901
|
|
902
|
Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society. J Am Coll Cardiol 2016; 67:2419-2440. [PMID: 27079335 PMCID: PMC7733163 DOI: 10.1016/j.jacc.2016.03.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.
Collapse
|
903
|
Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation. Transl Stroke Res 2016; 8:122-130. [PMID: 27212039 DOI: 10.1007/s12975-016-0471-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
Previous cross-sectional studies have demonstrated a higher incidence of dehydration in patients admitted for stroke suggesting a possible association. However, the temporality of the association has not been well established. We examined whether dehydration increases the risk of ischemic stroke in patients with a recent hospitalization for atrial fibrillation (AF). Data was from 1994 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records New Jersey hospitals, for AF hospitalizations (n = 1,282,787). Estimates for the association between AF hospitalization with/without dehydration and ischemic stroke within 30 days post-AF discharge were determined using log-linear multivariable modeling adjusting for socio-demographic factors and comorbid conditions. Within 10 days of discharge for AF, patients 18-80 years old (YO) with comorbid dehydration had a 60 % higher risk of ischemic stroke compared to AF patients without comorbid dehydration (adjusted risk ratio (ARR) 1.60, 95 % confidence interval (CI) 1.28-2.00). Eighteen- to 80-YO patients had a 34 % higher risk of ischemic stroke in days 11-20 post-AF discharge (ARR 1.34, 95 % CI 1.04, 1.74). There was no difference in the risk of stroke in 18-80-YO patients with or without prior dehydration during days 21-30 post-AF discharge. We also found no difference in the risk of ischemic stroke during any time period in patients over 80 YO. Dehydration may be a significant risk factor for ischemic stroke in patients 18-80 YO with AF.
Collapse
|
904
|
Song Y, Xu B, Xu R, Tung R, Frank E, Tromble W, Fu T, Zhang W, Yu T, Zhang C, Fan F, Zhang Y, Li J, Bao H, Cheng X, Qin X, Tang G, Chen Y, Yang T, Sun N, Li X, Zhao L, Hou FF, Ge J, Dong Q, Wang B, Xu X, Huo Y. Independent and Joint Effect of Brachial-Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Adults. Hypertension 2016; 68:46-53. [PMID: 27217412 DOI: 10.1161/hypertensionaha.115.07023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
Abstract
Pulse wave velocity (PWV) has been shown to influence the effects of antihypertensive drugs in the prevention of cardiovascular diseases. Data are limited on whether PWV is an independent predictor of stroke above and beyond hypertension control. This longitudinal analysis examined the independent and joint effect of brachial-ankle PWV (baPWV) with hypertension control on the risk of first stroke. This report included 3310 hypertensive adults, a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurements for baPWV. During a median follow-up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than among those in the lower quartiles (6.3% versus 2.4%; hazard ratio, 1.66; 95% confidence interval, 1.06-2.60). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% versus 1.8%; hazard ratio, 2.32; 95% confidence interval, 1.49-3.61). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate hypertension control had the highest risk of stroke compared with their counterparts (7.5% versus 1.3%; hazard ratio, 3.57; 95% confidence interval, 1.88-6.77). There was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (4.2% versus 1.3%; hazard ratio, 2.29, 95% confidence interval, 1.09-4.81). In summary, among hypertensive patients, baPWV and hypertension control were found to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared with other groups.
Collapse
Affiliation(s)
- Yun Song
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Benjamin Xu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Richard Xu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Renee Tung
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Eric Frank
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Wayne Tromble
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Tong Fu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Weiyi Zhang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Tao Yu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Chunyan Zhang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Fangfang Fan
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Yan Zhang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Jianping Li
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Huihui Bao
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Xiaoshu Cheng
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Xianhui Qin
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Genfu Tang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Yundai Chen
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Tianlun Yang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Ningling Sun
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Xiaoying Li
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Lianyou Zhao
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Fan Fan Hou
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Junbo Ge
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Qiang Dong
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Binyan Wang
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China
| | - Xiping Xu
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China.
| | - Yong Huo
- From the National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (Y.S., W.Z., C.Z., X.Q., F.F.H., B.W., X.X.); Department of Cardiology, Peking University First Hospital, Beijing, China (B.X., R.X., T.F., F.F., Y.Z., J.L., Y.H.); River Hill High School, Clarksville, MD (B.X., R.X., R.T., E.F., W.T.); Renmin University Affiliated High School of China, Beijing, China (T.F.); Shenzhen College of International Education, Guangdong, China (W.Z.); Institute for Biomedicine, Anhui Medical University, Hefei, China (T.Y., G.T.); Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China (H.B., X.C.); Department of Cardiology (Y.C.) and Department of Geriatric Cardiology (X.L.), General Hospital of People's Liberation Army, Beijing, China; Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China (T.Y.); Department of Cardiology, Peking University People's Hospital, Beijing, China (N.S.); Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China (L.Z.); and Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital (J.G.) and Department of Neurology, Huashan Hospital (Q.D.), Fudan University, Shanghai, China.
| |
Collapse
|
905
|
A Targeted Metabolomics MRM-MS Study on Identifying Potential Hypertension Biomarkers in Human Plasma and Evaluating Acupuncture Effects. Sci Rep 2016; 6:25871. [PMID: 27181907 PMCID: PMC4867614 DOI: 10.1038/srep25871] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/22/2016] [Indexed: 02/08/2023] Open
Abstract
The critical role of metabolic abnormality in hypertension is increasingly recognized, but its biomarkers are not clearly identified. In this study, 47 chemical compounds recorded by literature were employed as target metabolites of essential hypertension (EH). We detected their content in the plasma of EH patients and healthy subjects by using the Multiple Reaction Monitoring-Mass Spectrometry (MRM-MS). After screening the most altered compounds, acupuncture was used to treat patients for 3 months and these plasma metabolites were tested again. The results showed that oleic acid (OA) and myoinositol (MI) were the most important differential metabolites between the hypertensive plasma and the healthy plasma. They were also closely correlated with 24-hour blood pressure and nocturnal dipping. Moreover, plasma OA and MI could be restored to normal levels by acupuncture, accompanying with reduction of 24-hour systolic and diastolic blood pressure [from 145.10 ± 9.28 mm Hg to 140.70 ± 9.59 mm Hg (P < 0.0001), and 88.35 ± 7.92 mm Hg to 85.86 ± 7.95 mm Hg (P = 0.0024), respectively] and improvement of circadian blood pressure rhythm. This study demonstrated that plasma OA and MI were potential hypertension biomarkers and they could be used to preliminarily assess the treating effects such as acupuncture.
Collapse
|
906
|
DeFilipp Z, Duarte RF, Snowden JA, Majhail NS, Greenfield DM, Miranda JL, Arat M, Baker KS, Burns LJ, Duncan CN, Gilleece M, Hale GA, Hamadani M, Hamilton BK, Hogan WJ, Hsu JW, Inamoto Y, Kamble RT, Lupo-Stanghellini MT, Malone AK, McCarthy P, Mohty M, Norkin M, Paplham P, Ramanathan M, Richart JM, Salooja N, Schouten HC, Schoemans H, Seber A, Steinberg A, Wirk BM, Wood WA, Battiwalla M, Flowers MED, Savani BN, Shaw BE. Metabolic Syndrome and Cardiovascular Disease after Hematopoietic Cell Transplantation: Screening and Preventive Practice Recommendations from the CIBMTR and EBMT. Biol Blood Marrow Transplant 2016; 22:1493-1503. [PMID: 27184625 PMCID: PMC4949101 DOI: 10.1016/j.bbmt.2016.05.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022]
Abstract
Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus, and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31–49% amongst HCT recipients. While MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to review literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors.
