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Güvendi Şengör B, Yılmaz C, Zehir R. A High De Ritis Ratio Predicts Poor Myocardial Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2024; 75:857-864. [PMID: 37377080 DOI: 10.1177/00033197231187072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Successful reperfusion of myocardial tissue is the goal of primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association between the De Ritis ratio (AST/ALT) and myocardial reperfusion in patients with STEMI who underwent pPCI. We retrospectively investigated 1236 consecutive patients who were hospitalized for STEMI and underwent pPCI. ST-segment resolution (STR) was defined as the return of the deviated ST-segment to baseline; poor myocardial reperfusion was defined as <70% STR. Patients were divided into 2 groups according to the median De Ritis ratio (.921); 618 patients (50%) were assigned to the De Ritis low group while 618 patients (50%) were assigned to the De Ritis high group. Stent size, neutrophil-to lymphocyte ratio (NLR), and the De Ritis ratio found to be associated with poor myocardial reperfusion (Odds ratio (OR) 1.45, 95% CI 1.07-1.98, P = .01, OR 1.22, 95% CI 1.01-1.48, P = .03 and OR 10.9, 95% CI 7.9-15, P < .001, respectively). A high De Ritis ratio was associated with poor myocardial reperfusion in STEMI patients who underwent pPCI. As an easily obtainable test in clinical practice, the De Ritis ratio may help identify patients at major risk for impaired myocardial perfusion.
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Affiliation(s)
- Büşra Güvendi Şengör
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey
| | | | - Regayip Zehir
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey
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52
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Alvarez-Jimenez L, Morales-Palomo F, Moreno-Cabañas A, Mora-Gonzalez D, Turrillas MDCM, Mora-Rodriguez R. Time-course atherogenic blood lipid response to statin discontinuation in dyslipidemic adults. Nutr Metab Cardiovasc Dis 2024; 34:2334-2343. [PMID: 39013748 DOI: 10.1016/j.numecd.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND AND AIMS Half of dyslipidemic patients sometimes discontinue statin medication. It is unclear if blood atherogenic risk increases right after statin discontinuation or if there is a lingering protective effect. We sought to determine if a legacy effect prevented blood lipid increases during the first stages of statin cessation. METHODS AND RESULTS Atherogenic blood lipid profile was measured in 10 overweight (BMI 31 ± 3 kg m-2) middle-aged males (62 ± 7 years old), statin users, while fasted and postprandially. Trials were conducted before (i.e., Day 0) and after 4, 7, 15, and 30 days of statin withdrawal and 20 days after statins reloading (Day 50). Four days after statin discontinuation, blood fasting LDL-c, total cholesterol (CHOL), and triglyceride (TG) concentrations increased by 30%, 18%, and 17%, respectively (P < 0.05). The increases in LDL-c, CHOL, and TG peaked after 7-15 days at 79%, 48%, and 34% of basal levels (P < 0.001), respectively. There were no significant correlations between the increases in blood lipids and the dose or years under statin treatment (P = 0.156-0.575). Twenty days after resuming statins, blood LDL-c (2.79 ± 1.06 vs 2.20 ± 0.50 mmol L-1; P = 0.568), CHOL (4.85 ± 1.41 vs 4.25 ± 0.83 mmol L-1; P = 0.747), and TG (1.47 ± 0.60 vs 1.50 ± 0.68 mmol L-1; P = 0.782), returned to basal levels. CONCLUSIONS Our data does not support a statin lingering/legacy effect in blood lipids since they dangerously increased after only 4 days of statin withdrawal in every patient, regardless of dose and years under treatment. Reloading statins restored blood lipids, evidencing a reproducible biological effect at the whole-body level.
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Affiliation(s)
| | | | - Alfonso Moreno-Cabañas
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Spain; Centre for Nutrition, Exercise, and Metabolism, University of Bath, Bath, United Kingdom
| | - Diego Mora-Gonzalez
- Department of Nursing, Physiotherapy, and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
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53
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Li L, Dai F, Xu J, Dong J, Wu B, He S, Liu H. Geometric consistency among atherosclerotic plaques in carotid arteries evaluated by multidimensional parameters. Heliyon 2024; 10:e37419. [PMID: 39309847 PMCID: PMC11414503 DOI: 10.1016/j.heliyon.2024.e37419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024] Open
Abstract
The three-dimensional (3D) geometry of carotid atherosclerotic plaques is associated with multiple cardiovascular diseases. However, it is unknown if carotid plaques of different sizes are consistent in 3D geometry, with a lack of quantitative observation. We aim to evaluate the geometric consistency of carotid plaques using the correlations between multidimensional parameters. 42 cases with asymptomatic stenosis caused by atherosclerotic plaque in the carotid artery were included. Carotid plaques and calcifications were identified on computed tomography angiography images and 3D reconstructed. Multidimensional geometric parameters (length, surface area, volume, etc.) were measured on the reconstructed 3D structures. Linear and non-linear (power function) fittings were used to investigate the relationships between multidimensional parameters. The analysis was performed based on cases and plaques, respectively. Spearman rank correlation analysis, R-squared, and p-values were used to evaluate the significance of the relationship. Significant relationship was defined as R-squared >0.25 and p < 0.05. In total, 112 atherosclerotic plaques and 74 calcifications were extracted. In plaque-based analysis, significant correlations were widely observed between paired multidimensional parameters of carotid plaques, where non-linear fitting showed higher R-squared values. Plaque volume and surface area were significantly correlated with total volume and total surface area of intra-plaque calcifications. In subject-based analysis, triglycerides and total cholesterol were significantly correlated with carotid plaque size. There is a consistency in geometry among carotid atherosclerotic plaques of different sizes. The size of a carotid plaque is associated with the patient's lipid profile.
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Affiliation(s)
- Ling Li
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region of China
| | - Fangyu Dai
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China
| | - Jie Xu
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China
| | - Jiaoxuan Dong
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China
| | - Bin Wu
- Department of Neurology, People's Hospital of Quzhou, Quzhou, 324002, Zhejiang Province, China
| | - Songbin He
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, 316000, Zhejiang Province, China
- Department of Neurology, Zhoushan Hospital, Zhejiang University, School of Medicine, Zhoushan, 316000, Zhejiang Province, China
| | - Haipeng Liu
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, UK
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54
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Manzo-Silberman S, Couturaud F, Bellemain-Appaix A, Vautrin E, Gompel A, Drouet L, Marliere S, Sollier CBD, Uhry S, Eltchaninoff H, Bergot T, Motreff P, Lahlou N, Cottin Y, Mounier-Vehier C, Gilard M, Montalescot G. Characteristics of Young Women Presenting With Acute Myocardial Infarction: The Prospective, Multicenter, Observational Young Women Presenting Acute Myocardial Infarction in France Study. J Am Heart Assoc 2024:e034456. [PMID: 39319493 DOI: 10.1161/jaha.124.034456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/01/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND The percentage of women <50 years of age hospitalized with myocardial infarction is increasing. We describe the clinical, morphological, and biological characteristics, as well as the clinical outcomes of this population. METHODS AND RESULTS This prospective, observational study included consecutive women <50 years of age admitted for myocardial infarction at 30 centers in France (May 2017-June 2019). The primary outcome was the composite of net adverse clinical events: all-cause death, cardiovascular death, recurrent myocardial infarction, stent thrombosis, any stroke, or major bleeding occurring during hospitalization with a 12-month follow up. Three hundred fourteen women were included. The mean age was 43.0 (±5.7) years, 60.8% presented with ST-segment-elevation myocardial infarction, 75.5% were current smokers, 31.2% had a history of complicated pregnancy, and 55.1% reported recent emotional stress. Most (91.6%) women presented with typical chest pain. Of patients on an estrogen-containing contraceptive, 86.0% had at least 1 contraindication. Of patients with ST-segment-elevation myocardial infarction, 17.8% had myocardial infarction with nonobstructive coronary arteries and 14.6% had spontaneous coronary artery dissection, whereas 29.3% presented with multivessel vessel disease. During hospitalization, 11 net adverse clinical events occurred in 9 (2.8%) women, but no deaths or stent thromboses occurred. By 12 months, 14 net adverse clinical events occurred in 10 (3.2%) women; 2 (0.6%) died (from progressive cancer) and 25 (7.9%) had an ischemia-driven repeat percutaneous coronary intervention. CONCLUSIONS Most young women with myocardial infarction reported typical chest pain and had modifiable cardiovascular risk factors. History of adverse pregnancy outcomes and prescription of combined oral contraceptive despite a contraindication were prevalent, emphasizing the need for comprehensive cardiological and gynecological evaluation and follow-up. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03073447.
