied "Clalit Health Care" records, to include patients <18 years diagnosed with AM, hospitalized between the years 2008-2018. After validation, we investigated clinical symptoms and signs, pneumococcal vaccination status, complications, laboratory and microbiological parameters, imaging, antibiotic treatment and surgical interventions. Results: AM was diagnosed in 1189 patients, mean age of 2.71 years and 591 (49.71%) were female. Most presented with protrusion of pinna (83.1%), retro auricular redness (73.5%) and fever (71.8%). Patients <2 years of age had more symptoms (3.8 ± 1.4, opposed to 3.6 ± 1.5, P = 0.006) and showed higher white blood cell count and C-reactive protein values. Local and intracranial complications occurred in 233 (20.8%) and 75 (6.5%) patients, respectively. Complications were associated with increased white blood cell count and C-reactive protein and related to bacterial type, specifically Fusobacterium necrophorum (P < 0.0001), for which 50% had an intracranial complication. Between the years 2008-2018, Streptococcus pneumoniae-positive cultures decreased (30.9% to 10.3%, P > 0.0001) as opposed to group-A Streptococcus (10.9% to 30.9%, P = 0.002). Conclusions: This study shows a difference in AM appearance in the <2 years population and the association between white blood cell count, C-reactive protein and microbiology results with the occurrence of a complication. This may play a role in the management process, such as imaging and intervention needs. Although performed during the pneumococcal vaccine era, the disease microbiology was shown to change significantly throughout the study.
Language	English
Publishing date	2024-03-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000004325
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