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Giugliano D, Esposito K, De Nicola L. Diabetic kidney disease: The fourth pharmacological pillar may be semaglutide. Diabetes Obes Metab 2024; 26:4813-4815. [PMID: 39219442 DOI: 10.1111/dom.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Dario Giugliano
- Endocrine and Metabolic Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Katherine Esposito
- Endocrine and Metabolic Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Luca De Nicola
- Nephrologic Unit, Department of Advanced Medical and Surgical Sciences, Università della Campania Luigi Vanvitelli, Naples, Italy
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Yang J, Zhao ML, Jiang LH, Zhang YW, Ma TT, Lou CR, Lu WF, Zhao Y, Lu Q. Association between single and multiple cardiometabolic diseases and all-cause mortality among Chinese older adults: A prospective, nationwide cohort study. Nutr Metab Cardiovasc Dis 2024; 34:2570-2578. [PMID: 39098378 DOI: 10.1016/j.numecd.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND AIM Cardiometabolic diseases (CMDs) are leading causes of death and disability, but little is known about the additive mortality effects of multiple CMDs. This study aimed to examine the association between single and multiple CMDs and all-cause mortality among older Chinese population. METHODS AND RESULTS Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database, we analyzed data from 2008 to 2018 to assess the relationship between CMDs and mortality. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for single and multiple CMDs. At baseline, 11,351 participants (56.9% female) aged 60 years or older were included. 11.91% of participants had a single CMD, 1.51% had two CMDs, and 0.22% had three CMDs. Over a decade follow-up, 8992 deaths (79.2%) were recorded. A dose-response relationship was observed, with the mortality risk increasing by 17% for each additional disease. The fully-adjusted HRs for all-cause mortality were 1.16, 1.36, and 2.03 for one, two, and three CMDs, respectively. Larger effects of single and multiple CMDs were observed in the male group (P = 0.015) and the younger senior group (P < 0.001). CONCLUSIONS This large-scale study found that CMDs multiply mortality risks, especially in younger seniors and males. The risk is highest when heart disease and stroke coexist, and diabetes further increases it. Public health efforts should prioritize evidence-based management and prevention of CMDs.
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Affiliation(s)
- Jin Yang
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China
| | - Mei-Li Zhao
- Neurology Department, The Second Hospital of Tianjin Medical University, 300211, Tianjin, China
| | - Li-Hong Jiang
- Neurology Department, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Yan-Wen Zhang
- Cardiology Department, Tianjin Medical University General Hospital, Tianjin, 300070, China
| | - Ting-Ting Ma
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China
| | - Chun-Rui Lou
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China
| | - Wen-Feng Lu
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China; Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Hong Kong, 100872, China.
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin, 300070, China.
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Cui Z, Yi X, Huang Y, Li M, Zhang Z, Kuang L, Song R, Liu J, Pan R, Yi W, Jin X, Song J, Cheng J, Wang W, Su H. Effects of socioeconomic status and regional inequality on the association between PM 2.5 and its components and cardiometabolic multimorbidity: A multicenter population-based survey in eastern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 946:174453. [PMID: 38964410 DOI: 10.1016/j.scitotenv.2024.174453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Despite evidence linking fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM), the impact of its components remains unclear. Socioeconomic status (SES) and regional disparities may confound their association. We aim to evaluate the associations between PM2.5 components and CMM and explore how socioeconomic status and regional disparities affect these relationships. METHODS We recruited 108,941 participants aged 35-76 years from ten cities in eastern China. Individual exposure was assessed using Tracking Air Pollution in China (TAP) data, including PM2.5 and five components: ammonium (NH4+), black carbon (BC), nitrates (NO3-), organic matter (OM), and sulfates (SO42-). Generalized linear models and quantile g-computation models were employed to quantify the effects of PM2.5 components on CMM and to identify key components. Stratified analyses were performed to investigate the modifying effect of SES and regional disparities. RESULTS For each increase in interquartile range (IQR), BC (odds ratio [OR] 1.37, 95 % CI 1.29-1.47), OM (1.38, 1.29-1.48), NH4+ (1.31, 1.21-1.40), NO3- (1.34, 1.25-1.44), and SO42- (1.28, 1.20-1.38) were positively associated with CMM. Joint exposure to five components was significantly positively associated with CMM (OR: 1.27, 95 % CI: 1.21-1.33), with SO42- having the highest estimated weight, followed by NO3- and BC. These associations were stronger for participants from low socio-economic status and poor regions. CONCLUSION In summary, we found a stronger hazard effect of PM2.5 and its components on CMM, compared to those suffering from CMDs, particularly among participants with low socioeconomic status and in poor regions. SO42- may be a primary contributor to the association between PM2.5 components and CMM. These findings underscore the importance of prioritizing CMM and targeting SO42-related pollution sources in health policies, particularly amid China's aging population, reducing environmental health inequalities is critical.
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Affiliation(s)
- Zhiqian Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Xinxu Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Yuxin Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Ming Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Zichen Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Lingmei Kuang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Rong Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Jintao Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Rubing Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Weizhuo Yi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Xiaoyu Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Jian Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | - Jian Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China
| | | | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui 230032, China.
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Chen D, Zhang Y, Zhou Y, Liang Z. Association of Short-term Pain and Chronic Pain Intensity With Cardiometabolic Multimorbidity Progression: A Multistate Markov Model Analysis. Anesth Analg 2024:00000539-990000000-00973. [PMID: 39383101 DOI: 10.1213/ane.0000000000007228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
BACKGROUND The impact of pain intensity on the progression trajectories of cardiometabolic multimorbidity (CMM) is not well understood. We attempted to dissect the relationship of short-term pain (STP) and chronic pain intensity with the temporal progression of CMM. METHODS We conducted a prospective cohort study based on the UK Biobank participants. Incident cases of cardiometabolic diseases (CMDs) were identified based on self-reported information and multiple health-related records in the UK Biobank. CMM was defined as the occurrence of at least 2 CMDs, including heart failure (HF), ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D). The pain intensity was categorized into 5 levels based on pain duration and the number of sites involved, including chronic widespread pain (CWSP), chronic multilocation pain (CMLP), chronic single-location pain (CSLP), STP, and free-of-pain (FOP). Multistate models were used to assess the impact of pain intensity on the CMM trajectories from enrollment to initial cardiometabolic disease (ICMD), subsequently to CMM, and ultimately to death. RESULTS A total of 429,145 participants were included. Over the course of a 12.8-year median follow-up, 13.1% (56,137/429,145) developed ICMD, 19.6% (10,979/56,137) further progressed to CMM, and a total of 5.3% (22,775/429,145) died. Compared with FOP, CMLP (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.06-1.17) and CWSP (HR, 1.26; 95% CI, 1.13-1.42) elevated the risk of transitioning from ICMD to CMM. STP (HR, 0.89; 95% CI, 0.82-0.96), CSLP (HR, 0.88; 95% CI, 0.82-0.95), and CMLP (HR, 0.87; 95% CI, 0.81-0.93) lowered the risk of transition from ICMD to mortality, and STP also reduced the risk of transition from enrollment to mortality (HR, 0.94; 95% CI, 0.89-0.98). The results of disease-specific transitions revealed that the influence of pain intensity varied across transitional stages. Specifically, CMLP and CWSP heightened the risk of conversion from T2D or IHD to CMM, whereas only CWSP substantially elevated the transition risk from HF to CMM. CONCLUSIONS Our results highlighted reductions in chronic pain may mitigate both the onset and progression of CMM, potentially having an important impact on future revisions of cardiometabolic and pain-related guidelines.
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Affiliation(s)
- Dongze Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yali Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Yi Zhou
- Department of Third Research, Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Zhisheng Liang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Mou P, Qu H, Guan J, Yao Y, Zhang Z, Dong J. Extreme temperature events, functional dependency, and cardiometabolic multimorbidity: Insights from a national cohort study in China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 284:117013. [PMID: 39241607 DOI: 10.1016/j.ecoenv.2024.117013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Extreme temperature events (ETEs), including heatwaves and cold spells, are attracting increasing attention because of their impacts on human health. However, the association between ETEs and cardiometabolic multimorbidity (CMM) and the role of functional dependency in this relationship remain unclear. METHODS A prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, considering 12 definitions each for heatwaves and cold spells, and three levels of functional dependency. Mixed Cox models with time-varying variables were used to comprehensively assess the independent and combined effects of ETEs and functional dependency on CMM. Additionally, subgroup analyses were conducted to investigate whether the relationship between ETEs and CMM was modified by the baseline characteristics. RESULTS Heatwave and cold spell exposures were associated with an increased risk of CMM (HR range: 1.028-1.102 and 1.046-1.187, respectively). Compared to participants with normal functional abilities, the risk of CMM increased with higher levels of functional dependency (HR range: 1.938-2.185). ETEs exposure and functional dependency are jointly associated with CMM risk. Participants with high-intensity ETEs exposure and high functional dependency had the greatest risk of developing CMM. Participants aged 60 and above were more susceptible to the effects of ETEs on CMM. Additionally, urban residents and those in northern regions were more vulnerable to heatwaves. CONCLUSION Both ETEs exposure and functional dependency increase the risk of developing CMM. Participants with functional dependency exposed to high-intensity ETEs faced the highest risk of developing CMM. These findings highlight the significant impact of ETEs on CMM and the importance of protecting vulnerable populations during periods of extreme temperature.
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Affiliation(s)
- Pengsen Mou
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China; Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China
| | - Huiyan Qu
- Yichang Center for Disease Control and Prevention, Yichang, PR China
| | - Jiaxin Guan
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China; Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China
| | - Yuxin Yao
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China; Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China
| | - Zhongbo Zhang
- Department of Pancreatic and Biliary Surgery, The First Hospital of China Medical University, 155 Nanjing North Street, Heping, Shenyang 110001, PR China.
| | - Jing Dong
- Key Laboratory of Environmental Stress and Chronic Disease Control and Prevention, Ministry of Education, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China; Department of Occupational and Environmental Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang 110122, PR China.
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Joshi N, Qasim MZ, Kanumilli S, Shaukat F, Kumar A, Mahek F, Khalid S, Zeeshan M, Shaik MY, Nishat SM, Gandhi F, Belletieri C. Exploring the clinical effectiveness of glucagon-like peptide-1 receptor agonists in managing cardiovascular complications: an updated comprehensive review and future directives. Ann Med Surg (Lond) 2024; 86:5947-5956. [PMID: 39359798 PMCID: PMC11444620 DOI: 10.1097/ms9.0000000000002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 08/09/2024] [Indexed: 10/04/2024] Open
Abstract
The possible cardiovascular advantages of glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of drugs predominantly used to treat type 2 diabetes (T2D), have garnered increasing attention in recent years. Clinical trials have looked into the possibility that GLP-1RAs have extra cardioprotective benefits in addition to their ability to manage T2D, demonstrating significant major adverse cardiovascular events (MACE) reduction and a favorable safety profile. GLP-1 RAs improve cardiovascular outcomes, especially in those with existing cardiovascular disease. MACE has been steadily declining with this class of drugs, which results in a noticeable rise in cardiovascular outcome trials (CVOTs). GLP-1 RAs have a variety of impacts on the cardiovascular system beyond their function in glycemic control. They offer direct cardioprotection, vasodilation, promotion of salt excretion, reduction of weight, improved lipid profile, and anti-inflammatory qualities through a variety of mechanisms. Thus, this review focuses on GLP-1RAs, its mechanism of action, its clinical effectiveness in CVOTs, the mechanism behind its cardiovascular benefits, its potential role in heart failure, cardiovascular outcomes, its underutilization, and future directives. In conclusion, GLP-1 RAs shows potential in controlling T2D while also lowering cardiovascular risk, but warrants further study into long-term results and real-world data to optimize treatment regimens, ultimately increasing patient outcomes and lowering the burden of cardiovascular disease in T2D populations.
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Affiliation(s)
- Nandan Joshi
- Department of Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat
| | | | - Srilakshmidevi Kanumilli
- Department of Internal Medicine, GSL Medical College, Rajamahendravaram, Jagannadhapuram Agraharam, Andhra Pradesh
| | - Faiza Shaukat
- Department of Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore
| | - Ateesh Kumar
- Department of Internal Medicine, Dow Medical College, Karachi
| | - Fnu Mahek
- Department of Internal Medicine, Peoples University of Medical and Health Sciences, Nawabshah, Pakistan
| | - Saif Khalid
- Department of Internal Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mohd Zeeshan
- Department of Internal Medicine, Career Institute of Medical Sciences and Hospital, Lucknow
| | - Mahboob Younus Shaik
- Department of Internal Medicine, Deccan College of Medical Sciences, Hyderabad, India
| | - Syeed Mahmud Nishat
- Department of Internal Medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh
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Zhao X, Xu X, Yan Y, Lipnicki DM, Pang T, Crawford JD, Chen C, Cheng CY, Venketasubramanian N, Chong E, Blay SL, Lima-Costa MF, Castro-Costa E, Lipton RB, Katz MJ, Ritchie K, Scarmeas N, Yannakoulia M, Kosmidis MH, Gureje O, Ojagbemi A, Bello T, Hendrie HC, Gao S, Guerra RO, Auais M, Gomez JF, Rolandi E, Davin A, Rossi M, Riedel-Heller SG, Löbner M, Roehr S, Ganguli M, Jacobsen EP, Chang CCH, Aiello AE, Ho R, Sanchez-Juan P, Valentí-Soler M, Ser TD, Lobo A, De-la-Cámara C, Lobo E, Sachdev PS, Xu X. Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 51:101198. [PMID: 39308753 PMCID: PMC11416683 DOI: 10.1016/j.lanwpc.2024.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/09/2024] [Accepted: 08/25/2024] [Indexed: 09/25/2024]
Abstract
Background Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical. Methods Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies. Findings Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = -0.207, 95% CI = (-0.255, -0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = -0.040, 95% CI = (-0.047, -0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies. Interpretation Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness. Funding Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.