Collapse
Affiliation(s)
- Zachariah DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust and Department of Oncology & Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Navneet S Majhail
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Diana M Greenfield
- Specialized Cancer Services, Sheffield Teaching Hospital NHS Foundation Trust, Shefflied, United Kingdom
| | - José López Miranda
- Department of Medicine, Reina Sofia University Hospital, Maimonides Institute for Biomedical Research at Cordoba (IMIBIC), University of Cordoba, CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain
| | - Mutlu Arat
- Florence Nightingale Sisli Hospital, Hematopoietic Stem Cell Transplantation Unit, Istanbul, Turkey
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Linda J Burns
- National Marrow Donor Program, University of Minnesota, Minneapolis, Minnesota
| | - Christine N Duncan
- Pediatric Stem Cell Transplant, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Maria Gilleece
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Gregory A Hale
- All Children's Hospital, John Hopkins Medicine, St. Petersburg, Florida
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Betty K Hamilton
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - William J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jack W Hsu
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | | | - Adriana K Malone
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip McCarthy
- Roswell Park Cancer Institute, BMT Program, Department of Medicine, Buffalo, New York
| | - Mohamad Mohty
- University Pierre & Marie Curie, Paris, France; Hopital Saint-Antoine, AP-HP, Paris, France; INSERM UMRs 938, Paris, France
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Pamela Paplham
- Roswell Park Cancer Institute, BMT Program, Department of Medicine, Buffalo, New York
| | - Muthalagu Ramanathan
- Department Hematology, Oncology and Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, Massachusetts
| | - John M Richart
- Saint Louis University, Department of Internal Medicine, Division of Hematology and Medical Oncology, St. Louis, Missouri
| | | | - Harry C Schouten
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Helene Schoemans
- Department of Hematology, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Adriana Seber
- Hospital Samaritano, Sao Paulo, Brazil; Associação da Medula Ossea - AMEO, Sao Paulo, Brazil
| | - Amir Steinberg
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Baldeep M Wirk
- Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Minoo Battiwalla
- Hematology Branch, National Institutes of Health, Bethesda, Maryland
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | | | | |
Collapse
|
907
|
Paulus JK, Lai LYH, Lundquist C, Daneshmand A, Buettner H, Lutz JS, Raman G, Wessler BS, Kent DM. Field Synopsis of the Role of Sex in Stroke Prediction Models. J Am Heart Assoc 2016; 5:JAHA.115.002809. [PMID: 27151514 PMCID: PMC4889171 DOI: 10.1161/jaha.115.002809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Guidelines for stroke prevention recommend development of sex‐specific stroke risk scores. Incorporating sex in Clinical Prediction Models (CPMs) may support sex‐specific clinical decision making. To better understand their potential to guide sex‐specific care, we conducted a field synopsis of the role of sex in stroke‐related CPMs. Methods and Results We identified stroke‐related CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Database, a systematic summary of cardiovascular CPMs published from January 1990 to May 2012. We report the proportion of models including the effect of sex on stroke incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 92 stroke‐related CPMs, 30 (33%) contained a coefficient for sex or presented sex‐stratified models. Only 12/58 (21%) CPMs predicting outcomes in patients included sex, compared to 18/30 (60%) models predicting first stroke (P<0.0001). Sex was most commonly included in models predicting stroke among a general population (69%). Female sex was consistently associated with reduced mortality after ischemic stroke (n=4) and higher risk of stroke from arrhythmias or coronary revascularization (n=5). Models predicting first stroke versus outcomes among patients with stroke (odds ratio=5.75, 95% CI 2.18–15.14, P<0.001) and those developed from larger versus smaller sample sizes (odds ratio=4.58, 95% CI 1.73–12.13, P=0.002) were significantly more likely to include sex. Conclusions Sex is included in a minority of published CPMs, but more frequently in models predicting incidence of first stroke. The importance of sex‐specific care may be especially well established for primary prevention.
Collapse
Affiliation(s)
- Jessica K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Lana Y H Lai
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Christine Lundquist
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Ali Daneshmand
- Department of Neurology, Tufts Medical Center, Boston, MA
| | | | - Jennifer S Lutz
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Gowri Raman
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA Division of Cardiology, Tufts Medical Center, Boston, MA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| |
Collapse
|
908
|
Summers RL, Sterling SA. Emergent Bleeding in Patients Receiving Direct Oral Anticoagulants. Air Med J 2016; 35:148-155. [PMID: 27255877 DOI: 10.1016/j.amj.2016.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/13/2016] [Indexed: 06/05/2023]
Abstract
Direct oral anticoagulants (DOACs) offer clinical advantages over warfarin, such as minimal medication and food interactions and fixed dosing without the need for routine monitoring of coagulation status. As with all anticoagulants, bleeding, either spontaneous or provoked, is the most common complication. The long-term use of these drugs is increasing, and there is a crucial need for emergency medicine service professionals to understand the optimal management of associated bleeding. This review aims to describe the indications and pharmacokinetics of available DOACs; to discuss the risk of bleeding; to provide a treatment algorithm to manage DOAC-associated emergency bleeding; and to discuss future directions in bleeding management, including the role of specific reversal agents, such as the recently approved idarucizumab for reversal of the direct thrombin inhibitor dabigatran. Because air medical personnel are increasingly likely to encounter patients receiving DOACs, it is important that they have an understanding of how to manage patients with emergent bleeding.
Collapse
Affiliation(s)
- Richard L Summers
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - Sarah A Sterling
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
909
|
Affiliation(s)
- Jakub Toczek
- From the Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; and Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | - Mehran M. Sadeghi
- From the Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine and Yale Cardiovascular Research Center, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; and Veterans Affairs Connecticut Healthcare System, West Haven, CT
| |
Collapse
|
910
|
Schipper MH, Jellema K, Rijsman RM. Occurrence of Obstructive Sleep Apnea Syndrome in Patients with Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2016; 25:1249-1253. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022] Open
|
911
|
Brachmann J, Morillo CA, Sanna T, Di Lazzaro V, Diener HC, Bernstein RA, Rymer M, Ziegler PD, Liu S, Passman RS. Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients: Three-Year Results From the Cryptogenic Stroke and Underlying Atrial Fibrillation Trial. Circ Arrhythm Electrophysiol 2016; 9:e003333. [PMID: 26763225 DOI: 10.1161/circep.115.003333] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) can be a cause of previously diagnosed cryptogenic stroke. However, AF can be paroxysmal and asymptomatic, thereby making detection with routine ECG methods difficult. Oral anticoagulation is highly effective in reducing recurrent stroke in patients with AF, but its initiation is dependent on the detection of AF. Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF) is the first randomized study to report the detection of AF in cryptogenic stroke patients using continuous long-term monitoring via insertable cardiac monitors (ICM). METHODS AND RESULTS Patients with prior cryptogenic stroke were randomized to control (n=220) or ICM (n=221) and followed for ≤36 months. Cumulative AF detection rates in the ICM arm increased progressively during this period (3.7%, 8.9%, 12.4%, and 30.0% at 1, 6, 12, and 36 months, respectively), but remained low in the control arm (3.0% at 36 months). This resulted in oral anticoagulation prescription in 94.7% of ICM patients with AF detected at 6 months, 96.6% at 12 months, and 90.5% at 36 months. Among ICM patients with AF detected, the median time to AF detection was 8.4 months, 81.0% of first AF episodes were asymptomatic, and 94.9% had at least 1 day with >6 minutes of AF. CONCLUSIONS Three-year monitoring by ICM in cryptogenic stroke patients demonstrated a significantly higher AF detection rate compared with routine care. Given the frequency of asymptomatic first episodes and the long median time to detection, these findings highlight the limitations of using traditional AF detection methods. The majority of patients with AF were prescribed oral anticoagulation therapy. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov; Unique identifier: NCT00924638.