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Affiliation(s)
- Stéphane Manzo-Silberman
- Sorbonne University, Institute of Cardiology-Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group Paris France
| | - Francis Couturaud
- Chest Diseases, CHU_Brest, INSERM U1304, Univ_Brest, Brest Brest France
| | - Anne Bellemain-Appaix
- Cardiology Hospital of Antibes Juan Les Pins Antibes France
- ACTION Study Group Paris France
| | | | - Anne Gompel
- Gynecology University Paris Cité Paris France
| | | | | | | | - Sabrina Uhry
- Department of Cardiology Haguenau Hospital Haguenau France
| | - Hélène Eltchaninoff
- Department of Cardiology Normandie University, UNIROUEN, U1096, CHU Rouen Rouen France
| | | | - Pascal Motreff
- Cardiology University Hospital Gabriel Montpied Clermont-Ferrand France
| | - Najiba Lahlou
- Specialized Hormonology and Metabolism Laboratory AP-HP Centre Hôpital Cochin, Paris University Paris France
| | - Yves Cottin
- Cardiology University Hospital of Dijon Dijon France
| | | | - Martine Gilard
- Chest Diseases, CHU_Brest, INSERM U1304, Univ_Brest, Brest Brest France
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Kavey REW. Myopathy in Statin-Treated Children and Adolescents: A Practical Approach. Curr Atheroscler Rep 2024:10.1007/s11883-024-01239-x. [PMID: 39316353 DOI: 10.1007/s11883-024-01239-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE OF REVIEW This paper reviews the existing literature on statin-related myopathy in children and adolescents, to inform development of a practical management approach. RECENT FINDINGS Reports of statin treatment in the pediatric population revealed no evidence of muscle pathology, with asymptomatic elevation of creatine kinase(CK) levels and symptoms of muscle pain without CK elevation seen equally in subjects and controls in RCTs. By contrast, rare cases of rhabdomyolysis have now been documented in statin-treated children; this serious problem had never been previously reported. Statin-induced myopathy is rare in childhood so routine monitoring of CK levels is unnecessary in asymptomatic patients, reserved for those with muscle pain. Rare case reports of rhabdomyolysis in statin-treated children and adolescents suggest that parent and patient education on symptoms of adverse statin effects should include immediate physician contact with the appearance of dark urine, with or without muscle pain.
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Affiliation(s)
- Rae-Ellen W Kavey
- University of Rochester Medical Center, 1475 East Avenue, Rochester, NY, 14610, USA.
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56
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Xie L, Li Y, Chen J, Luo S, Huang B. Blood Urea Nitrogen to Left Ventricular Ejection Ratio as a Predictor of Short-Term Outcome in Acute Myocardial Infarction Complicated by Cardiogenic Shock. J Vasc Res 2024:1-11. [PMID: 39312885 DOI: 10.1159/000541021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/16/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Cardiogenic shock (CS) is the most critical complication after acute myocardial infarction (AMI) with mortality above 50%. Both blood urea nitrogen and left ventricular ejection fraction were important prognostic indicators. We aimed to evaluate the prognostic value of admission blood urea nitrogen to left ventricular ejection fraction ratio (BUNLVEFr) in patients with AMI complicated by CS (AMI-CS). METHODS 268 consecutive patients with AMI-CS were divided into two groups according to the admission BUNLVEFr cut-off value determined by Youden index. The primary endpoint was 30-day all-cause mortality and the secondary endpoint was the composite events of major adverse cardiovascular events (MACEs). Cox proportional hazard models were performed to analyze the association of BUNLVEFr with the outcome. RESULTS The optimal cut-off value of BUNLVEFr is 16.63. The 30-day all-cause mortality and MACEs in patients with BUNLVEFr≥16.63 was significantly higher than in patients with BUNLVEFr<16.63 (30-day all-cause mortality: 66.2% vs. 17.1%, p < 0.001; 30-day MACEs: 80.0% vs. 48.0%, p < 0.001). After multivariable adjustment, BUNLVEFr≥16.63 remained an independent predictor for higher risk of 30-day all-cause mortality (HR = 3.553, 95% CI: 2.125-5.941, p < 0.001) and MACEs (HR = 2.026, 95% CI: 1.456-2.820, p < 0.001). Subgroup analyses found that the effect of BUNLVEFr was consistent in different subgroups (all p-interaction>0.05). CONCLUSION The admission BUNLVEFr provided important prognostic information for AMI-CS patients.
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Affiliation(s)
- Linfeng Xie
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
| | - Yuanzhu Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Manier A, Seunes C, Broucqsault D, Verhaeghe M, Behal H, Petit V, Hannebicque G. [Value of coordinated geriatric and cardiological expertise in elderly patients' eligibility for percutaneous aortic valve replacement]. Ann Cardiol Angeiol (Paris) 2024; 73:101800. [PMID: 39317080 DOI: 10.1016/j.ancard.2024.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 07/03/2024] [Accepted: 08/05/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is the gold standard treatment for aortic stenosis in the elderly. Pre-identification of patients likely to benefit from this procedure remains crucial. A standardised geriatric assessment is used to identify the major geriatric syndromes likely to influence postoperative outcomes. OBJECTIVE To identify factors associated with lack of TAVI management and to compare one-year survival in TAVI vs. non-TAVI patients. METHODS Retrospective study, between 2016 and 2020, at the Arras hospital. Patients aged 70 years and older with symptomatic severe aortic stenosis who had undergone geriatric assessment were included. RESULTS One hundred and ninety-two (192) patients, mean age 82.3 years. The 1-year mortality rate was 18% in the TAVI group and 44% in the non-TAVI group (p < 0.001). Parameters associated with no TAVI were Euroscore (ESL) 1 (19.6 ± 10.9 vs. 23.2 ± 13.5, p = 0.020), malnutrition (14% vs. 35%, p = 0.004), walking speed < 0.8 m/s (39% vs. 75%, p = 0.001), Activities of Daily Life (ADL) score (5.4 ± 1 vs. 4.2 ± 1. 6, p < 0. 001) and Instrumental Activities of Daily Life (IADL) score (2.6 ± 1.2 vs. 1.8 ± 1.4, p = 0.002), Mini Geriatric Depression Scale (mini GDS) ≥ 1 (16% vs. 38%, p = 0.045), Mini Mental State Examination (MMSE) score (25.1 ± 3.5 vs. 21.6 ± 4.3 < 0.001). CONCLUSIONS Geriatric syndromes are important determinants of TAVI candidacy. Cardiological surgical risk scores are not effective in discriminating between patients. Coordinated assessment may optimise selection. Therefore, geriatric assessment should be systematically performed as part of the pre-TAVI evaluation.
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Affiliation(s)
- A Manier
- Gériatrie, Centre hospitalier Universitaire de Lille, France.
| | - C Seunes
- Service de cardiologie, Centre hospitalier d'Arras, France
| | - D Broucqsault
- Service de cardiologie, Hôpital Privé Bois Bernard, France
| | - M Verhaeghe
- Service de cardiologie, Centre hospitalier d'Arras, France
| | - H Behal
- CHU Lille, Statistique, Évaluation Économique et Data-management, France
| | - V Petit
- Équipe mobile d'évaluation gériatrique, Centre Hospitalier d'Arras, France
| | - G Hannebicque
- Service de cardiologie, Centre hospitalier d'Arras, France
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58
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Elliott J, Bodinier B, Whitaker M, Wada R, Cooke G, Ward H, Tzoulaki I, Elliott P, Chadeau-Hyam M. Sex inequalities in cardiovascular risk prediction. Cardiovasc Res 2024; 120:1327-1335. [PMID: 38833617 DOI: 10.1093/cvr/cvae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
AIMS Evaluate sex differences in cardiovascular disease (CVD) risk prediction, including use of (i) optimal sex-specific risk predictors and (ii) sex-specific risk thresholds. METHODS AND RESULTS Prospective cohort study using UK Biobank, including 121 724 and 182 632 healthy men and women, respectively, aged 38-73 years at baseline. There were 11 899 (men) and 9110 (women) incident CVD cases (hospitalization or mortality) with a median of 12.1 years of follow-up. We used recalibrated pooled cohort equations (PCEs; 7.5% 10-year risk threshold as per US guidelines), QRISK3 (10% 10-year risk threshold as per UK guidelines), and Cox survival models using sparse sex-specific variable sets (via LASSO stability selection) to predict CVD risk separately in men and women. LASSO stability selection included 12 variables in common between men and women, with 3 additional variables selected for men and 1 for women. C-statistics were slightly lower for PCE than QRISK3 and models using stably selected variables, but were similar between men and women: 0.67 (0.66-0.68), 0.70 (0.69-0.71), and 0.71 (0.70-0.72) in men and 0.69 (0.68-0.70), 0.72 (0.71-0.73), and 0.72 (0.71-0.73) in women for PCE, QRISK3, and models using stably selected variables, respectively. At current clinically implemented risk thresholds, test sensitivity was markedly lower in women than men for all models: at 7.5% 10-year risk, sensitivity was 65.1 and 68.2% in men and 24.0 and 33.4% in women for PCE and models using stably selected variables, respectively; at 10% 10-year risk, sensitivity was 53.7 and 52.3% in men and 16.8 and 20.2% in women for QRISK3 and models using stably selected variables, respectively. Specificity was correspondingly higher in women than men. However, the sensitivity in women at 5% 10-year risk threshold increased to 50.1, 58.5, and 55.7% for PCE, QRISK3, and models using stably selected variables, respectively. CONCLUSION Use of sparse sex-specific variables improved CVD risk prediction compared with PCE but not QRISK3. At current risk thresholds, PCE and QRISK3 work less well for women than men, but sensitivity was improved in women using a 5% 10-year risk threshold. Use of sex-specific risk thresholds should be considered in any re-evaluation of CVD risk calculators.