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Affiliation(s)
- Xuhao Zhao
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yifan Yan
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Darren M. Lipnicki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Ting Pang
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - John D. Crawford
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Christopher Chen
- Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, NUHS, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Eddie Chong
- Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sergio Luis Blay
- Center for Studies in Public Health and Aging, Belo Horizonte, Brazil
| | | | - Erico Castro-Costa
- Department of Psychiatry- Federal University of Sao Paulo- UNIFESP, Sao Paulo, Brazil
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen Ritchie
- Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Institut du Cerveau Trocadéro, Paris, France
| | - Nikolaos Scarmeas
- First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Columbia University, New York, USA
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Mary H. Kosmidis
- Lab of Neuropsychology & Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Oye Gureje
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akin Ojagbemi
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toyin Bello
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hugh C. Hendrie
- Department of Psychiatry and Indiana Alzheimer Disease Center Indiana School of Medicine, Indianapolis, USA
| | - Sujuan Gao
- Indiana Alzheimer Disease Research Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, USA
| | | | - Mohammad Auais
- School of Rehabilitation Therapy, Kingston, Ontario, Canada
| | - José Fernando Gomez
- Research Group on Geriatrics and Gerontology. Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - Elena Rolandi
- Golgi Cenci Foundation, Abbiategrasso, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Mary Ganguli
- Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, USA
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, USA
| | - Chung-Chou H. Chang
- Departments of Medicine and Bioostatistics, School of Medicine and School of Public Health, University of Pittsburgh, USA
| | - Allison E. Aiello
- Robert N. Butler Columbia Aging Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | | | | | - Teodoro del Ser
- Alzheimer's Centre Reina Sofia-CIEN Foundation-ISCIII, 28031, Madrid, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Concepción De-la-Cámara
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Elena Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza CIBERSAM, Madrid, Spain
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Xin Xu
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
- Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - for Cohort Studies of Memory in an International Consortium (COSMIC)
- School of Public Health, The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, NUHS, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Raffles Neuroscience Centre, Raffles Hospital, Singapore
- Center for Studies in Public Health and Aging, Belo Horizonte, Brazil
- Instituto Rene' Rachou, Fundac¸ão Oswaldo Cruz, Rio de Janeiro, Brazil
- Department of Psychiatry- Federal University of Sao Paulo- UNIFESP, Sao Paulo, Brazil
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France
- First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Columbia University, New York, USA
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
- Lab of Neuropsychology & Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Psychiatry and Indiana Alzheimer Disease Center Indiana School of Medicine, Indianapolis, USA
- Indiana Alzheimer Disease Research Center, Indianapolis
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Brazil
- School of Rehabilitation Therapy, Kingston, Ontario, Canada
- Research Group on Geriatrics and Gerontology. Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
- Golgi Cenci Foundation, Abbiategrasso, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
- Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, USA
- Departments of Medicine and Bioostatistics, School of Medicine and School of Public Health, University of Pittsburgh, USA
- Robert N. Butler Columbia Aging Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
- Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
- Alzheimer's Centre Reina Sofia-CIEN Foundation-ISCIII, 28031, Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza CIBERSAM, Madrid, Spain
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Institut du Cerveau Trocadéro, Paris, France
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, USA
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
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8
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Cheng W, Du Z, Lu B. Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study. Sci Rep 2024; 14:22635. [PMID: 39349699 PMCID: PMC11442589 DOI: 10.1038/s41598-024-72988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 09/12/2024] [Indexed: 10/04/2024] Open
Abstract
Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69 years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37 months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19 months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.
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Affiliation(s)
- Wenke Cheng
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310053, China
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Zhongyan Du
- Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University, Hangzhou, 310053, China.
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China.
- Zhejiang Engineering Research Center for "Preventive Treatment" Smart Health of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Bo Lu
- Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Hongkou District, Shanghai, 200437, China.
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
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9
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Yang W, Li W, Wang S, Qi X, Sun Z, Dove A, Xu W. Association of cardiometabolic multimorbidity with risk of late-life depression: a nationwide twin study. Eur Psychiatry 2024; 67:e58. [PMID: 39320861 PMCID: PMC11457118 DOI: 10.1192/j.eurpsy.2024.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/22/2024] [Accepted: 07/10/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases (CMDs) including heart disease, stroke, and type 2 diabetes have been individually linked to depression. However, their combined impact on depression risk is unclear. We aimed to examine the association between cardiometabolic multimorbidity and depression and explore the role of genetic background in this association. METHODS Within the Swedish Twin Registry, 40,080 depression-free individuals (mean age 60 years) were followed for 18 years. Cardiometabolic multimorbidity was defined as having ≥2 CMDs. CMDs and depression were ascertained based on the National Patient Register. Cox regression was used to estimate the CMD-depression association in a classical cohort study design and a matched co-twin design involving 176 twin pairs. By comparing the associations between monozygotic and dizygotic co-twins, the contribution of genetic background was estimated. RESULTS At baseline, 4809 (12.0%) participants had one CMD and 969 (2.4%) had ≥2 CMDs. Over the follow-up period, 1361 participants developed depression. In the classical cohort design, the multi-adjusted hazard ratios (95% confidence interval [CIs]) of depression were 1.52 (1.31-1.76) for those with one CMD and 1.83 (1.29-2.58) for those with ≥2 CMDs. CMDs had a greater risk effect on depression if they developed in mid-life (<60 years) as opposed to late life (≥60 years). In matched co-twin analysis, the CMD-depression association was significant among dizygotic twins (HR = 1.63, 95% CI, 1.02-2.59) but not monozygotic twins (HR = 0.90, 95% CI, 0.32-2.51). CONCLUSIONS Cardiometabolic multimorbidity is associated with an elevated risk of depression. Genetic factors may contribute to the association between CMDs and depression.
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Affiliation(s)
- Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Weiwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Shuqi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xiuying Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Zhuoyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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10
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Zhang Y, Tao Q, Cheng Y, Fawad M, Liang Z, Xu X. Gestational diabetes mellitus, body mass index, and cardiometabolic multimorbidity: a prospective cohort study. Ann Epidemiol 2024; 99:S1047-2797(24)00237-0. [PMID: 39322091 DOI: 10.1016/j.annepidem.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 09/10/2024] [Accepted: 09/21/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) could increase the risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, evidence on its association with cardiometabolic multimorbidity (CMM) was limited. This study aimed to evaluate the association between GDM and the prevalence, incidence, patterns, and progression of CMM; and the role of body mass index (BMI) in such association. METHODS This study included 203,372 women who have given birth in UK Biobank. The diagnoses of GDM and cardiometabolic diseases (including stroke, coronary heart disease [CHD], and T2DM) were reported by participants or obtained through linkage to inpatient hospital data until 31st December 2020. BMI was assessed at the baseline assessment. CMM was defined as having two or more of included cardiometabolic diseases. Logistic regression models and Cox proportional hazard models were used to assess the association between GDM and CMM, and the modifications on both additive and multiplicative scales were assessed to evaluate the effect of BMI on such association. RESULTS A total of 1,217 women had a history of GDM, 2,351 participants had CMM at the end of follow-up and 1,601 was newly diagnosed during follow-up. GDM was associated with higher prevalence (odds ratio [OR]=4.64, 95% confidence interval [95% CI]=3.54-6.08) and incidence (hazard ratio [HR]=3.62, 95% CI=2.62-5.00) of CMM. In particular, GDM was associated with higher odds of T2DM, coexisting T2DM and vascular disease, and T2DM followed by vascular disease. Formal testing for effect modification suggested multiplicative modification by BMI for the association between GDM and incident CMM. CONCLUSIONS GDM was associated with CMM in women's late life, with multiplicative modification effects of BMI. Our results suggest that maternal and lifestyle interventions (e.g., weight management) are warranted for the primary and secondary prevention of CMM, particularly in women with a history of GDM.
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Affiliation(s)
- Yue Zhang
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Qingqing Tao
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China; Department of Maternal and Child Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yangyang Cheng
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Muhammad Fawad
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhaoxia Liang
- Obstetrical Department, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaolin Xu
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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11
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Lu X, Zhu X, Li G, Wu L, Shao L, Fan Y, Pan CW, Wu Y, Borné Y, Ke C. Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity. J Clin Endocrinol Metab 2024:dgae552. [PMID: 39287934 DOI: 10.1210/clinem/dgae552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Indexed: 09/19/2024]
Abstract
CONTEXT Cardiometabolic multimorbidity (CM) is an increasing public health concern. Previous observational studies have suggested inverse associations between coffee, tea, and caffeine intake and risks of individual cardiometabolic diseases; however, their associations with CM and related biological markers are unknown. METHODS This prospective study involved 172 315 (for caffeine analysis) and 188 091 (tea and coffee analysis) participants free of any cardiometabolic diseases at baseline from the UK Biobank; 168 metabolites were measured among 88 204 and 96 393 participants. CM was defined as the coexistence of at least 2 of the following conditions: type 2 diabetes, coronary heart disease, and stroke. RESULTS Nonlinear inverse associations of coffee, tea, and caffeine intake with the risk of new-onset CM were observed. Compared with nonconsumers or consumers of less than 100 mg caffeine per day, consumers of moderate amount of coffee (3 drinks/d) or caffeine (200-300 mg/d) had the lowest risk for new-onset CM, with respective hazard ratios (95% CIs) of 0.519 (0.417-0.647) and 0.593 (0.499-0.704). Multistate models revealed that moderate coffee or caffeine intake was inversely associated with risks of almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. A total of 80 to 97 metabolites, such as lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls, were identified to be associated with both coffee, tea, or caffeine intake and incident CM. CONCLUSION Habitual coffee or caffeine intake, especially at a moderate level, was associated with a lower risk of new-onset CM and could play important roles in almost all transition phases of CM development. Future studies are warranted to validate the implicated metabolic biomarkers underlying the relation between coffee, tea, and caffeine intake and CM.
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Affiliation(s)
- Xujia Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou 215123, Jiangsu, China
| | - Xiaohong Zhu
- Suzhou Centers for Disease Control and Prevention, Suzhou 215000, Jiangsu, China
| | - Guochen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou 215123, Jiangsu, China
| | - Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou 215123, Jiangsu, China
| | - Yulong Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou 215123, Jiangsu, China
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
| | - Ying Wu
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - Yan Borné
- Department of Clinical Sciences Malmö, Lund University, Malmö 20502, Sweden
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou 215123, Jiangsu, China
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12
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Wen S, Huang X, Huang Z, Zhang X, Dai C, Han F, Zheng W, Wang F, Chen S, Zhang B, Huang Y. The association of changes in the Chinese visceral adiposity index and cardiometabolic diseases: a cohort study. Diabetol Metab Syndr 2024; 16:228. [PMID: 39272152 PMCID: PMC11401298 DOI: 10.1186/s13098-024-01460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVE The relationship between changes in Chinese visceral adiposity index (CVAI) and cardiometabolic diseases (CMD) in middle-aged and elderly individuals remains unclear. This study aimed to explore whether changes in the CVAI were associated with CMD incidence. METHODS This study included 3,243 individuals aged over 45 years from the China Health and Retirement Longitudinal Study. The exposures were changes in the CVAI and cumulative CVAI from 2012 to 2015. Changes in the CVAI were classified using K-means clustering analysis, and the cumulative CVAI was calculated as follows: (CVAI2012 + CVAI2015)/2 × time (2015-2012). Multivariable logistic regression models were used to assess the relationship between different CVAI change classes and CMD incidence. Restricted cubic splines regression was used to assess the dose-response relationship between cumulative CVAI and CMD incidence. To investigate the relationship between combined exposure to each component of CAVI and CMD incidence, a weighted quantile sum regression analysis was employed. RESULTS During the 5 years of follow-up, 776 (24%) incident CMD cases were identified. Changes in CVAI and cumulative CVAI were independently and positively associated with CMD. After adjusting for potential confounders, compared with Class 1, the adjusted ORs (95% CIs) for incident CMD were 1.18 (0.90-1.57) for Class 2, 1.40 (1.03-1.92) for Class 3, and 1.56 (1.04-2.34) for Class 4. When cumulative CVAI was categorized into quartiles, compared with Q1, the adjusted ORs (95% CIs) for incident CMD were 1.30 (1.00-1.70) for Q2, 1.34 (1.01-1.79) for Q3, and 1.63 (1.15-2.31) for Q4. In addition, cumulative CVAI in the overall population exhibited a linear association with CMD (Poverall = 0.012, Pnon-linearity = 0.287), diabetes (Poverall = 0.022, Pnon-linearity = 0.188), and stroke (Poverall = 0.002, Pnon-linearity = 0.978), but showed no significant association with heart disease (Poverall = 0.619, Pnon-linearity = 0.442). CONCLUSION Participants with higher baseline CVAI level and a change of elevating CVAI level may suffer an increased incidence of CMD. Furthermore, our findings elucidate the underlying mechanisms of the CVAI by highlighting TG as the primary contributor to the observed associations. Long-term CVAI monitoring is of significant importance for early identification and prevention of CMD, with significant implications for clinical practice.
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Affiliation(s)
- Song Wen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Xingjie Huang
- Department of Cardiology, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541000, Guangxi, China
| | - Zehan Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Xinjie Zhang
- Graduate School of Chengde Medical University, Chengde, 067000, Hebei, China
- Department of Surgical Urology, Hebei Province Xingtai People's Hospital, Xingtai, 054031, Hebei, China
| | - Chang Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Feihuang Han
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Weidong Zheng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Feng Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China
| | - Shubo Chen
- Graduate School of Chengde Medical University, Chengde, 067000, Hebei, China
- Department of Surgical Urology, Hebei Province Xingtai People's Hospital, Xingtai, 054031, Hebei, China
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
- Hypertension Laboratory, Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, Guangdong, China.
