551
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Huang ZX, Chen LH, Xiong R, He YN, Zhang Z, Zeng J, Cai Q, Liu Z. Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations. Healthc Policy 2020; 13:2115-2123. [PMID: 33116991 PMCID: PMC7568636 DOI: 10.2147/rmhp.s274340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carotid atherosclerosis (CA) is closely related to stroke, and Framingham Risk Score (FRS) has been used for CA risk evaluation. However, FRS could only be used for subjects of up to 74 years old. The present study was to determine if Essen Stroke Risk Score (ESRS) could be used to estimate CA risk in community populations without age limits. METHODS In the present prospective multi-community screening study, we evaluated the prevalence of CA using high-resolution ultrasound in 521 males and 1039 females (35 to 91 years old). Both FRS and ESRS were calculated for the subjects. Multivariate logistic regression analysis was used to determine the predictive values of FRS and ESRS for CA in these subjects. RESULTS Ultrasound data showed that CA was present in 56.2% of the participants (total of 1560). Multivariate logistic regression analysis showed that ESRS was associated with CA with odds ratio (OR): 1.34 (95% confidence interval (CI), 1.12-1.60, p=0.001). Central obesity (OR: 1.40, CI: 1.07-1.83, p=0.015), female (OR: 0.55, CI: 0.39-0.77, p <0.001) and age (OR: 2.63, CI: 2.27-3.06, p <0.001) were also associated with CA. Based on the estimated area under curve (AUC), FRS (AUC 0.775) was better than ESRS (AUC 0.693) (z statistic 6.774, p <0.001) for CA prediction for individuals of ≤74 years old. However, receiver operating characteristic analysis showed ESRS was a good CA predictor for all subjects (AUC of 0.715). CONCLUSION ESRS could be used as an alternative to FRS to predict CA in community population of all age.
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Affiliation(s)
- Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.,Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Li-Hua Chen
- Department of Neurology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Ran Xiong
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Yan-Ni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Zhu Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.,Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jie Zeng
- Department of Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Qiankun Cai
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Zhenguo Liu
- Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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552
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VCAM-1 Target in Non-Invasive Imaging for the Detection of Atherosclerotic Plaques. BIOLOGY 2020; 9:biology9110368. [PMID: 33138124 PMCID: PMC7692297 DOI: 10.3390/biology9110368] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Simple Summary Cardiovascular diseases are the first cause of morbimortality worldwide. They are mainly caused by atherosclerosis, with progressive plaque formation in the arterial wall. In this context, several imaging techniques have been developed to screen, detect and quantify atherosclerosis. Early screening improves primary prevention and promotes the prescription of adequate medication before adverse clinical events. In this review, we focus on the imaging of vascular cell adhesion molecule-1, an adhesion molecule involved in the first stages of the development of atherosclerosis. This molecule could therefore be a promising target to detect early atherosclerosis non-invasively. Potential clinical applications are critically discussed. Abstract Atherosclerosis is a progressive chronic arterial disease characterised by atheromatous plaque formation in the intima of the arterial wall. Several invasive and non-invasive imaging techniques have been developed to detect and characterise atherosclerosis in the vessel wall: anatomic/structural imaging, functional imaging and molecular imaging. In molecular imaging, vascular cell adhesion molecule-1 (VCAM-1) is a promising target for the non-invasive detection of atherosclerosis and for the assessment of novel antiatherogenic treatments. VCAM-1 is an adhesion molecule expressed on the activated endothelial surface that binds leucocyte ligands and therefore promotes leucocyte adhesion and transendothelial migration. Hence, for several years, there has been an increase in molecular imaging methods for detecting VCAM-1 in MRI, PET, SPECT, optical imaging and ultrasound. The use of microparticles of iron oxide (MPIO), ultrasmall superparamagnetic iron oxide (USPIO), microbubbles, echogenic immunoliposomes, peptides, nanobodies and other nanoparticles has been described. However, these approaches have been tested in animal models, and the remaining challenge is bench-to-bedside development and clinical applicability.
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553
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Gioscia-Ryan RA, Clayton ZS, Zigler MC, Richey JJ, Cuevas LM, Rossman MJ, Battson ML, Ziemba BP, Hutton DA, VanDongen NS, Seals DR. Lifelong voluntary aerobic exercise prevents age- and Western diet- induced vascular dysfunction, mitochondrial oxidative stress and inflammation in mice. J Physiol 2020; 599:911-925. [PMID: 33103241 DOI: 10.1113/jp280607] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
KEY POINTS The results of the present study establish the temporal pattern of age-related vascular dysfunction across the adult lifespan in sedentary mice consuming a non-Western diet, and the underlying mechanisms The results demonstrate that consuming a Western diet accelerates and exacerbates vascular ageing across the lifespan in sedentary mice They also show that lifelong voluntary aerobic exercise has remarkable protective effects on vascular function throughout the lifespan, in the setting of ageing alone, as well as ageing compounded by Western diet consumption Overall, the results indicate that amelioration of mitochondrial oxidative stress and inflammation are key mechanisms underlying the voluntary aerobic exercise-associated preservation of vascular function across the lifespan in both the presence and absence of a Western dietary pattern ABSTRACT: Advancing age is the major risk factor for cardiovascular diseases, driven largely by vascular endothelial dysfunction (impaired endothelium-dependent dilatation, EDD) and aortic stiffening (increased aortic pulse wave velocity, aPWV). In humans, vascular ageing occurs in the presence of differences in diet and physical activity, but the interactive effects of these factors are unknown. We assessed carotid artery EDD and aPWV across the lifespan in mice consuming standard (normal) low-fat chow (NC) or a high-fat/high-sucrose Western diet (WD) in the absence (sedentary, SED) or presence (voluntary wheel running, VWR) of aerobic exercise. Ageing impaired nitric oxide-mediated EDD (peak EDD 88 ± 12% 6 months P = 0.003 vs. 59 ± 9% 27 months NC-SED), which was accelerated by WD (60 ± 18% 6 months WD-SED). In NC mice, aPWV increased 32% with age (423 ± 13 cm/s at 24 months P < 0.001 vs. 321 ± 12 cm/s at 6 months) and absolute values were an additional ∼10% higher at any age in WD mice (P = 0.042 vs. NC-SED). Increases in aPWV with age in NC and WD mice were associated with 30-65% increases in aortic intrinsic wall stiffness (6 vs. 19-27 months, P = 0.007). Lifelong aerobic exercise prevented age- and WD-related vascular dysfunction across the lifespan, and this protection appeared to be mediated by mitigation of vascular mitochondrial oxidative stress and inflammation. Our results depict the temporal impairment of vascular function over the lifespan in mice, acceleration and exacerbation of that dysfunction with WD consumption, the remarkable protective effects of voluntary aerobic exercise, and the underlying mechanisms.
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Affiliation(s)
- Rachel A Gioscia-Ryan
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Melanie C Zigler
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - James J Richey
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Lauren M Cuevas
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Matthew J Rossman
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Micah L Battson
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Brian P Ziemba
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - David A Hutton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Nicholas S VanDongen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
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554
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Sozzi FB, Belmonte M, Schiavone M, Canetta C, Gupta R, Blasi F. Women’s Cardiac Health in 2020: A Systematic Review. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1718503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractAlthough substantial progress has been made toward improving gender- and sex-specific cardiovascular disease (CVD) management and outcomes, contemporary reports indicate a persistent knowledge gap with regard to optimal risk-stratification and management in female cardiac heart disease (CHD) patients. Prominent patient and system delays in diagnosing CHD are, in part, due to the limited awareness for the latent CVD risk in women, a lack of sex-specific thresholds within clinical guidelines, and subsequent limited performance of contemporary diagnostic approaches in women. Several traditional risk factors for CHD affect both women and men. But other factors can play a bigger role in the development of heart disease in women. In addition, little is known about the influence of socioenvironmental and contextual factors on gender-specific disease manifestation and outcomes. It is imperative that we understand the mechanisms that contribute to worsening risk factors profiles in young women to reduce future atherosclerotic CVD morbidity and mortality. This comprehensive review focuses on the novel aspects of cardiovascular health in women and sex differences as they relate to clinical practice and prevention, diagnosis, and treatment of CVD. Increased recognition of the prevalence of traditional cardiovascular risk factors and their differential impact in women, as well as emerging nontraditional risk factors unique to or more common in women, contribute to new understanding mechanisms, leading to worsening outcome for women.