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Affiliation(s)
- Joshua Elliott
- Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, The Bays, Entrance, 2 S Wharf Rd, London W2 1NY, UK
| | - Barbara Bodinier
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
| | - Matthew Whitaker
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
| | - Rin Wada
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
| | - Graham Cooke
- Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, The Bays, Entrance, 2 S Wharf Rd, London W2 1NY, UK
| | - Helen Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, The Bays, Entrance, 2 S Wharf Rd, London W2 1NY, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, The Bays, Entrance, 2 S Wharf Rd, London W2 1NY, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
- British Heart Foundation Centre for Research Excellence, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Dementia Research Institute at Imperial College London, 86 Wood Ln, London W12 0BZ, UK
- Health Data Research UK, Imperial College London, Exhibition Rd, South Kensington, London SW7 2AZ, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, The Bays, Entrance, 2 S Wharf Rd, London W2 1NY, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
- British Heart Foundation Centre for Research Excellence, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Dementia Research Institute at Imperial College London, 86 Wood Ln, London W12 0BZ, UK
- Health Data Research UK, Imperial College London, Exhibition Rd, South Kensington, London SW7 2AZ, UK
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, 90 Wood Ln, London W12 0BZ, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Praed Street, London W2 1NY, UK
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59
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Rutten FH, Groenewegen A. Mineralocorticoid receptor antagonists for every patient with heart failure. Lancet 2024; 404:1080-1081. [PMID: 39232491 DOI: 10.1016/s0140-6736(24)01755-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Frans H Rutten
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CG, Netherlands.
| | - Amy Groenewegen
- Department of General Practice and Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CG, Netherlands
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Ozaki Y, Tobe A, Onuma Y, Kobayashi Y, Amano T, Muramatsu T, Ishii H, Yamaji K, Kohsaka S, Ismail TF, Uemura S, Hikichi Y, Tsujita K, Ako J, Morino Y, Maekawa Y, Shinke T, Shite J, Igarashi Y, Nakagawa Y, Shiode N, Okamura A, Ogawa T, Shibata Y, Tsuji T, Hayashida K, Yajima J, Sugano T, Okura H, Okayama H, Kawaguchi K, Zen K, Takahashi S, Tamura T, Nakazato K, Yamaguchi J, Iida O, Ozaki R, Yoshimachi F, Ishihara M, Murohara T, Ueno T, Yokoi H, Nakamura M, Ikari Y, Serruys PW, Kozuma K. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01036-y. [PMID: 39302533 DOI: 10.1007/s12928-024-01036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 08/04/2024] [Indexed: 09/22/2024]
Abstract
Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Okazaki Medical Center, Fujita Health University School of Medicine, 1-98 Dengaku, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tevfik F Ismail
- King's College London, London, UK
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Shiro Uemura
- Cardiovascular Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Junya Ako
- Department of Cardiology, Kitasato University Hospital, Sagamihara, Japan
| | - Yoshihiro Morino
- Department of Cardiology, Iwate Medical University Hospital, Shiwa, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Junya Shite
- Cardiology Division, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yasumi Igarashi
- Division of Cardiology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Yoshihisa Nakagawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Nobuo Shiode
- Division of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Atsunori Okamura
- Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, Osaka, Japan
| | - Takayuki Ogawa
- Division of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshisato Shibata
- Division of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | | | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Teruyasu Sugano
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hideki Okayama
- Division of Cardiology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saeko Takahashi
- Division of Cardiology, Tokushukai Shonan Oiso Hospital, Oiso, Japan
| | | | - Kazuhiko Nakazato
- Department of Cardiology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Osamu Iida
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Reina Ozaki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fuminobu Yoshimachi
- Department of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ueno
- Division of Cardiology, Marin Hospital, Fukuoka, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | | | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Chaiwisitkun A, Muengtaweepongsa S. Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis. World J Exp Med 2024; 14:95540. [PMID: 39312695 PMCID: PMC11372743 DOI: 10.5493/wjem.v14.i3.95540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/22/2024] [Accepted: 06/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. RESULTS Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.
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Affiliation(s)
- Ausanee Chaiwisitkun
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
| | - Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
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Bae HJ, Jung HW, Hong SP. More precise method of low-density lipoprotein cholesterol estimation for tobacco and electronic cigarette smokers: A cross-sectional study. PLoS One 2024; 19:e0309002. [PMID: 39302923 DOI: 10.1371/journal.pone.0309002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/04/2024] [Indexed: 09/22/2024] Open
Abstract
Smoking is associated with elevated low-density lipoprotein cholesterol (LDL-C) levels. However, the accuracies of the Friedewald, Sampson, and Martin LDL-C-estimating equations based on smoking status are unclear. We analyzed the accuracy of LDL-C levels estimated using these three equations based on tobacco and electronic cigarette smoking status. Data on LDL-C and other lipid components were obtained from the Korea National Health and Nutrition Examination Survey from January 2009 to December 2021. Direct LDL-C (dLDL-C) levels and smoking data of 12,325 participants were evaluated. Current smokers had higher triglyceride levels than never smokers. Electronic cigarette smokers had higher triglyceride and dLDL-C levels than never smokers. The Martin equation yielded more accurate mean absolute deviations than the other equations for the group with triglyceride levels <400 mg/dL as well as more accurate median absolute deviation values, except for the group with dLDL-C levels <40 mg/dL. Similar estimates were derived from the equations when the triglyceride levels were <150 mg/dL. However, the Martin equation may lead to the overestimation of LDL-C levels. In conclusion, the Martin equation is suitable for triglyceride levels <400 mg/dL regardless of the electronic cigarette/tobacco smoking status; if the triglyceride level is <150 mg, the Friedewald equation could also be considered, regardless of the electronic cigarette/tobacco smoking status.
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Affiliation(s)
- Han-Joon Bae
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Hae Won Jung
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Seung-Pyo Hong
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea
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Backmann V, Dykun I, Kampf J, Balcer B, Roggel A, Totzeck M, Rassaf T, Mahabadi AA. Comprehensive strain assessment and mortality after acute myocardial infarction: a retrospective observational study based on the Essen Coronary Artery Disease registry. Heart 2024:heartjnl-2024-324715. [PMID: 39304326 DOI: 10.1136/heartjnl-2024-324715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND AIMS Current ESC guidelines on the management of patients after acute myocardial infarction only include the evaluation of left ventricular (LV) function by assessment of the ejection fraction in addition to clinical risk scores to estimate the patient's prognosis. We aimed to determine, whether comprehensive evaluation of cardiac function using LV and right ventricular (RV) global longitudinal strain (GLS) and left atrial (LA) reservoir strain improves the prediction of survival in patients with acute myocardial infarction. METHODS In patients with non-ST segment elevation or ST segment elevation myocardial infarction receiving echocardiography within 1 year after revascularisation, LV-GLS, RV-GLS and LA reservoir strain were quantified. In multivariable Cox regression analysis, HRs and 95% CIs were calculated per 1 SD increase in strain measure, adjusting for age, sex, systolic blood pressure, low-density lipoprotein cholesterol, smoking, diabetes and family history of premature coronary artery disease. RESULTS During a median follow-up of 1.5 (0.5-4.2) years, 157 (11.1%) out of 1409 patients (64.4±13.5 years, 24.7% female) died. LV-GLS (1.68 (1.37-2.06), p<0.001), RV-GLS (1.39 (1.16-1.67), p<0.001) and LA reservoir strain (0.57 (0.47-0.69), p<0.001) were associated with mortality. Adding LV ejection fraction, tricuspid annular plane systolic excursion (TAPSE) or LA volume index to these models did not alter the association of strain measures of the LV (1.41 (1.06-1.89), p=0.02), RV (1.48 (1.03-2.13), p=0.04) or LA (0.61 (0.49-0.76), p<0.001). In receiver operating characteristics, combining the three strain measures improved the prediction of mortality above risk factors (AUC: 0.67 (0.63-0.71) to 0.75 (0.70-0.80)), while further addition of LV ejection fraction, TAPSE and LA volume index did not (0.75 (0.70-0.81)). CONCLUSION The comprehensive evaluation of contractility of various cardiac chambers via transthoracic echocardiography using myocardial strain analysis, when routinely performed after acute myocardial infarction, may help to detect patients at increased mortality risk.
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Affiliation(s)
- Viktoria Backmann
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Iryna Dykun
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Jürgen Kampf
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Bastian Balcer
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Anja Roggel
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, University Hospital Essen, Essen, Germany
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El Din Taha HS, Kandil H, Badran HM, Farag N, Khamis H, Nasr G, Samy M, Abdrabou M, Abuelezz M, Shaker MM. 2024 Egyptian consensus statement on the role of non-statin therapies for LDL cholesterol lowering in different patient risk categories. Egypt Heart J 2024; 76:131. [PMID: 39302613 DOI: 10.1186/s43044-024-00562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND The new millennium has witnessed increased understanding of cardiovascular (CV) risk factors and improvement in atherosclerotic cardiovascular disease (ASCVD) management. The role of LDL cholesterol and other atherogenic lipid particles in the development of atherosclerosis is now beyond doubt. MAIN BODY Statins have been widely used and recommended in guidelines for preventing and managing ischemic events. However, statins have side effects, and many patients do not achieve their low-density lipoprotein cholesterol (LDL-C) goals. In recent years, non-statin lipid-lowering agents have gained increasing use as adjuncts to statins or as alternatives in patients who cannot tolerate statins. This consensus proposes a simple approach for initiating non-statin lipid-lowering therapy and provides evidence-based recommendations. Our key advancements include the identification of patients at extreme risk for CV events, the consideration of initial combination therapy of statin and ezetimibe in very high-risk and extreme-risk groups and the extended use of bempedoic acid in patients not reaching LDL-C targets especially in resource-limited settings. CONCLUSIONS Overall, this consensus statement provides valuable insights into the expanding field of non-statin therapies and offers practical recommendations to enhance CV care, specifically focusing on improving LDL-C control in Egypt. While these recommendations hold promise, further research and real-world data are needed for validation and refinement.
