501
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Affiliation(s)
- Thomas F Lüscher
- Consultant and Director of Research, Education & Development, Royal Brompton and Harefield Hospital Trust, London, UK.,Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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502
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Pawlak M, Niescierowicz K, Winata CL. Decoding the Heart through Next Generation Sequencing Approaches. Genes (Basel) 2018; 9:E289. [PMID: 29880785 PMCID: PMC6027153 DOI: 10.3390/genes9060289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 12/23/2022] Open
Abstract
: Vertebrate organs develop through a complex process which involves interaction between multiple signaling pathways at the molecular, cell, and tissue levels. Heart development is an example of such complex process which, when disrupted, results in congenital heart disease (CHD). This complexity necessitates a holistic approach which allows the visualization of genome-wide interaction networks, as opposed to assessment of limited subsets of factors. Genomics offers a powerful solution to address the problem of biological complexity by enabling the observation of molecular processes at a genome-wide scale. The emergence of next generation sequencing (NGS) technology has facilitated the expansion of genomics, increasing its output capacity and applicability in various biological disciplines. The application of NGS in various aspects of heart biology has resulted in new discoveries, generating novel insights into this field of study. Here we review the contributions of NGS technology into the understanding of heart development and its disruption reflected in CHD and discuss how emerging NGS based methodologies can contribute to the further understanding of heart repair.
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Affiliation(s)
- Michal Pawlak
- International Institute of Molecular and Cell Biology in Warsaw, 02-109 Warsaw, Poland.
| | | | - Cecilia Lanny Winata
- International Institute of Molecular and Cell Biology in Warsaw, 02-109 Warsaw, Poland.
- Max-Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany.
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503
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Lombardi F, Huikuri H, Schmidt G, Malik M. The decline of rate and mortality of acute myocardial infarction. Almost there, still a long way to go. Eur J Prev Cardiol 2018; 25:1028-1030. [PMID: 29873239 DOI: 10.1177/2047487318780497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Federico Lombardi
- UOC Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy
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504
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Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F, Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N, Extramiana F, Cariou A, Jouven X, Marijon E. Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation. Eur Heart J 2018; 39:1981-1987. [PMID: 29566157 PMCID: PMC5982722 DOI: 10.1093/eurheartj/ehy098] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/30/2017] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Aims Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Methods and results Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80-22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12-12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Conclusion Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.
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Affiliation(s)
- Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Wulfran Bougouin
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Nicole Karam
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Emergency Department, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Estelle Gandjbakhch
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Antoine-Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Cardiology Department, Maxcure Hospitals, Behind Cyber Towers, Hitec City, 500081 Hyderabad, India
| | - Alexandre Zhao
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Denis Amet
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Daniel Jost
- Paris Firefighters Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Guillaume Geri
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Intensive Care Unit, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Lionel Lamhaut
- SAMU de Paris, Necker Hospital, 149 rue Sèvres, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Bertrand Ludes
- Forensic Medical Institute, 2 Voie Mazas, 75012 Paris, France
| | - Patrick Bruneval
- Pathology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Isabelle Plu
- Pathology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Françoise Hidden-Lucet
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Albuisson
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Genetic Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Piot
- Cardiology Department, Centre Cardiologique du Nord, 32-36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Christine Alonso
- Cardiology Department, Clinique Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Antoine Leenhardt
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, University Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Intensive Care Unit, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
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505
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Fluschnik N, Ojeda F, Zeller T, Jørgensen T, Kuulasmaa K, Becher PM, Sinning C, Blankenberg S, Westermann D. Predictive value of long-term changes of growth differentiation factor-15 over a 27-year-period for heart failure and death due to coronary heart disease. PLoS One 2018; 13:e0197497. [PMID: 29771963 PMCID: PMC5957420 DOI: 10.1371/journal.pone.0197497] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Growth differentiation factor-15 (GDF-15), Cystatin C and C-reactive protein (CRP) have been discussed as biomarkers for prediction of cardiac diseases. The aim of this study was to investigate the predictive value of single and repeated measurements of GDF-15 compared to Cystatin C and CRP for incidence of heart failure (HF) and death due to coronary heart disease (CHD) in the general population. METHODS AND RESULTS Levels of GDF-15, CRP and Cystatin C were determined in three repeated measurements collected 5 years apart in the DAN-MONICA (Danish-Multinational MONitoring of trends and determinants in Cardiovascular disease) cohort (participants at baseline n = 3785). Cox regression models adjusted for cardiovascular risk factors revealed significantly increased hazard ratios (HR) for GDF-15 for incident HF 1.36 (HR per interquartile range (IQR) increase, 95% confidence interval (CI): 1.16; 1.59) and for death from CHD 1.51 (HR per IQR increase, 95% CI: 1.31, 1.75) (both with p<0.001). Joint modeling of time-to-event and longitudinal GDF-15 over a median 27-year follow-up period showed that the marker evolution was positively associated with death of CHD (HR per IQR increase 3.02 95% CI: (2.26, 4.04), p < 0.001) and HF (HR per IQR increase 2.12 95% CI: (1.54, 2.92), p<0.001). However using Cox models with follow-up time starting at the time of the third examination, serial measurement of GDF-15, modeled as changes between the measurements, did not improve prediction over that of the most recent measurement. CONCLUSIONS GDF-15 is a promising biomarker for prediction of HF and death due to CHD in the general population, which may provide prognostic information to already established clinical biomarkers. Repeated measurements of GDF-15 displayed only a slight improvement in the prediction of these endpoints compared to a single measurement.