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Affiliation(s)
- Fabiola B. Sozzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit, Cystic Fibrosis Adult Center, and Cardiovascular Unit, Milan, Italy
| | - Marta Belmonte
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit, Cystic Fibrosis Adult Center, and Cardiovascular Unit, Milan, Italy
| | - Marco Schiavone
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit, Cystic Fibrosis Adult Center, and Cardiovascular Unit, Milan, Italy
| | - Ciro Canetta
- Internal Medicine Unit, Crema Hospital, Lombardy, Italy
| | - Rakesh Gupta
- JROP Institute of Echocardiography, Delhi, India
| | - Francesco Blasi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit, Cystic Fibrosis Adult Center, and Cardiovascular Unit, Milan, Italy
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555
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Padmanabhan A, Alexanian M, Linares-Saldana R, González-Terán B, Andreoletti G, Huang Y, Connolly AJ, Kim W, Hsu A, Duan Q, Winchester SAB, Felix F, Perez-Bermejo JA, Wang Q, Li L, Shah PP, Haldar SM, Jain R, Srivastava D. BRD4 (Bromodomain-Containing Protein 4) Interacts with GATA4 (GATA Binding Protein 4) to Govern Mitochondrial Homeostasis in Adult Cardiomyocytes. Circulation 2020; 142:2338-2355. [PMID: 33094644 DOI: 10.1161/circulationaha.120.047753] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gene regulatory networks control tissue homeostasis and disease progression in a cell type-specific manner. Ubiquitously expressed chromatin regulators modulate these networks, yet the mechanisms governing how tissue specificity of their function is achieved are poorly understood. BRD4 (bromodomain-containing protein 4), a member of the BET (bromo- and extraterminal domain) family of ubiquitously expressed acetyl-lysine reader proteins, plays a pivotal role as a coactivator of enhancer signaling across diverse tissue types in both health and disease and has been implicated as a pharmacological target in heart failure. However, the cell-specific role of BRD4 in adult cardiomyocytes remains unknown. METHODS We combined conditional mouse genetics, unbiased transcriptomic and epigenomic analyses, and classic molecular biology and biochemical approaches to understand the mechanism by which BRD4 in adult cardiomyocyte homeostasis. RESULTS Here, we show that cardiomyocyte-specific deletion of Brd4 in adult mice leads to acute deterioration of cardiac contractile function with mutant animals demonstrating a transcriptomic signature characterized by decreased expression of genes critical for mitochondrial energy production. Genome-wide occupancy data show that BRD4 enriches at many downregulated genes (including the master coactivators Ppargc1a, Ppargc1b, and their downstream targets) and preferentially colocalizes with GATA4 (GATA binding protein 4), a lineage-determining cardiac transcription factor not previously implicated in regulation of adult cardiac metabolism. BRD4 and GATA4 form an endogenous complex in cardiomyocytes and interact in a bromodomain-independent manner, revealing a new functional interaction partner for BRD4 that can direct its locus and tissue specificity. CONCLUSIONS These results highlight a novel role for a BRD4-GATA4 module in cooperative regulation of a cardiomyocyte-specific gene program governing bioenergetic homeostasis in the adult heart.
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Affiliation(s)
- Arun Padmanabhan
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.).,Division of Cardiology, Department of Medicine (A.P., S.M.H.), University of California, San Francisco
| | - Michael Alexanian
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Ricardo Linares-Saldana
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Bárbara González-Terán
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Gaia Andreoletti
- Bakar Computational Health Sciences Institute (G.A.), University of California, San Francisco
| | - Yu Huang
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Andrew J Connolly
- Department of Pathology (A.J.C.), University of California, San Francisco
| | - Wonho Kim
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Austin Hsu
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Qiming Duan
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Sarah A B Winchester
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Franco Felix
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Juan A Perez-Bermejo
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.)
| | - Qiaohong Wang
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Li Li
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Parisha P Shah
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Saptarsi M Haldar
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.).,Division of Cardiology, Department of Medicine (A.P., S.M.H.), University of California, San Francisco
| | - Rajan Jain
- Institute of Regenerative Medicine, Penn Cardiovascular Institute, Departments of Medicine and Cell and Developmental Biology, Perelman School of Medicine, Philadelphia, PA (R.L.-S., W.K., Q.W., L.L., P.P.S., R.J.)
| | - Deepak Srivastava
- Gladstone Institute of Cardiovascular Disease, San Francisco, CA (A.P., M.A., B.G.-T., Y.H., A.H., Q.D., S.A.B.W., F.F., J.A.P.-B., S.M.H., D.S.).,Department of Pediatrics (D.S.), University of California, San Francisco.,Department of Biochemistry and Biophysics (D.S.), University of California, San Francisco.,Roddenberry Center for Stem Cell Biology and Medicine at Gladstone, San Francisco, CA (D.S.)
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556
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Vynckier P, Ferrannini G, Rydén L, Tokgözoğlu L, Bruthans J, Kotseva K, Wood D, De Backer T, Gevaert S, De Bacquer D, De Smedt D. Medical Treatment in Coronary Patients: Is there Still a Gender Gap? Results from European Society of Cardiology EUROASPIRE V Registry. Cardiovasc Drugs Ther 2020; 35:801-808. [PMID: 33068226 DOI: 10.1007/s10557-020-07095-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study is aimed at investigating gender differences in the medical management of patients with coronary heart disease (CHD). METHODS Analyses were based on the ESC EORP EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) survey. Consecutive patients between 18 and 80 years, hospitalized for a coronary event, were included in the study. Information on cardiovascular medication intake at hospital discharge and at follow-up (≥ 6 months to < 2 years after hospitalization) was collected. RESULTS Data was available for 8261 patients (25.8% women). Overall, no gender differences were observed in the prescription and use of cardioprotective medication like aspirin, beta-blockers, and ACE-I/ARBs (P > 0.01) at discharge and follow-up respectively. However, a statistically significant difference was found in the use of statins at follow-up, in disfavor of women (82.8% vs. 77.7%; P < 0.001). In contrast, at follow-up, women were more likely to use diuretics (31.5% vs. 39.5%; P < 0.001) and calcium channel blockers (21.2% vs. 28.8%; P < 0.001), whereas men were more likely to use anticoagulants (8.8% vs. 7.0%; P < 0.001). Overall, no gender differences were found in total daily dose intake (P > 0.01). Furthermore, women were less likely than men to have received a CABG (20.4% vs. 13.2%; P < 0.001) or PCI (82.1% vs. 74.9%; P < 0.001) at follow-up. No gender differences were observed in prescribed (P = 0.10) and attended (P = 0.63) cardiac rehabilitation programs. CONCLUSION The EUROASPIRE V results show only limited gender differences in the medical management of CHD patients. Current findings suggest growing awareness about risk in female CHD patients.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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557
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Wu X, Reboll MR, Korf-Klingebiel M, Wollert KC. Angiogenesis after acute myocardial infarction. Cardiovasc Res 2020; 117:1257-1273. [PMID: 33063086 DOI: 10.1093/cvr/cvaa287] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/09/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial infarction (MI) inflicts massive injury to the coronary microcirculation leading to vascular disintegration and capillary rarefication in the infarct region. Tissue repair after MI involves a robust angiogenic response that commences in the infarct border zone and extends into the necrotic infarct core. Technological advances in several areas have provided novel mechanistic understanding of postinfarction angiogenesis and how it may be targeted to improve heart function after MI. Cell lineage tracing studies indicate that new capillary structures arise by sprouting angiogenesis from pre-existing endothelial cells (ECs) in the infarct border zone with no meaningful contribution from non-EC sources. Single-cell RNA sequencing shows that ECs in infarcted hearts may be grouped into clusters with distinct gene expression signatures, likely reflecting functionally distinct cell populations. EC-specific multicolour lineage tracing reveals that EC subsets clonally expand after MI. Expanding EC clones may arise from tissue-resident ECs with stem cell characteristics that have been identified in multiple organs including the heart. Tissue repair after MI involves interactions among multiple cell types which occur, to a large extent, through secreted proteins and their cognate receptors. While we are only beginning to understand the full complexity of this intercellular communication, macrophage and fibroblast populations have emerged as major drivers of the angiogenic response after MI. Animal data support the view that the endogenous angiogenic response after MI can be boosted to reduce scarring and adverse left ventricular remodelling. The improved mechanistic understanding of infarct angiogenesis therefore creates multiple therapeutic opportunities. During preclinical development, all proangiogenic strategies should be tested in animal models that replicate both cardiovascular risk factor(s) and the pharmacotherapy typically prescribed to patients with acute MI. Considering that the majority of patients nowadays do well after MI, clinical translation will require careful selection of patients in need of proangiogenic therapies.
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Affiliation(s)
- Xuekun Wu
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Marc R Reboll
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Mortimer Korf-Klingebiel
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
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558
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Armario P, Brotons C, Elosua R, Alonso de Leciñana M, Castro A, Clarà A, Cortés O, Díaz Rodriguez Á, Herranz M, Justo S, Lahoz C, Pedro-Botet J, Pérez Pérez A, Santamaria R, Tresserras R, Aznar Lain S, Royo-Bordonada MÁ. [Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines]. HIPERTENSION Y RIESGO VASCULAR 2020; 38:21-43. [PMID: 33069629 DOI: 10.1016/j.hipert.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
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Affiliation(s)
- Pedro Armario
- Sociedad Española-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España.
| | - Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, España
| | | | | | - Almudena Castro
- Sociedad Española de Cardiología-Coordinadora Nacional Sección de Prevención, Madrid, España
| | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, España
| | - Olga Cortés
- Asociación Española Pediatría de Atención Primaria, Madrid, España
| | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria-FAECAP, Madrid, España
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna, Madrid, España
| | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria-SESPAS, Barcelona, España
| | - Susana Aznar Lain
- Facultad de Ciencias del Deporte, Universidad Castilla La Mancha, Toledo, España
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Abstract
The global pandemic as a result of the SARS-CoV2 virus has seen over 16 m people infected and over 650,000 deaths, with men at double the risk of both developing the severe form of the disease and mortality. There are both biological (sex) and socio-cultural (gender) factors, compounded by socio-economic factors and ethnicity, that impact on the aftermath of what has occurred over the short time that this novel coronavirus has been circulating the world. The potential life-long morbidity as a result of the infection and as a consequence of highly invasive critical care treatment needs to be factored into the rehabilitation of survivors. There are also many men whose lives will have been severely affected both physically and emotionally by the pandemic without ever contracting the disease, with the widespread disruption to normal existence and its impact on their social world and the economy. The implications of the closure of many healthcare services over the initial lockdown will also have both a shorter- and longer-term impact on other diseases due to missed early diagnosis and disrupted treatment regimes. Getting effective public health messages out to the population is critical and this current pandemic is demonstrating that there needs to be a more focused view on men's health behavior. Without effective public support for preventative action, the more likely the disease will continue its path unabated. This review explores the wider ramifications of the disease both for those men who have survived the disease and those that have been affected by the wider social effects of the pandemic. The pandemic should be a wake-up call for all involved in the planning and delivery of health and social care for the greater attention to the central role of sex and gender.