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Wu W, Chen Y, Zhang C, Wu K, Zheng H, Cai Z, Wang Y, Fu P, Lan Y, Chen S, Wu S, Chen Y. Remnant cholesterol is superior to other lipid-related parameters for the prediction of cardiometabolic disease risk in individuals with hypertension: The Kailuan study. Int J Cardiol 2024; 417:132541. [PMID: 39265790 DOI: 10.1016/j.ijcard.2024.132541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/20/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND It is uncertain which lipid-related parameter is most suitable for predicting the risk of cardiometabolic disease (CMD) in individuals with hypertension. AIMS To explore which lipid-related parameter is most suitable for predicting the risk of CMD. METHODS AND RESULTS We studied 30,378 patients with hypertension who completed the 2006-2007 Kailuan health examination and followed up until December 31, 2021. In the constructed model, the utilities of lipid-related parameters for the prediction of CMD were compared using the C-index, NRI, and IDI. The best predictor (remnant cholesterol, RC) was identified and the participants were grouped according to RC quartile. Cox proportional hazard analysis was then used to evaluate the relationship between RC and the risk of CMD. During a median follow-up period of 14.7 years (IQR 5.3-15.1), 9502 (31.27 %) participants with hypertension developed CMD. The C-index, NRI, and IDI values for RC were higher than those for the other lipid parameters. After adjustment for multiple potential confounding factors, compared with the quartile (Q)1 RC group, the adjusted hazard ratios for CMD of the Q2-Q4 groups were 1.09 (1.03-1.16), 1.17 (1.11-1.24), and 1.25 (1.18-1.33) (P < 0.0001). Restrictive cubic spline analysis revealed dose-dependent relationships of lipid parameters with the risk of CMD. CONCLUSIONS RC is superior to other lipid parameters for the prediction of the risk of CMD in individuals with hypertension. As the concentration of RC increases, the risk of CMD in such individuals also increases.
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Affiliation(s)
- Weiqiang Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China; Shantou University Medical College, Shantou, China
| | - Yanjuan Chen
- Department of Endocrinology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Changyi Zhang
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Kuangyi Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Huancong Zheng
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiwei Cai
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yuxian Wang
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peng Fu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yulong Lan
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China.
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
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Yu B, Jia S, Sun T, Liu J, Jin J, Zhang S, Xiao Q, Dong H, Ou Y. Sarcopenic obesity is associated with cardiometabolic multimorbidity in Chinese middle-aged and older adults: a cross-sectional and longitudinal study. J Nutr Health Aging 2024; 28:100353. [PMID: 39244787 DOI: 10.1016/j.jnha.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Sarcopenic obesity (SO) has been found to increase the risk of metabolic disorders, however, its relationship with cardiometabolic multimorbidity (CMM) remains unexplored. This study aims to investigate the potential association between SO and CMM in the middle-aged and older population. METHODS Our study subjects were from CHARLS. SO was defined as the combination of impaired grip strength (grip strength <28 kg for men and <18 kg for women) and increased body mass index (BMI ≥25 kg/m2). CMM was defined as having two or more cardiometabolic diseases, including diabetes mellitus, stroke, and heart disease. The participants were divided into four groups according to their sarcopenia and obesity status, and logistic regression analysis was used to examine the association between SO and CMM. RESULTS A total of 15,252 study subjects were included in the cross-sectional study, with an average age of 60.6 years and a male proportion of 47.4%. In the cross-sectional analysis conducted in 2015, the prevalence of CMM was highest in the SO group (9.1%), followed by the obesity (3.7%) and sarcopenia (3.5%) group. After adjustment for confounding factors, SO [OR (95%CI): 2.453 (1.742-3.455)], sarcopenia [OR (95% CI): 1.601 (1.157-2.217)], obesity [OR (95% CI): 1.446 (1.107-1.888)] were all observed to be associated with CMM, with the strongest association in the SO group. Furthermore, in the longitudinal analysis, only the SO group demonstrated a significant risk for developing CMM [OR (95% CI): 2.302 (1.239-4.228)]. CONCLUSIONS SO was independently and positively associated with CMM in middle-aged and older population.
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Affiliation(s)
- Bingyan Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Shize Jia
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Tiantian Sun
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518107, China
| | - Jieliang Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Junguo Jin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Shanghong Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Qiyao Xiao
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Haojian Dong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; Nyingchi People's Hospital, Nyingchi 860000, Tibet, China.
| | - Yanqiu Ou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
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Gu X, Gao D, Zhou X, Ding Y, Shi W, Park J, Wu S, He Y. Association between fatty liver index and cardiometabolic multimorbidity: evidence from the cross-sectional national health and nutrition examination survey. Front Cardiovasc Med 2024; 11:1433807. [PMID: 39301498 PMCID: PMC11411361 DOI: 10.3389/fcvm.2024.1433807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024] Open
Abstract
Background Metabolic dysfunction associated steatotic liver disease (MASLD) contributes to the cardiometabolic diseases through multiple mechanisms. Fatty liver index (FLI) has been formulated as a non-invasive, convenient, and cost-effective approach to estimate the degree of MASLD. The current study aims to evaluate the correlation between FLI and the prevalent cardiometabolic multimorbidity (CMM), and to assess the usefulness of FLI to improve the detection of the prevalent CMM in the general population. Methods 26,269 subjects were enrolled from the National Health and Nutrition Examination Survey 1999-2018. FLI was formulated based on triglycerides, body mass index, γ -glutamyltransferase, and waist circumference. CMM was defined as a history of 2 or more of diabetes mellitus, stroke, myocardial infarction. Results The prevalence of CMM was 10.84%. With adjustment of demographic, anthropometric, laboratory, and medical history covariates, each standard deviation of FLI leaded to a 58.8% risk increase for the prevalent CMM. The fourth quartile of FLI had a 2.424 times risk for the prevalent CMM than the first quartile, and a trend towards higher risk was observed. Smooth curve fitting showed that the risk for prevalent CMM increased proportionally along with the elevation of FLI. Subgroup analysis demonstrated that the correlation was robust in several conventional subpopulations. Receiver-operating characteristic curve analysis revealed an incremental value of FLI for detecting prevalent CMM when adding it to conventional cardiometabolic risk factors (Area under the curve: 0.920 vs. 0.983, P < 0.001). Results from reclassification analysis confirmed the improvement from FLI. Conclusion Our study demonstrated a positive, linear, and robust correlation between FLI and the prevalent CMM, and our findings implicate the potential usefulness of FLI to improve the detection of prevalent CMM in the general population.
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Affiliation(s)
- Xinsheng Gu
- Department of Cardiology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Di Gao
- Department of Cardiology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Xinjian Zhou
- Department of Intensive Care Unit, Shanghai Eighth People's Hospital, Shanghai, China
| | - Yueyou Ding
- Department of Cardiology, Shanghai Eighth People's Hospital, Shanghai, China
| | - Wenrui Shi
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jieun Park
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Yue He
- Department of Cardiology, Shanghai Eighth People's Hospital, Shanghai, China
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Liu F, Meng Y, Wang R, Shen S, Li P, He F. Combined influence of depression symptoms and ratio of triglyceride to high-density lipoprotein cholesterol on cardiometabolic multimorbidity: Findings from the China Health and Retirement Longitudinal Study 2011-2018. J Affect Disord 2024; 360:242-248. [PMID: 38821370 DOI: 10.1016/j.jad.2024.05.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Previous studies had reported depression symptoms and TG/HDLC ratio may share pathophysiological pathway. The aim was to investigate the combined effects of depression symptoms and TG/HDL-C ratio on the risk of CMM. METHODS This cohort study extracted data from 2011 to 2018 of CHARLS. The CMM event occurred from 2013 to 2018, defined as suffering from more than one of stroke, cardiac events, and diabetes mellitus. Cox proportional hazards regression models were used to assess the association between the baseline combined effects of depression symptoms and TG/HDL-C ratio with incidence of CMM, stroke, cardiac events, and diabetes mellitus. RESULTS A total of 8349 participants (3966 men and 4383 women) were included in the study, with a mean age of 58.5 years. During a 7-year follow-up survey, 370 (4.43 %) participants developed CMM. Compared to individuals with no depression symptoms and low TG/HDLC ratio, the multivariable-adjusted HRs (95%CI) for the new-onset CMM for patients with the depression symptoms alone, high TG/HDLC ratio alone, and depression symptoms and high TG/HDLC ratio were 1.37 (95 % CI = 0.95-1.98), 1.62 (95 % CI = 1.22-2.14), 1.94 (95 % CI = 1.39-2.72), respectively (P < 0.001). LIMITATIONS Firstly, potential confounding factors such as dietary intake and nutrition were not collected at the time of study design. Secondly, exposure to the outcome was self-reported, which may cause recall bias or misclassification. Finally, the population was aged ≥45 years, so the results cannot be generalized to all age groups. CONCLUSION Our findings indicated that patients with depression and high TG/HDLC ratio had a higher risk of developing CMM.
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Affiliation(s)
- Fanghua Liu
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Yang Meng
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Suwen Shen
- Department of medical administration, Suzhou Industrial Park Medical and Health Management Center, Suzhou, Jiangsu 215004, China
| | - Pengbin Li
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China
| | - Fan He
- Baoshan Center for Disease Control and Prevention, Shanghai 201901, China.
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Cook WK, Li L, Martinez P, Kerr WC. When the Going Gets Tough: Multimorbidity and Heavy and Binge Drinking Among Adults. Am J Prev Med 2024; 67:407-416. [PMID: 38904593 PMCID: PMC11338724 DOI: 10.1016/j.amepre.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Multimorbidity, the presence of two or more long-term health conditions in the same individual, is an emerging epidemic associated with increased morbidity and mortality. Continued drinking concurrent with alcohol-related chronic conditions, particularly with multimorbidity, is likely to further elevate health risk. This study aimed to examine the associations of multimorbidity among diabetes, hypertension, heart disease, and cancer with drinking, and moderation of these associations by age. METHODS Logistic regression modeling was performed in 2023 using a nationally representative sample of U.S. adults from the 2015-19 National Survey on Drug Use and Health. Multimorbidity was assessed using (1) a count of these conditions and (2) disease-specific categories. The outcomes were past month heavy drinking (7+/14+ drinks weekly) and binge drinking (4+/5+ drinks per occasion) for women and men. RESULTS A pattern of reduced odds for drinking outcomes associated with a greater degree of multimorbidity was found. This pattern was more apparent in models using the continuous measure of multimorbidity than in those using the categorical measure, and more consistent for binge drinking than for heavy drinking and for women than for men. Significant age interactions were found: the log odds of heavy drinking and binge drinking for both men and women decreased as the number of conditions increased, and more steeply for those ages 50+ than the younger. The log odds of heavy drinking varied little among men under age 50 regardless of multimorbidity. CONCLUSIONS Alcohol interventions to reduce drinking with multimorbidity, particularly among heavy-drinking men under age 50, are warranted.
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Affiliation(s)
- Won K Cook
- Public Health Institute, Alcohol Research Group, Emeryville, California.
| | - Libo Li
- Public Health Institute, Alcohol Research Group, Emeryville, California
| | | | - William C Kerr
- Public Health Institute, Alcohol Research Group, Emeryville, California
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Chekol Tassew W, Ferede YA, Zeleke AM. Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa: A systematic review and meta-analysis. Metabol Open 2024; 23:100297. [PMID: 39006881 PMCID: PMC11246013 DOI: 10.1016/j.metop.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Background In sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40-75 years old. Most clinical guidelines recommend prescribing statins to individuals with type 2 diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of cardiovascular disease in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing cardiovascular disease in type 2 diabetes patients. Methods The findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist. We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered. Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A funnel plot, a visual tool, was utilized to evaluate publication bias. Results The search strategy resulted in 7695 published original articles. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined. The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41-63.24). Age greater than 65 years (AOR = 3.56, 95% CI: 1.70-7.45; I2 = 54.7%), comorbidity (AOR = 1.13, 95% CI: 0.27-4.63, I2 = 96.4%), dyslipidemia (AOR = 3.15, 95% CI: 1.54-6.44, I2 = 61.7%), DM duration greater than ten years (AOR = 1.36, 95% CI: 0.81-2.28, I2 = 77.3%), and government insurance (AOR = 8.85, 95% CI: 2.72-28.76, I2 = 81.5%) were factors associated with statin prescription among type 2 diabetic patients. Conclusions In general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk.
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Affiliation(s)
- Worku Chekol Tassew
- Teda Health Science College, Department of Medical Nursing, Gondar, Ethiopia
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Li J, Liu X, Yang X, Cheng Y, Liu L, Zhang Y, Zhao Y. Impact of vitamins A, D, and homocysteine on cardiometabolic multimorbidity in Northwest China. Nutr Metab (Lond) 2024; 21:70. [PMID: 39215279 PMCID: PMC11363622 DOI: 10.1186/s12986-024-00845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To investigate the impact of vitamin A (VA), vitamin D (VD), and homocysteine (Hcy) on cardiometabolic multimorbidity (CMM). METHODS This study is a cross-sectional study conducted in Ningxia Province, China. A total of 5000 participants aged 25-74 were recruited and divided into two groups based on the definition of cardiometabolic multimorbidity: the CMM group and the Non CMM group. Demographic, lifestyle, and laboratory data were collected to investigate the correlation between vitamin A, D, Hcy levels and CMM risk. The association was analyzed using multiple logistic regression and restricted cubic spline method. RESULTS CMM incidence increased with age, being higher in females (20.05%) compared to males, Hypertension was present in 96.20% of CMM cases. Reduced VD levels correlated with an elevated CMM risk (OR = 1.799, 95% CI: 1.466-2.238), showing an inverse dose-response relationship, even after adjusting for confounders (OR = 1.553, 95% CI: 1.233-1.956). However, VA and Hcy levels were not significantly associated with CMM risk. The inverse correlation between VD status and CMM risk was more pronounced in males, obese individuals, and those with normal blood lipid profiles (P < 0.05). CONCLUSIONS The risk of CMM increases with age, especially in women. Inadequate VD status increases vulnerability to CMM, suggesting that optimising VD reduces the risk of CMM.