Collapse
Affiliation(s)
- Johannes Brachmann
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.).
| | - Carlos A Morillo
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Tommaso Sanna
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Vincenzo Di Lazzaro
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Hans-Christoph Diener
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Richard A Bernstein
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Marylin Rymer
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Paul D Ziegler
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Shufeng Liu
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Rod S Passman
- From the Department of Cardiology, Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany (J.B.); Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); Department of Cardiac Intensive Care, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (T.S.); Department of Neurology, Institute of Neurology, Università Campus Bio-Medico, Rome, Italy (V.D.L.); Department of Neurology & Stroke Center, University Hospital Essen, Essen, Germany (H.-C.D.); Davee Department of Neurology (R.A.B.) and Bluhm Cardiovascular Institute (R.S.P.), Northwestern University Feinberg School of Medicine, Chicago, IL; University of Kansas Medical Center, Kansas City, KS (M.R.); Departments of Diagnostics and Monitoring Research (P.D.Z.) and Statistics (S.L.), Medtronic, Mounds View, MN; and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (R.S.P.)
| |
Collapse
|
912
|
Ro YS, Shin SD, Song KJ, Kim JY, Lee EJ, Lee YJ, Ahn KO, Hong KJ. Risk of Diabetes Mellitus on Incidence of Out-of-Hospital Cardiac Arrests: A Case-Control Study. PLoS One 2016; 11:e0154245. [PMID: 27105059 PMCID: PMC4841534 DOI: 10.1371/journal.pone.0154245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/11/2016] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the risk of diabetes mellitus (DM) on incidence of out-of-hospital cardiac arrest (OHCA) and to investigate whether difference in effects of DM between therapeutic methods was observed. Methods This study was a case-control study using the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project database and 2013 Korean Community Health Survey (CHS). Cases were defined as EMS-treated adult (18 year old and older) OHCA patients with presumed cardiac etiology collected at 27 emergency departments from January to December 2014. OHCA patients whose arrest occurred at nursing homes or clinics and cases with unknown information on DM were excluded. Four controls were matched to one case with strata including age, gender, and county from the Korean CHS database. Multivariable conditional logistic regression analysis was conducted to estimate the risk of DM and treatment modality on incidence of OHCA. Results Total 1,386 OHCA patients and 5,544 community-based controls were analyzed. A total of 370 (26.7%) among cases and 860 (15.5%) among controls were diagnosed with DM. DM was associated with increasing risk of OHCA (AOR: 1.92 (1.65–2.24)). By DM treatment modality comparing with non-DM group, AOR (95% CI) was the highest in non-pharmacotherapy only group (4.65 (2.00–10.84)), followed by no treatment group (4.17 (2.91–5.96)), insulin group (2.69 (1.82–3.96)), and oral hypoglycemic agent group (1.55 (1.31–1.85)). Conclusion DM increased the risk of OHCA, which was the highest in the non-pharmacotherapy group and decreased in magnitude with pharmacotherapy.
Collapse
Affiliation(s)
- Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Yeong Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Eui Jung Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Lee
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Ok Ahn
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | | |
Collapse
|
913
|
McCutcheon BA, Kerezoudis P, Porter AL, Rinaldo L, Murphy M, Maloney P, Shepherd D, Hirshman BR, Carter BS, Lanzino G, Bydon M, Meyer F. Coma and Stroke Following Surgical Treatment of Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study. World Neurosurg 2016; 91:272-8. [PMID: 27108027 DOI: 10.1016/j.wneu.2016.04.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. METHODS The American College of Surgeons National Surgical Quality Improvement Program data set between 2007 and 2013 was used for this retrospective cohort analysis. Demographic, comorbidity, and operative characteristics associated with the development of a major neurologic complication (i.e., coma or stroke) were elucidated using a backward selection stepwise logistic regression analysis. This model was subsequently used to fit a predictive score for major neurologic complications. RESULTS Inclusion criteria were met by 662 patients. Of these patients, 57 (8.61%) developed a major neurologic complication (i.e., coma or stroke) within the 30-day postoperative period. On multivariable analysis, operative time (log odds 0.004 per minute; 95% confidence interval [CI], 0.002-0.007), age (log odds 0.05 per year; 95% CI, 0.02-0.08), history of chronic obstructive pulmonary disease (log odds 1.26; 95% CI, 0.43-2.08), and diabetes (log odds 1.15; 95% CI, 0.38-1.91) were associated with an increased odds of major neurologic complications. When patients were categorized according to quartile of a predictive score generated from the multivariable analysis, rates of major neurologic complications were 1.8%, 4.3%, 6.7%, and 21.2%. CONCLUSIONS Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
Collapse
Affiliation(s)
- Brandon A McCutcheon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Panagiotis Kerezoudis
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda L Porter
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan Murphy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Maloney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Shepherd
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Hirshman
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fredric Meyer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
914
|
Intracerebral Hemorrhage, Oxidative Stress, and Antioxidant Therapy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:1203285. [PMID: 27190572 PMCID: PMC4848452 DOI: 10.1155/2016/1203285] [Citation(s) in RCA: 203] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/20/2015] [Accepted: 03/28/2016] [Indexed: 12/20/2022]
Abstract
Hemorrhagic stroke is a common and severe neurological disorder and is associated with high rates of mortality and morbidity, especially for intracerebral hemorrhage (ICH). Increasing evidence demonstrates that oxidative stress responses participate in the pathophysiological processes of secondary brain injury (SBI) following ICH. The mechanisms involved in interoperable systems include endoplasmic reticulum (ER) stress, neuronal apoptosis and necrosis, inflammation, and autophagy. In this review, we summarized some promising advances in the field of oxidative stress and ICH, including contained animal and human investigations. We also discussed the role of oxidative stress, systemic oxidative stress responses, and some research of potential therapeutic options aimed at reducing oxidative stress to protect the neuronal function after ICH, focusing on the challenges of translation between preclinical and clinical studies, and potential post-ICH antioxidative therapeutic approaches.
Collapse
|
915
|
Rich MW, Chyun DA, Skolnick AH, Alexander KP, Forman DE, Kitzman DW, Maurer MS, McClurken JB, Resnick BM, Shen WK, Tirschwell DL. Knowledge Gaps in Cardiovascular Care of the Older Adult Population. Circulation 2016; 133:2103-22. [DOI: 10.1161/cir.0000000000000380] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
916
|
Oh MS, Yu KH, Lee JH, Jung S, Kim C, Jang MU, Lee J, Lee BC. Aspirin resistance is associated with increased stroke severity and infarct volume. Neurology 2016; 86:1808-17. [PMID: 27060166 DOI: 10.1212/wnl.0000000000002657] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate whether aspirin resistance is associated with initial stroke severity and infarct volume, using diffusion-weighted imaging (DWI) in patients with acute ischemic stroke that occurred while taking aspirin. METHODS We studied a total of 310 patients who were admitted within 48 hours of acute ischemic stroke onset. All patients had been taking aspirin for at least 7 days before stroke onset. Aspirin resistance, defined as high residual platelet reactivity (HRPR) on aspirin treatment, was measured using the VerifyNow assay and defined as an aspirin reaction unit ≥550. Initial stroke severity was assessed using the NIH Stroke Scale (NIHSS) score. Infarct volume was measured using DWI. RESULTS HRPR occurred in 86 patients (27.7%). The initial NIHSS score (median [interquartile range]) was higher in patients with HRPR than in the non-HRPR group (6 [3-15] vs 3 [1-8], p < 0.001). DWI infarct volumes were also larger in the HRPR group compared to the non-HRPR group (5.4 [0.8-43.2] vs 1.7 [0.4-10.3], p = 0.002). A multivariable median regression analysis showed that HRPR was significantly associated with an increase of 2.1 points on the NIHSS (95% confidence interval 0.8-4.0, p < 0.001) and an increase of 2.3 cm(3) in DWI infarct volume (95% confidence interval 0.4-3.9, p < 0.001). CONCLUSIONS Aspirin resistance is associated with an increased risk of severe stroke and large infarct volume in patients taking aspirin before stroke onset.