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Affiliation(s)
- Alan White
- School of Health and Community Studies, Leeds Beckett University, Leeds, West Yorkshire , United Kingdom of Great Britain and Northern Ireland
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560
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Role of CMR Mapping Techniques in Cardiac Hypertrophic Phenotype. Diagnostics (Basel) 2020; 10:diagnostics10100770. [PMID: 33003571 PMCID: PMC7601617 DOI: 10.3390/diagnostics10100770] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
Non-ischemic cardiomyopathies represent a heterogeneous group of myocardial diseases potentially leading to heart failure, life-threatening arrhythmias, and eventually death. Myocardial dysfunction is associated with different underlying pathological processes, ultimately inducing changes in morphological appearance. Thus, classification based on presenting morphological phenotypes has been proposed, i.e., dilated, hypertrophic, restrictive, and right ventricular cardiomyopathies. In light of the key diagnostic and prognostic role of morphological and functional features, cardiovascular imaging has emerged as key element in the clinical workflow of suspected cardiomyopathies, and above all, cardiovascular magnetic resonance (CMR) represents the ideal technique to be used: thanks to its physical principles, besides optimal spatial and temporal resolutions, incomparable contrast resolution allows to assess myocardial tissue abnormalities in detail. Traditionally, weighted images and late enhancement images after gadolinium-based contrast agent administration have been used to perform tissue characterization, but in the last decade quantitative assessment of pre-contrast longitudinal relaxation time (native T1), post-contrast longitudinal relaxation time (post-contrast T1) and transversal relaxation time (T2), all displayed with dedicated pixel-wise color-coded maps (mapping), has contributed to give precious knowledge insight, with positive influence of diagnostic accuracy and prognosis assessment, mostly in the setting of the hypertrophic phenotype. This review aims to describe the available evidence of the role of mapping techniques in the assessment of hypertrophic phenotype, and to suggest their integration in the routine CMR evaluation of newly diagnosed cardiomyopathies with increased wall thickness.
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561
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Eremiasova L, Hubacek JA, Danzig V, Adamkova V, Mrazova L, Pitha J, Lanska V, Cífková R, Vitek L. Serum Bilirubin in the Czech Population ― Relationship to the Risk of Myocardial Infarction in Males ―. Circ J 2020; 84:1779-1785. [DOI: 10.1253/circj.cj-20-0192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lenka Eremiasova
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University
- 2nd Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine
| | - Vilém Danzig
- 2nd Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University
| | - Věra Adamkova
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine
| | - Lenka Mrazova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine
| | - Jan Pitha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine
| | - Věra Lanska
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine
| | - Renata Cífková
- 2nd Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University
- Center for Cardiovascular Prevention, 1st Faculty of Medicine and Thomayer Hospital, Charles University
| | - Libor Vitek
- Institute of Medical Biochemistry and Laboratory Diagnostics, Faculty General Hospital and 1st Faculty of Medicine, Charles University
- 4th Department of Internal Medicine, 1st Faculty of Medicine Faculty and General Hospital, Charles University
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562
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Li Y, Wu W, Liu W, Zhou M. Roles and mechanisms of renalase in cardiovascular disease: A promising therapeutic target. Biomed Pharmacother 2020; 131:110712. [PMID: 32916539 DOI: 10.1016/j.biopha.2020.110712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular disease (CVD) is prevalent worldwide and remains a leading cause of death. Although substantial progress has been made in the diagnosis and treatment of CVD, the prognosis remains unsatisfactory. Renalase is a newly discovered cytokine that is synthesized by the kidney and then secreted into blood. Numerous studies have suggested the efficacy of renalase in treating CVD by metabolizing catecholamines in the circulatory system. As a new biomarker of heart disease, renalase is normally recognized as a signalling molecule that activates cytoprotective intracellular signals to lower blood pressure, protect ischaemic heart muscle and promote atherosclerotic plaque stability in CVD, which subsequently improves cardiac function. Due to its important regulatory role in the circulatory system, renalase has gradually become a potential target in the treatment of CVD. This review summarizes the structure, mechanism and function of renalase in CVD, thereby providing preclinical evidence for alternative approaches and new prospects in the development of renalase-related drugs against CVD.
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Affiliation(s)
- Yue Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Weidong Wu
- London Metropolitan University, London, N7 8DB, United Kingdom
| | - Weihong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Mingxue Zhou
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China.
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563
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Vancheri F, Longo G, Vancheri S, Henein M. Coronary Microvascular Dysfunction. J Clin Med 2020; 9:E2880. [PMID: 32899944 PMCID: PMC7563453 DOI: 10.3390/jcm9092880] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023] Open
Abstract
Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed "ischemia with non-obstructive coronary artery disease" (INOCA) and for a small proportion of "myocardial infarction with non-obstructive coronary artery disease" (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).
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Affiliation(s)
- Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy;
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden;
- Department of Fluid Mechanics, Brunel University, Middlesex, London UB8 3PH, UK
- Molecular and Nuclear Research Institute, St George’s University, London SW17 0RE, UK
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564
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Teles RC. “A momentary lapse of opinion”: The reader should be aware of the iatrogenic potential of this publication. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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565
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van der Ende MY, Waardenburg IE, Lipsic E, Bos JH, Hak E, Snieder H, Harst PVD. The effect of feedback on cardiovascular risk factors on optimization of primary prevention: The PharmLines initiative. Int J Cardiol Hypertens 2020; 6:100042. [PMID: 33447768 PMCID: PMC7803074 DOI: 10.1016/j.ijchy.2020.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND It is unknown whether population based single assessment of cardiovascular disease (CVD) risk and feedback to individuals and general practitioners results in initiation of preventive cardiovascular pharmacotherapy in those at risk. METHODS The population based cohort study Lifelines was linked to the IADB.nl pharmacy database to assess information on the initiation of preventive medication (N = 48,770). At the baseline visit, information on cardiovascular risk factors was collected and reported to the participants and their general practitioners. An interrupted-time-series-analysis was plotted, in which the start year of blood pressure and lipid lowering medication was displayed in years before or after the baseline visit. Subsequently, predictors of the initiation of pharmacotherapy were determined and possible reduction in cardiovascular events that could be achieved by optimal treatment of individuals at risk. RESULTS Before the Lifelines baseline visit, 34% (out of 1,527, 95% Confidence interval (CI) 32%-36%) and 30% (out of 1,991, 95%CI 28%-32%) of the individuals at risk had a blood pressure or lipid lowering drug prescription, respectively. In those at risk, the use of blood pressure lowering medication, increased substantially during the year of the baseline visit. Treating individuals at increased risk (≥5% 10-year risk) with lipid or blood pressure lowering medication (N = 8515 and N = 6899) would have prevented 162 and 183 CVD events, respectively, in the upcoming five years. CONCLUSION Primary prevention of CVD in the general population appears suboptimal. Feedback of cardiovascular risk factors resulted in a substantial increase of blood pressure lowering medication and extrapolated health benefits.
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Affiliation(s)
- M. Yldau van der Ende
- University of Groningen, University Medical Center Groningen, The Department of Cardiology, Groningen, the Netherlands
| | - Ingmar E. Waardenburg
- University of Groningen, University Medical Center Groningen, The Department of Cardiology, Groningen, the Netherlands
| | - E. Lipsic
- University of Groningen, University Medical Center Groningen, The Department of Cardiology, Groningen, the Netherlands
| | - Jens H.J. Bos
- PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - H. Snieder
- University of Groningen, University Medical Center Groningen, The Department of Epidemiology, Groningen, the Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, The Department of Cardiology, Groningen, the Netherlands
- Heart and Lung Division, University Medical Center Utrecht, University of Utrehct, Utrecht, the Netherlands
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566
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Leitner DR, Toplak H, Kedenko L, Steinmaurer T, Gräff V, Metzner T, Schwaiger EM, Prager R. Efficacy and tolerability of alirocumab in Austrian clinical practice - results of the non-interventional PEARL-AT study. Curr Med Res Opin 2020; 36:1419-1425. [PMID: 32568565 DOI: 10.1080/03007995.2020.1786678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Proprotein convertase subtilisin/kexin type 9 inhibition can be an effective treatment in patients with primary hypercholesterolemia, particularly in cases with concomitant coronary heart disease, peripheral artery occlusive disease or cerebrovascular occlusive disease for secondary prevention after an acute atherosclerotic ischemic event. The primary objective of the PEARL-AT study was to assess effectiveness and safety of alirocumab in a real-world setting in Austria. METHODS Non-interventional, prospective study conducted across Austria between September 2016 and July 2018. 113 patients, for whom the decision for treatment with alirocumab according to the Austrian Summary of Product Characteristics (SmPC) was made, were enrolled and were followed-up over 24 weeks. The primary endpoint of the study was the average change of low density lipoprotein cholesterol (LDL-C) levels by week 24. RESULTS In total, 112 patients with at least one post-baseline visit were included. Alirocumab was initiated using 75 mg (57.1%) and 150 mg (42.9%) every two weeks. Average LDL-C levels decreased by 75.0 mg/dl at week 24 in 87 patients with available LDL-C at baseline and week 24 (in 25 patients LDL-C was missing at least at one time point). The mean relative change of LDL-C was -50.0% (median: 57.8%, SD: 28.4). Throughout the study, 46 adverse events were documented in 21 (18.6%) patients. The most frequent adverse events were gastrointestinal disorders. CONCLUSIONS The present data indicate a good overall efficacy of alirocumab in a real-world Austrian population. Effectiveness and safety were both in line with the clinical trial program as well as previous real-world observations.