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Affiliation(s)
- Juan Li
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaowei Liu
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaolong Yang
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yalong Cheng
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Lan Liu
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, 750004, China
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yuhong Zhang
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China.
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, 750004, China.
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China.
| | - Yi Zhao
- Public Health School, Ningxia Medical University, Yinchuan, Ningxia, China.
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, 750004, China.
- Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China.
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Hu F, Qin W, Xu L. Association between Dietary Patterns and Cardiometabolic Multimorbidity among Chinese Rural Older Adults. Nutrients 2024; 16:2830. [PMID: 39275148 PMCID: PMC11397048 DOI: 10.3390/nu16172830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
BACKGROUND The global population is aging rapidly, leading to an increase in the prevalence of cardiometabolic multimorbidity (CMM). This study aims to investigate the association between dietary patterns and CMM among Chinese rural older adults. METHODS The sample was selected using a multi-stage cluster random sampling method and a total of 3331 rural older adults were ultimately included. Multivariate logistic regression analysis was used to examine the association between the latent dietary patterns and CMM. RESULTS The prevalence of CMM among rural older adults was 44.64%. This study identified four potential categories: "Low Consumption of All Foods Dietary Pattern (C1)", "High Dairy, Egg, and Red Meat Consumption, Low Vegetable and High-Salt Consumption Dietary Pattern (C2)", "High Egg, Vegetable, and Grain Consumption, Low Dairy and White Meat Consumption Dietary Pattern (C3)" and "High Meat and Fish Consumption, Low Dairy and High-Salt Consumption Dietary Pattern (C4)". Individuals with a C3 dietary pattern (OR, 0.80; 95% CI, 0.66-0.98; p = 0.028) and a C4 dietary pattern (OR, 0.70; 95% CI, 0.51-0.97; p = 0.034) significantly reduced the prevalence of CMM compared with the C1 dietary pattern. CONCLUSIONS Rural older adults have diverse dietary patterns, and healthy dietary patterns may reduce the risk of CMM.
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Affiliation(s)
- Fangfang Hu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan 250012, China
| | - Wenzhe Qin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan 250012, China
| | - Lingzhong Xu
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Center for Health Economics Experiment and Public Policy Research, Shandong University, Jinan 250012, China
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Morissette A, Mulvihill EE. Cardioprotective benefits of metabolic surgery and GLP-1 receptor agonist-based therapies. Trends Endocrinol Metab 2024:S1043-2760(24)00193-0. [PMID: 39127552 DOI: 10.1016/j.tem.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
Individuals with excessive adipose tissue and type 2 diabetes mellitus (T2DM) face a heightened risk of cardiovascular morbidity and mortality. Metabolic surgery is an effective therapy for people with severe obesity to achieve significant weight loss. Additionally, metabolic surgery improves blood glucose levels and can lead to T2DM remission, reducing major adverse cardiovascular outcomes (MACE). Glucagon-like peptide 1 (GLP-1) receptor agonists (GLP-1RAs) are a class of medication that effectively reduce body weight and MACE in patients with T2DM. This review explores the potential mechanisms underlying the cardioprotective benefits of metabolic surgery and GLP-1RA-based therapies and discusses recent evidence and emerging therapies in this dynamic area of research.
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Affiliation(s)
- Arianne Morissette
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada
| | - Erin E Mulvihill
- The University of Ottawa Heart Institute, 40 Ruskin Street, H-3229A, Ottawa, Ontario, KIY 4W7, Canada; Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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22
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Sun D, Gao Y, Xu B, Xiang L, Liu W, Luo H, Wu IXY. Association of coffee consumption with cardiometabolic multimorbidity: A prospective cohort study in the UK biobank. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00301-6. [PMID: 39277537 DOI: 10.1016/j.numecd.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND AND AIMS Previous observational studies have investigated the association between coffee consumption and single cardiometabolic disease. Yet, the extent to which coffee might confer health advantages to individuals with a singular cardiometabolic disease remains unclear. This study aimed to further investigate the association of coffee consumption and the onset and progression from single cardiometabolic disease to cardiometabolic multimorbidity (CMM). METHODS AND RESULTS This prospective cohort study included 185,112 participants from the UK Biobank who were enrolled between 2006 and 2010 and followed up until 2020. Coffee consumption was collected using a 24-h dietary questionnaire. CMM was defined as the coexistence of at least two cardiometabolic diseases, including type 2 diabetes (T2D), coronary heart disease (CHD) and stroke. Cox proportional hazards and multi-state models estimated the associations between coffee consumption and CMM. During a median follow-up of 11.4 years, 1585 participants developed CMM. Compared with nonconsumers, coffee consumers had lower risks for the transitions from baseline to single cardiometabolic disease, with the respective lowest hazard ratios and 95% confidence intervals (CIs) for the transitions from baseline to T2D, CHD and stroke after multivariable adjustment being 0.79 (CI, 0.72-0.87), 0.91 (CI, 0.86-0.97) and 0.87 (CI, 0.78-0.96). Coffee consumption resulted in a significant reduction in the risk of the transitions from CHD and stroke to CMM, with the lowest estimates were 0.56 (CI, 0.43-0.73) and 0.60 (CI, 0.43-0.83). Similar associations were observed in unsweetened coffee. Sugar-sweetened coffee was associated with some transitions at low levels of consumption. The associations between artificially sweetened coffee and CMM were less consistent. CONCLUSIONS Coffee consumption was associated with lower risk for almost all transition phases of CMM development and consistent findings were observed with unsweetened coffee.
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Affiliation(s)
- Dingkui Sun
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Yinyan Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Boya Xu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Linghui Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Wenqi Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Han Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China
| | - Irene X Y Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Central South University, No. 168-2, Tongzipo Road, Yuelu District, Changsha, Hunan 410000, China.
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Sahin I, Bakiner O, Demir T, Sari R, Atmaca A. Current Position of Gliclazide and Sulfonylureas in the Contemporary Treatment Paradigm for Type 2 Diabetes: A Scoping Review. Diabetes Ther 2024; 15:1687-1716. [PMID: 38935188 PMCID: PMC11263312 DOI: 10.1007/s13300-024-01612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
The increasing burden of type 2 diabetes (T2D), in relation to alarming rise in the prevalence; challenges in the diagnosis, prevention, and treatment; as well as the substantial impact of disease on longevity and quality of life, is a major concern in healthcare worldwide. Sulfonylureas (SUs) have been a cornerstone of T2D pharmacotherapy for over 60 years as oral antidiabetic drugs (OADs), while the newer generation SUs, such as gliclazide modified release (MR), are known to be associated with low risk of hypoglycemia in addition to the cardiovascular neutrality. This scoping review aimed to specifically address the current position of gliclazide MR among other SUs in the contemporary treatment paradigm for T2D and to provide a practical guidance document to assist clinicians in using gliclazide MR in real-life clinical practice. The main topics addressed in this paper include the role of early and sustained glycemic control and use of SUs in T2D management, the properties of gliclazide MR in relation to its effectiveness and safety, the use of gliclazide therapy in special populations, and the place of SUs as a class and gliclazide MR specifically in the current T2D treatment algorithm.
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Affiliation(s)
- Ibrahim Sahin
- Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Okan Bakiner
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ramazan Sari
- Department of Endocrinology and Metabolism, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Aysegul Atmaca
- Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Dove A, Dunk MM, Wang J, Guo J, Whitmer RA, Xu W. Anti-Inflammatory Diet and Dementia in Older Adults With Cardiometabolic Diseases. JAMA Netw Open 2024; 7:e2427125. [PMID: 39133488 PMCID: PMC11320167 DOI: 10.1001/jamanetworkopen.2024.27125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/13/2024] [Indexed: 08/13/2024] Open
Abstract
Importance Inflammation has been proposed as a mechanism linking cardiometabolic diseases (CMDs) to increased risk of dementia. However, whether an anti-inflammatory diet can support brain and cognitive health among people with CMDs is unclear. Objective To examine CMD status and dietary inflammatory potential in association with dementia risk and brain magnetic resonance imaging (MRI) measures using joint effect analysis. Design, Setting, and Participants The UK Biobank is an ongoing community-based cohort study with baseline assessments conducted between March 13, 2006, and October 1, 2010. The present study included 84 342 dementia-free older adults (≥60 years), who were followed up until January 20, 2022 (maximum, 15 years). A subsample (n = 8917) underwent brain MRI scans between May 2, 2014, and March 13, 2020. Exposures Baseline CMDs (including type 2 diabetes, heart disease, and stroke) were ascertained from medical records. Dietary Inflammatory Index scores (anti-inflammatory [≤-1.5 points], neutral [>-1.5 to <0.5 points], or proinflammatory [≥0.5 points]) were calculated from participants' average intake of 31 nutrients, assessed up to 5 times using the Oxford WebQ, a web-based, 24-hour dietary assessment. Main Outcomes and Measures Incident dementia was identified through linkage to medical records. Regional brain volumes were collected from brain MRI scans. Results The study included 84 342 participants (mean [SD] age, 64.1 [2.9] years; 43 220 [51.2%] female). At baseline, 14 079 (16.7%) had at least 1 CMD. Over a median follow-up of 12.4 (IQR, 11.8-13.1) years, 1559 individuals (1.9%) developed dementia. With the use of joint effect analysis, the hazard ratio of dementia was 2.38 (95% CI, 1.93-2.93) for people with CMDs and a proinflammatory diet and 1.65 (95% CI, 1.36-2.00) for those with CMDs and an anti-inflammatory diet (reference: CMD-free, anti-inflammatory diet). Dementia risk was 31% lower (hazard ratio, 0.69; 95% CI, 0.55-0.88; P = .003) among people with CMDs and an anti-inflammatory diet. On brain MRI, participants with CMDs and an anti-inflammatory diet compared with a proinflammatory diet additionally had significantly larger gray matter volume (β = -0.15; 95% CI, -0.24 to -0.06 vs β = -0.27; 95% CI, -0.38 to -0.16) and smaller white matter hyperintensity volume (β = 0.05; 95% CI, -0.04 to 0.14 vs β = 0.16; 95% CI, 0.05-0.27). Conclusions and Relevance In this cohort study, people with CMDs and an anti-inflammatory compared with proinflammatory diet had a significantly lower hazard ratio of dementia, larger gray matter volume, and smaller white matter hyperintensity volume.
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Affiliation(s)
- Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Michelle M. Dunk
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jiao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing, China
| | - Jie Guo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Rachel A. Whitmer
- Department of Public Health Sciences and Neurology, University of California, Davis
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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25
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Gimeno Orna JA, Mañas Martínez AB, Rodríguez Padial L, Anguita Sánchez M, Barrios V, Muñiz García J, Pérez Pérez A. Impact of the presence and type of cardiovascular disease on the risk of mortality in type 2 diabetic patients: The DIABET-IC trial. ENDOCRINOL DIAB NUTR 2024; 71:278-289. [PMID: 39095283 DOI: 10.1016/j.endien.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION All-cause mortality and cardiovascular mortality (CVM) risk can be very high in adults with type 2 diabetes mellitus (DM2) with previous cardiovascular disease (CVD). Our objective was to determine this risk among the different clinical spectrum of CVD. MATERIAL AND METHODS The DIABET-IC trial is a multicenter, prospective, observational, and analytical study. Consecutive subjects with DM2 attending our outpatients' clinics were recruited. Data on clinical features, lab test results, and echocardiographic measures were collected. Patients were categorized depending on the presence and type of CVD: heart failure (HF), coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral artery disease (PAD). All-cause mortality and CVM were the dependent variables analyzed. Mortality rate was expressed as deaths per 1000 patients-year. Cox proportional hazards regressions models were used to establish the mortality risk associated with every type of CVD. RESULTS We studied a total of 1246 patients (mean age, 6.3 (SD, 9.9) years; 31.6%, female) with an initial prevalence of CVD of 59.3%. A total of 122 deaths (46 due to CVD) occurred at the 2.6-year follow-up. All-cause and MCV rates associated with the presence of PAD (85.6/1000 and 33.6/1000, respectively) and HF (72.9/1000 and 28.7/1000 respectively) were the most elevated of all. In multivariate analysis, HF increased all-cause mortality risk (HR, 1.63; CI 95% 1.03-2.58; P=.037) and the risk of CVM (HR, 3.41; 95% CI, 1.68-6.93; P=.001). CONCLUSIONS Mortality among DM2 patients is highly increased in the presence of HF and PAD. This justifies the screening of these conditions to intensify therapeutic strategies.