Collapse
Affiliation(s)
- Mi Sun Oh
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea.
| | - Kyung-Ho Yu
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - Ju-Hun Lee
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - San Jung
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - Chulho Kim
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - Min Uk Jang
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - Juneyoung Lee
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea
| | - Byung-Chul Lee
- From the Department of Neurology (M.S.O., K.-H.Y., J.-H.L., S.J., C.K., M.U.J., B.-C.L.), Hallym University College of Medicine, Hallym Neurological Institute; and Department of Biostatistics (J.L.), Korea University College of Medicine, South Korea.
| |
Collapse
|
917
|
Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients’ perspectives on aerobic exercise early after stroke. Disabil Rehabil 2016; 39:684-690. [DOI: 10.3109/09638288.2016.1161833] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Erik C. Prout
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
| | - Avril Mansfield
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - William E. McIlroy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute (University Health Network), Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Canada
| |
Collapse
|
918
|
Marulanda-Londoño E, Chaturvedi S. Stroke due to large vessel atherosclerosis: Five new things. Neurol Clin Pract 2016; 6:252-258. [PMID: 29443138 DOI: 10.1212/cpj.0000000000000247] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose of review Extracranial (EC) and intracranial (IC) large vessel atherosclerosis account for about 20% of ischemic stroke cases. In recent years, new treatments have emerged for treatment of both EC and IC disease. Recent findings The stroke rate in patients with carotid stenosis is decreasing with modern medical therapy. For patients with asymptomatic stenosis, the stroke rate is likely <1% per year. Some subsets of patients with symptomatic carotid disease benefit less from revascularization, and medical management can be considered in these patients. A second clinical trial has confirmed that aggressive medical management is the treatment of choice for IC atherosclerotic disease. Vessel wall imaging may be useful to define pathophysiology in patients with IC stenosis and could ultimately help tailor therapy, but further studies are needed. Medical therapy is preferred to stenting for patients with vertebral artery-origin stenosis. Summary Recent data and emerging concepts regarding large vessel atherosclerosis are provided.
Collapse
Affiliation(s)
- Erika Marulanda-Londoño
- Stroke Program and Department of Neurology (EM-L, SC), University of Miami Miller School of Medicine, and Miami VA Hospital (SC), Miami, FL
| | - Seemant Chaturvedi
- Stroke Program and Department of Neurology (EM-L, SC), University of Miami Miller School of Medicine, and Miami VA Hospital (SC), Miami, FL
| |
Collapse
|
919
|
Abstract
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer’s disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.
Collapse
Affiliation(s)
- Daniele Lo Coco
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Gianluca Lopez
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| |
Collapse
|
920
|
Nouh A, Hussain M, Mehta T, Yaghi S. Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice. Front Neurol 2016; 7:37. [PMID: 27047443 PMCID: PMC4800279 DOI: 10.3389/fneur.2016.00037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/07/2016] [Indexed: 12/31/2022] Open
Abstract
Up to a third of strokes are rendered cryptogenic or of undetermined etiology. This number is specifically higher in younger patients. At times, inadequate diagnostic workups, multiple causes, or an under-recognized etiology contributes to this statistic. Embolic stroke of undetermined source, a new clinical entity particularly refers to patients with embolic stroke for whom the etiology of embolism remains unidentified despite through investigations ruling out established cardiac and vascular sources. In this article, we review current classification and discuss important clinical considerations in these patients; highlighting cardiac arrhythmias and structural abnormalities, patent foramen ovale, paradoxical sources, and potentially under-recognized, vascular, inflammatory, autoimmune, and hematologic sources in relation to clinical practice.
Collapse
Affiliation(s)
- Amre Nouh
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
| | - Mohammed Hussain
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
| | - Tapan Mehta
- Hartford Hospital, University of Connecticut , Hartford, CT , USA
| | | |
Collapse
|
921
|
Lundberg GP, Dunbar SB, Wenger NK. Guidelines for the Reduction of Cardiovascular Disease in Women. J Obstet Gynecol Neonatal Nurs 2016; 45:402-12. [PMID: 26993208 DOI: 10.1016/j.jogn.2016.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/30/2022] Open
Abstract
Since 1984, more women than men have died each year from cardiovascular disease. Various organizations, such as the American Heart Association and the American College of Cardiology, have published prevention guidelines for heart disease and stroke that may improve care for women. In this article, we review these guidelines, the results of new studies on emerging risk factors, and new approaches for reducing cardiovascular disease in women.
Collapse
|
922
|
Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, Moore WS, Hill MD, Mantese VA, Clark WM, Timaran CH, Heck D, Leimgruber PP, Sheffet AJ, Howard VJ, Chaturvedi S, Lal BK, Voeks JH, Hobson RW. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med 2016; 374:1021-31. [PMID: 26890472 PMCID: PMC4874663 DOI: 10.1056/nejmoa1505215] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years. METHODS Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers. In addition to assessing the primary composite end point, we assessed the primary end point for the long-term extension study, which was ipsilateral stroke after the periprocedural period. RESULTS Among 2502 patients, there was no significant difference in the rate of the primary composite end point between the stenting group (11.8%; 95% confidence interval [CI], 9.1 to 14.8) and the endarterectomy group (9.9%; 95% CI, 7.9 to 12.2) over 10 years of follow-up (hazard ratio, 1.10; 95% CI, 0.83 to 1.44). With respect to the primary long-term end point, postprocedural ipsilateral stroke over the 10-year follow-up occurred in 6.9% (95% CI, 4.4 to 9.7) of the patients in the stenting group and in 5.6% (95% CI, 3.7 to 7.6) of those in the endarterectomy group; the rates did not differ significantly between the groups (hazard ratio, 0.99; 95% CI, 0.64 to 1.52). No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately. CONCLUSIONS Over 10 years of follow-up, we did not find a significant difference between patients who underwent stenting and those who underwent endarterectomy with respect to the risk of periprocedural stroke, myocardial infarction, or death and subsequent ipsilateral stroke. The rate of postprocedural ipsilateral stroke also did not differ between groups. (Funded by the National Institutes of Health and Abbott Vascular Solutions; CREST ClinicalTrials.gov number, NCT00004732.).
Collapse
Affiliation(s)
- Thomas G Brott
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - George Howard
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Gary S Roubin
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - James F Meschia
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Ariane Mackey
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - William Brooks
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Wesley S Moore
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Michael D Hill
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Vito A Mantese
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Wayne M Clark
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Carlos H Timaran
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Donald Heck
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Pierre P Leimgruber
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Alice J Sheffet
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Virginia J Howard
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Seemant Chaturvedi
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Brajesh K Lal
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Jenifer H Voeks
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| | - Robert W Hobson
- From the Mayo Clinic, Jacksonville, FL (T.G.B., J.F.M.); the University of Alabama at Birmingham (G.H., V.J.H.) and Cardiovascular Associates of the Southeast (G.S.R.) - both in Birmingham; Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC (A.M.), and the University of Calgary, Calgary, AB (M.D.H.) - both in Canada; Baptist Health Lexington, KY (W.B.); the University of California, Los Angeles, Los Angeles (W.S.M.); Mercy Hospital St. Louis, St. Louis (V.A.M.); Oregon Health and Science University, Portland (W.M.C.); the University of Texas Southwestern Medical Center, Dallas (C.H.T); Novant Health Clinical Research, Winston-Salem, NC (D.H.); the Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA (P.P.L.); Rutgers New Jersey Medical School, Newark (A.J.S., R.W.H.); the University of Miami Miller School of Medicine, Miami (S.C.); the University of Maryland Medical Center, Baltimore (B.K.L.); and the Medical University of South Carolina, Charleston (J.H.V.)
| |
Collapse
|
923
|
Huang JF, Meschia JF. Interventions for Extracranial Carotid Artery Stenosis: An Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:34. [PMID: 26971800 DOI: 10.1007/s11936-016-0455-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OPINION STATEMENT Clinical trials demonstrate that stroke risk after the periprocedural period is similar for carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA), making CAS an acceptable alternative to CEA. However, there tends to be a higher procedural risk of stroke for CAS than for CEA and a potentially higher rate of myocardial infarction in patients undergoing CEA as compared to CAS. Furthermore, lower rates of complications with revascularization and of post-revascularization stroke have been attributed to advances in medical management, improved surgical technique, and new devices. We discuss identifying patients who may have higher complication rates and recent clinical studies and medical advances directed at reducing stroke risk in patients with extracranial carotid stenosis.