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Affiliation(s)
- Deborah R Leitner
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Hermann Toplak
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Ludmilla Kedenko
- First Department of Internal Medicine, Paracelsus Medical University/Salzburger Landeskliniken, Salzburg, Austria
| | - Thomas Steinmaurer
- Department of Internal Medicine, Hospital Barmherzige Brüder Linz, Linz, Austria
| | - Verena Gräff
- Landesklinik St. Veit im Pongau, St. Veit im Pongau, Austria
| | | | | | - Rudolf Prager
- Karl Landsteiner Society, Institute of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria
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567
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Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology. ACTA ACUST UNITED AC 2020; 73:910-918. [PMID: 32921586 PMCID: PMC7456304 DOI: 10.1016/j.rec.2020.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care.
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568
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Teles RC. "A momentary lapse of opinion": The reader should be aware of the iatrogenic potential of this publication. Rev Port Cardiol 2020; 39:489-491. [PMID: 32847714 DOI: 10.1016/j.repc.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rui Campante Teles
- UNICARV (Unidade de Intervenção Cardiovascular), Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; CEDOC (Centro de Estudos de Doenças Crónicas), NOVA Medical School, Lisboa, Portugal; Champion Valve For Life, Portugal.
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569
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Meininger GA, Hill MA. Frontiers in Vascular Physiology Grand Challenges in Vascular Physiology. Front Physiol 2020; 11:852. [PMID: 32848829 PMCID: PMC7426502 DOI: 10.3389/fphys.2020.00852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gerald A Meininger
- Dalton Cardiovascular Research Center and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, United States
| | - Michael A Hill
- Dalton Cardiovascular Research Center and Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, United States
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570
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Lekadir K, Leiner T, Young AA, Petersen SE. Editorial: Current and Future Role of Artificial Intelligence in Cardiac Imaging. Front Cardiovasc Med 2020; 7:137. [PMID: 32850987 PMCID: PMC7426695 DOI: 10.3389/fcvm.2020.00137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karim Lekadir
- Universitat de Barcelona, Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques and Informàtica, Barcelona, Spain
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Alistair A Young
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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571
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The risk of cardiovascular complications in inflammatory bowel disease. Clin Exp Med 2020; 20:481-491. [PMID: 32785793 PMCID: PMC7568702 DOI: 10.1007/s10238-020-00639-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing disease of unknown etiology involving gastrointestinal tract. IBD comprises two main entities: ulcerative colitis and Crohn's disease. Several studies showed increased risk of cardiovascular complications in chronic inflammatory disorders, especially during IBD relapses. Endothelium plays a role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction is associated with increased risk of atherosclerosis development. There are several potential links between chronic IBD-related inflammatory processes and the risk of cardiovascular disease, but insight into pathogenetic pathways remains unclear. We present the current concepts and review of adult and pediatric studies on the risk of CVD in IBD.
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572
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Tada H, Fujino N, Nomura A, Nakanishi C, Hayashi K, Takamura M, Kawashiri MA. Personalized medicine for cardiovascular diseases. J Hum Genet 2020; 66:67-74. [PMID: 32772049 DOI: 10.1038/s10038-020-0818-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 07/19/2020] [Indexed: 12/24/2022]
Abstract
Personalized medicine is an emerging concept involving managing the health of patients based on their individual characteristics, including particular genotypes. Cardiovascular diseases are heritable traits, and family history information is useful for risk prediction. As such, determining genetic information (germline genetic mutations) may also be applied to risk prediction. Furthermore, accumulating evidence suggests that genetic background can provide guidance for selecting effective treatments and preventive strategies in individuals with particular genotypes. These concepts may be applicable both to rare Mendelian diseases and to common complex traits. In this review, we define the concept and provide examples of personalized medicine based on human genetics for cardiovascular diseases, including coronary artery disease, arrhythmia, and cardiomyopathies. We also provide a particular focus on Mendelian randomization studies, especially those examining loss-of function genetic variations, for identifying high-risk individuals, as well as signaling pathways that may be useful targets for improving healthy living without cardiovascular events.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Chiaki Nakanishi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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573
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Wienbergen H, Fach A, Langer H, Hambrecht R. Update Lebensstil – Was funktioniert in der Praxis? AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1130-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungAktuelle Versorgungsstudien zeigen eine alarmierende Zunahme Lebensstil-assoziierter kardiovaskulärer Risikofaktoren, wie Adipositas und körperliche Inaktivität, in der Gesamtbevölkerung und bei Patienten mit Herz-Kreislauf-Erkrankungen. Um dem entgegenzuwirken, ist es wichtig, Patienten nach Koronarereignissen langfristig zu Verhaltensänderungen zu motivieren. Eine kürzlich publizierte Studie zeigte, dass ein intensives Präventionsprogramm (IPP) für 12 Monate, das primär von nicht ärztlichen Präventionsassistenten durchgeführt wurde und auf engmaschigen Kontakten zu den Patienten beruhte, die kardiovaskulären Risikofaktoren nachhaltig besser einstellen konnte. In der Gesamtbevölkerung ist eine Anleitung zu Lebensstilmodifikationen in verschiedenen Lebensphasen wichtig: beginnend im Kindes- und Jugendalter, über das Berufsleben, bis hin zum Rentenalter. Ein besonders hoher Bedarf besteht in Bevölkerungsschichten mit niedrigem sozioökonomischen Status. Durch präventive
Maßnahmen, wie Aufklärung zu mehr Bewegung, gesunder Ernährung und Nicht-Rauchen, kann hier ein großer Beitrag geleistet werden, die kardiovaskuläre Morbidität und Letalität zu senken.
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Affiliation(s)
- Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Andreas Fach
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
| | - Harald Langer
- Universitäres Herzzentrum Lübeck, Medizinische Klinik II, Lübeck
| | - Rainer Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser, Bremen
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574
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Abstract
Rosuvastatin/ezetimibe combines two lipid-lowering agents: rosuvastatin, an HMG-CoA reductase inhibitor (i.e. statin) with particularly strong inhibitory effects on hepatic cholesterol synthesis, and ezetimibe, which inhibits the intestinal absorption of cholesterol. A fixed-dose combination (FDC) of rosuvastatin/ezetimibe is indicated as an adjunctive therapy to diet for the management of primary hypercholesterolemia in adults in numerous countries worldwide. In well-designed clinical trials evaluating the therapeutic efficacy of rosuvastatin/ezetimibe administered as either separate agents or as an FDC, rosuvastatin/ezetimibe was significantly more effective than rosuvastatin monotherapy (including at double the dose of rosuvastatin) or simvastatin/ezetimibe in reducing low-density lipoprotein cholesterol (LDL-C) and total cholesterol in adults with hypercholesterolemia. Furthermore, rosuvastatin/ezetimibe enabled significantly higher proportions of patients to achieve recommended LDL-C levels than rosuvastatin monotherapy or simvastatin/ezetimibe. Rosuvastatin/ezetimibe did not significantly differ from rosuvastatin monotherapy with respect to incidences of treatment-related or serious adverse events in these short-term trials and displayed a similar safety profile to simvastatin/ezetimibe. While additional cardiovascular outcomes data and head-to-head comparisons with atorvastatin/ezetimibe would be of interest, rosuvastatin/ezetimibe is a potent and generally well-tolerated drug combination that extends the range of options available for the pharmacological management of primary hypercholesterolemia in adults.