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Affiliation(s)
- José Antonio Gimeno Orna
- Servicio de Endocrinología y Nutrición, HCU Lozano Blesa, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
| | - Ana Belén Mañas Martínez
- Servicio de Endocrinología y Nutrición, HCU Lozano Blesa, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - Manuel Anguita Sánchez
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica, Universidad de Córdoba, CIBER Cardiovascular, Córdoba, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Muñiz García
- Universidad da Coruña, Grupo de Investigación Cardiovascular, Departamento de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Antonio Pérez Pérez
- Servicio de Endocrinología y Nutrición. Instituto de Investigación, Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona, CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Barcelona, Spain
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26
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Wang R, Wang H, Liu S, Yang L, Ma L, Liu F, Li Y, Li P, Shi Y, Sun M, Song Y, Hou W, Mi W, Ma Y. Coronary heart disease increases the risk of perioperative ischemic stroke after noncardiac surgery: A retrospective cohort study. CNS Neurosci Ther 2024; 30:e14912. [PMID: 39185787 PMCID: PMC11345749 DOI: 10.1111/cns.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE To investigate the association between coronary heart disease (CHD) and the risk of perioperative ischemic stroke in patients undergoing noncardiac surgery. METHODS This retrospective study evaluated the incidence of ischemic stroke within 30 days after a noncardiac surgery. A cohort of 221,541 patients who underwent noncardiac surgery between January 2008 and August 2019 was segregated according to whether they were diagnosed with CHD. Primary, sensitivity, and subgroup logistic regression analyses were conducted to confirm that CHD is an independent risk factor for perioperative ischemic stroke. Propensity score matching analysis was used to account for the potential residual confounding effect of covariates. RESULTS Among the 221,541 included patients undergoing noncardiac surgery, 484 patients (0.22%) experienced perioperative ischemic stroke. The risk of perioperative ischemic stroke was higher in patients with CHD (0.7%) compared to patients without CHD (0.2%), and multivariate logistic regression analysis showed that CHD was associated with a significantly increased risk of perioperative ischemic stroke (odds ratio (OR), 3.7943; 95% confidence interval (CI) 2.865-4.934; p < 0.001). In a subset of patients selected by propensity score matching (PSM) in which all covariates between the two groups were well balanced, the association between CHD and increased risk of perioperative ischemic stroke remained significantly significant (OR 1.8150; 95% CI, 1.254-2.619; p = 0.001). In the subgroup analysis stratified by age, preoperative β-blockers, and fibrinogen-to-albumin ratio (FAR), the association between CHD and perioperative ischemic stroke was stable (p for interaction >0.05). Subgroup analyses also showed that CHD was significantly increased the risk of perioperative ischemic stroke in the preoperative mean arterial pressure (MAP) ≥94.2 mmHg subgroups (p for interaction <0.001). CONCLUSION CHD is significantly associated with an increased risk of perioperative ischemic stroke and is an independent risk factor for perioperative ischemic stroke after noncardiac surgery. Strict control of preoperative blood pressure may reduce the risk of perioperative ischemic stroke for patients with CHD undergoing noncardiac surgery.
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Affiliation(s)
- Rui Wang
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Han Wang
- Department of OrthopedicsAir Force Medical CenterBeijingChina
| | - Siyuan Liu
- Department of AnesthesiologyAffiliated Hospital of Nantong UniversityNantongChina
| | - Lujia Yang
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Libin Ma
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Fengjin Liu
- Department of EmergencyYantai Yuhuangding HospitalYantaiChina
| | - Yingfu Li
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Peng Li
- Department of AnesthesiologyThe Sixth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yizheng Shi
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Miao Sun
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yuxiang Song
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Wugang Hou
- Department of Anesthesiology and Perioperative MedicineXijing Hospital, Air Force Military Medical UniversityXi’anChina
| | - Weidong Mi
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Yulong Ma
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
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Wang J, Yang Y, Su Q, Wang J, Zeng H, Chen Y, Zhou J, Wang Y. Association between muscle strength and cardiometabolic multimorbidity risk among middle-aged and older Chinese adults: a nationwide longitudinal cohort study. BMC Public Health 2024; 24:2012. [PMID: 39068419 PMCID: PMC11282630 DOI: 10.1186/s12889-024-19521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Cardiometabolic multimorbidity (CM) is emerging as a global health challenge. This study investigated the potential impact of muscle strength on the risk of CM in middle-aged and older Chinese adults. METHODS In total, 7610 participants were identified from the China Health and Retirement Longitudinal Study (CHARLS). Muscle strength was measured by absolute, relative grip strength (normalized for body mass index) and chair-rising time which were classified into three categories according to tertiles stratified by gender. Cox proportional hazards models were adopted to evaluate the effect of muscle strength on CM. RESULTS During follow-up, 235(3.76%) participants from none cardiometabolic diseases (CMD), 140 (19.23%) from diabetes, 119 (21.17%) from heart disease, and 22 (30.56%) from stroke progressed to CM. In participants who had low relative grip strength, CM was more likely to occur in individuals with heart disease at baseline (HR: 1.89, 95%CIs: 1.10 to 3.23). Those with high chair-rising time had a higher risk of CM than those with low chair-rising time in the individuals with diabetes (HR: 1.85, 95%CIs:1.20 to 2.86) and with heart disease (HR: 1.67, 95%CIs:1.04 to 2.70). However, we did not observe an association between muscle strength and CM in participants without CMD or with stroke at baseline. CONCLUSIONS In Chinese middle-aged and older adults, low relative grip strength was associated with a higher risk of CM in individuals with heart disease, while high chair-rising time was associated with a higher risk of CM in individuals with diabetes or heart disease.
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Affiliation(s)
- Jingxian Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Qing Su
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Juejin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Hao Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Yaqing Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Junxi Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Chashan High Education Zone, Wenzhou, China.
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang, China.
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28
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Liu X, Li S, Wang X, Fan J, Gong W, Yan Y, Ai H, Que B, Zheng W, Nie S. Impact of obstructive sleep apnea on prognosis of patients with cardiometabolic multimorbidity. Diabetol Metab Syndr 2024; 16:178. [PMID: 39060937 PMCID: PMC11282628 DOI: 10.1186/s13098-024-01403-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Cardiometabolic multimorbidity (CMM) is a growing global health problem, and obstructive sleep apnea (OSA) is recognized as an important risk factor for cardiovascular disease. However, the impact of OSA on the prognosis of CMM patients remains unclear. METHODS This study was a sub-study of OSA-acute coronary syndrome (ACS) and included 1, 927 hospitalized ACS patients. Patients were divided into the CMM group and the non-CMM group. OSA was diagnosed using the apnea-hypopnea index (AHI). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). The secondary endpoint included cardiac events, all-cause death and all repeat revascularizations. RESULTS This study enrolled 1, 927 patients hospitalized for ACS, with a median follow-up of 3 years. Among them, 723 patients (37.5%) had CMM, while 1, 204 patients (62.5%) did not have CMM. Over half of the patients in each group had OSA. OSA patients exhibited worse cardiometabolic profiles than their non-OSA counterparts, including higher body mass index (BMI), glycemic indices, lipids and inflammation. In the CMM group, OSA patients had a significantly higher incidence of MACCE than non-OSA patients (34.7% vs. 23.7%, p = 0.004). These results remained significant after adjustment, indicating that OSA substantially increased the risk of MACCE in the CMM group (adjusted hazard ratio [HR]: 1.432; 95% confidence interval [CI]: 1.017-2.016; p = 0.040). Conversely, the incidence of MACCE was similar between OSA and non-OSA subgroups within the non-CMM cohort. Subgroup analyses showed that OSA increased the risk of MACCE in CMM patients aged ≥ 60 years (adjusted HR: 1.642; 95% CI: 1.031-2.615; p = 0.037) and in those with specific clinical characteristics. CONCLUSION OSA significantly impacts the prognosis of CMM patients, highlighting the need for targeted OSA screening and management strategies to improve outcomes in this population potentially.
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Grants
- 2020YFC2004800 National Key Research and Development Program of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- 81970292, 82270258, 82100260, 82200495 National Natural Science Foundation of China
- QLM20230608 Beijing Hospitals Authority Youth Programme
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Affiliation(s)
- Xiaogang Liu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China
| | - Siyi Li
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wen Zheng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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29
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Lu Z, Ntlapo N, Tilly MJ, Geurts S, Aribas E, Ikram MK, de Groot NMS, Kavousi M. Burden of cardiometabolic disorders and lifetime risk of new-onset atrial fibrillation among men and women: the Rotterdam Study. Eur J Prev Cardiol 2024; 31:1141-1149. [PMID: 38307013 DOI: 10.1093/eurjpc/zwae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
AIMS To examine the association between the burden of cardiometabolic disorders with new-onset atrial fibrillation (AF) and lifetime risk of AF incidence among men and women. METHODS AND RESULTS Four thousand one hundred and one men and 5421 women free of AF at baseline (1996-2008) from the population-based Rotterdam Study were included. Sex-specific Cox proportional-hazards regression models were used to assess the association between the burden of cardiometabolic disorders and risk of new-onset AF. The remaining lifetime risk for AF was estimated at index ages of 55, 65, and 75 years up to age 108. Mean age at baseline was 65.5 ± 9.4 years. Median follow-up time was 12.8 years. In the fully adjusted model, a stronger association was found between a larger burden of cardiometabolic disorders and incident AF among women [hazard ratio (HR): 1.33% and 95% conference interval (CI): 1.22-1.46], compared to men [1.18 (1.08-1.29)] (P for sex-interaction <0.05). The lifetime risk for AF significantly increased with the number of cardiometabolic disorders among both sexes. At an index age of 55 years, the lifetime risks (95% CIs) for AF were 27.1% (20.8-33.4), 26.5% (22.8-30.5), 29.9% (26.7-33.2), 30.8% (25.7-35.8), and 33.3% (23.1-43.6) among men, for 0, 1, 2, 3, and ≥4 comorbid cardiometabolic disorders. Corresponding risks were 15.8% (10.5-21.2), 23.0% (19.8-26.2), 29.7% (26.8-32.6), 26.2% (20.8-31.6), and 34.2% (17.3-51.1) among women. CONCLUSION We observed a significant combined impact of cardiometabolic disorders on AF risk, in particular among women. Participants with cardiometabolic multimorbidity had a significantly higher lifetime risk of AF, especially at a young index age.
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Affiliation(s)
- Zuolin Lu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Noluthando Ntlapo
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, office Na-2714, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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30
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Tang Y, Xiao Y, Yang F, Gao X, Zhu X, Qiao G. Association between dietary vitamin A intake and risk of cardiometabolic multimorbidity. Sci Rep 2024; 14:16656. [PMID: 39030396 PMCID: PMC11271594 DOI: 10.1038/s41598-024-67723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024] Open
Abstract
The association between vitamin A and single cardiometabolic diseases has been extensively studied, but the relationship between dietary vitamin A intake and the risk of cardiometabolic multimorbidity (CMM) has not been studied. Therefore, the present study was conducted to explore the association with CMM risk by analyzing different sources of vitamin A. This study utilized 13,603 subjects aged ≥ 18 years from 1997 to 2015 from the China Health and Nutrition Survey (CHNS). Dietary intake was calculated from 3 consecutive 24-h dietary recalls combined with a house hold food inventory. CMM is defined as the development of at least two cardiometabolic diseases. After a median follow-up of 9.0 years, there were 1050 new cases of CMM. The risk of CMM was significantly lower in those with higher vitamin A intake (Q1 vs Q5 HR 0.66, 95% CI 0.54-0.81). β-carotene (Q1 vs Q5 HR 0.82, 95% CI 0.66-1.02) and retinol (Q1 vs Q5 HR 0.59, 95% CI 0.48-0.73) intake had a similarly negative correlation. Using restricted cubic spline found an L-shaped relationship between retinol intake and CMM (p non-linear < 0.001). Negative associations were also found in specific CMD groups (hypertension, cardiovascular disease, stroke and diabetes). Dietary intake of vitamin A was negatively associated with CMM risk, and this protective effect was more pronounced in patients with cardiovascular disease. There was an L-shaped association between retinol intake and CMM risk.
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Affiliation(s)
- Yudi Tang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Yao Xiao
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, Hubei, China
- Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, 430061, Hubei, China
- Hubei Academy of Traditional Chinese Medicine, Wuhan, 430074, Hubei, China
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xiaolian Gao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China.
| | - Guiyuan Qiao
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China.
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31
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Peng S, Li Z, Ji JS, Chen B, Yin X, Zhang W, Liu F, Shen H, Xiang H. Interaction between Extreme Temperature Events and Fine Particulate Matter on Cardiometabolic Multimorbidity: Evidence from Four National Cohort Studies. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:12379-12389. [PMID: 38961056 PMCID: PMC11256764 DOI: 10.1021/acs.est.4c02080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
Accumulating evidence linked extreme temperature events (ETEs) and fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM); however, it remained unknown if and how ETEs and PM2.5 interact to trigger CMM occurrence. Merging four Chinese national cohorts with 64,140 free-CMM adults, we provided strong evidence among ETEs, PM2.5 exposure, and CMM occurrence. Performing Cox hazards regression models along with additive interaction analyses, we found that the hazards ratio (HRs) of CMM occurrence associated with heatwave and cold spell were 1.006-1.019 and 1.063-1.091, respectively. Each 10 μg/m3 increment of PM2.5 concentration was associated with 17.9% (95% confidence interval: 13.9-22.0%) increased risk of CMM. Similar adverse effects were also found among PM2.5 constituents of nitrate, organic matter, sulfate, ammonium, and black carbon. We observed a synergetic interaction of heatwave and PM2.5 pollution on CMM occurrence with relative excess risk due to the interaction of 0.999 (0.663-1.334). Our study provides novel evidence that both ETEs and PM2.5 exposure were positively associated with CMM occurrence, and the heatwave interacts synergistically with PM2.5 to trigger CMM.