Collapse
Affiliation(s)
- Josephine F Huang
- The Department of Neurology (JFH, JFM), Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - James F Meschia
- The Department of Neurology (JFH, JFM), Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| |
Collapse
|
924
|
Albers GW, Bernstein RA, Brachmann J, Camm J, Easton JD, Fromm P, Goto S, Granger CB, Hohnloser SH, Hylek E, Jaffer AK, Krieger DW, Passman R, Pines JM, Reed SD, Rothwell PM, Kowey PR. Heart Rhythm Monitoring Strategies for Cryptogenic Stroke: 2015 Diagnostics and Monitoring Stroke Focus Group Report. J Am Heart Assoc 2016; 5:e002944. [PMID: 27068633 PMCID: PMC4943268 DOI: 10.1161/jaha.115.002944] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA
| | - Richard A Bernstein
- Davee Department of Neurology, Feinberg School of Medicine of Northwestern University, Chicago, IL
| | - Johannes Brachmann
- Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany
| | - John Camm
- Cardiovascular and Cell Sciences Research Institute, St. George's University of London and Imperial College, London, UK
| | - J Donald Easton
- Department of Neurology, University of California San Francisco, Sandler Neurosciences Center, San Francisco, CA
| | - Peter Fromm
- Center for Cardiovascular Health, South Nassau Communities Hospital, Oceanside, NY
| | - Shinya Goto
- Department of Medicine, Tokai University School of Medicine, Isehara, Japan
| | | | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Amir K Jaffer
- Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Derk W Krieger
- Faculty of Health and Medical Science, University of Copenhagen, Denmark German Neuroscience Center, Dubai Healthcare City, Dubai, UAE
| | - Rod Passman
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jesse M Pines
- Office for Clinical Practice Innovation, George Washington University, Washington, DC
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Peter R Kowey
- Division of Cardiovascular Diseases, Lankenau Heart Institute, Wynnewood, PA Department of Medicine, Jefferson Medical College, Philadelphia, PA
| |
Collapse
|
925
|
Carotid Artery Stenosis: Anesthetic Considerations for Open and Endovascular Management. Int Anesthesiol Clin 2016; 54:33-51. [PMID: 26967801 DOI: 10.1097/aia.0000000000000094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
926
|
Kara B, Nayman A, Guler I, Gul EE, Koplay M, Paksoy Y. Quantitative Assessment of Left Ventricular Function and Myocardial Mass: A Comparison of Coronary CT Angiography with Cardiac MRI and Echocardiography. Pol J Radiol 2016; 81:95-102. [PMID: 27026794 PMCID: PMC4787523 DOI: 10.12659/pjr.895843] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to compare the left ventricular parameters obtained from multi-detector row computed tomography (MDCT) studies with two-dimensional echocardiography (2DE), and magnetic resonance imaging (MRI), which is accepted as the gold standard in the evaluation of left ventricular functions. The study also aimed to evaluate whether or not there is a relationship between the MR-Argus and CMR tools software programs which are used in post-process calculations of data obtained by MRI. Material/Methods Forty patients with an average age of 51.4±14.9 years who had been scanned with cardiac MDCT were evaluated with cardiac MRI and 2DE. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), and myocardial mass values calculated by MDCT, MRI, and 2DE were compared with each other. Two different MR software programs were used to compare left ventricular functions. The CMR tools LV tutorials method is accepted as the gold standard because it can be used in three-dimensional functional evaluation. The Pearson Correlation and Bland-Altman analysis were performed to compare the results from the two MR methods (MR-Argus and CMR tools) and the results from both the MDCT and the 2DE with the CMR tools results. Results Strong positive correlations for EF values were found between the MDCT and CMR tools (r=0.702 p<0.001), and between the MR-Argus and CMR tools (r=0.746 p<0.001). The correlation between the 2DE and CMR tools (r=0.449 p<0.004), however, was only moderate. Similar results were obtained for the other parameters. The strongest correlation for ESV, EDV, and EF was between the two MR software programs. The correlation coefficient between the MDCT and CMR tools is close to the correlation coefficient between the two software programs. While the correlation between 2DE and CMR tools was satisfactory for ESV, EDV, and CO values, it was at a moderate level for the other parameters. Conclusions Left ventricular functional analysis can be performed easily and reliably with cardiac MDCT used for coronary artery evaluation and it also gives more accurate results than 2DE.
Collapse
Affiliation(s)
- Bedia Kara
- Department of Radiology, Buyuksehir Hospital, Konya, Turkey
| | - Alaaddin Nayman
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Enes Elvin Gul
- Department of Cardiology, Medipol Mega University, Istanbul, Turkey
| | - Mustafa Koplay
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Yahya Paksoy
- Department of Radiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| |
Collapse
|
927
|
Affiliation(s)
- Marco Roffi
- Division of Cardiology, University Hospital, Geneva, Switzerland
| | - Zsolt Kulcsár
- Division of Neuroradiology, University Hospital, Geneva, Switzerland
| | - Emmanuel Carrera
- Department of Neurology, University Hospital, Geneva, Switzerland
| | - Alberto Cremonesi
- Cardiovascular Department, Maria Cecilia Hospital-GVM Care & Research, Cotignola, Italy
| |
Collapse
|
928
|
Cavallari LH, Mason DL. Cardiovascular Pharmacogenomics--Implications for Patients With CKD. Adv Chronic Kidney Dis 2016; 23:82-90. [PMID: 26979147 DOI: 10.1053/j.ackd.2015.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 01/20/2023]
Abstract
CKD is an independent risk factor for cardiovascular disease (CVD). Thus, patients with CKD often require treatment with cardiovascular drugs, such as antiplatelet, antihypertensive, anticoagulant, and lipid-lowering agents. There is significant interpatient variability in response to cardiovascular therapies, which contributes to risk for treatment failure or adverse drug effects. Pharmacogenomics offers the potential to optimize cardiovascular pharmacotherapy and improve outcomes in patients with CVD, although data in patients with concomitant CKD are limited. The drugs with the most pharmacogenomic evidence are warfarin, clopidogrel, and statins. There are also accumulating data for genetic contributions to β-blocker response. Guidelines are now available to assist with applying pharmacogenetic test results to optimize warfarin dosing, selection of antiplatelet therapy after percutaneous coronary intervention, and prediction of risk for statin-induced myopathy. Clinical data, such as age, body size, and kidney function have long been used to optimize drug prescribing. An increasing number of institutions are also implementing genetic testing to be considered in the context of important clinical factors to further personalize drug therapy for patients with CVD.