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575
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Motovska Z, Ionita O. Perspectives of cardiovascular research in Central and Eastern Europe ( letter). Eur Heart J Suppl 2020; 22:F51-F53. [PMID: 32694954 PMCID: PMC7361657 DOI: 10.1093/eurheartj/suaa099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,IIIrd Internal - Cardiology Department, University Hospital Kralovske Vinohrady, CCUs, Srobarova 50, 100 34, Prague, Czech Republic
| | - Oana Ionita
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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576
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Rychter AM, Skrzypczak-Zielińska M, Zielińska A, Eder P, Souto EB, Zawada A, Ratajczak AE, Dobrowolska A, Krela-Kaźmierczak I. Is the Retinol-Binding Protein 4 a Possible Risk Factor for Cardiovascular Diseases in Obesity? Int J Mol Sci 2020; 21:E5229. [PMID: 32718041 PMCID: PMC7432399 DOI: 10.3390/ijms21155229] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Although many preventive and treatment approaches have been proposed, cardiovascular disease (CVD) remains one of the leading causes of deaths worldwide. Current epidemiological data require the specification of new causative factors, as well as the development of improved diagnostic tools to provide better cardiovascular management. Excessive accumulation of adipose tissue among patients suffering from obesity not only constitutes one of the main risk factors of CVD development but also alters adipokines. Increased attention is devoted to bioactive adipokines, which are also produced by the adipose tissue. The retinol-binding protein 4 (RBP4) has been associated with numerous CVDs and is presumably associated with an increased cardiovascular risk. With this in mind, exploring the role of RBP4, particularly among patients with obesity, could be a promising direction and could lead to better CVD prevention and management in this patient group. In our review, we summarized the current knowledge about RBP4 and its association with essential aspects of cardiovascular disease-lipid profile, intima-media thickness, atherosclerotic process, and diet. We also discussed the RBP4 gene polymorphisms essential from a cardiovascular perspective.
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Affiliation(s)
- Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
| | | | - Aleksandra Zielińska
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; (M.S.-Z.); (A.Z.)
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
| | - Eliana B. Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- CEB—Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Agnieszka Zawada
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
| | - Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
| | - Iwona Krela-Kaźmierczak
- Department of Gastroenterology, Dietetics and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (P.E.); (A.Z.); (A.E.R.); (A.D.); (I.K.-K.)
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577
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Two early rehabilitation training models in male patients after coronary artery bypass surgery: application of continuous walking training as an alternative to interval cycle ergometer training. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:87-93. [PMID: 32728371 PMCID: PMC7379224 DOI: 10.5114/kitp.2020.97265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
Introduction Walking training is a good alternative to the commonly used cycle ergometer training. It is still necessary to develop rehabilitation programs based on walking characterized by a high degree of safety and effectiveness. Aim Application of continuous walking training as an alternative to interval cycle ergometer training in men after coronary artery bypass graft (CABG) surgery, using the 6-minute walk test (6-MWT) to determine the initial training load. Material and methods Forty-four men aged 45 to 76 years, up to 3 months after CABG surgery, were randomly assigned to continuous training on a treadmill (study group) or interval training on a cycle ergometer (control group), performed 6 times per week (12-15 sessions). Participants underwent the treadmill exercise stress test (TEST) and 6-MWT at the begining and after completion of the rehabilitation program. Before and 3 minutes after the 6th and 12th training session blood lactate concentration was determined. Results Energy expenditure in TEST increased from 4.4 to 6.3 MET in the study group and from 5.0 to 6.5 MET in the control group. Distance walked in 6-MWT increased from 420 to 519 m and from 438 to 510 m, respectively. Resting heart rate (HR) and double product (DP) decreased only in the study group as well as systolic blood pressure (SBP), HR and DP at peak exercise load in baseline TEST. Mean energy expenditure during training sessions was 2.6 MET in the study group and 2.8 MET in the control group (NS). Exercise blood lactate concentration did not exceed 2.0 mmol/l in both groups. Conclusions Both rehabilitation programs were of similar effectiveness and their intensity did not exceed the anaerobic threshold.
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578
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Lüscher TF. Clinical trials in interventional cardiology: a challenging necessity. Eur Heart J 2020; 41:2509-2512. [PMID: 33216877 DOI: 10.1093/eurheartj/ehaa585] [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
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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579
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Huber K, Ulmer H, Lang IM, Mühlberger V. Coronary interventions in Austria, Germany, and Switzerland. Eur Heart J 2020; 41:2599-2600. [PMID: 32385514 DOI: 10.1093/eurheartj/ehaa291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, and Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Irene M Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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580
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Dominguez-Rodriguez A, Rodríguez S, Hernández-Vaquero D. Air pollution is intimately linked to global climate change: change in Cardiovascular Disease Statistics 2019. Eur Heart J 2020; 41:2601. [PMID: 32388556 DOI: 10.1093/eurheartj/ehaa295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alberto Dominguez-Rodriguez
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, Tenerife, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Sergio Rodríguez
- Estación Experimental de Zonas Áridas, EEZA, CSIC, Almería, Spain
- Instituto de Productos Naturales y Agrobiología, IPNA, CSIC, Tenerife, Spain
| | - Daniel Hernández-Vaquero
- Heart Area. Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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581
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Kirov H, Tkebuchava S, Faerber G, Diab M, Sandhaus T, Doenst T. Lost in circulation. J Card Surg 2020; 35:1885-1890. [PMID: 32643849 DOI: 10.1111/jocs.14821] [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: 11/30/2022]
Abstract
BACKGROUND Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent. METHODS We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014. RESULTS From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular-assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left-sided minithoracotomy (n = 2). The operations were performed on-pump in five (62.5%) and off-pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained-device-related right heart failure. The other patients survived and had uneventful postoperative courses. CONCLUSIONS Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Sophio Tkebuchava
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Tim Sandhaus
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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582
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Barrios V, Cosín-Sales J, Bravo M, Escobar C, Gámez JM, Huelmos A, Ortiz Cortés C, Egocheaga I, García-Pinilla JM, Jiménez-Candil J, López-de-Sá E, Torres Llergo J, Obaya JC, Pallares-Carratalá V, Sanmartín M, Vidal-Pérez R, Cequier Á. [Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology]. Rev Esp Cardiol 2020; 73:910-918. [PMID: 32836664 PMCID: PMC7345370 DOI: 10.1016/j.recesp.2020.06.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
La pandemia producida por la infección por el coronavirus SARS-CoV-2 (COVID-19) ha cambiado la forma de entender nuestras consultas. Para reducir el riesgo de contagio de los pacientes más vulnerables (aquellos con cardiopatías) y del personal sanitario, se han suspendido la mayoría de las consultas presenciales y se han puesto en marcha las consultas telemáticas. Este cambio se ha implementado en muy poco tiempo, pero parece que ha venido para quedarse. No obstante, hay grandes dudas sobre aspectos organizativos, legales, posibilidades de mejora, etc. En este documento de consenso de la Sociedad Española de Cardiología, tratamos de dar las claves para mejorar la calidad asistencial en nuestras nuevas consultas telemáticas, revisando las afecciones que el cardiólogo clínico atiende con más frecuencia en su consulta ambulatoria y proponiendo unos mínimos en ese proceso asistencial. Estas enfermedades son la cardiopatía isquémica, la insuficiencia cardiaca y las arritmias. En los 3 escenarios tratamos de clarificar los aspectos fundamentales que hay que revisar en la entrevista telefónica, a qué pacientes habrá que atender en una consulta presencial y cuáles serán los criterios para su seguimiento en atención primaria. El documento también recoge distintas mejoras que pueden introducirse en la consulta telemática para mejorar la asistencia de nuestros pacientes.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, España
| | - Marisol Bravo
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - José M Gámez
- Servicio de Cardiología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - Ana Huelmos
- Servicio de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Carolina Ortiz Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | | | - José Manuel García-Pinilla
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, España.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | | | | | | | | | | | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
| | - Rafael Vidal-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Ángel Cequier
- Servicio de Cardiología, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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583
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Seferović PM, Ašanin M, Polovina M. Practice makes perfect: improved long‐term survival in non‐ischaemic dilated cardiomyopathy with contemporary treatment. Eur J Heart Fail 2020; 22:1122-1124. [DOI: 10.1002/ejhf.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Petar M. Seferović
- Faculty of Medicine Belgrade University Belgrade Serbia
- Serbian Academy of Science and Arts Belgrade Serbia
| | - Milika Ašanin
- Faculty of Medicine Belgrade University Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
| | - Marija Polovina
- Faculty of Medicine Belgrade University Belgrade Serbia
- Department of Cardiology Clinical Centre of Serbia Belgrade Serbia
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584
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Targeting mitochondrial fitness as a strategy for healthy vascular aging. Clin Sci (Lond) 2020; 134:1491-1519. [PMID: 32584404 DOI: 10.1042/cs20190559] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide and aging is the primary risk factor for CVD. The development of vascular dysfunction, including endothelial dysfunction and stiffening of the large elastic arteries (i.e., the aorta and carotid arteries), contribute importantly to the age-related increase in CVD risk. Vascular aging is driven in large part by oxidative stress, which reduces bioavailability of nitric oxide and promotes alterations in the extracellular matrix. A key upstream driver of vascular oxidative stress is age-associated mitochondrial dysfunction. This review will focus on vascular mitochondria, mitochondrial dysregulation and mitochondrial reactive oxygen species (ROS) production and discuss current evidence for prevention and treatment of vascular aging via lifestyle and pharmacological strategies that improve mitochondrial health. We will also identify promising areas and important considerations ('research gaps') for future investigation.