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Affiliation(s)
- Nina Fluschnik
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
- * E-mail:
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - Torben Jørgensen
- Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter Moritz Becher
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK Affiliation, partner site Hamburg/Kiel/Lübeck, Germany
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506
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Liberale L, Diaz-Cañestro C, Bonetti NR, Paneni F, Akhmedov A, Beer JH, Montecucco F, Lüscher TF, Camici GG. Post-ischaemic administration of the murine Canakinumab-surrogate antibody improves outcome in experimental stroke. Eur Heart J 2018; 39:3511-3517. [DOI: 10.1093/eurheartj/ehy286] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/03/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Luca Liberale
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, 6 viale Benedetto XV, Genoa, Italy
| | - Candela Diaz-Cañestro
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
| | - Nicole R Bonetti
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, Baden, Switzerland
| | - Francesco Paneni
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
| | - Alexander Akhmedov
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
| | - Jürg H Beer
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Im Ergel 1, Baden, Switzerland
| | - Fabrizio Montecucco
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Ospedale Policlinico San Martino 10 Largo Benzi, Genoa, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, Genoa, Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Giovanni G Camici
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Wagistrasse 12, Schlieren, Switzerland
- Zurich Neuroscience Center, University of Zurich, Winterthurer Strasse 190, Zurich, Switzerland
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507
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Lüscher TF. Refining cardiovascular risk: anthropometric measures, potassium, high altitude exposure, and cancer therapy. Eur Heart J 2018; 39:1499-1502. [DOI: 10.1093/eurheartj/ehy222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Thomas F Lüscher
- Editorial Office, Zurich Heart House, 8032 Zurich, Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland and Royal Brompton and Harefield Hospital Trust and Imperial College, London, SW3 6NP, UK
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508
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Lüscher TF. Acute coronary syndromes: the tipping point of coronary artery disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Editorial Office, Zurich Heart House, 8032 Zurich, Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland and Royal Brompton and Harefield Hospital Trust and Imperial College, London, SW3 6NP, UK
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509
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510
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Lustigova M, Dzurova D, Pikhart H, Kubinova R, Bobak M. Cardiovascular health among the Czech population at the beginning of the 21st century: a 12-year follow-up study. J Epidemiol Community Health 2018; 72:442-448. [PMID: 29439193 PMCID: PMC5909738 DOI: 10.1136/jech-2017-209967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/03/2018] [Accepted: 01/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the late 1980s, Czechia was among the countries which had the highest cardiovascular mortality in the world. In spite of enormous improvements since that time, there are still large opportunities in further improving cardiovascular health. METHODS Based on the Czech Health, Alcohol and Psychosocial Factors in Eastern Europe sample (n=8449 at baseline, 12 years of follow-up, 494 cardiovascular disease (CVD) deaths up to 2015-events), the impact of selected covariates such as education, smoking habits, high blood pressure, blood cholesterol level, diabetes, obesity, physical activity and binge drinking and their multifactorial effects on cardiovascular mortality was evaluated by Cox regression. In addition, population attributable fractions (PAFs) were used to quantify the impact of these factors on CVD mortality in the population. RESULTS Education was found as the strongest determinant of CVD mortality (primary vs university, HR 2.77, P<0.001; PAF=50.5%). CVD risk was two times higher for persons with diabetes compared with those without (HR 2.02, P<0.001, PAF=23.2%). Furthermore, significant factors found were smoking (smoker vs non-smoker, HR 1.91, P<0.001; PAF=26.5%), high blood pressure (HR 1.73, P<0.001; PAF=35.3%) and physical inactivity (none vs sufficient, HR 1.60, P<0.001; PAF=22.9%). Conversely, the effect of obesity was low (HR 1.29, P value =0.020), and binge drinking and high blood cholesterol level were not significant at all. CONCLUSIONS Education had the largest impact on cardiovascular mortality among the Czech population. More than 50% of CVD death would be prevented if the whole population had the same risk values as the highest educated population. Reducing disparities in health related to education should benefit from attention to cardiovascular health literacy.