Collapse
|
929
|
|
930
|
Bahrmann P, Harms F, Schambeck CM, Wehling M, Flohr J. [New oral anticoagulants for prophylaxis of stroke. Results of an expert conference on practical use in geriatric patients]. Z Gerontol Geriatr 2016; 49:216-26. [PMID: 26861870 DOI: 10.1007/s00391-016-1027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/28/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
Geriatric patients with non-valvular atrial fibrillation (AF) are increasingly being treated with novel oral anticoagulants (NOAC) to prevent ischemic stroke. This article highlights the outcome of an expert meeting on the practical use of NOAC in elderly patients. An interdisciplinary group of experts discussed the current situation of stroke prevention in geriatric patients and its practical management in daily clinical practice. The topic was examined through focused impulse presentations and critical analyses as the basis for the expert consensus. The key issues are summarized in this paper. The European Society of Cardiology (ESC) guidelines from 2012 for the management of patients with non-valvular AF recommend NOAC as the preferred treatment and vitamin K antagonists (VKA) only as an alternative option. Currently, the NOAC factor Xa inhibitors apixaban and rivaroxaban and the thrombin inhibitor dabigatran are more commonly used in clinical practice for patients with AF. Although these drugs have many similarities and are often grouped together it is important to recognize that the pharmacology and dose regimes differ between compounds. Especially n elderly patients NOAC drugs have some advantages compared to VKA, e.g. less drug-drug interactions with concomitant medication and a more favorable risk-benefit ratio mostly driven by the reduction of bleeding. Treatment of anticoagulation in geriatric patients requires weighing the serious risk of stroke against an equally high risk of major bleeding and pharmacoeconomic considerations. Geriatric patients in particular have the greatest benefit from NOAC, which can also be administered in cases of reduced renal function. Regular control of the indications is indispensable, as also for all other medications of the patient. The use of NOAC should certainly not be withheld from geriatric patients who have a clear need for oral anticoagulation.
Collapse
Affiliation(s)
- Philipp Bahrmann
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90419, Nürnberg, Deutschland.
| | - Fred Harms
- European Health Care Foundation, Zug, Schweiz
| | | | - Martin Wehling
- Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität, Heidelberg, Deutschland
| | - Jürgen Flohr
- Allgemeinmedizinische Gemeinschaftspraxis, Leipzig, Deutschland
| |
Collapse
|
931
|
André C. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery. ARQUIVOS DE NEURO-PSIQUIATRIA 2016. [PMID: 26222364 DOI: 10.1590/0004-282x20150085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.
Collapse
Affiliation(s)
- Charles André
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
932
|
Reddy VY, Akehurst RL, Armstrong SO, Amorosi SL, Brereton N, Hertz DS, Holmes DR. Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin. Europace 2016; 18:979-86. [PMID: 26838691 PMCID: PMC4927063 DOI: 10.1093/europace/euv412] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/04/2015] [Indexed: 01/21/2023] Open
Abstract
Aims Atrial fibrillation (AF) patients with contraindications to oral anticoagulation have had few options for stroke prevention. Recently, a novel oral anticoagulant, apixaban, and percutaneous left atrial appendage closure (LAAC) have emerged as safe and effective therapies for stroke risk reduction in these patients. This analysis assessed the cost effectiveness of LAAC with the Watchman device relative to apixaban and aspirin therapy in patients with non-valvular AF and contraindications to warfarin therapy. Methods and results A cost-effectiveness model was constructed using data from three studies on stroke prevention in patients with contraindications: the ASAP study evaluating the Watchman device, the ACTIVE A trial of aspirin and clopidogrel, and the AVERROES trial evaluating apixaban. The cost-effectiveness analysis was conducted from a German healthcare payer perspective over a 20-year time horizon. Left atrial appendage closure yielded more quality-adjusted life years (QALYs) than aspirin and apixaban by 2 and 4 years, respectively. At 5 years, LAAC was cost effective compared with aspirin with an incremental cost-effectiveness ratio (ICER) of €16 971. Left atrial appendage closure was cost effective compared with apixaban at 7 years with an ICER of €9040. Left atrial appendage closure was cost saving and more effective than aspirin and apixaban at 8 years and remained so throughout the 20-year time horizon. Conclusions This analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin.
Collapse
Affiliation(s)
- Vivek Y Reddy
- Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
| | | | | | | | | | | | | |
Collapse
|
933
|
Affiliation(s)
- Lauren Morris
- aDiabetes Centre, Royal Oldham Hospital, Oldham bCentre for Endocrinology and Diabetes, Univesrity of Manchester, Manchester cUniversity of Salford, Salford, UK
| | | |
Collapse
|
934
|
Loci associated with ischaemic stroke and its subtypes (SiGN): a genome-wide association study. Lancet Neurol 2016; 15:174-184. [PMID: 26708676 PMCID: PMC4912948 DOI: 10.1016/s1474-4422(15)00338-5] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/21/2015] [Accepted: 11/11/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The discovery of disease-associated loci through genome-wide association studies (GWAS) is the leading genetic approach to the identification of novel biological pathways underlying diseases in humans. Until recently, GWAS in ischaemic stroke have been limited by small sample sizes and have yielded few loci associated with ischaemic stroke. We did a large-scale GWAS to identify additional susceptibility genes for stroke and its subtypes. METHODS To identify genetic loci associated with ischaemic stroke, we did a two-stage GWAS. In the first stage, we included 16 851 cases with state-of-the-art phenotyping data and 32 473 stroke-free controls. Cases were aged 16 to 104 years, recruited between 1989 and 2012, and subtypes of ischaemic stroke were recorded by centrally trained and certified investigators who used the web-based protocol, Causative Classification of Stroke (CCS). We constructed case-control strata by identifying samples that were genotyped on nearly identical arrays and were of similar genetic ancestral background. We cleaned and imputed data by use of dense imputation reference panels generated from whole-genome sequence data. We did genome-wide testing to identify stroke-associated loci within each stratum for each available phenotype, and we combined summary-level results using inverse variance-weighted fixed-effects meta-analysis. In the second stage, we did in-silico lookups of 1372 single nucleotide polymorphisms identified from the first stage GWAS in 20 941 cases and 364 736 unique stroke-free controls. The ischaemic stroke subtypes of these cases had previously been established with the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification system, in accordance with local standards. Results from the two stages were then jointly analysed in a final meta-analysis. FINDINGS We identified a novel locus (G allele at rs12122341) at 1p13.2 near TSPAN2 that was associated with large artery atherosclerosis-related stroke (first stage odds ratio [OR] 1·21, 95% CI 1·13-1·30, p=4·50 × 10-8; joint OR 1·19, 1·12-1·26, p=1·30 × 10-9). Our results also supported robust associations with ischaemic stroke for four other loci that have been reported in previous studies, including PITX2 (first stage OR 1·39, 1·29-1·49, p=3·26 × 10-19; joint OR 1·37, 1·30-1·45, p=2·79 × 10-32) and ZFHX3 (first stage OR 1·19, 1·11-1·27, p=2·93 × 10-7; joint OR 1·17, 1·11-1·23, p=2·29 × 10-10) for cardioembolic stroke, and HDAC9 (first stage OR 1·29, 1·18-1·42, p=3·50 × 10-8; joint OR 1·24, 1·15-1·33, p=4·52 × 10-9) for large artery atherosclerosis stroke. The 12q24 locus near ALDH2, which has previously been associated with all ischaemic stroke but not with any specific subtype, exceeded genome-wide significance in the meta-analysis of small artery stroke (first stage OR 1·20, 1·12-1·28, p=6·82 × 10-8; joint OR 1·17, 1·11-1·23, p=2·92 × 10-9). Other loci associated with stroke in previous studies, including NINJ2, were not confirmed. INTERPRETATION Our results suggest that all ischaemic stroke-related loci previously implicated by GWAS are subtype specific. We identified a novel gene associated with large artery atherosclerosis stroke susceptibility. Follow-up studies will be necessary to establish whether the locus near TSPAN2 can be a target for a novel therapeutic approach to stroke prevention. In view of the subtype-specificity of the associations detected, the rich phenotyping data available in the Stroke Genetics Network (SiGN) are likely to be crucial for further genetic discoveries related to ischaemic stroke. FUNDING US National Institute of Neurological Disorders and Stroke, National Institutes of Health.