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585
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Barbato E, Noc M, Baumbach A, Dudek D, Bunc M, Skalidis E, Banning A, Legutko J, Witt N, Pan M, Tilsted HH, Nef H, Tarantini G, Kazakiewicz D, Huculeci R, Cook S, Magdy A, Desmet W, Cayla G, Vinereanu D, Voskuil M, Goktekin O, Vardas P, Timmis A, Haude M. Mapping interventional cardiology in Europe: the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas Project. Eur Heart J 2020; 41:2579-2588. [DOI: 10.1093/eurheartj/ehaa475] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/02/2020] [Accepted: 05/19/2020] [Indexed: 02/05/2023] Open
Abstract
Abstract
Aims
The European Association of Percutaneous Cardiovascular Interventions (EAPCI) Atlas of Interventional Cardiology has been developed to map interventional practice across European Society of Cardiology (ESC) member countries. Here we present the main findings of a 16-country survey in which we examine the national availability of interventional infrastructure, human resource, and procedure volumes.
Methods and results
Sixteen ESC member countries participated in the EAPCI Atlas survey. Interventional data were collected by the National Cardiac Society of each participating country. An annual median of 5131 [interquartile range (IQR) 4013–5801] diagnostic heart procedures per million people were reported, ranging from <2500 in Egypt and Romania to >7000 in Turkey and Germany. Procedure rates showed significant correlation (r = 0.67, P = 0.013) with gross national income (GNI) per capita. An annual median of 2478 (IQR 1690–2633) percutaneous coronary interventions (PCIs) per million people were reported, ranging from <1000 in Egypt and Romania to >3000 in Switzerland, Poland, and Germany. Procedure rates showed significant correlation with GNI per capita (r = 0.62, P = 0.014). An annual median of 48.2 (IQR 29.1–105.2) transcatheter aortic valve implantation procedures per million people were performed, varying from <25 per million people in Egypt, Romania, Turkey, and Poland to >100 per million people in Denmark, France, Switzerland, and Germany. Procedure rates showed significant correlation with national GNI per capita (r = 0.92, P < 0.001).
Conclusion
The first report from the EAPCI Atlas has shown considerable international heterogeneity in interventional cardiology procedure volumes. The heterogeneity showed association with national economic resource, a reflection no doubt of the technological costs of developing an interventional cardiology service.
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Affiliation(s)
- Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Kopernika 17, Krakow, Poland
| | - Matjaz Bunc
- University Clinical Center Ljubljana, Zaloška c. 004, Ljubljana, Slovenia
| | | | - Adrian Banning
- Oxford Heart Centre, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, UK
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Nils Witt
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Manuel Pan
- Reina Sofía Hospital, Department of Cardiology, University of Córdoba (IMIBIC), Spain
| | | | - Holger Nef
- University of Giessen, Department of Cardiology and Angiology, Germany
| | - Giuseppe Tarantini
- Interventional Cardiology, Department of Cardiac Thoracic and Vascular Science University of Padua, Italy
| | - Dzianis Kazakiewicz
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Radu Huculeci
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Stephane Cook
- Cardiology, University Hospital Fribourg, Switzerland
| | | | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospital Leuven, and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Guillaume Cayla
- Department of cardiology, University of Montpellier, Nimes, France
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | | | - Panos Vardas
- Heart Sector, Hygeia Group Hospitals, 5 Erythrou Stavrou Str, 151 23, Marousi, Athens, Greece
| | - Adam Timmis
- Queen Mary University of London, Barts Heart Centre, London, UK
| | - Michael Haude
- Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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586
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Gioscia-Ryan RA, Clayton ZS, Fleenor BS, Eng JS, Johnson LC, Rossman MJ, Zigler MC, Evans TD, Seals DR. Late-life voluntary wheel running reverses age-related aortic stiffness in mice: a translational model for studying mechanisms of exercise-mediated arterial de-stiffening. GeroScience 2020; 43:423-432. [PMID: 32529594 PMCID: PMC8050175 DOI: 10.1007/s11357-020-00212-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 01/02/2023] Open
Abstract
Aortic stiffening, assessed as pulse-wave velocity (PWV), increases with age and is an important antecedent to, and independent predictor of, cardiovascular diseases (CVD) and other clinical disorders of aging. Aerobic exercise promotes lower levels of aortic stiffness in older adults, but the underlying mechanisms are incompletely understood, largely due to inherent challenges of mechanistic studies of large elastic arteries in humans. Voluntary wheel running (VWR) is distinct among experimental animal exercise paradigms in that it allows investigation of the physiologic effects of aerobic training without potential confounding influences of aversive molecular signaling related to forced exercise. In this study, we investigated whether VWR in mice may be a suitable model for mechanistic studies (i.e., "reverse translation") of the beneficial effects of exercise on arterial stiffness in humans. We found that 10 weeks of VWR in old mice (~ 28 months) reversed age-related elevations in aortic PWV assessed in vivo (Old VWR: 369 ± 19 vs. old sedentary: 439 ± 20 cm/s, P < 0.05). The de-stiffening effects of VWR were accompanied by normalization of age-related increases in ex vivo mechanical stiffness of aortic segments and aortic accumulation of collagen-I and advanced glycation end products, as well as lower levels of aortic superoxide and nitrotyrosine. Our results suggest that late-life VWR in mice recapitulates the aortic de-stiffening effects of exercise in humans and indicates important mechanistic roles for decreased oxidative stress and extracellular matrix remodeling. Therefore, VWR is a suitable model for further study of the mechanisms underlying beneficial effects of exercise on arterial stiffness.
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Affiliation(s)
- Rachel A. Gioscia-Ryan
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Zachary S. Clayton
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | | | - Jason S. Eng
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Lawrence C. Johnson
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Matthew J. Rossman
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Melanie C. Zigler
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Trent D. Evans
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
| | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, 354 UCB, Boulder, CO 80309 USA
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587
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Liberale L, Montecucco F. Adipocytokines and cardiovascular diseases: Putative role of Neuregulin 4. Eur J Clin Invest 2020; 50:e13306. [PMID: 32511758 DOI: 10.1111/eci.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/30/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genova - Italian Cardiovascular Network, Genoa, Italy
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588
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Sabatino J, Ferrero P, Chessa M, Bianco F, Ciliberti P, Secinaro A, Oreto L, Avesani M, Bucciarelli V, Calcaterra G, Calabrò MP, Russo MG, Bassareo PP, Guccione P, Indolfi C, Di Salvo G. COVID-19 and Congenital Heart Disease: Results from a Nationwide Survey. J Clin Med 2020; 9:E1774. [PMID: 32521643 PMCID: PMC7355526 DOI: 10.3390/jcm9061774] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The pandemic of Novel Coronavirus Disease 2019 (COVID-19) is challenging, given the large number of hospitalized patients. Cardiovascular co-morbidities are linked to a higher mortality risk. Thus, patients with Congenital Heart Disease (CHD) might represent a high-risk population. Nevertheless, no data about them are available, yet. Hence, we conducted a nationwide survey to assess clinical characteristics and outcomes in patients with congenital heart disease affected by COVID-19. METHODS AND RESULTS This is a multi-centre, observational, nationwide survey, involving high-volume Italian CHD centres. COVID-19 diagnosis was defined as either "clinically suspected" or "confirmed", where a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) test had been performed and was positive. Cardiovascular comorbidities were observed among adult patients-atrial fibrillation (seven; 9%), hypertension (five; 7%), obesity (seven; 9%) and diabetes (one; 1%)-but were absent among children. Cardiovascular complications were mainly observed in the "confirmed" COVID-19+ group, consisting of heart failure (9%), palpitations/arrhythmias (3%), stroke/TIA (3%) and pulmonary hypertension (3%). Cardiovascular symptoms such as chest pain (1%), myocardial injury (1%) and pericardial effusion (1%) were also recorded. On the contrary, CHD patients from the clinically suspected COVID-19 group presented no severe symptoms or complications. CONCLUSIONS Despite previous reports pointing to a higher case-fatality rate among patients with cardiovascular co-morbidities, we observed a mild COVID-19 clinical course in our cohort of CHD patients. Although these results should be confirmed in larger cohorts to investigate the underlying mechanisms, the findings of low cardiovascular complications rates and no deaths are reassuring for CHD patients.
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Affiliation(s)
- Jolanda Sabatino
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (J.S.); (C.I.)
| | - Paolo Ferrero
- Pediatric cardiology and ACHD, Cardiovascular Department, ASST Papa Giovanni 23, 24127 Bergamo, Italy;
| | - Massimo Chessa
- ACHD UNIT-Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20097 Milan, Italy;
| | - Francesco Bianco
- Pediatric and Congenital Cardiology Unit, Azienda Ospedaliero Universitaria Ancona, 60126 Ancona, Italy; (F.B.); (V.B.)
| | - Paolo Ciliberti
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (P.C.); (P.G.)
| | - Aurelio Secinaro
- Department of Imaging, Advanced Cardiovascular Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Lilia Oreto
- Mediterranean Pediatric Cardiology Center, Bambino Gesù Pediatric Hospital, 98039 Taormina (ME), Italy;
| | - Martina Avesani
- Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy;
| | - Valentina Bucciarelli
- Pediatric and Congenital Cardiology Unit, Azienda Ospedaliero Universitaria Ancona, 60126 Ancona, Italy; (F.B.); (V.B.)
| | | | - Maria Pia Calabrò
- Department of Human Pathology of Adulthood and Childhood, University of Messina, 98125 Messina, Italy;
| | - Maria Giovanna Russo
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, 80131 Naples, Italy;
| | - Pier Paolo Bassareo
- University College of Dublin, Mater Misericordiae University Hospital, Dublin 4, Ireland;
| | - Paolo Guccione
- Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (P.C.); (P.G.)
