PREDICTORS OF CORONARY ARTERY DISEASE IN PATIENTS WITH POLYCYTHEMIA VERA AND ESSENTIAL THROMBOCYTOSIS: RESULTS FROM THE NATIONAL INPATIENT SAMPLE 2009-10.
Background: Myelproliferative disorders (MPDs) including Polycythemia Vera (PCV) and Essential thrombocytosis (ET) are associated with increase in arterial and venous thromboembolic events. Chronic endothelial damage, hyperviscosity and platelet activation are possible mechanistic factors resulting in accelerated atherogenesis and coronary artery disease (CAD). However the differences in prevalence of CAD and traditional risk factors (TRFs) between PCV and ET are unknown. Hence, we aimed to determine the prevalence and predictors of CAD in PCV and ET patients using a national registry.
Methods: All patients ≥18 years diagnosed with PCV and ET were identified in the Nationwide Inpatient Sample (NIS) 2009-2010 database using 9th revision of International Classification of Diseases (ICD) codes 238.4 and 238.71 respectively. Demographic factors namely age, gender, race and TRFs including diabetes, hypertension, hyperlipidemia and tobacco use were identified. Multivariate logistic regression was performed to evaluate the predictors of CAD.
Results: Prevalence of PCV was 0.08% (n=38,393) and ET was 0.17% (n=77,109) of all discharges. Mean age of the population was 61.2±0.1 years and 54% were females. CAD was present in 22% of the total population with significant difference in PCV compared to ET (26% vs 19%; p<0.0001). Traditional risk factors including age (64±0.2 vs 60±0.2; p<0.001), male sex (58% vs 41%; p<0.0001), hypertension (64% vs 51%; p<0.0001), hyperlipidemia (29% versus 22%; p<0.0001) and tobacco use (25% vs 17%; p<0.0001) were more prevalent in PCV. In hospital mortality was 2.8% with increase mortality in PCV (3.5 vs 2.4%; p<0.0001). ET predicted less CAD even after adjusting for demographics and all traditional risk factors [0.85 (0.79-0.92); p=0.000].
Conclusions: CAD is present in 22% of patients with PCV and ET. PCV was associated with increase in TRFs, CAD and in hospital mortality rates compared to ET. In addition, ET predicted less CAD after adjusting for all confounding factors. These findings warrant increase awareness of CAD in patients with MPDs and aggressive management especially in PCV
Published In/Presented At
Krishnamoorthy, P. Mittal, V. Garg, J. Shah, N. Patel, N. C. (2016). PREDICTORS OF CORONARY ARTERY DISEASE IN PATIENTS WITH POLYCYTHEMIA VERA AND ESSENTIAL THROMBOCYTOSIS: RESULTS FROM THE NATIONAL INPATIENT SAMPLE 2009-10. Journal of the American College of Cardiology, 67(13).
Cardiology | Medical Sciences | Medicine and Health Sciences
Department of Medicine, Department of Medicine Faculty, Cardiology Division