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Affiliation(s)
- Shouxin Peng
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Zhaoyuan Li
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - John S. Ji
- Vanke
School of Public Health, Tsinghua University, Beijing 100084, China
| | - Bingbing Chen
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xiaoyi Yin
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wei Zhang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Feifei Liu
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Huanfeng Shen
- School
of Resource and Environmental Sciences, Wuhan University, Wuhan 430079, China
| | - Hao Xiang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
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Zhang A, Wei P, Ding L, Zhang H, Jiang Z, Mi L, Yu F, Tang M. Associations of serum lead, cadmium, and mercury concentrations with all-cause and cause-specific mortality among individuals with cardiometabolic multimorbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 280:116556. [PMID: 38852466 DOI: 10.1016/j.ecoenv.2024.116556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
Epidemiological evidence indicates an association between exposure to toxic metals and the occurrence of cardiometabolic diseases (CMDs). However, the impact of exposure to harmful metallic elements, such as lead (Pb), cadmium (Cd), and mercury (Hg), on mortality in individuals with cardiometabolic multimorbidity (CMM) remains uncertain. Therefore, in this study, we analyzed data from 4139 adults diagnosed with CMM from the National Health and Nutrition Examination Survey 1999-2016. CMM was defined as the presence of at least two CMDs (hypertension, diabetes, stroke, and coronary artery disease). Over an average follow-up period of 9.0 years, 1379 deaths from all causes, 515 deaths related to cardiovascular disease (CVD), and 215 deaths attributable to cancer were recorded. After adjusting for potential covariates, serum Pb concentrations were not associated with all-cause, CVD, or cancer mortality. Participants exposed to Cd had an elevated risk of all-cause mortality (hazard ratio [HR], 1.23; 95 % CI, 1.16-1.30), CVD-related mortality (HR, 1.23; 95 % CI, 1.12-1.35), and cancer-related mortality (HR, 1.29; 95 % CI, 1.13-1.47). Participants with serum Hg levels in the highest quantile had lower risks of all-cause (HR, 0.64; 95 % CI, 0.52-0.80) and CVD-related (HR, 0.62; 95 % CI, 0.44-0.88) mortality than did those in the lowest quantile. Stratified analyses revealed significant interactions between serum Cd concentrations and age for CVD-related mortality (P for interaction =0.011), indicating that CMM participants aged < 60 years who were exposed to Cd were at a greater risk of CVD-related mortality. A nonlinear relationship was observed between serum Cd concentrations and all-cause (P for nonlinear relationship = 0.012) and CVD-related (P for nonlinear relationship < 0.001) mortality. Minimizing Cd exposure in patients with CMM may help prevent premature death.
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Affiliation(s)
- Aikai Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Ding
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Hongda Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Zihan Jiang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Lijie Mi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Fengyuan Yu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
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Liu J, Liu W, Wang L, Wang N, Wu L, Liu X, Liu Z, Zhou Y, Yin X, Liu Y, Wu Q, Cui Y, Liang L. Association of Visceral Adiposity Index and Handgrip Strength with Cardiometabolic Multimorbidity among Middle-Aged and Older Adults: Findings from Charls 2011-2020. Nutrients 2024; 16:2277. [PMID: 39064720 PMCID: PMC11280108 DOI: 10.3390/nu16142277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
The visceral adiposity index (VAI) and handgrip strength (HGS) are identified as important objectives for the prevention of illness. Nevertheless, there is limited understanding regarding the impact of the VAI and HGS on cardiometabolic multimorbidity (CMM). We aimed to ascertain the impact of the VAI and HGS on CMM among middle-aged and older people. Data spanning from 2011 to 2020 were derived from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7909 individuals aged 45 years and older were included. Cox proportional hazard regression was utilized to examine the correlation among the VAI, HGS, and CMM. Throughout the 10-year follow-up, we determined that both the VAI (HR = 1.330; 95%CI = 1.179-1.500) and HGS (HR = 0.745, 95%CI = 0.645-0.861) exhibited significant associations with CMM risk. Individuals exposed to both a high VAI and low HGS were found to have higher hazards of CMM (HR = 1.377, 95%CI = 1.120-1.694) in contrast to participants exposed to one or none of these conditions. The older (HR = 1.414; 95%CI = 1.053-1.899) and male (HR = 1.586; 95%CI = 1.114-2.256) groups are more likely to experience CMM risk. Our findings suggest that both the VAI and HGS have significant effects on CMM risk. Appropriate interventions focused on vulnerable groups are recommended to prevent the incidence of CMM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin 150081, China; (J.L.); (W.L.); (L.W.); (N.W.); (L.W.); (X.L.); (Z.L.); (Y.Z.); (X.Y.); (Y.L.); (Q.W.); (Y.C.)
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Liu C, Liu R, Tian N, Fa W, Liu K, Wang N, Zhu M, Liang X, Ma Y, Ren Y, Wang Y, Cong L, Tang S, Vetrano DL, Ngandu T, Kivipelto M, Hou T, Du Y, Qiu C. Cardiometabolic multimorbidity, peripheral biomarkers, and dementia in rural older adults: The MIND-China study. Alzheimers Dement 2024. [PMID: 38982798 DOI: 10.1002/alz.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/20/2024] [Accepted: 06/01/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Evidence has emerged that cardiometabolic multimorbidity (CMM) is associated with dementia, but the underlying mechanisms are poorly understood. METHODS This population-based study included 5704 older adults. Of these, data were available in 1439 persons for plasma amyloid-β (Aβ), total tau, and neurofilament light chain (NfL) and in 1809 persons for serum cytokines. We defined CMM following two common definitions used in previous studies. Data were analyzed using general linear, logistic, and mediation models. RESULTS The presence of CMM was significantly associated with an increased likelihood of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) (p < 0.05). CMM was significantly associated with increased plasma Aβ40, Aβ42, and NfL, whereas CMM that included visceral obesity was associated with increased serum cytokines. The mediation analysis suggested that plasma NfL significantly mediated the association of CMM with AD. DISCUSSION CMM is associated with dementia, AD, and VaD in older adults. The neurodegenerative pathway is involved in the association of CMM with AD. HIGHLIGHTS The presence of CMM was associated with increased likelihoods of dementia, AD, and VaD in older adults. CMM was associated with increased AD-related plasma biomarkers and serum inflammatory cytokines. Neurodegenerative pathway was partly involved in the association of CMM with AD.
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Affiliation(s)
- Cuicui Liu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Rui Liu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Na Tian
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Wenxin Fa
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Keke Liu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Nan Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Min Zhu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Xiaoyan Liang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Yixun Ma
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Yifei Ren
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
| | - Yongxiang Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Solna, Sweden
| | - Lin Cong
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Shi Tang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Tiia Ngandu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tingting Hou
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Yifeng Du
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, P.R. China
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
| | - Chengxuan Qiu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
- Institute of Brain Science and Brain-Inspired Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Solna, Sweden
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Yin X, Chen Y, Zhou L, Yang H, Wang Y. Association between chronic pain and risk of cardiometabolic multimorbidity: a prospective cohort study. Reg Anesth Pain Med 2024:rapm-2024-105486. [PMID: 38986566 DOI: 10.1136/rapm-2024-105486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Although chronic pain was deleteriously related to single cardiometabolic diseases, the relationship between chronic pain and cardiometabolic multimorbidity remains unclear. The purpose of this study was to investigate the association between chronic pain with the risk of cardiometabolic multimorbidity. METHODS A prospective cohort study included 452 818 participants who were free of cardiometabolic multimorbidity at baseline. Chronic pain was assessed in diverse anatomical sites including the head, face, neck/shoulder, stomach/abdominal area, back, hip and knee or 'all over the body'. Participants were classified into six groups according to the amount of chronic pain sites: no chronic pain, chronic pain at one, two, three and four or more sites, and those reporting pain 'all over the body'. Cardiometabolic multimorbidity was defined as the occurrence of at least two cardiometabolic diseases, involving type 2 diabetes, ischaemic heart disease and stroke. RESULTS After a median follow-up of 13.7 years, 4445 participants developed cardiometabolic multimorbidity. Compared with individuals without chronic pain, those experiencing chronic pain in four or more sites were associated with a 1.82-fold (HR: 1.82, 95% CI: 1.61, 2.06) higher risk of cardiometabolic multimorbidity. Pain distributed 'all over the body' was associated with a 59% (HR: 1.59, 95% CI: 1.30, 1.93) increased risk of cardiometabolic multimorbidity Additionally, individuals who had chronic pain in both the head and stomach/abdomen showed the highest risk with cardiometabolic multimorbidity (HR: 1.88, 95% CI: 1.60, 2.20). CONCLUSIONS Our findings suggested that there was an elevated risk of cardiometabolic multimorbidity associated with an increased amount of chronic pain sites.
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Affiliation(s)
- Xin Yin
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanchun Chen
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lihui Zhou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hongxi Yang
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
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Zhao C, Ma T, Cheng X, Zhang G, Bai Y. Genome-wide association study of cardiometabolic multimorbidity in the UK Biobank. Clin Genet 2024; 106:72-81. [PMID: 38409652 DOI: 10.1111/cge.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
Considering the high prevalence and poor prognosis of cardiometabolic multimorbidity (CMM), identifying causal factors and actively implementing preventive measures is crucial. However, Mendelian randomization (MR), a key method for identifying the causal factors of CMM, requires knowledge of the effects of SNPs on CMM, which remain unknown. We first analyzed the genetic overlap of single cardiometabolic diseases (CMDs) using the latest genome-wide association study (GWAS) for evidential support and comparison. We observed strong positive genetic correlations and shared loci among all CMDs. Further, GWAS and post-GWAS analyses of CMM were performed in 407 949 European ancestry individuals from the UK Biobank. Eleven loci and 12 lead SNPs were identified. By comparison, we found these SNPs were a subset of SNPs associated with CMDs, including both shared and non-shared SNPs. Then, the polygenic risk score model predicted the risk of CMM (C-index = 0.62) and we identified candidate genes related to lipid metabolism and immune function. Finally, as an example, two-sample MR analysis based on the GWAS revealed potential causal effects of total cholesterol, serum urate, body mass index, and smoking on CMM. These results provide a basis for future MR research and inspire future studies on the mechanism and prevention of CMM.
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Affiliation(s)
- Chenxuan Zhao
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Li C, Wang S, Liu K, Zheng Y, Li Q, Zhang Y, Jiang L, Sun H, Liu M. The association of cardiometabolic multimorbidity and fear of falling among older adults: Data from the national health and aging trends study. Geriatr Nurs 2024; 58:361-367. [PMID: 38875762 DOI: 10.1016/j.gerinurse.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults. METHODS Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression. RESULTS Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40). CONCLUSIONS These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults.
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Affiliation(s)
- Chunxiao Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shuomin Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Kehan Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu Zheng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qianyuan Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yunpeng Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Suzhou, China
| | - Li Jiang
- Guangxi Medical University Nursing College, Nanning, China
| | - Hongyu Sun
- Peking University School of Nursing, Beijing, China.
| | - Minhui Liu
- Ningxia Medical University School of Nursing, Ningxia, China. https://twitter.com/MinhuiLiu2
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Dauriz M, Csermely A, Santi L, Tregnaghi E, Grotto A, Lucianer T, Altomari A, Rinaldi E, Tardivo S, Bonetti B, Bonora E. Diabetes mellitus in stroke unit: prevalence and outcomes-the Verona acute coronary syndrome and stroke in diabetes outcome (VASD-OUTCOME) study. Acta Diabetol 2024:10.1007/s00592-024-02318-w. [PMID: 38951223 DOI: 10.1007/s00592-024-02318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is limited. Therefore, we estimated prevalence and impact of DM on in-hospital survival and complications in a contemporary cohort of subjects with CVA. METHODS We retrospectively evaluated the records of 937 patients admitted for CVA at the Stroke Unit of Verona University Hospital during a 3-year period. Pre-existing or de novo DM was ascertained by prior diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose ≥ 200 mg/dL. Multiple regressions were applied to test DM as predictor of in-hospital mortality, complications (composite of infections, cardio- and cerebrovascular complications, major bleeding and pulmonary complications), duration and costs of hospitalization. RESULTS Diabetes prevalence was 21%, of which 22% de novo diagnoses. Compared to non-DM, diabetic individuals were older and carried an increased burden of cardiovascular risk factors. Compared to known DM, de novo DM individuals were younger, had higher admittance plasma glucose and poorer cardiovascular comorbidities. Overall, DM versus non-DM individuals did not show significantly increased risk of death (14.0 vs. 9.3%; crude-OR 1.59 95% CI 0.99-2.56). Controlling for confounders did not improve significance. DM resulted independent predictor for in-hospital complications (36.2% vs. 26.9%; adj-OR 1.49, 1.04-2.13), but not for duration and costs of hospitalization. CONCLUSION DM frequently occurs in patients admitted for stroke and carries an excess burden of adverse in-hospital complications, urgently calling for strategies to anticipate DM diagnosis and tailored treatment in high-risk individuals.