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Affiliation(s)
| | | | | | - Nabil Farag
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Gamila Nasr
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mina Samy
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Shamali M. Strategies and barriers of illness control after hospital readmission: perspectives of patients with chronic heart failure. Evid Based Nurs 2024; 27:127. [PMID: 38050038 DOI: 10.1136/ebnurs-2023-103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Mahdi Shamali
- Department of Gastroenterology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
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Saad ALGhasab N, Fogacci F, Avagimyan A, Cicero AFG. Expanding therapeutic options: overview of novel pharmacotherapies for dyslipidemia. Expert Opin Pharmacother 2024:1-11. [PMID: 39286934 DOI: 10.1080/14656566.2024.2406270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 08/18/2024] [Accepted: 09/16/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Dyslipidemia plays a crucial role in the development of atherosclerotic cardiovascular diseases. AREAS COVERED This article explores the emerging therapeutic targets for the treatment of dyslipidemia and provides novel insights into this field. Thus, it aims to contribute to the understanding and advancement of therapeutic options for managing dyslipidemia. EXPERT OPINION Optimizing the use of available first- and second-line lipid-lowering drugs allows us to adequately control low-density lipoprotein cholesterol (LDL-C) levels, even in statin-intolerant individuals and in patients at high and very high risk of developing cardiovascular diseases who must reach more aggressive LDL-C targets. The drugs under development will further improve our ability to manage the overall lipid-related cardiovascular disease risk and target other dyslipidemia biomarkers.
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Affiliation(s)
- Naif Saad ALGhasab
- Department of Internal Medicine, Medical College, Ha'il University, Ha'il, Saudi Arabia
- Department of Cardiology, Libin cardiovascular institute, Calgary University, Calgary, Canada
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ashot Avagimyan
- Anatomical Pathology and Clinical Morphology Department, Yerevan State Medical University, Yerevan, Armenia
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOUBO, Bologna, Italy
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Kılıçkap G, Dölek BA, Çevik Nİ, Bahadır GK, Tekdemir H, Vural M. Time difference for the presence of coronary calcium in those with and without coronary risk factors and statin use. Acta Cardiol 2024:1-9. [PMID: 39295537 DOI: 10.1080/00015385.2024.2404791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/11/2024] [Accepted: 07/10/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis. We aimed to assess to what extent risk factors and statin use modify the time to occurrence of CAC. METHODS The study population included 3484 patients who underwent CAC score measurements and CT angiography between January 2021 and March 2022. To assess to what extent risk factors and statin use modify the time to occurrence of CAC, a time difference for a 50% probability of having a non-zero CAC score between those with and without these factors was calculated. RESULTS The mean age was 52.1 ± 10.9 years, and 43.1% of the population were women. Age was the most important factor for having non-zero CAC (z value 21.84, p-value <0.001). This is followed by male gender (Odds ratio [OR] and 95% CI 3.53 [2.96-4.21]; p < 0.001), and statin use (OR 3.09 [2.41-3.97], p < 0.001). A non-zero CAC develops on average 10.3 years earlier in men compared with women, and 9.1 years earlier in statin users compared with non-users. Diabetes mellitus, hypertension, and smoking were also associated with earlier occurrence of CAC score, but to a lower extent. CONCLUSION Apart from age, male gender and statin use are the major factors for the occurrence of CAC and are associated with CAC occurrence 9-10 years earlier.
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Affiliation(s)
- Gülsüm Kılıçkap
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Betül Akdal Dölek
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Numan İlteriş Çevik
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Gülsüm Kübra Bahadır
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Halil Tekdemir
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Murat Vural
- Radiology Department, T.C. Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
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Jiang L, Xu HY, Li Y, Shi K, Fang H, Yan WF, Guo YK, Yang ZG. The differential effects of dyslipidemia status and triglyceride-glucose index on left ventricular global function and myocardial microcirculation in diabetic individuals: a cardiac magnetic resonance study. Cardiovasc Diabetol 2024; 23:345. [PMID: 39300497 DOI: 10.1186/s12933-024-02435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND It remains unclear whether the association between dyslipidemia status and triglyceride-glucose (TyG) index with myocardial damage varies in the context of type 2 diabetes mellitus (T2DM). This study aimed to determine the differential effects of dyslipidemia status and TyG index on left ventricular (LV) global function and myocardial microcirculation in patients with T2DM using cardiac magnetic resonance (CMR) imaging. METHODS A total of 226 T2DM patients and 72 controls who underwent CMR examination were included. The T2DM group was further categorized into subgroups based on the presence or absence of dyslipidemia (referred to as T2DM (DysL+) and T2DM (DysL-)) or whether the TyG index exceeded 9.06. CMR-derived LV perfusion parameters, remodeling index, and global function index (GFI) were assessed and compared among groups. A multivariable linear regression model was employed to evaluate the effects of various variables on LV myocardial microcirculation, remodeling index, and GFI. RESULTS The LV GFI sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (p < 0.001), and was lower (p = 0.003) in T2DM with higher TyG index group than in lower TyG index group. The LV remodeling index was higher in higher TyG index group than in lower TyG index group (p = 0.002), but there was no significant difference in whether the subgroup was accompanied by dyslipidemia. Multivariable analysis revealed that the TyG index, but not dyslipidemia status, was independently associated with LV remodeling index (β coefficient[95% confidence interval], 0.152[0.025, 0.268], p = 0.007) and LV GFI (- 0.159[- 0.281, - 0.032], p = 0.014). For LV myocardial microcirculation, perfusion index, upslope, and max signal intensity sequentially decreased in controls, T2DM (DysL-), and T2DM (DysL+) groups (all p < 0.001). Dyslipidemia status independently correlated with perfusion index (- 0.147[- 0.272, - 0.024], p = 0.02) and upslope (- 0.200[- 0.320, 0.083], p = 0.001), while TyG index was independently correlated with time to maximum signal intensity (0.141[0.019, 0.257], p = 0.023). CONCLUSIONS Both dyslipidemia status and higher TyG index were associated with further deterioration of LV global function and myocardial microvascular function in the context of T2DM. The effects of dyslipidemia and a higher TyG index appear to be differential, which indicates that not only the amount of blood lipids and glucose but also the quality of blood lipids are therapeutic targets for preventing further myocardial damage.
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Affiliation(s)
- Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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de Oliveira HD, Batista CN, Lima MN, Lima AC, Dos Passos BABR, Freitas RJRX, Silva JD, Xisto DG, Rangel-Ferreira MV, Pelajo M, Rocco PRM, Ribeiro-Gomes FL, de Castro Faria-Neto HC, Maron-Gutierrez T. Acetylsalicylic acid and dihydroartemisinin combined therapy on experimental malaria-associated acute lung injury: analysis of lung function and the inflammatory process. Malar J 2024; 23:285. [PMID: 39300444 DOI: 10.1186/s12936-024-05017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/16/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Severe malaria can cause respiratory symptoms, which may lead to malaria-acute lung injury (MA-ALI) due to inflammation and damage to the blood-gas barrier. Patients with severe malaria also often present thrombocytopenia, and the use of acetylsalicylic acid (ASA), a commonly used non-steroidal anti-inflammatory drug with immunomodulatory and antiplatelet effects, may pose a risk in regions where malaria is endemic. Thus, this study aimed to investigate the systemic impact of ASA and dihydroartemisinin (DHA) on ALI induced in mice by Plasmodium berghei NK65 (PbNK65). METHODS C57BL/6 mice were randomly divided into control (C) and PbNK65 infected groups and were inoculated with uninfected or 104 infected erythrocytes, respectively. Then, the animals were treated with DHA (3 mg/kg) or vehicle (DMSO) at the 8-day post-infection (dpi) for 7 days and with ASA (100 mg/kg, single dose), and analyses were performed at 9 or 15 dpi. Lung mechanics were performed, and lungs were collected for oedema evaluation and histological analyses. RESULTS PbNK65 infection led to lung oedema, as well as increased lung static elastance (Est, L), resistive (ΔP1, L) and viscoelastic (ΔP2, L) pressures, percentage of mononuclear cells, inflammatory infiltrate, hemorrhage, alveolar oedema, and alveolar thickening septum at 9 dpi. Mice that received DHA or DHA + ASA had an increase in Est, L, and CD36 expression on inflammatory monocytes and higher protein content on bronchoalveolar fluid (BALF). However, only the DHA-treated group presented a percentage of inflammatory monocytes similar to the control group and a decrease in ΔP1, L and ΔP2, L compared to Pb + DMSO. Also, combined treatment with DHA + ASA led to an impairment in diffuse alveolar damage score and lung function at 9 dpi. CONCLUSIONS Therapy with ASA maintained lung morpho-functional impairment triggered by PbNK65 infection, leading to a large influx of inflammatory monocytes to the lung tissue. Based on its deleterious effects in experimental MA-ALI, ASA administration or its treatment maintenance might be carefully reconsidered and further investigated in human malaria cases.
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Affiliation(s)
- Helena D'Anunciação de Oliveira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Camila Nunes Batista
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Maiara Nascimento Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Ana Carolina Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | | | - Rodrigo Jose Rocha Xavier Freitas
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Johnatas Dutra Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora Gonçalves Xisto
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcelo Pelajo
- Laboratory of Pathology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Hugo Caire de Castro Faria-Neto
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil
| | - Tatiana Maron-Gutierrez
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Av. Brasil, 4036 - Bloco 2. Manguinhos, Rio de Janeiro, RJ, 21040-361, Brazil.