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Affiliation(s)
- Michala Lustigova
- Environmental and Population Health Monitoring Centre, National Institute of Public Health, Prague, Czech Republic.,Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ruzena Kubinova
- Environmental and Population Health Monitoring Centre, National Institute of Public Health, Prague, Czech Republic
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
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511
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Søndergaard L, Saraste A, Christersson C, Vahanian A. The year in cardiology 2017: valvular heart disease. Eur Heart J 2018; 39:650-657. [DOI: 10.1093/eurheartj/ehx772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/15/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, 20520 Turku, Finland
| | - Christina Christersson
- Department of Medical Science, Cardiology, Uppsala University, Akademiska Sjukhuset, 751 85 Uppsala, Sweden
| | - Alec Vahanian
- Department of Cardiology, Bichat Hospital, University Paris VII, Paris 75018, France
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512
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Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality for both women and men. Emerging evidence supports that ischemic heart disease (IHD) may manifest differently in women and men, in ways ranging from the clinical presentation, diagnosis, and management of disease to the basic biology and biomechanics of cardiomyocyte function and the coronary circulation. Women consistently present with a higher burden of symptoms and comorbidities as compared with men and experience worse outcomes. These data have proved perplexing given the decreased likelihood of women to demonstrate obstructive coronary artery disease (CAD) on coronary angiography. Reported sex differences have long been influenced by the practice of defining heart disease primarily as obstructive CAD, but obstructive plaque is now recognized as neither necessary nor sufficient to explain symptoms of IHD, and it is no longer adequate to tailor diagnostic and treatment strategies only to this subset of patients. To date, women remain underrepresented in guideline-changing heart disease research and trials, creating important limitations in the evidence base for cardiovascular medicine. Smaller epicardial coronary arteries in women as compared to men, coupled with differences in shear stress and inflammatory mediators over the life span, may modify the development of CAD in susceptible patients into a diffuse pattern with more contribution from coronary vasomotor dysfunction than focal obstruction. Newer studies corroborate that symptomatic women are more likely than men to present with nonobstructive CAD and coronary microvascular dysfunction. When present, these processes increase cardiovascular risk in both women and men but may constitute an especially malignant phenotype in a subset of severely affected women, with implications for the management of not only CAD but also heart failure with preserved ejection fraction. This represents a state-of-the-art review of sex differences in the coronary system, with an eye toward how diverse pathophysiological processes may contribute to IHD phenotypes prevalent in women and men. Beyond providing women and men with equitable optimal care according to current paradigms, understanding the pathophysiology of IHD beyond a conventional focus on obstructive CAD is needed to address what is likely a combination of biological as well as environmental determinants of their prognosis.
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Affiliation(s)
- Viviany R Taqueti
- Heart and Vascular Center; Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology (Nuclear Medicine and Molecular Imaging), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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513
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Gradolí J, Vidal V, Brady AJ, Facila L. Anticoagulation in Patients with Ischaemic Heart Disease and Peripheral Arterial Disease: Clinical Implications of COMPASS Study. Eur Cardiol 2018; 13:115-118. [PMID: 30697356 DOI: 10.15420/ecr.2018.12.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Patients with established cardiovascular disease may suffer further cardiovascular events, despite receiving optimal medical treatment. Although platelet inhibition plays a central role in the prevention of new events, the use of anticoagulant therapies to reduce events in atheromatous disease has, until recently, been overlooked. The recent Rivaroxaban for the Prevention of Major Cardiovascular Events in Coronary or Peripheral Artery Disease (COMPASS) study showed an important reduction in cardiovascular events without increasing the risk of fatal and intracranial bleeding when using rivaroxaban, a novel oral anticoagulant, combined with aspirin. This article reviews the available evidence regarding the use of anticoagulant therapies for prevention of cardiovascular events, the results of the COMPASS study and how these results may affect patient management in everyday clinical practice.
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Affiliation(s)
- Josep Gradolí
- Department of Cardiology, Hospital General Universitario, University of Valencia Valencia, Spain
| | - Verónica Vidal
- Department of Cardiology, Hospital General Universitario, University of Valencia Valencia, Spain
| | - Adrian Jb Brady
- Department of Cardiology, Glasgow Royal Infirmary Glasgow, UK
| | - Lorenzo Facila
- Department of Cardiology, Hospital General Universitario, University of Valencia Valencia, Spain
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