Collapse
|
935
|
Leung JM, Sin DD. Chronic Obstructive Pulmonary Disease and Stroke. Strange Bedfellows. Am J Respir Crit Care Med 2016; 193:227-8. [DOI: 10.1164/rccm.201510-1977ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
936
|
Covassin N, Somers VK. Sleep apnea, hypertension, and hemorrhagic stroke-déjà vu all over again. ACTA ACUST UNITED AC 2016; 10:197-200. [PMID: 26861674 DOI: 10.1016/j.jash.2016.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Naima Covassin
- Division of Cardiovascular of Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virend K Somers
- Division of Cardiovascular of Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
937
|
Abstract
PURPOSE OF REVIEW The indications for aspirin (ASA) for both primary and secondary prevention of thrombotic events continue to evolve. We review some of these indications and the recent literature regarding the perioperative administration of ASA. RECENT FINDINGS ASA for primary prevention of cardiac ischemia, stroke, cancer, and death remains controversial. When used for primary prevention, ASA may be safely discontinued perioperatively. Patients with coronary or carotid artery stents should continue to receive ASA perioperatively. For patients with ischemic heart disease currently receiving ASA for secondary prevention of cardiac ischemia and stroke undergoing general surgery, orthopedic surgery, ophthalmological surgery, cardiovascular surgery, major vascular surgery, or a urological procedure, continuation of ASA is probably well tolerated, but further study is required. There is no indication to initiate ASA perioperatively in patients with stable ischemic heart disease as the risks outweigh the benefits. Until further data become available, decisions regarding the perioperative continuation of ASA should be made on a case-by-case risk-benefit analysis. SUMMARY The continuation or discontinuation of ASA perioperatively remains a complicated issue. Further, well designed trials are needed for additional clarification.
Collapse
|
938
|
Boersma LVA, Schmidt B, Betts TR, Sievert H, Tamburino C, Teiger E, Pokushalov E, Kische S, Schmitz T, Stein KM, Bergmann MW. Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 2016; 37:2465-74. [PMID: 26822918 PMCID: PMC4996118 DOI: 10.1093/eurheartj/ehv730] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/10/2015] [Indexed: 12/20/2022] Open
Abstract
Aims
Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk patients with non-valvular atrial fibrillation. The objective of the multicentre EWOLUTION registry was to obtain clinical data on procedural success and complications, and long-term patient outcomes, including bleeding and incidence of stroke/transient ischaemic attack (TIA). Here, we report on the peri-procedural outcomes of up to 30 days.
Methods and results
Baseline/implant data are available for 1021 subjects. Subjects in the study were at high risk of stroke (average CHADS
2
score: 2.8 ± 1.3, CHA
2
DS
2
-VASc: 4.5 ± 1.6) and moderate-to-high risk of bleeding (average HAS-BLED score: 2.3 ± 1.2). Almost half of the subjects (45.4%) had a history of TIA, ischaemic stroke, or haemorrhagic stroke; 62% of patients were deemed unsuitable for novel oral anticoagulant by their physician. The device was successfully deployed in 98.5% of patients with no flow or minimal residual flow achieved in 99.3% of implanted patients. Twenty-eight subjects experienced 31 serious adverse events (SAEs) within 1 day of the procedure. The overall 30-day mortality rate was 0.7%. The most common SAE occurring within 30 days of the procedure was major bleeding requiring transfusion. Incidence of SAEs within 30 days was significantly lower for subjects deemed to be ineligible for oral anticoagulation therapy (OAT) compared with those eligible for OAT (6.5 vs. 10.2%,
P
= 0.042).
Conclusion
Left atrial appendage closure with the WATCHMAN device has a high success rate in complete LAAC with low peri-procedural risk, even in a population with a higher risk of stroke and bleeding, and multiple co-morbidities. Improvement in implantation techniques has led to a reduction of peri-procedural complications previously limiting the net clinical benefit of the procedure.
Collapse
Affiliation(s)
- Lucas V A Boersma
- Cardiology Department, St Antonius Hospital, PO 2500, 3430 EM Nieuwegein, the Netherlands
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Horst Sievert
- Cardio Vasculäres Centrum Sankt Katharinen, Frankfurt, Germany
| | | | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | | | | | | | | |
Collapse
|
939
|
Abstract
Antiplatelet agents represent a cornerstone in the management of patients at increased cardiovascular risk. Essential hypertension is considered a major public health problem leading to increased cardiovascular morbidity and mortality. The majority of patients with essential hypertension exhibit also additional cardiovascular risk factors and present with increased platelet activation. Despite recent innovations in the field of antiplatelet treatment and the introduction of novel agents, the role of antiplatelet treatment in patients with essential hypertension remains understudied. This review aims to shed light on novel experimental and clinical data in the evolving field of antiplatelet treatment in essential hypertension. In particular, recent data regarding aspirin, clopidogrel, novel P2Y12 inhibitors, and other agents with potential antiplatelet effects are critically reviewed.
Collapse
|
940
|
Abstract
Nutrition plays an increasingly significant role in lifestyle strategies for cardiovascular prevention. Foods and dietary patterns that encompass specific foods and beverages and their combinations, with synergies among their components, are the subject of much epidemiologic and clinical research in relation to health issues, including cardiovascular disease. Foods with the highest evidence for beneficial effects on cardiovascular outcomes (mainly fatal and nonfatal coronary artery disease and stroke) and intermediate risk markers (principally cholesterol and blood pressure) are fruits and vegetables, legumes, nuts, whole grains, dairy products, fish, and alcohol consumed in moderation. Epidemiologic and clinical trial evidence on cardiovascular health issues is reviewed for these foods and for the dietary pattern with the highest probability of a causal link with cardiovascular protection, namely the Mediterranean diet. When pertinent, mechanisms of protection derived from specific nutrients in foods are also examined. The explosion of knowledge in cardioprotective foods and diets needs to be translated to the public, as dietary quality is still far from optimal in large segments of the population.
Collapse
|
941
|
Murakami K, Tsubota-Utsugi M, Satoh M, Asayama K, Inoue R, Ishiguro A, Matsuda A, Kanno A, Yasui D, Murakami T, Metoki H, Kikuya M, Imai Y, Ohkubo T. Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohasama Study. Stroke 2016; 47:323-8. [PMID: 26732573 DOI: 10.1161/strokeaha.115.011131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. METHODS We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a self-administered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. RESULTS During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98). CONCLUSIONS Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Monitoring of higher-level functional capacity might be useful to detect those at higher risk of developing stroke in the future.
Collapse
Affiliation(s)
- Keiko Murakami
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Megumi Tsubota-Utsugi
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Michihiro Satoh
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kei Asayama
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ryusuke Inoue
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Aya Ishiguro
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ayako Matsuda
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsuhiro Kanno
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Daisaku Yasui
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takahisa Murakami
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takayoshi Ohkubo
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| |
Collapse
|
942
|
Sun J, Guo Y, Wang X, Zeng Q. mHealth For Aging China: Opportunities and Challenges. Aging Dis 2016; 7:53-67. [PMID: 26816664 DOI: 10.14336/ad.2015.1011] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/11/2015] [Indexed: 12/17/2022] Open
Abstract
The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.