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Affiliation(s)
- Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elena Tregnaghi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Alberto Grotto
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Tiziano Lucianer
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Anna Altomari
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Bruno Bonetti
- Division of Neurology, Department of Neurological Sciences, Hospital Trust of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
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Kennedy J, Alexander P, Taillie LS, Jaacks LM. Estimated effects of reductions in processed meat consumption and unprocessed red meat consumption on occurrences of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality in the USA: a microsimulation study. Lancet Planet Health 2024; 8:e441-e451. [PMID: 38969472 DOI: 10.1016/s2542-5196(24)00118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND High consumption of processed meat and unprocessed red meat is associated with increased risk of multiple chronic diseases, although there is substantial uncertainty regarding the relationship for unprocessed red meat. We developed a microsimulation model to estimate how reductions in processed meat and unprocessed red meat consumption could affect rates of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality in the US adult population. METHODS We used data from two versions of the US National Health and Nutrition Examination Survey, one conducted during 2015-16 and one conducted during 2017-18, to create a simulated US population. The starting cohort was restricted to respondents aged 18 years or older who were not pregnant and had 2 days of dietary-recall data. First, we used previously developed risk models to estimate the baseline disease risk of an individual. For type 2 diabetes we used a logistic-regression model and for cardiovascular disease and colorectal cancer we used Cox proportional-hazard models. We then multiplied baseline risk by relative risk associated with individual processed meat and unprocessed red meat consumption. Prevented occurrences of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality were computed by taking the difference between the incidence in the baseline and intervention scenarios. All stages were repeated for ten iterations to correspond to a 10-year time span. Scenarios were reductions of 5%, 10%, 30%, 50%, 75%, and 100% in grams consumed of processed meat, unprocessed red meat, or both. Each scenario was repeated 50 times for uncertainty analysis. FINDINGS The total number of individual respondents included in the simulated population was 8665, representing 242 021 876 US adults. 4493 (51·9%) of 8665 individuals were female and 4172 (48·1%) were male; mean age was 49·54 years (SD 18·38). At baseline, weighted mean daily consumption of processed meat was 29·1 g, with a 30% reduction being 8·7 g per day, and of unprocessed red meat was 46·7 g, with a 30% reduction being 14·0 g per day. We estimated that a 30% reduction in processed meat intake alone could lead to 352 900 (95% uncertainty interval 345 500-359 900) fewer occurrences of type 2 diabetes, 92 500 (85 600-99 900) fewer occurrences of cardiovascular disease, 53 300 (51 400-55 000) fewer occurrences of colorectal cancer, and 16 700 (15 300-17 700) fewer all-cause deaths during the 10-year period. A 30% reduction in unprocessed red meat intake alone could lead to 732 600 (725 700-740 400) fewer occurrences of type 2 diabetes, 291 500 (283 900-298 800) fewer occurrences of cardiovascular disease, 32 200 (31 500-32 700) fewer occurrences of colorectal cancer, and 46 100 (45 300-47 200) fewer all-cause deaths during the 10-year period. A 30% reduction in both processed meat and unprocessed red meat intake could lead to 1 073 400 (1 060 100-1 084 700) fewer occurrences of type 2 diabetes, 382 400 (372 100-391 000) fewer occurrences of cardiovascular disease, 84 400 (82 100-86 200) fewer occurrences of colorectal cancer, and 62 200 (60 600-64 400) fewer all-cause deaths during the 10-year period. INTERPRETATION Reductions in processed meat consumption could reduce the burden of some chronic diseases in the USA. However, more research is needed to increase certainty in the estimated effects of reducing unprocessed red meat consumption. FUNDING The Wellcome Trust.
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Affiliation(s)
- Joe Kennedy
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK.
| | - Peter Alexander
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK; School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Lindsey Smith Taillie
- Carolina Population Center, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
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Htoo PT, Tesfaye H, Schneeweiss S, Wexler DJ, Everett BM, Glynn RJ, Schmedt N, Koeneman L, Déruaz-Luyet A, Paik JM, Patorno E. Effectiveness and safety of empagliflozin: final results from the EMPRISE study. Diabetologia 2024; 67:1328-1342. [PMID: 38509341 DOI: 10.1007/s00125-024-06126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
AIMS/HYPOTHESIS Limited evidence exists on the comparative safety and effectiveness of empagliflozin against alternative glucose-lowering medications in individuals with type 2 diabetes with the broad spectrum of cardiovascular risk. The EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) cohort study was designed to monitor the safety and effectiveness of empagliflozin periodically for a period of 5 years with data collection from electronic healthcare databases. METHODS We identified individuals ≥18 years old with type 2 diabetes who initiated empagliflozin or dipeptidyl peptidase-4 inhibitors (DPP-4i) from 2014 to 2019 using US Medicare and commercial claims databases. After 1:1 propensity score matching using 143 baseline characteristics, we identified four a priori-defined effectiveness outcomes: (1) myocardial infarction (MI) or stroke; (2) hospitalisation for heart failure (HHF); (3) major adverse cardiovascular events (MACE); and (4) cardiovascular mortality or HHF. Safety outcomes included lower-limb amputations, non-vertebral fractures, diabetic ketoacidosis (DKA), acute kidney injury (AKI), severe hypoglycaemia, retinopathy progression, and short-term kidney and bladder cancers. We estimated HRs and rate differences (RDs) per 1000 person-years, overall and stratified by age, sex, baseline atherosclerotic cardiovascular disease (ASCVD) and heart failure. RESULTS We identified 115,116 matched pairs. Compared with DPP-4i, empagliflozin was associated with lower risks of MI/stroke (HR 0.88 [95% CI 0.81, 0.96]; RD -2.08 [95% CI (-3.26, -0.90]), HHF (HR 0.50 [0.44, 0.56]; RD -5.35 [-6.22, -4.49]), MACE (HR 0.73 [0.62, 0.86]; RD -6.37 [-8.98, -3.77]) and cardiovascular mortality/HHF (HR 0.57 [0.47, 0.69]; RD -10.36 [-12.63, -8.12]). Absolute benefits were larger in older individuals and in those with ASCVD/heart failure. Empagliflozin was associated with an increased risk of DKA (HR 1.78 [1.44, 2.19]; RD 1.59 [1.08, 2.09]); decreased risks of AKI (HR 0.62 [0.54, 0.72]; RD -2.39 [-3.08, -1.71]), hypoglycaemia (HR 0.75 [0.67, 0.84]; RD -2.46 [-3.32, -1.60]) and retinopathy progression (HR 0.78 [0.63, 0.96)]; RD -9.49 [-16.97, -2.10]); and similar risks of other safety events. CONCLUSIONS/INTERPRETATION Empagliflozin relative to DPP-4i was associated with risk reductions of MI or stroke, HHF, MACE and the composite of cardiovascular mortality or HHF. Absolute risk reductions were larger in older individuals and in those who had history of ASCVD or heart failure. Regarding the safety outcomes, empagliflozin was associated with an increased risk of DKA and lower risks of AKI, hypoglycaemia and progression to proliferative retinopathy, with no difference in the short-term risks of lower-extremity amputation, non-vertebral fractures, kidney and renal pelvis cancer, and bladder cancer.
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Affiliation(s)
- Phyo T Htoo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Helen Tesfaye
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Deborah J Wexler
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Brendan M Everett
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Niklas Schmedt
- Global Epidemiology, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Lisette Koeneman
- Global Medical Affairs, Lilly Deutschland GmbH, Bad Homburg vor der Höhe, Germany
| | - Anouk Déruaz-Luyet
- Global Epidemiology, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Renal (Kidney) Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Li P, Wang R, Liu F, Ma L, Yang H, Qu M, Liu S, Sun M, Liu M, Ma Y, Mi W. High body mass index is associated with elevated risk of perioperative ischemic stroke in patients who underwent noncardiac surgery: A retrospective cohort study. CNS Neurosci Ther 2024; 30:e14838. [PMID: 38987899 PMCID: PMC11236734 DOI: 10.1111/cns.14838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 06/22/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Body mass index (BMI) serves as a global metric for assessing obesity and overall health status. However, the impact of BMI, treated as a continuous variable, on the risk of perioperative stroke remains poorly understood. This retrospective cohort study aimed to elucidate the association between BMI and the risk of perioperative ischemic stroke in patients undergoing non-cardiovascular surgery. METHODS A cohort of 223,415 patients undergoing noncardiac surgery at the First Medical Center of Chinese PLA General Hospital between January 1, 2008 and August 31, 2019 was screened. Preoperative high BMI, defined as BMI >22.64 kg/m2, was the primary exposure, and the outcome of interest was the new diagnosis of perioperative ischemic stroke within 30 days post-surgery. Robust controls for patient and intraoperative factors were implemented to minimize residual confounding. Logistic regression and propensity score matching were employed, and patients were stratified into subgroups for further investigation. RESULTS The overall incidence of perioperative ischemic stroke was 0.23% (n = 525) in the cohort. After adjusting for patient-related variables (OR 1.283; 95% CI, 1.04-1.594; p < 0.05), surgery-related variables (OR 1.484; 95% CI, 1.2-1.849; p < 0.001), and all confounding variables (OR 1.279; 95% CI, 1.025-1.607; p < 0.05), patients with BMI >22.64 kg/m2 exhibited a significantly increased risk of perioperative ischemic stroke. This association persisted in the propensity score matched cohort (OR 1.577; 95% CI, 1.203-2.073; p < 0.01). Subgroup analyses indicated that preoperative BMI >22.64 kg/m2 correlated with an elevated risk of perioperative ischemic stroke in female patients, those with coronary heart disease, peripheral vascular diseases, and individuals undergoing neurosurgery. CONCLUSION We first identified BMI >22.64 kg/m2 as a substantial and independent risk factor for perioperative ischemic stroke in Chinese noncardiac surgery patients. Normal BMI may not suffice as a universal preventive standard. Instead, a more stringent perioperative weight management approach is recommended, particularly for specific subgroups such as female patients, those with coronary heart disease and peripheral vascular disease, and individuals scheduled for neurosurgery.
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Affiliation(s)
- Peng Li
- Department of AnesthesiologyThe Sixth Medical Center of Chinese PLA General HospitalBeijingChina
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Rui Wang
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Fengjin Liu
- Department of EmergencyYantai Yuhuangding HospitalShandongChina
| | - Libin Ma
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Huikai Yang
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Mengyao Qu
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Siyuan Liu
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Miao Sun
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Min Liu
- Department of Anesthesiology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Yulong Ma
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
| | - Weidong Mi
- Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
- Nation Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina
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Li W, Wang Q, Ning J, Zhang J, Li Z, Savitz SI, Tahanan A, Rahbar MH. Enhancing long-term survival prediction with two short-term events: Landmarking with a flexible varying coefficient model. Stat Med 2024; 43:2607-2621. [PMID: 38664221 DOI: 10.1002/sim.10086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 05/24/2024]
Abstract
Patients with cardiovascular diseases who experience disease-related short-term events, such as hospitalizations, often exhibit diverse long-term survival outcomes compared to others. In this study, we aim to improve the prediction of long-term survival probability by incorporating two short-term events using a flexible varying coefficient landmark model. Our objective is to predict the long-term survival among patients who survived up to a pre-specified landmark time since the initial admission. Inverse probability weighting estimation equations are formed based on the information of the short-term outcomes before the landmark time. The kernel smoothing method with the use of cross-validation for bandwidth selection is employed to estimate the time-varying coefficients. The predictive performance of the proposed model is evaluated and compared using predictive measures: area under the receiver operating characteristic curve and Brier score. Simulation studies confirm that parameters under the landmark models can be estimated accurately and the predictive performance of the proposed method consistently outperforms existing methods that either do not incorporate or only partially incorporate information from two short-term events. We demonstrate the practical application of our model using a community-based cohort from the Atherosclerosis Risk in Communities (ARIC) study.
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Affiliation(s)
- Wen Li
- Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School at Houston, Houston, Texas, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Qian Wang
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas, USA
| | - Jing Ning
- Department of Biostatistics, University of Texas MD Anderson Cancer Center at Houston, Houston, Texas, USA
| | - Jing Zhang
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas, USA
| | - Zhouxuan Li
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas, USA
| | - Sean I Savitz
- Department of Neurology and Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| | - Amirali Tahanan
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas McGovern Medical School at Houston, Houston, Texas, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Epidemiology, Human Genetics and Environmental Sciences (EHGES), University of Texas School of Public Health at Houston, Houston, Texas, USA
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Wang Q, Schmidt AF, Lennon LT, Papacosta O, Whincup PH, Wannamethee G. Association of Life's Simple 7 lifestyle metric with cardiometabolic disease-free life expectancy in older British men. COMMUNICATIONS MEDICINE 2024; 4:104. [PMID: 38834824 DOI: 10.1038/s43856-024-00534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases (CMD), including myocardial infarction, stroke, and type 2 diabetes, are leading causes of disability and mortality globally, particularly for people at an older age. The impact of adhering to the Life's Simple 7 (LS7) on the number of years an individual will live without CMD in older adults remains less studied. METHODS This study included a cohort of 2662 British men aged 60-79 years free of CMD at baseline from the British Regional Heart Study (BRHS). Each LS7 factor (BMI, blood pressure, blood glucose, total cholesterol, smoking, physical activity, and diet) was categorized as poor, intermediate, or ideal, and a composite LS7 adherence was determined by summing the number of LS7 ideal levels achieved. Flexible parametric Royston-Parmar proportional-hazards model was applied to estimate CMD-free life expectancy. RESULTS Here we show that compared to men with the lowest LS7 adherence [with 18.42 years (95% CI: 16.93, 19.90) of CMD-free life at age 60], men having an ideal LS7 adherence are estimated to gain an additional 4.37 years (95% CI: 2.95, 5.79) of CMD-free life. The CMD-free life gain benefits are consistent across social class groups of manual and non-manual workers. Among LS7 factors, achieving an ideal physical activity provides the largest CMD-free survival benefit: 4.84 years (95% CI: 3.37, 6.32) of additional CMD-free life compared with the physically inactive group. CONCLUSIONS Our study quantifies and highlights the benefits of adhering to the LS7 ideal levels for living a longer life without CMD in older adults.