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Kong L, Wu Y, Yang H, Guo M, Zhong Y, Li J, Wu S, Xiong Z. Nonlinear association between remnant cholesterol and reversion from impaired fasting glucose to normoglycemia: a multicenter cohort study. Lipids Health Dis 2024; 23:303. [PMID: 39300559 DOI: 10.1186/s12944-024-02286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Remnant cholesterol (RC), a potent atherogenic lipid, has been shown to be strongly correlated with insulin resistance and the pathogenesis of diabetes mellitus. However, the relationship between RC and normoglycemia reversal in individuals with impaired fasting glucose (IFG) is crucial and remains unclear. This investigation, which aimed to clarify this association, is important for understanding and potentially improving the management of diabetes. METHOD This study, which included 15,019 IFG participants from 11 Chinese cities between 2010 and 2016, was conducted with a rigorous research process. Cox regression analysis revealed intriguing findings regarding the relationship between RC and normoglycemia reversal in individuals with IFG. Potential nonlinear associations were further explored via smooth curve-fitting techniques and 4-knot restricted cubic spline functions, ensuring a comprehensive analysis. To examine the validity of the results, an array of subgroup and sensitivity analyses were conducted, further bolstering the robustness of the findings. RESULTS By the end of the 2.89-year median follow-up period, 6,483 of the 15,019 IFG participants (43.17%) had reverted to normoglycemia. The findings, which reveal that increased RC levels are inversely associated with the likelihood of normoglycemia reversal, are novel and significant. According to the fully adjusted Cox proportional hazards model analysis, an increase of one standard deviation in RC was associated with a 20% decrease in the likelihood of normoglycemia reversal among IFG participants (HR: 0.80, 95% CI: 0.77-0.82). A nonlinear association between RC and normoglycemia reversal was observed, with an inflection point at 41.37 mg/dL. This suggests that the growth rate of the likelihood of reversion decreased and stabilized after the inflection point was reached. Moreover, significant interactions were observed between the age groups, providing a more nuanced understanding of this complex relationship. CONCLUSION Among Chinese adults with IFG, RC exhibited a negative nonlinear relationship with the probability of normoglycemia reversal. When RC levels reached or exceeded 41.38 mg/dL, the probability of achieving normoglycemia progressively diminished and subsequently stabilized. Maintaining RC levels below 41.38 mg/dL can significantly improve the probability of normoglycemia reversal among individuals with IFG, especially those aged 60 years or older.
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Affiliation(s)
- Laixi Kong
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Yuqing Wu
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Huiqi Yang
- Nanbu County People's Hospital, Nanchong, Sichuan, 637300, China
| | - Maoting Guo
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Yuxin Zhong
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China
| | - Jingru Li
- Nanbu County People's Hospital, Nanchong, Sichuan, 637300, China
| | - Shuang Wu
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China.
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan, China.
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Winckel T, Friedrich N, Zylla S, Fenzlaff M, Schöpfel J, Gauß KF, Petersmann A, Nauck M, Völzke H, Hannemann A. Bone turnover: the role of lipoproteins in a population-based study. Lipids Health Dis 2024; 23:302. [PMID: 39300501 DOI: 10.1186/s12944-024-02290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Dyslipidemia has been associated with reduced bone mineral density and osteoporotic fractures, but the relation between lipid and bone metabolism remains poorly understood. Analysing the effects of lipoprotein subclasses on bone turnover may provide valuable insights into this association. We therefore examined whether lipoprotein subclasses, measured by proton nuclear magnetic resonance (1H-NMR) spectroscopy, are associated with bone turnover markers (BTMs) and with the ultrasound-based bone stiffness index. METHODS Data from 1.349 men and 1.123 women, who participated in the population-based Study of Health in Pomerania-TREND were analysed. Serum intact amino-terminal propeptide of type I procollagen (P1NP, bone formation) and carboxy-terminal telopeptide of type I collagen (CTX, bone resorption) concentrations were measured. Associations between the lipoprotein data and the BTMs or the stiffness index were investigated using linear regression models. RESULTS The triglyceride or cholesterol content in very-low-density lipoprotein and intermediate-density lipoprotein particles was inversely associated with both BTMs, with effect estimates being slightly higher for CTX than for P1NP. The triglyceride content in low-density lipoprotein and high-density lipoprotein particles and the Apo-A2 content in high-density lipoprotein particles was further inversely associated with the BTMs. Associations with the ultrasound-based bone stiffness index were absent. CONCLUSIONS Consistent inverse associations of triglycerides with bone turnover were observed, which argue for a protective effect on bone health, at least in the normal range. Yet, the presented associations did not translate into effects on the ultrasound-based bone stiffness. Further, there was no relevant gain of information by assessing the lipoprotein subclasses. Nevertheless, our study highlights the close relations between lipid and bone metabolism in the general population.
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Affiliation(s)
- Todd Winckel
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Marc Fenzlaff
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
| | - Juliane Schöpfel
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
| | - Karen Friederike Gauß
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475, Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
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Grossi B, Barati S, Ramella A, Migliavacca F, Rodriguez Matas JF, Dubini G, Chakfé N, Heim F, Cozzi O, Condorelli G, Stefanini GG, Luraghi G. Validation evidence with experimental and clinical data to establish credibility of TAVI patient-specific simulations. Comput Biol Med 2024; 182:109159. [PMID: 39303394 DOI: 10.1016/j.compbiomed.2024.109159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/30/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The objective of this study is to validate a novel workflow for implementing patient-specific finite element (FE) simulations to virtually replicate the Transcatheter Aortic Valve Implantation (TAVI) procedure. METHODS Seven patients undergoing TAVI were enrolled. Patient-specific anatomical models were reconstructed from pre-operative computed tomography (CT) scans and subsequentially discretized, considering the native aortic leaflets and calcifications. Moreover, high-fidelity models of CoreValve Evolut R and Acurate Neo2 valves were built. To determine the most suitable material properties for the two stents, an accurate calibration process was undertaken. This involved conducting crimping simulations and fine-tuning Nitinol parameters to fit experimental force-diameter curves. Subsequently, FE simulations of TAVI procedures were conducted. To validate the reliability of the implemented implantation simulations, qualitative and quantitative comparisons with post-operative clinical data, such as angiographies and CT scans, were performed. RESULTS For both devices, the simulation curves closely matched the experimental data, indicating successful validation of the valves mechanical behaviour. An accurate qualitative superimposition with both angiographies and CTs was evident, proving the reliability of the simulated implantation. Furthermore, a mean percentage difference of 1,79 ± 0,93 % and 3,67 ± 2,73 % between the simulated and segmented final configurations of the stents was calculated in terms of orifice area and eccentricity, respectively. CONCLUSION This study shows the successful validation of TAVI simulations in patient-specific anatomies, offering a valuable tool to optimize patients care through personalized pre-operative planning. A systematic approach for the validation is presented, laying the groundwork for enhanced predictive modeling in clinical practice.
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Affiliation(s)
- Benedetta Grossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Sara Barati
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Anna Ramella
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Francesco Migliavacca
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Gabriele Dubini
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Nabil Chakfé
- Department of Vascular Surgery, Kidney Transplantation and Innovation, University Hospital of Strasbourg, Strasbourg, France; GEPROMED, Strasbourg, France
| | - Frédéric Heim
- GEPROMED, Strasbourg, France; Laboratoire de Physique et Mecanique des Textiles, Universite' de Haute-Alsace, Mulhouse, France
| | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Luraghi
- Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy.
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Stenberg E, Cao Y, Ottosson J, Hedberg S, Näslund E. Glycaemic and weight effects of metabolic surgery or semaglutide in diabetes dosage for patients with type 2 diabetes. Diabetes Obes Metab 2024. [PMID: 39295084 DOI: 10.1111/dom.15952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 09/21/2024]
Abstract
AIM To compare weight and glucometabolic outcomes of semaglutide and metabolic and bariatric surgery (MBS) for patients with type 2 diabetes and obesity. MATERIALS AND METHODS Patients treated with either semaglutide for a duration of ≥2 years or MBS in Sweden were identified within the Scandinavian Obesity Surgery Registry and the National Diabetes Registry and matched in a 1:1-2 ratio using a propensity score matching with a generalized linear model, including age, sex, glycated haemoglobin before treatment, duration of type 2 diabetes, use of insulin, presence of comorbidities and history of cancer, with good matching results but with a remaining imbalance for glomerular filtration rate and body mass index, which were then adjusted for in the following analyses. Main outcomes were weight loss and glycaemic control. RESULTS The study included 606 patients in the surgical group matched to 997 controls who started their treatment from 2018 until 2020. Both groups improved in weight and glucometabolic control. At 2 years after the intervention, mean glycated haemoglobin was 42.3 ± 11.18 after MBS compared with 50.7 ± 12.48 after semaglutide treatment (p < 0.001) with 382 patients (63.0%) and 139 (13.9%), respectively, reaching complete remission without other treatment than the intervention (p < 0.001). Mean total weight loss reached 26.4% ± 8.83% after MBS compared with 5.2% ± 7.87% after semaglutide (p < 0.001). CONCLUSION Semaglutide and MBS were both associated with improvements in weight and improved glycaemic control at 2 years after the start of the intervention, but MBS was associated with better weight loss and glucometabolic control.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yang Cao
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Suzanne Hedberg
- Department of Surgery (Östra Sjukhuset), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Gong W, Yan Y, Liu J, Wang X, Zheng W, Que B, Ai H, Smith SC, Fonarow GC, Morgan L, Zhao D, Ma C, Han Y, Nie S. In-Hospital Mortality and Treatment in Patients With Acute Coronary Syndrome With and Without Standard Modifiable Cardiovascular Risk Factors: Findings From the CCC-ACS Project. J Am Heart Assoc 2024:e029252. [PMID: 39291502 DOI: 10.1161/jaha.122.029252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Patients with acute coronary syndrome without standard modifiable cardiovascular risk factors (SMuRFs; hypertension, smoking, dyslipidemia, diabetes) have not been well studied, with little known about their characteristics, quality of care, or outcomes. We sought to systematically analyze patients with ACS without SMuRFs, especially to evaluate the effectiveness of guideline-directed medical therapy for these patients. METHODS AND RESULTS In the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project (2014-2019), we examined the presence and absence of SMuRFs and features among 89 462 patients with initial acute coronary syndrome. The main outcome was in-hospital all-cause mortality. Among eligible patients, 11.0% had none of the SMuRFs (SMuRF-less). SMuRF-less patients had higher in-hospital mortality (unadjusted hazard ratio [HR], 1.49 [95% CI, 1.19-1.87]). After adjustment for clinical characteristics and treatments, the associations between SMuRF status and in-hospital mortality persisted (adjusted HR, 1.35 [95% CI, 1.07-1.70]). Guideline-directed optimal medical therapy (receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and statins) was not associated with lower mortality (adjusted HR, 0.98 [95% CI, 0.58-1.67]) in SMuRF-less patients, unlike the association in patients with SMuRFs (adjusted HR, 0.80 [95% CI, 0.66-0.98]). Sensitivity analyses were consistent with these results. CONCLUSIONS SMuRF-less patients were associated with an increased risk of in-hospital mortality. Guideline-directed medical therapy was less effective in SMuRF-less patients than in patients with SMuRFs. Dedicated studies are needed to confirm the optimal therapy for SMuRF-less patients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02306616.