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy; (J.S.); (C.I.)
| | - Giovanni Di Salvo
- Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy;
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589
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van den Oever LB, Cornelissen L, Vonder M, Xia C, van Bolhuis JN, Vliegenthart R, Veldhuis RNJ, de Bock GH, Oudkerk M, van Ooijen PMA. Deep learning for automated exclusion of cardiac CT examinations negative for coronary artery calcium. Eur J Radiol 2020; 129:109114. [PMID: 32531719 DOI: 10.1016/j.ejrad.2020.109114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Coronary artery calcium (CAC) score has shown to be an accurate predictor of future cardiovascular events. Early detection by CAC scoring might reduce the number of deaths by cardiovascular disease (CVD). Automatically excluding scans which test negative for CAC could significantly reduce the workload of radiologists. We propose an algorithm that both excludes negative scans and segments the CAC. METHOD The training and internal validation data were collected from the ROBINSCA study. The external validation data were collected from the ImaLife study. Both contain annotated low-dose non-contrast cardiac CT scans. 60 scans of participants were used for training and 2 sets of 50 CT scans of participants without CAC and 50 CT scans of participants with an Agatston score between 10 and 20 were collected for both internal and external validation. The effect of dilated convolutional layers was tested by using 2 CNN architectures. We used the patient-level accuracy as metric for assessing the accuracy of our pipeline for detection of CAC and the Dice coefficient score as metric for the segmentation of CAC. RESULTS Of the 50 negative cases in the internal and external validation set, 62 % and 86 % were classified correctly, respectively. There were no false negative predictions. For the segmentation task, Dice Coefficient scores of 0.63 and 0.84 were achieved for the internal and external validation datasets, respectively. CONCLUSIONS Our algorithm excluded 86 % of all scans without CAC. Radiologists might need to spend less time on participants without CAC and could spend more time on participants that need their attention.
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Affiliation(s)
- Leonardus B van den Oever
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Ludo Cornelissen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Marleen Vonder
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Congying Xia
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | | | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - Raymond N J Veldhuis
- University of Twente, Department of Electrical Engineering, Computer Science and Mathematics, Enschede, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Matthijs Oudkerk
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter M A van Ooijen
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
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590
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Iung B, Ducrocq G. Management of myocardial infarction: Pay more attention to comorbidities. Int J Cardiol 2020; 308:13-14. [PMID: 32241574 DOI: 10.1016/j.ijcard.2020.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Paris, France; Université de Paris, France.
| | - Gregory Ducrocq
- Cardiology Department, Bichat Hospital, APHP, Paris, France; Université de Paris, France
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591
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Szabó MR, Gáspár R, Pipicz M, Zsindely N, Diószegi P, Sárközy M, Bodai L, Csont T. Hypercholesterolemia Interferes with Induction of miR-125b-1-3p in Preconditioned Hearts. Int J Mol Sci 2020; 21:ijms21113744. [PMID: 32466450 PMCID: PMC7312064 DOI: 10.3390/ijms21113744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Ischemic preconditioning (IPre) reduces ischemia/reperfusion (I/R) injury in the heart. The non-coding microRNA miR-125b-1-3p has been demonstrated to play a role in the mechanism of IPre. Hypercholesterolemia is known to attenuate the cardioprotective effect of preconditioning; nevertheless, the exact underlying mechanisms are not clear. Here we investigated, whether hypercholesterolemia influences the induction of miR-125b-1-3p by IPre. Male Wistar rats were fed with a rodent chow supplemented with 2% cholesterol and 0.25% sodium-cholate hydrate for 8 weeks to induce high blood cholesterol levels. The hearts of normo- and hypercholesterolemic animals were then isolated and perfused according to Langendorff, and were subjected to 35 min global ischemia and 120 min reperfusion with or without IPre (3 × 5 min I/R cycles applied before index ischemia). IPre significantly reduced infarct size in the hearts of normocholesterolemic rats; however, IPre was ineffective in the hearts of hypercholesterolemic animals. Similarly, miR-125b-1-3p was upregulated by IPre in hearts of normocholesterolemic rats, while in the hearts of hypercholesterolemic animals IPre failed to increase miR-125b-1-3p significantly. Phosphorylation of cardiac Akt, ERK, and STAT3 was not significantly different in any of the groups at the end of reperfusion. Based on these results we propose here that hypercholesterolemia attenuates the upregulation of miR-125b-1-3p by IPre, which seems to be associated with the loss of cardioprotection.
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Affiliation(s)
- Márton R. Szabó
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
| | - Renáta Gáspár
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
| | - Márton Pipicz
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
| | - Nóra Zsindely
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52., H-6726 Szeged, Hungary;
| | - Petra Diószegi
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
| | - Márta Sárközy
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
| | - László Bodai
- Department of Biochemistry and Molecular Biology, Faculty of Science and Informatics, University of Szeged, Közép fasor 52., H-6726 Szeged, Hungary;
| | - Tamás Csont
- Metabolic Diseases and Cell Signaling (MEDICS) Research Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Dóm tér 9., H-6720 Szeged, Hungary; (M.R.S.); (R.G.); (M.P.); (P.D.); (M.S.)
- Interdisciplinary Centre of Excellence, University of Szeged, Dugonics tér 13., H-6720 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-096
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592
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Mancuso T, Barone A, Salatino A, Molinaro C, Marino F, Scalise M, Torella M, De Angelis A, Urbanek K, Torella D, Cianflone E. Unravelling the Biology of Adult Cardiac Stem Cell-Derived Exosomes to Foster Endogenous Cardiac Regeneration and Repair. Int J Mol Sci 2020; 21:E3725. [PMID: 32466282 PMCID: PMC7279257 DOI: 10.3390/ijms21103725] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiac remuscularization has been the stated goal of the field of regenerative cardiology since its inception. Along with the refreshment of lost and dysfunctional cardiac muscle cells, the field of cell therapy has expanded in scope encompassing also the potential of the injected cells as cardioprotective and cardio-reparative agents for cardiovascular diseases. The latter has been the result of the findings that cell therapies so far tested in clinical trials exert their beneficial effects through paracrine mechanisms acting on the endogenous myocardial reparative/regenerative potential. The endogenous regenerative potential of the adult heart is still highly debated. While it has been widely accepted that adult cardiomyocytes (CMs) are renewed throughout life either in response to wear and tear and after injury, the rate and origin of this phenomenon are yet to be clarified. The adult heart harbors resident cardiac/stem progenitor cells (CSCs/CPCs), whose discovery and characterization were initially sufficient to explain CM renewal in response to physiological and pathological stresses, when also considering that adult CMs are terminally differentiated cells. The role of CSCs in CM formation in the adult heart has been however questioned by some recent genetic fate map studies, which have been proved to have serious limitations. Nevertheless, uncontested evidence shows that clonal CSCs are effective transplantable regenerative agents either for their direct myogenic differentiation and for their paracrine effects in the allogeneic setting. In particular, the paracrine potential of CSCs has been the focus of the recent investigation, whereby CSC-derived exosomes appear to harbor relevant regenerative and reparative signals underlying the beneficial effects of CSC transplantation. This review focuses on recent advances in our knowledge about the biological role of exosomes in heart tissue homeostasis and repair with the idea to use them as tools for new therapeutic biotechnologies for "cell-less" effective cardiac regeneration approaches.
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Affiliation(s)
- Teresa Mancuso
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Antonella Barone
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Alessandro Salatino
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Claudia Molinaro
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Fabiola Marino
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Mariangela Scalise
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Michele Torella
- Department of Translational Medical Sciences, AORN dei Colli/Monaldi Hospital, University of Campania “L. Vanvitelli”, Via Leonardo Bianchi, 80131 Naples, Italy;
| | - Antonella De Angelis
- Department of Experimental Medicine, Section of Pharmacology, University of Campania “L.Vanvitelli”, 80121 Naples, Italy;
| | - Konrad Urbanek
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Daniele Torella
- Molecular and Cellular Cardiology, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (T.M.); (A.B.); (A.S.); (C.M.); (F.M.); (M.S.); (K.U.)
| | - Eleonora Cianflone
- Molecular and Cellular Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
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593
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Zeng ZY, Liu SX, Xu H, Xu X, Liu XZ, Zhao XX. Association of triglyceride glucose index and its combination of obesity indices with prehypertension in lean individuals: A cross-sectional study of Chinese adults. J Clin Hypertens (Greenwich) 2020; 22:1025-1032. [PMID: 32442359 DOI: 10.1111/jch.13878] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
Abstract
For normal-weight population, the management of prehypertension may be more beneficial by identifying insulin resistance (IR) status than relying solely on traditional indicators of obesity. We investigated the association of triglyceride glucose (TyG) index, a simple surrogate marker of IR, and its combination of obesity indices with prehypertension in lean individuals. A total of 105 070 lean adults without hypertension were included in this analysis. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), and TyG were calculated according to the corresponding formula; TyG-BMI, TyG-WC, and TyG-WHtR were calculated by multiplying the corresponding two parameters. Gardner-Altman plots, partial correlation, and logistic regression analyses were applied to explore the associations in continuous variables and quartiles. The prehypertensive ones had higher mean values of TyG, TyG-BMI, TyG-WC, and TyG-WHtR than normotensive individuals. All the four indicators showed positive correlations with systolic blood pressure and diastolic blood pressure. After full adjustment, only TyG-BMI and TyG-WC were significantly associated with prehypertension in both genders. Furthermore, TyG-BMI had the highest OR for prehypertension. Our study showed that TyG-BMI might be an accessible and complementary monitor in the hierarchical management of non-obese prehypertensive patients.