Collapse
Affiliation(s)
- Jing Sun
- 1Department of International Inpatient, Chinese PLA General Hospital, Beijing 100853, China
| | - Yutao Guo
- 2Department of Geriatric Cardiology, Institute of Health Management, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoning Wang
- 3The State Key Laboratory and Normal Aging, Chinese PLA General Hospital, Beijing 100853, China
| | - Qiang Zeng
- 1Department of International Inpatient, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
943
|
Bu XL, Jiao SS, Lian Y, Wang YJ. Perspectives on the Tertiary Prevention Strategy for Alzheimer's Disease. Curr Alzheimer Res 2016; 13:307-16. [PMID: 26667888 PMCID: PMC4997925 DOI: 10.2174/1567205013666151215110114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/13/2022]
Abstract
Amyloid-beta (Aβ) plays a pivotal role in Alzheimer's disease (AD) pathogenesis, and is the most promising disease-modifying target for AD. A succession of failures in Aβ-targeting clinical trials, however, has prompted questions on whether Aβ is the true cause of AD and a valid therapeutic target. Therefore, current therapeutic targets and intervention strategies must be reconsidered. In addition to Aβ, multiple pathological events such as tau hyperphosphorylation, oxidative stress and neuroinflammation are involved in the disease pathogenesis and cause cross-talk between these pathological pathways, which synergistically drive disease progression. Increasing evidence also reveals that the pathogenesis varies at different stages of the disease. Therefore, targeting Aβ alone at all stages of the disease would not be sufficient to halt or reverse disease progression. In the light of the pathophysiologic similarities between the development of ischemic stroke and AD, we can formulate management strategies for AD from the successful practice of ischemic stroke management, namely the tertiary prevention strategy. These new perspectives of tertiary prevention target both Aβ and different pathological pathways of AD pathogenesis at different stages of the disease, and may represent a promising avenue for the effective prevention and treatment of AD.
Collapse
Affiliation(s)
| | | | | | - Yan-Jiang Wang
- Department of Neurology and Centre for Clinical Neuroscience, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China.
| |
Collapse
|
944
|
Paraskevas K, Kalmykov E, Naylor A. Stroke/Death Rates Following Carotid Artery Stenting and Carotid Endarterectomy in Contemporary Administrative Dataset Registries: A Systematic Review. Eur J Vasc Endovasc Surg 2016; 51:3-12. [DOI: 10.1016/j.ejvs.2015.07.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
|
945
|
Pahus SH, Hansen AT, Hvas AM. Thrombophilia testing in young patients with ischemic stroke. Thromb Res 2016; 137:108-112. [DOI: 10.1016/j.thromres.2015.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/01/2015] [Accepted: 11/06/2015] [Indexed: 12/26/2022]
|
946
|
|
947
|
Abstract
With 16.9 million people who suffered a first-ever stroke in 2010 worldwide, stroke is a very common vascular disease. Epidemiologic studies have played an essential role in assessing this burden and in detecting the risk factors for stroke. Primary prevention of these risk factors, primarily hypertension, smoking, diabetes, and atrial fibrillation, has reduced the incidence in high-income countries. However, stroke remains a major cause of death and disability, and therefore research should be continued. Subarachnoid hemorrhages are less prevalent than strokes but have an even higher risk of death. Similar to stroke, epidemiologic studies identified smoking and hypertension as its most important risk factors, together with excessive alcohol intake. Although rare, arterial dissections, CADASIL, arteriovenous malformations, venous sinus thrombosis, moyamoya disease, and vasculitis can lead to serious symptoms. The burden and risk factors of those rare diseases are more challenging to assess. Whenever possible, they should be recognized in a timely manner for their increased risk of stroke, but most often they are diagnosed only at the time of stroke. Some cerebrovascular abnormalities do not result in immediate symptoms. This subclinical cerebrovascular disease includes silent infarcts, white-matter lesions, and microbleeds, and is incidentally found by neuroimaging. These lesions are not innocent, as several epidemiologic studies have associated subclinical cerebrovascular disease with an increased risk of stroke, cognitive decline, dementia, and death.
Collapse
Affiliation(s)
- M L P Portegies
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
948
|
Relationship between pre-stroke cardiovascular medication use and stroke severity. Eur J Clin Pharmacol 2015; 72:495-502. [PMID: 26706251 DOI: 10.1007/s00228-015-2001-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/18/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Stroke is a major health problem with important morbidity and mortality. Various risk factors and cardiovascular medication groups are known to have an influence on stroke incidence, but less is known about the relation between medication use and stroke severity. AIM To determine if relationships exist between the pre-stroke cardiovascular medication use and stroke severity. METHODS A retrospective study was conducted on a database with anonymized data of 1974 patients with a suspected stroke, admitted to the Universitair Ziekenhuis (UZ) Brussel. Stroke severity was quantified using the National Institute of Health Stroke Scale (NIHSS). Cardiovascular medication groups were first included in a multivariable linear regression model. Second, to obtain clinically interpretable results, all variables that were retained in the final linear regression model were introduced in a cumulative odds ordinal logistic regression model with proportional odds. RESULTS Angiotensin II receptor blockers (ARBs), statins, and antiarrhythmics were significantly associated with stroke severity at the 10 % α level in a multivariable linear regression model, suggesting a possible effect of these medication groups on stroke severity. Only pre-stroke statin use showed a significant relationship with the NIHSS score in the ordinal logistic regression model with an adjusted odds ratio of 0.740 (95 % CI 0.580-0.944; p = 0.015). CONCLUSION Pre-stroke use of statins is significantly associated with lower stroke severity. No significant relationship was detected between pre-stroke use of other medication groups and stroke severity, defined by the NIHSS score.
Collapse
|
949
|
Luepker RV, Steffen LM, Duval S, Zantek ND, Zhou X, Hirsch AT. Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980-2009: The Minnesota Heart Survey. J Am Heart Assoc 2015; 4:e002320. [PMID: 26702085 PMCID: PMC4845283 DOI: 10.1161/jaha.115.002320] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/15/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Daily low-dose aspirin is recommended for primary prevention of myocardial infarction and stroke in higher-risk patients. Population trends in aspirin use for cardiovascular disease (CVD) prevention in an urban population (Minneapolis/St. Paul, 2010 population 2.85 million) from 1980 to 2009 were evaluated. METHODS AND RESULTS Surveys of randomly selected adults aged 25 to 74 years were collected at 5-year intervals. Self-reports of regular aspirin use for CVD prevention and history of CVD were obtained. Six cross-sectional surveys included 12 281 men and 14 258 women. Age-adjusted aspirin use for primary prevention increased during this period from 1% to 21% among men and 1% to 12% among women. Aspirin use was highest in those aged 65 to 74 years. For secondary prevention, age-adjusted aspirin use increased from 19% to 74% among men and 11% to 64% among women. While data are based on self-report, a substudy using a biochemical indicator of aspirin use (serum thromboxane B2) supports the validity of self-report. CONCLUSIONS Aspirin for CVD prevention is commonly used by a large and growing portion of the general population. It is not known if this is based on professional advice or self-prescribed use. It is also likely that many who would benefit do not use aspirin and others use aspirin inappropriately.
Collapse
Affiliation(s)
- Russell V. Luepker
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Lyn M. Steffen
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Sue Duval
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Nicole D. Zantek
- Laboratory Medicine and PathologyUniversity of MinnesotaMinneapolisMN
| | - Xia Zhou
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Alan T. Hirsch
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
- Lillehei Heart Institute and Cardiovascular DivisionUniversity of Minnesota Medical SchoolMinneapolisMN
| |
Collapse
|
950
|
Kim JH, Borden WB. Within-the-Clinic Shared Decision for an Over-the-Counter Medication. J Am Heart Assoc 2015; 4:JAHA.115.002927. [PMID: 26702080 PMCID: PMC4845293 DOI: 10.1161/jaha.115.002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ju H Kim
- Division of Cardiology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (J.H.K., W.B.B.)
| | - William B Borden
- Division of Cardiology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC (J.H.K., W.B.B.)
| |
Collapse
|