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Affiliation(s)
- Wei Gong
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Yan Yan
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Wen Zheng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Bin Que
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Hui Ai
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Sidney C Smith
- Division of Cardiology University of North Carolina Chapel Hill NC USA
| | - Gregg C Fonarow
- Division of Cardiology Geffen School of Medicine at University of California Los Angeles CA USA
| | - Louise Morgan
- International Quality Improvement Department American Heart Association Dallas TX USA
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Changsheng Ma
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
| | - Yaling Han
- Department of Cardiology General Hospital of Northern Theater Command Shenyang China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China
- National Clinical Research Center for Cardiovascular Diseases Beijing China
- Beijing Institute of Heart Lung, and Blood Vessel Diseases Beijing China
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Wang A, Zhai Y, Zhang J, Che B, Zheng X, Peng Y, Xu T, He J, Zhang Y, Zhong C. Serum Soluble Corin and Long-Term Clinical Outcomes After Acute Ischemic Stroke. J Am Heart Assoc 2024:e035075. [PMID: 39291499 DOI: 10.1161/jaha.123.035075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Corin plays important roles in the regulation of blood volume and pressure and cardiac function by activating natriuretic peptide pathway, exerting multiple cardioprotective effects. But the impacts of soluble corin on clinical outcomes after ischemic stroke are unclear. We aimed to investigate the associations between serum soluble corin and long-term clinical outcomes after acute ischemic stroke. METHODS AND RESULTS We measured the concentrations of serum soluble corin in 3162 participants (2010 men and 1152 women) from the China Antihypertensive Trial in Acute Ischemic Stroke. The clinical outcomes were recurrent stroke, cardiovascular events, all-cause mortality, and unfavorable functional outcome within 24 months after stroke. Risk reclassification for study clinical outcomes of models with soluble corin were evaluated. Serum soluble corin was inversely associated with recurrent stroke, cardiovascular events, and unfavorable functional outcome after ischemic stroke. After adjusting for multiple covariates, each additional SD of log-corin was associated with a 21% (95% CI, 11-30), 16% (95% CI, 6-26), and 12% (95% CI, 3-21) decreased risk for recurrent stroke, cardiovascular events, and unfavorable functional outcome, respectively. Furthermore, the addition of soluble corin to the basic model with conventional risk factors significantly improved risk discrimination for recurrent stroke, cardiovascular events, and the composite outcome of all-cause mortality and cardiovascular events, as shown by C-statistics (all P<0.05). CONCLUSIONS Serum soluble corin was associated with decreased risks of long-term clinical outcomes, and may be a promising prognostic biomarker for risk stratification in patients with acute ischemic stroke.
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Affiliation(s)
- Aili Wang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
| | - Yujia Zhai
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
| | - Jin Zhang
- Suzhou Industrial Park Centers for Disease Control and Prevention Suzhou China
| | - Bizhong Che
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
| | - Xiaowei Zheng
- Public Health Research Center and Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University Wuxi Jiangsu China
| | - Yanbo Peng
- Department of Neurology Affiliated Hospital of North China University of Science and Technology Tangshan China
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
| | - Jiang He
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA
- Department of Medicine Tulane University School of Medicine New Orleans LA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology Suzhou Medical College of Soochow University Suzhou China
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Kim H, Lee KY, Choo EH, Hwang BH, Kim JJ, Kim CJ, Chang K, Hong YJ, Kim JH, Ahn Y, Choi Y. Long-Term Risk of Cardiovascular Death in Patients With Mildly Reduced Ejection Fraction After Acute Myocardial Infarction: A Multicenter, Prospective Registry Study. J Am Heart Assoc 2024; 13:e034870. [PMID: 39248255 DOI: 10.1161/jaha.124.034870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The prognostic implication of mildly reduced ejection fraction (mrEF) after acute myocardial infarction has not been clearly demonstrated. We investigated the long-term risk of cardiovascular death and its predictors in patients with mrEF following acute myocardial infarction. METHODS AND RESULTS A total of 18 668 patients who presented with acute myocardial infarction were included in 2 prospective, multicenter registries. The incidence of adverse cardiovascular events according to the left ventricular ejection fraction (EF) strata at index admission were evaluated. A score system consisting of clinical variables were developed to predict long-term cardiovascular death in the mrEF group. There were 2548 patients with reduced EF (EF ≤40%), 4266 patients with mrEF (EF 41%-49%), and 11 854 patients with preserved EF (EF ≥50%). During a median follow-up period of 37.9 months, the cardiovascular death rate was 22.3% in the reduced EF group, 10.3% in the mrEF group, and 7.3% in the preserved EF group (P<0.001). In the mrEF group, age>65 years, hypertension, stroke, severe renal insufficiency, and Killip class ≥3 were independent predictors for cardiovascular death. Presence of >2 predictors best discriminated the high-risk patients for cardiovascular death with an area under the curve of 0.746. Incidence of cardiovascular death in the high-risk mrEF group was comparable with the rEF group, while it was lower in the low-risk mrEF group than in the pEF group. CONCLUSIONS Patients with mrEF after acute myocardial infarction had a modest risk of cardiovascular death. Clinical predictors could help discriminate a high-risk subpopulation with cardiovascular death risks comparable with those in the reduced EF group.
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Affiliation(s)
- Hwajung Kim
- Division of Cardiology, Department of Internal Medicine Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Byeong-Hee Hwang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Jin Jin Kim
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Chan Joon Kim
- Division of Cardiology, Department of Internal Medicine Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Uijeongbu Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
| | - Young Joon Hong
- Department of Cardiology Chonnam National University Medical School, Chonnam National University Hospital Gwangju Republic of Korea
| | - Ju Han Kim
- Department of Cardiology Chonnam National University Medical School, Chonnam National University Hospital Gwangju Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology Chonnam National University Medical School, Chonnam National University Hospital Gwangju Republic of Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine The Catholic University of Korea Seoul Republic of Korea
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Kim C, Sohn JH, Lee M, Kim Y, Mo HJ, Oh MS, Yu KH, Lee SH. Impact of prior use of antiplatelet agents and non-vitamin K antagonist oral anticoagulants on stroke outcomes among endovascular-treated patients with high pre-stroke CHA2DS2-VASc score. J Neurointerv Surg 2024; 16:1053-1059. [PMID: 37620129 DOI: 10.1136/jnis-2023-020698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND We assessed the influence of prior non-vitamin K antagonist (NOAC) use on stroke outcomes after endovascular treatment (EVT) in patients at a high risk of stroke based on their pre-stroke CHA2DS2-VASc score, and compared them with those who did not use any antithrombotic (NAU) or antiplatelet (APT) agents. METHODS Data were collected from a multicenter database comprising consecutive acute ischemic stroke patients who underwent EVT during a span of 103 months. We evaluated pre-stroke CHA2DS2-VASc scores in enrolled patients and measured instances of successful reperfusion and symptomatic hemorrhagic transformation (SHT) following EVT as the main outcome measures. RESULTS Among 12 807 patients with acute ischemic stroke, 3765 (29.4%) had a history of atrial fibrillation. Of these, 418 patients with CHA2DS2-VASc scores ≥2 received EVT alone. The prior NOAC group showed higher successful reperfusion rates compared with the prior NAU and APT groups (p=0.04). Multivariate analysis revealed that prior NOAC use increased the likelihood of successful reperfusion after EVT (OR [95% CI] 2.54 [1.34 to 4.83], p=0.004) and improved stroke outcomes, while the prior APT group did not. Furthermore, the prior NOAC use group was not associated with SHT after EVT. Propensity score matching confirmed these findings. CONCLUSION Prior use of NOAC is associated with improved outcomes in high-risk stroke patients (pre-stroke CHA2DS2-VASc score ≥2) undergoing EVT.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea (the Republic of)
- Institute of New Frontier Research Team, Hallym University, Chuncheon, Korea (the Republic of)
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea (the Republic of)
- Institute of New Frontier Research Team, Hallym University, Chuncheon, Korea (the Republic of)
| | - Minwoo Lee
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea (the Republic of)
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (the Republic of)
| | - Hee Jung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea (the Republic of)
| | - Mi Sun Oh
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea (the Republic of)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea (the Republic of)
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea (the Republic of)
- Institute of New Frontier Research Team, Hallym University, Chuncheon, Korea (the Republic of)
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Santas E, Villar S, Palau P, Llàcer P, de la Espriella R, Miñana G, Lorenzo M, Núñez-Marín G, Górriz JL, Carratalá A, Rodríguez E, Bayes-Genís A, Sanchis J, Núñez J. High-sensitivity C-reactive protein and risk of clinical outcomes in patients with acute heart failure. Sci Rep 2024; 14:21672. [PMID: 39289385 PMCID: PMC11408489 DOI: 10.1038/s41598-024-72137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024] Open
Abstract
Inflammation is relevant in the pathogenesis and progression of heart failure (HF). Previous studies have shown that elevated high-sensitivity C-reactive protein (hsCRP) are associated with greater severity and may be associated with adverse outcomes. In this study, we sought to evaluate the prognostic role of hsCRP in a non-selected cohort of patients with acute HF. We prospectively included a multicenter cohort of 3,395 patients following an admission for acute HF. HsCRP levels were evaluated during the first 24 h following admission. Study endpoints were the risks of all-cause mortality, CV-mortality, and total HF readmissions. The mean age was 74.2 ± 11.2 years and 1,826 (53.8%) showed a left ventricular ejection fraction (LVEF) ≥ 50%. Median hsCRP was 12.9 mg/L (5.4-30 mg/L). Over a median follow-up of 1.8 (0.6-4.1) years, 1,574 (46.4%) patients died, and 1,341 (39.5%) patients were readmitted for worsening HF. After multivariable adjustment, hsCRP values were significantly and positively associated with a higher risk of all-cause and CV mortality (p = 0.003 and p = 0.001, respectively), as well as a higher risk of recurrent HF admissions (p < 0.001). These results remained consistent across important subgroups, such as LVEF, sex, age, or renal function. In patients with acute HF, hsCRP levels were independently associated with an increased risk of long-term death and total HF readmissions.