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Affiliation(s)
- Zhen Yu Zeng
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Su Xuan Liu
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Hao Xu
- Department of Infectious Diseases, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Xia Xu
- Department of Rheumatology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
| | - Xing Zhen Liu
- Hangzhou Aeronautical Sanatorium of Chinese Air Force, Hangzhou, China
| | - Xian Xian Zhao
- Department of Cardiology, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China
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594
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Glezer MG, Vygodin VA. Effectiveness of Trimetazidine in Patients with Stable Angina Pectoris of Various Durations: Results from ODA. Cardiol Ther 2020; 9:395-408. [PMID: 32430799 PMCID: PMC7584693 DOI: 10.1007/s40119-020-00174-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Trimetazidine (TMZ) is an antianginal agent that acts directly at the myocardial cell level and which is now available in a once-daily (od) formulation. METHODS ODA, a 3-month, observational, multicenter study in Russia, assessed the effectiveness and tolerability of TMZ 80 mg od in patients with stable angina and persisting symptoms, in real-life settings. The present analysis explored the effects of adding TMZ to background antianginal treatment with respect to the duration of stable angina. RESULTS A total of 3032 patients were divided into four groups according to stable angina pectoris duration since diagnosis, ranging from less than 1 year to more than 10 years. A decrease in frequency of angina attacks was observed, including in patients with angina duration < 1 year, in whom the frequency of weekly angina attacks decreased from 3.8 ± 2.9 to 1.4 ± 1.7 at 1 month and 0.6 ± 1.0 at 3 months. Short-acting nitrate consumption and proportion of angina-free patients decreased, and self-reported physical activity and adherence to antianginal therapy improved in all patient groups, including recently diagnosed patients and starting already at month 1. CONCLUSIONS Addition of TMZ 80 mg od to antianginal treatment was effective in reducing the frequency of angina attacks and the use of short-acting nitrates, improving Canadian Cardiovascular Society (CCS) class, self-reported physical activity, and adherence to antianginal therapy. These beneficial effects were observed in patient groups with different durations of stable angina, suggesting an opportunity for decreasing angina burden even in recently diagnosed patients. TRIAL REGISTRATION ISRCTN registry Identifier, ISRCTN97780949.
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Affiliation(s)
- Maria G Glezer
- Department of Cardiology, Functional and Ultrasonic Diagnostics, Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Vladimir A Vygodin
- Laboratory of Biostatistics, National Medical Research Center for Preventive Medicine of the Ministry of Healthcare, Moscow, Russia
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595
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Cífková R, Bruthans J, Wohlfahrt P, Krajčoviechová A, Šulc P, Jozífová M, Eremiášová L, Pudil J, Linhart A, Widimský J, Filipovský J, Mayer O, Škodová Z, Poledne R, Stávek P, Lánská V. 30-year trends in major cardiovascular risk factors in the Czech population, Czech MONICA and Czech post-MONICA, 1985 - 2016/17. PLoS One 2020; 15:e0232845. [PMID: 32392239 PMCID: PMC7213700 DOI: 10.1371/journal.pone.0232845] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy. Methods There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25–64 years). Results Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001). Conclusions The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.
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Affiliation(s)
- Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic.,Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Bruthans
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Alena Krajčoviechová
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Pavel Šulc
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Marie Jozífová
- Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University in Prague, Prague, Czech Republic
| | - Lenka Eremiášová
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Pudil
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Aleš Linhart
- Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jiří Widimský
- Department of Medicine III, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic
| | - Jan Filipovský
- Department of Medicine II, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Otto Mayer
- Department of Medicine II, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Zdenka Škodová
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Rudolf Poledne
- Atherosclerosis Research Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Stávek
- Atherosclerosis Research Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Věra Lánská
- Medical Statistics Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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596
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Lüscher TF. Chronic coronary syndromes: perfusion pressure, FFR, and secondary prevention. Eur Heart J 2020; 41:1611-1614. [PMID: 33216867 DOI: 10.1093/eurheartj/ehaa380] [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
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Moreira AC, Mesquita G, Gomes MS. Ferritin: An Inflammatory Player Keeping Iron at the Core of Pathogen-Host Interactions. Microorganisms 2020; 8:microorganisms8040589. [PMID: 32325688 PMCID: PMC7232436 DOI: 10.3390/microorganisms8040589] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022] Open
Abstract
Iron is an essential element for virtually all cell types due to its role in energy metabolism, nucleic acid synthesis and cell proliferation. Nevertheless, if free, iron induces cellular and organ damage through the formation of free radicals. Thus, iron levels must be firmly controlled. During infection, both host and microbe need to access iron and avoid its toxicity. Alterations in serum and cellular iron have been reported as important markers of pathology. In this regard, ferritin, first discovered as an iron storage protein, has emerged as a biomarker not only in iron-related disorders but also in inflammatory diseases, or diseases in which inflammation has a central role such as cancer, neurodegeneration or infection. The basic research on ferritin identification and functions, as well as its role in diseases with an inflammatory component and its potential as a target in host-directed therapies, are the main considerations of this review.
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Affiliation(s)
- Ana C. Moreira
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (G.M.); (M.S.G.)
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
- Correspondence:
| | - Gonçalo Mesquita
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (G.M.); (M.S.G.)
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria Salomé Gomes
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal; (G.M.); (M.S.G.)
- IBMC—Instituto de Biologia Molecular e Celular, Universidade do Porto, 4200-135 Porto, Portugal
- ICBAS—Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal
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598
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What do we know about the role of lipoprotein(a) in atherogenesis 57 years after its discovery? Prog Cardiovasc Dis 2020; 63:219-227. [PMID: 32277995 DOI: 10.1016/j.pcad.2020.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022]
Abstract
Elevated circulating concentrations of lipoprotein(a) [Lp(a)] is strongly associated with increased risk of atherosclerotic cardiovascular disease (CVD) and degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies. Everybody should have their Lp(a) concentration measured once in their lifetime. CVD risk is elevated when Lp(a) concentrations are high i.e. > 50 mg/dL (≥100 mmol/L). Extremely high Lp(a) levels >180 mg/dL (≥430 mmol/L) are associated with CVD risk similar to that conferred by familial hypercholesterolemia. Elevated Lp(a) level was previously treated with niacin, which exerts a potent Lp(a)-lowering effect. However, niacin is currently not recommended because, despite the improvement in lipid profile, no improvements on clinical outcomes have been observed. Furthermore, niacin use has been associated with severe adverse effects. Post hoc analyses of clinical trials with proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have shown that these drugs exert clinical benefits by lowering Lp(a), independent of their potent reduction of low-density lipoprotein cholesterol (LDL-C). It is not yet known whether PCSK9 inhibitors will be of clinical use in patients with elevated Lp(a). Apheresis is a very effective approach to Lp(a) reduction, which reduces CVD risk but is invasive and time-consuming and is thus reserved for patients with very high Lp(a) levels and progressive CVD. Studies are ongoing on the practical application of genetic approaches to therapy, including antisense oligonucleotides against apolipoprotein(a) and small interfering RNA (siRNA) technology, to reduce the synthesis of Lp(a).
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599
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Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-Analysis. Curr Hypertens Rep 2020; 22:34. [PMID: 32200440 DOI: 10.1007/s11906-020-01042-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This meta-analysis and systematic review was conducted to evaluate the effect of probiotics on blood pressure, body mass index (BMI), and blood glucose changes in patients with hypertension. RECENT FINDINGS We searched the PubMed, Cochrane, Embase, and ProQuest databases using a combination of MeSH and free text, from the inception of these databases to 20 January 2020, with no language restrictions. The quantitative PEDro scale method was used to assess the quality of the included studies. We used the random effects models to estimate the outcomes, with heterogeneity among the studies assessed using Cochran's Q statistic. Fourteen included studies published between 2002 and 2019 were included in the meta-analysis, reporting results of 846 hypertension participants. A significant reduction in SBP by - 2.05 mmHg (95% CI - 3.87, -0.24, P = 0.03), DBP by - 1.26 mmHg (95% CI - 2.51, - 0.004, P = 0.047), BMI by - 1.03 (95% CI - 1.28, - 0.97, P < 0.01), and blood glucose by - 0.18 mmol/L (95% CI - 0.30 - 0.05, P = 0.007) was observed following probiotics intervention. Our meta-analysis showed a modest but a significant reduction in SBP and DBP in patients with hypertension, particularly in those with diabetes mellitus, following probiotic supplementation. This effect was associated with treatment duration, dosage, and the age of subject but was not associated with single or multiple strains usage. Additionally, probiotic supplement had a beneficial effect in reducing BMI and blood glucose.
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600
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Chi C, Li C, Wu D, Buys N, Wang W, Fan H, Sun J. Effects of Probiotics on Patients with Hypertension: a Systematic Review and Meta-analysis. Curr Hypertens Rep 2020. [DOI: 10.1007/s11906-020-01041-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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