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Affiliation(s)
- Qiaoye Wang
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Amand Floriaan Schmidt
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Sun J, Xie Z, Ye M, Xu H, Dong Y, Liu C, Zhu W. S 2I 2N 0-3 score predicts short- and long-term mortality and morbidity in HFrEF: a post-hoc analysis of the GUIDE-IT trial. ESC Heart Fail 2024; 11:1422-1434. [PMID: 38327133 PMCID: PMC11098633 DOI: 10.1002/ehf2.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/11/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
AIMS This study investigated the S2I2N0-3 score, a simple tool comprising stroke history, insulin-treated diabetes, and N-terminal pro-brain natriuretic peptide, for forecasting mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). METHODS AND RESULTS Analysing 890 GUIDE-IT HFrEF trial participants, we stratified them by baseline S2I2N0-3 risk score into three risk groups. We examined the score's association with five adverse outcomes over short (90 days) and extended periods (median follow-up of 15 months) using Cox and competing risk models. Our analysis revealed significant positive associations between the S2I2N0-3 strata and adverse outcomes. When analysed as a continuous variable, each point increment of the S2I2N0-3 score was associated with a higher risk of short- and long-term cardiovascular death [short term: hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.03-1.98; long term: HR 1.18, 95% CI 1.02-1.38], all-cause death (HR 1.52, 95% CI 1.12-2.07; HR 1.18, 95% CI 1.03-1.36), HF hospitalization (HR 1.39, 95% CI 1.20-1.62; HR 1.18, 95% CI 1.06-1.31), any hospitalization (HR 1.19, 95% CI 1.06-1.34; HR 1.09, 95% CI 1.00-1.19), and the composite outcome of cardiovascular death and HF hospitalization (HR 1.39, 95% CI 1.21-1.60; HR 1.17, 95% CI 1.06-1.30). The S2I2N0-3 demonstrated reliable prognostic value, with C-indices ranging from 0.619 to 0.753 across outcomes and time points. When compared with the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score using Z-statistics, net reclassification index, and integrated discrimination improvement, the S2I2N0-3 showed comparable predictive power for all outcomes during both short- and long-term follow-ups. CONCLUSIONS The S2I2N0-3 risk score had modest predictive values for both short- and long-term clinical outcomes in HFrEF patients, offering equivalent performance to the established MAGGIC score.
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Affiliation(s)
- Junyi Sun
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular DiseasesGuangzhouChina
| | - Zhengshuo Xie
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular DiseasesGuangzhouChina
| | - Min Ye
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - He Xu
- Center of Translational MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yugang Dong
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular DiseasesGuangzhouChina
| | - Chen Liu
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular DiseasesGuangzhouChina
| | - Wengen Zhu
- Department of CardiologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhou510080China
- NHC Key Laboratory of Assisted Circulation (Sun Yat‐sen University)GuangzhouChina
- National‐Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular DiseasesGuangzhouChina
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Zhao Y, Liu J, Xia JH, Li C, Ma XQ. Dose-response relationship between sleep duration and cardiovascular metabolic multimorbidity among older adults in China: A nationwide survey. J Affect Disord 2024; 354:75-81. [PMID: 38479505 DOI: 10.1016/j.jad.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/04/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the relationship between the duration of sleep per day and cardiovascular metabolic multimorbidity (CMM) in older adults and to identify how many hours of sleep per day can lead to a lower risk of CMM in older adults. BACKGROUND CMM are a common syndrome in the older adults. There may be an association between sleep duration and CMM in older adults, with both insomnia and sleep deprivation having an impact on the health of older adults. Therefore, it is important to explore the possibility that older adults who sleep for a few hours per day may have a lower prevalence of CMM. METHODS The study included 9710 older adults. The sleep duration in this study was assessed by the question "How many hours of sleep do you currently get in a day? ". Older adults were defined as having CMM when they had two or more of the five categories of hypertension, diabetes, heart disease, stroke or cardiovascular disease, dyslipidemia. We used multivariate logistic regression analysis to explore the association among sleep duration and CMM. Restrictive cubic splines were used to examine the shape of the association among sleep duration and the CMM. The STROBE checklist was used for this cross-sectional study. RESULTS The mean age was 84.78 ± 11.73 years, with 55.5 % being female. Of the total sample, 21.3 % were CMM. When all covariates were adjusted, there was dose-response relationship between sleep duration and CMM. The dose-response relationship between CMM and sleep duration showed that older adults had a lower risk of cardiovascular and metabolic multimorbidity when they slept 9 h and 10 h per day. CONCLUSION With the increasing population of older adults, the number of older adults suffering from CMM continues to rise, and adequate sleep time can effectively prevent the occurrence of CMM. We should pay attention to the sleep problem of the older adults. RELEVANCE TO CLINICAL PRACTICE This study provided information for healthcare providers to identify circumstances that increase cardiovascular metabolic multimorbidity and suggest the appropriate sleep duration per day to reduce the risk of disease in older adults. PATIENT OR PUBLIC CONTRIBUTION Because of the public database data used in this study, all data were collected by survey agency personnel, so this section is not applicable to this study.
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Affiliation(s)
- Yu Zhao
- HanZhong Central Hospital, HanZhong, China
| | - Juan Liu
- HanZhong Central Hospital, HanZhong, China
| | | | - Cui Li
- HanZhong Central Hospital, HanZhong, China
| | - Xiu-Qin Ma
- HanZhong Central Hospital, HanZhong, China.
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Ayalew MB, Dieberg G, Quirk F, Spark MJ. Assessment of Potentially Inappropriate Prescribing for People With Type 2 Diabetes Mellitus Using IMPACT2DM, a New Explicit Tool. J Pharm Pract 2024; 37:546-556. [PMID: 36525968 DOI: 10.1177/08971900221145219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background: People with type 2 diabetes mellitus (T2DM) are at greater risk of potentially inappropriate prescribing (PIP) due to multiple comorbidities and polypharmacy. IMPACT2DM (Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus) is a tool designed to identify PIP for adults with T2DM. Objectives: To assess PIP for adults with T2DM in Ethiopia using the IMPACT2DM and to test the face validity and clinical validity of the tool. Methods: A cross-sectional study was undertaken using data extracted retrospectively from the medical records of adults being managed for T2DM at Debretabore Hospital. PIP was assessed using IMPACT2DM. Some items/item components of IMPACT2DM were modified to increase the tool's applicability for the outpatient setting, to clarify content or to use the terms most common in this particular setting. Multivariant logistic regression analyses were conducted to identify factors associated with PIP. Results: More than 90% of medical records had at least 1 PIP. Prescribing omission (80.9%) was the most commonly identified type of PIP. Adults with prescribing omissions are more likely to be ≥40 years old or to be prescribed with <5 medications. Adults with dosing problems were more likely ≥50 years old, or have had a fasting blood sugar (FBS) level out of the target range (80-130 mg/dL). Conclusions: IMPACT2DM is a clinically valid PIP identification tool for application in an Ethiopian outpatient setting. Health professionals should be alert to check for potential prescribing omissions for adults ≥40 years old and dosing problems for adults with an FBS level out of the target range or >50 years.
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Affiliation(s)
- Mohammed B Ayalew
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW, Australia
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Gudrun Dieberg
- Biomedical Science, School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Frances Quirk
- School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - Marion J Spark
- Pharmacy, School of Rural Medicine, University of New England, Armidale, NSW, Australia
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Natalia YA, Molenberghs G, Faes C, Neyens T. Geospatial patterns of excess mortality in Belgium: Insights from the first year of the COVID-19 pandemic. Spat Spatiotemporal Epidemiol 2024; 49:100660. [PMID: 38876554 DOI: 10.1016/j.sste.2024.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/21/2024] [Accepted: 05/14/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES Belgium experienced multiple COVID-19 waves that hit various groups in the population, which changed the mortality pattern compared to periods before the pandemic. In this study, we investigated the geographical excess mortality trend in Belgium during the first year of the COVID-19 pandemic. METHODS We retrieved the number of deaths and population data in 2020 based on gender, age, and municipality of residence, and we made a comparison with the mortality data in 2017-2019 using a spatially discrete model. RESULTS Excess mortality was significantly associated with age, gender, and COVID-19 incidence, with larger effects in the second half of 2020. Most municipalities had higher risks of mortality with a number of exceptions in the northeastern part of Belgium. Some discrepancies in excess mortality were observed between the north and south regions. CONCLUSIONS This study offers useful insight into excess mortality and will aid local and regional authorities in monitoring mortality trends.
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Affiliation(s)
| | - Geert Molenberghs
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium; I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, 3000 Leuven, Belgium
| | - Christel Faes
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium; I-BioStat, Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, 3000 Leuven, Belgium
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Sun R, Jia J, Wang S, Wang Z, Wang C, Xu Y, Yuan Y. Mediation effect of antithrombin III between chronic renal insufficiency and chronic coronary artery disease in T2DM patients. Endocrine 2024; 84:924-933. [PMID: 38190026 DOI: 10.1007/s12020-023-03669-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE The study aimed to investigate the potential effect of Antithrombin III (ATIII) between chronic renal insufficiency and chronic coronary artery disease (chronic CAD) in type 2 diabetes mellitus (T2DM) patients. METHODS T2DM patients hospitalized in ZhongDa Hospital from 2013 to 2018 were enrolled. Relationships between renal function, ATIII, and chronic CAD risk were explored using multivariate regression models. Multiplicative and additive interactions were investigated between ATIII and renal function for CAD risk, and the role of ATIII was determined by bootstrap mediation analysis in patients with chronic renal dysfunction. RESULTS A total of 4197 patients were included in the study, with a chronic CAD prevalence of 23.02%. Low ATIII level was statistically associated with chronic renal insufficiency and elevated CAD risk even after adjustments (P < 0.05). A positive correlation between renal function and ATIII was demonstrated, and each 1 SD increase in renal function, ATIII increased by 2.947% (2.406-3.488%, P < 0.001) and 0.969% (0.297-1.642%, P < 0.001) in crude and adjusted models respectively. Patients with decreased renal function and ATIII were at the highest chronic CAD risk (OR = 1.51, 95%CI:1.15-1.98, P < 0.05), while no multiplicative and additive interaction effects were significant. Bootstrap mediation analysis estimated that ATIII mediated approximately 4.27% of the effect of chronic renal insufficiency on chronic CAD risk. CONCLUSION ATIII may serve as a mediator between chronic renal insufficiency and chronic CAD, providing mechanistic clues for renal-heart association and new insight into clinical therapies.
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Affiliation(s)
- Ruoyu Sun
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
- School of Medicine, Southeast University, Nanjing, 210009, China
| | - Jianhong Jia
- Department of Endocrinology, Siyang Hospital of Traditional Chinese Medicine, Suqian, 223700, China
| | - Shaohua Wang
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Zheng Wang
- Gansu Province Maternal and Child-Care Hospital, Lanzhou, 730050, China
| | - Chenchen Wang
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China
| | - Yanchao Xu
- College of Computer Science and Technology, Zhejiang University, Hangzhou, 310058, China
| | - Yang Yuan
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, China.
- School of Medicine, Southeast University, Nanjing, 210009, China.
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Zhu ML, Fan JX, Guo YQ, Guo LJ, Que HD, Cui BY, Li YL, Guo S, Zhang MX, Yin YL, Li P. Protective effect of alizarin on vascular endothelial dysfunction via inhibiting the type 2 diabetes-induced synthesis of THBS1 and activating the AMPK signaling pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 128:155557. [PMID: 38547622 DOI: 10.1016/j.phymed.2024.155557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/03/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND In this study, we investigated the protective effects of alizarin (AZ) on endothelial dysfunction (ED). AZ has inhibition of the type 2 diabetes mellitus (T2DM)-induced synthesis of thrombospondin 1 (THBS1). Adenosine 5'-monophosphate- activated protein kinase (AMPK), particularly AMPKα2 isoform, plays a critical role in maintaining cardiac homeostasis. PURPOSE The aim of this study was to investigate the ameliorative effect of AZ on vascular injury caused by T2DM and to reveal the potential mechanism of AZ in high glucose (HG)-stimulated human umbilical vein endothelial cells (HUVECs) and diabetic model rats. STUDY DESIGN HUVECs, rats and AMPK-/- transgenic mice were used to investigate the mitigating effects of AZ on vascular endothelial dysfunction caused by T2DM and its in vitro and in vivo molecular mechanisms. METHODS In type 2 diabetes mellitus rats and HUVECs, the inhibitory effect of alizarin on THBS1 synthesis was verified by immunohistochemistry (IHC), immunofluorescence (IF) and Western blot (WB) so that increase endothelial nitric oxide synthase (eNOS) content in vitro and in vivo. In addition, we verified protein interactions with immunoprecipitation (IP). To probe the mechanism, we also performed AMPKα2 transfection. AMPK's pivotal role in AZ-mediated prevention against T2DM-induced vascular endothelial dysfunction was tested using AMPKα2-/- mice. RESULTS We first demonstrated that THBS1 and AMPK are targets of AZ. In T2DM, THBS1 was robustly induced by high glucose and inhibited by AZ. Furthermore, AZ activates the AMPK signaling pathway, and recoupled eNOS in stressed endothelial cells which plays a protective role in vascular endothelial dysfunction. CONCLUSIONS The main finding of this study is that AZ can play a role in different pathways of vascular injury due to T2DM. Mechanistically, alizarin inhibits the increase in THBS1 protein synthesis after high glucose induction and activates AMPKα2, which increases NO release from eNOS, which is essential in the prevention of vascular endothelial dysfunction caused by T2DM.
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Affiliation(s)
- Mo-Li Zhu
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Jia-Xin Fan
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Ya-Qi Guo
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Li-Juan Guo
- Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453119, China
| | - Hua-Dong Que
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Bao-Yue Cui
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yin-Lan Li
- College of Pharmacy, Heilongjiang University of Chinese Medicine, Heilongjiang, 150040, China
| | - Shuang Guo
- Hubei Key Laboratory of Diabetes and Angiopathy, Hubei University of Science and Technology, Xianning, 437100, China
| | - Ming-Xiang Zhang
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China
| | - Ya-Ling Yin
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China.
| | - Peng Li
- Henan international joint laboratory of cardiovascular remodeling and drug intervention, Sino-UK Joint Laboratory of Brain Function and Injury and Department of Physiology and Neurobiology, School of Basic Medical Sciences, College of Pharmacy, Xinxiang Medical University, Xinxiang, 453003, China; Hubei Key Laboratory of Diabetes and Angiopathy, Hubei University of Science and Technology, Xianning, 437100, China.
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