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Affiliation(s)
- Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
- Universitat de València, Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
- Universitat de València, Valencia, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
- Universitat de València, Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain
- Nephrology Department, Hospital Clinico Universitario, INCLIVA, Valencia, Spain
| | - Arturo Carratalá
- Clinical Biochemistry Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Enrique Rodríguez
- Clinical Biochemistry Department, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Antoni Bayes-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
- Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain.
- Universitat de València, Valencia, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Chan YH, Chao TF, Chen SW, Lee HF, Li PR, Yeh YH, Kuo CT, See LC, Lip GYH. SGLT2 Inhibitors vs GLP-1 Receptor Agonists and Clinical Outcomes in Patients With Diabetes With/Without Atrial Fibrillation. J Clin Endocrinol Metab 2024; 109:2617-2629. [PMID: 38466894 DOI: 10.1210/clinem/dgae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
CONTEXT The coexistence of diabetes mellitus and atrial fibrillation (AF) is associated with substantial risks of adverse cardiovascular events. OBJECTIVE The relevant outcomes associated with the use of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) vs glucagon-like peptide-1 receptor agonists (GLP-1RAs) among patients with type 2 diabetes (T2D) with/without concomitant AF remain unknown. METHODS In this nationwide retrospective cohort study from the Taiwan National Health Insurance Research Database, there were 344 392 and 31 351 patients with T2D without AF, and 11 462 and 816 T2D patients with AF treated with SGLT2is and GLP-1RAs, respectively, from May 1, 2016, to December 31, 2019. Patients were followed from the drug index date until the occurrence of study events, discontinuation of the index drug, or the end of the study period (December 31, 2020), whichever occurred first. We used propensity score-stabilized weight to balance covariates across the 2 medication groups. RESULTS The incidence rate of all study outcomes in patients with concomitant AF was much higher than in those without concomitant AF. For the AF cohort, SGLT2i vs GLP-1RA was associated with a lower risk of hospitalization for heart failure (HF) (2.32 vs 4.74 events per 100 person-years; hazard ratio [HR] 0.48, 95% CI 0.36-0.66), with no benefit seen for the non-AF cohort (P for homogeneity < .01). SGLT2i vs GLP-1RA was associated with a lower risk of composite kidney outcomes both in the AF (0.38 vs 0.79 events per 100 person-years; HR 0.47; 95% CI 0.23-0.96) and the non-AF cohorts (0.09 vs 0.18 events per 100 person-years; HR 0.53; 95% CI 0.43-0.64). There were no significant differences in the risk of major adverse cardiovascular events and all-cause mortality in those who received SGLT2i compared with GLP-1RA for the AF or non-AF cohorts. CONCLUSION Considering the high risk of developing HF and/or high prevalence of concomitant HF in patients with concomitant diabetes and AF, whether SGLT2is should be the preferred treatment to GLP-1RAs for such a high-risk population requires further investigation.
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Affiliation(s)
- Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang-Gung University, Taoyuan City 333, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Shao-Wei Chen
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Hsin-Fu Lee
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Division of Cardiology, Department of Medicine, New Taipei City Municipal Tucheng Hospital (Chang Gung Memorial Hospital, Tucheng Branch, Taiwan), New Taipei City 236, Taiwan
| | - Pei-Ru Li
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yung-Hsin Yeh
- The Cardiovascular Department, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Chi-Tai Kuo
- The Cardiovascular Department, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan City 333, Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L69 3BX, UK
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
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80
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Bajraktari G, Bytyçi I, Abdyli G, Ibrahimi P, Bajraktari A, Karahoda R, Elezi S, Henein MY. One-Month Dual Antiplatelet Therapy Reduces Major Bleeding Compared With Longer-Term Treatment Without Excess Stent Thrombosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Am J Cardiol 2024; 227:91-97. [PMID: 39029722 DOI: 10.1016/j.amjcard.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/06/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Dual antiplatelet therapy (DAPT) remains the gold standard in patients who underwent percutaneous coronary intervention (PCI). This meta-analysis aims to evaluate the clinical safety of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor after PCI with drug-eluting stents (DES). We searched PubMed, MEDLINE, Embase, Scopus, Google Scholar, Cochrane Central Registry, and ClinicalTrials.gov databases and identified 5 randomized controlled trials with 29,831 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary end point was major bleeding, and the co-primary end point was stent thrombosis. The secondary end point included all-cause mortality, cardiovascular death, myocardial infarction, stroke, and major adverse cardiovascular or cerebrovascular events. Compared with >1-month DAPT, the 1-month DAPT was associated with a lower rate of major bleeding (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.45 to 0.97, p = 0.03, I2 = 71%), whereas stent thrombosis had a similar rate in both study groups (OR 1.08, 95% CI 0.81 to 1.44, p = 0.60, I2 = 0.0%). The study groups had similar risks for all-cause mortality (OR 0.89, 95% CI 0.77 to 1.04, p = 0.14, I2 = 0.0%), cardiovascular death (OR 0.84, 95% CI 0.59 to 1.19, p = 0.32, I2 = 0.0%), myocardial infarction (OR 1.04, 95% CI 0.89 to 1.21, p = 0.62, I2 = 0.0%), and stroke (OR 0.82, 95% CI 0.64 to 1.05, p = 0.11, I2 = 6%). The risk of major adverse cardiovascular or cerebrovascular events was lower (OR 0.86, 95% CI 0.76 to 0.97, p = 0.02, I2 = 25%) in the 1-month DAPT compared with >1-month DAPT. In conclusion, in patients who underwent PCI with DES, 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor reduced major bleeding with no risk of increased thrombotic risk compared with longer-term DAPT.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo.
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Genc Abdyli
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Pranvera Ibrahimi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Artan Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Rona Karahoda
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Wang L, Travieso A, van der Hoeven N, Lombardi M, van Leeuwen MAH, Janssens G, Shabbir A, Mejía-Rentería H, Milasinovic D, Gonzalo N, Nijveldt R, van Royen N, Escaned J. Angiography-versus wire-based microvascular resistance index to detect coronary microvascular obstruction associated with ST-segment elevation myocardial infarction. Int J Cardiol 2024; 411:132256. [PMID: 38866108 DOI: 10.1016/j.ijcard.2024.132256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/12/2024] [Accepted: 06/09/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Microvascular obstruction (MVO) measured by cardiac magnetic resonance (CMR) after ST-segment elevation myocardial infarction (STEMI) has important prognostic implications. While invasive index of microvascular resistance (IMR) have been shown to predict the occurrence and extent of MVO, the role of the angiography-based microvascular resistance (Angio-IMR) for this purpose remains unknown. The present study aims to perform a head-to-head comparison of wire-based and angiography-derived microcirculatory resistance (IMR and Angio-IMR, respectively) for the detection of MVO. METHODS Patients with a first STEMI and multivessel disease underwent CMR for detection of MVO, and angio-IMR and IMR measurements during PPCI and at 30 day follow up, both in STEMI culprit and non-culprit vessels. RESULTS 58 patients were included (mean age 60.7 ± 9.9 years, 82% male). At the time of PPCI, angio-IMR and IMR exhibited significant correlation (r = 0.70, P < 0.001), and agreement (coefficient of agreement 0.58). Both indices showed good predictive value of MVO [Angio IMR: AUC 0.79 (95% CI: 0.667-0.928); IMR: AUC 0.70 (95% CI: 0.539-0.853); p = 0.15]. Angio-IMR 40 U and IMR 34 U were identified as best cut-offs for prediction of MVO. In non-culprit vessels, angio-IMR and IMR also correlated well (rho = 0.59, p < 0.001), with overall lower mean values compared to culprit vessels (Angio-IMR: 36 vs. 23; IMR: 39 vs. 22, p < 0.001 for both comparisons). CONCLUSION Angio-IMR constitutes a valid alternative to wire-based IMR in predicting MVO in STEMI. Angio-IMR and IMR show a good correlation in the acute and subacute STEMI phases, both in culprit and non-culprit vessels.
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Affiliation(s)
- Lin Wang
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Alejandro Travieso
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Nina van der Hoeven
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marco Lombardi
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain; Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Gladys Janssens
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Asad Shabbir
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Hernán Mejía-Rentería
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nieves Gonzalo
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Madrid, Spain.
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Abza LF, Yesuf MA, Emrie AA, Belay AS, Bekele TG, Tetema MD, Berriea FW, Baymot A. Self-care adherence and associated factors among hypertensive patients at Guraghe Zone, 2023. Heliyon 2024; 10:e36985. [PMID: 39281466 PMCID: PMC11402238 DOI: 10.1016/j.heliyon.2024.e36985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/18/2024] Open
Abstract
Background Hypertension is the primary cause of cardiovascular disease and early mortality. Self-care is important for the prevention of hypertensive-related complications, and it was found to be necessary to determine the self-care adherence of hypertensive patients in Guraghe Zone, as there are limited findings in this area. The other reason for conducting this study was that there are certain variables related to self-care that have not been well studied, such as BMI, the number of antihypertensive medications, and the duration of antihypertensive drugs the patients are taking. Objective To assess self-care adherence and associated factors among hypertensive patients at Guraghe zone public hospitals. Methods and materials A multi-center institution-based cross-sectional study was conducted at selected Guraghe zone hospitals from May 20 to June 20, 2023. A systematic random sampling method was employed to select 370 participants. Hypertension self-care Activity Level Scale Effects (H-SCALE) was used to measure the self-care status. A binary logistic regression model was applied, and variables with a p-value <0.05 with a 95 % CI in the multivariable analysis were considered significant. Results The study evaluated the self-care adherence of 370 patients, and 50.8 % of patients had good self-care adherence. Normal BMI (AOR = 2.049, 95 % CI: 1.041, 4.033), starting antihypertensive in <5 years (AOR = 2.530, 95 % CI: 1.462, 4.381), patients taking three or more antihypertensive (AOR = 4.534, 95 % CI: 2.005, 10.252), absence of comorbidity (AOR = 1.758, 95 % CI: 1.030, 3.003), and strong social support (AOR = 3.842, 95 % CI: 1.994, 7.402) were significantly associated with good self-care. Conclusion and recommendation: Nearly half of patients with hypertension had good self-care adherence. BMI, antihypertensive duration, number of antihypertensive, comorbidity, and social support were variables that showed significant association with self-care adherence. Patients need to implement the lifestyle recommendations in addition to regular follow-up to prevent complications. Health-care facilities need to provide health education on the proper implementation of self-care recommendations.
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Affiliation(s)
- Legese Fekede Abza
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 21, Wolkite, Ethiopia
| | - Muhaba Ahmedin Yesuf
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 21, Wolkite, Ethiopia
| | - Ambaw Abebaw Emrie
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 21, Wolkite, Ethiopia
| | - Alemayehu Sayih Belay
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 21, Wolkite, Ethiopia
| | | | - Mesfin Difer Tetema
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Fantahun Walle Berriea
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 21, Wolkite, Ethiopia
| | - Aemiro Baymot
- Department of Nursing, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Cha JM, Kim M, Jo HH, Seo WW, Rhee SY, Kim JH, Kim GH, Park J. Real-World Risk of Gastrointestinal Bleeding for Direct Oral Anticoagulants and Warfarin Users: A Distributed Network Analysis Using a Common Data Model. Gut Liver 2024; 18:814-823. [PMID: 38384200 PMCID: PMC11391140 DOI: 10.5009/gnl230406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 02/23/2024] Open
Abstract
Background/Aims Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myoungsuk Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyeong Ho Jo
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Won-Woo Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Center for Digital Health, Kyung Hee University, Seoul, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School, Busan, Korea
| | - Junseok Park
- Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University School of Medicine, Seoul, Korea
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Caldonazo T, Fischer J, Spagnolo A, Dell'Aquila M, Kirov H, Tasoudis P, Treml RE, Vervoort D, Sá MP, Doenst T, Diab M, Hagel S. Outcomes of complete removal versus conservative therapy in cardiac implantable electronic device infections - A systematic review and Meta-analysis. Int J Cardiol 2024; 411:132264. [PMID: 38878871 DOI: 10.1016/j.ijcard.2024.132264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/10/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Complete removal of cardiac implantable electronic devices (CIEDs) is recommended in patients with CIED infections, including both systemic and localized pocket infection. The aim of the study was to provide an up-to-date and comprehensive assessment of evidence relating to the effect of complete CIED extraction in patients with a CIED infection. METHODS We performed a systematic review and meta-analysis of studies reporting short- and mid-term outcomes in patients who had a device infection or infective endocarditis (IE) and underwent complete removal of the cardiac device (generator and leads) compared to those who received conservative therapy (no removal, partial removal, local antibiotic infiltration or isolated antibiotic therapy). The primary outcome was reinfection/relapse. Secondary outcomes were short-term (30-day/in-hospital) and mid-term (mean follow-up: 43.0 months) mortality. Random effects model was performed. RESULTS Thirty-two studies met the criteria for inclusion in the final analysis. Patients with complete CIED extraction (n = 905) exhibited a lower rate of relapse/re-infection compared to patients (n = 195) with a conservative treatment approach (n = 195, OR 0.02, 95%CI 0.01-0.06, p < 0.0001, mean-follow-up: 16.1 months). Additionally, these patients displayed a lower short- (OR 0.40, 95%CI 0.23-0.69, p = 0.01) and mid-term (OR 0.52, 95%CI 0.34-0.78, p = 0.002) mortality. CONCLUSIONS The analysis indicates that patients with a CIED infection who undergo complete CIED extraction exhibit a lower rate of relapse/re-infection. Additionally, a lower short- and mid-term mortality is observed, although it is acknowledged that this outcome may be influenced by treatment allocation bias.
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Affiliation(s)
- Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany.; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, United States..
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Alena Spagnolo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Michele Dell'Aquila
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, United States
| | - Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, United States
| | - Ricardo E Treml
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Germany
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America; UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany.; Department of Cardiac Surgery, Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Friedrich-Schiller-University Jena, Germany
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Shah SJ, Sharma K, Borlaug BA, Butler J, Davies M, Kitzman DW, Petrie MC, Verma S, Patel S, Chinnakondepalli KM, Einfeldt MN, Jensen TJ, Rasmussen S, Asleh R, Ben-Gal T, Kosiborod MN. Semaglutide and diuretic use in obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF-DM trials. Eur Heart J 2024; 45:3254-3269. [PMID: 38739118 PMCID: PMC11400859 DOI: 10.1093/eurheartj/ehae322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/27/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND AND AIMS In the STEP-HFpEF trial programme, treatment with semaglutide resulted in multiple beneficial effects in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Efficacy may vary according to baseline diuretic use, and semaglutide treatment could modify diuretic dose. METHODS In this pre-specified analysis of pooled data from the STEP-HFpEF and STEP-HFpEF-DM trials (n = 1145), which randomized participants with HFpEF and body mass index ≥ 30 kg/m2 to once weekly semaglutide 2.4 mg or placebo for 52 weeks, we examined whether efficacy and safety endpoints differed by baseline diuretic use, as well as the effect of semaglutide on loop diuretic use and dose changes over the 52-week treatment period. RESULTS At baseline, across no diuretic (n = 220), non-loop diuretic only (n = 223), and loop diuretic [<40 (n = 219), 40 (n = 309), and >40 (n = 174) mg/day furosemide equivalents] groups, there was progressively higher prevalence of hypertension and atrial fibrillation; and greater severity of obesity and heart failure. Over 52 weeks of treatment, semaglutide had a consistent beneficial effect on change in body weight across diuretic use categories (adjusted mean difference vs. placebo ranged from -8.8% [95% confidence interval (CI) -10.3, -6.3] to -6.9% [95% CI -9.1, -4.7] from no diuretics to the highest loop diuretic dose category; interaction P = .39). Kansas City Cardiomyopathy Questionnaire clinical summary score improvement was greater in patients on loop diuretics compared to those not on loop diuretics (adjusted mean difference vs. placebo: +9.3 [6.5; 12.1] vs. +4.7 points [1.3, 8.2]; P = .042). Semaglutide had consistent beneficial effects on all secondary efficacy endpoints (including 6 min walk distance) across diuretic subgroups (interaction P = .24-.92). Safety also favoured semaglutide vs. placebo across the diuretic subgroups. From baseline to 52 weeks, loop diuretic dose decreased by 17% in the semaglutide group vs. a 2.4% increase in the placebo group (P < .0001). Semaglutide (vs. placebo) was more likely to result in loop diuretic dose reduction (odds ratio [OR] 2.67 [95% CI 1.70, 4.18]) and less likely dose increase (OR 0.35 [95% CI 0.23, 0.53]; P < .001 for both) from baseline to 52 weeks. CONCLUSIONS In patients with obesity-related HFpEF, semaglutide improved heart failure-related symptoms and physical limitations across diuretic use subgroups, with more pronounced benefits among patients receiving loop diuretics at baseline. Reductions in weight and improvements in exercise function with semaglutide vs. placebo were consistent in all diuretic use categories. Semaglutide also led to a reduction in loop diuretic use and dose between baseline and 52 weeks. CLINICAL TRIAL REGISTRATION NCT04788511 and NCT04916470.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kavita Sharma
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Melanie Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics/Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Shachi Patel
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Khaja M Chinnakondepalli
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | - Rabea Asleh
- Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tuvia Ben-Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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Santos-de-Araújo AD, Bassi-Dibai D, Dourado IM, da Luz Goulart C, Marinho RS, de Almeida Mantovani J, de Souza GS, Dos Santos PB, Roscani MG, Phillips SA, Borghi-Silva A. Type 2 diabetes mellitus negatively affects the functional performance of 6-min step test in chronic heart failure: a 3-year follow-up study. Diabetol Metab Syndr 2024; 16:229. [PMID: 39272115 PMCID: PMC11401430 DOI: 10.1186/s13098-024-01464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) present a decrease in functional capacity due to the intrinsic nature of both pathologies. It is not known about the potential impact of T2DM on functional capacity when assessed by 6-min step test (6MST) and its effect as a prognostic marker for fatal and non-fatal events in patients with CHF. OBJECTIVE to evaluate the coexistence of T2DM and CHF in functional capacity through 6MST when compared to CHF non-T2DM, as well as to investigate the different cardiovascular responses to 6MST and the risk of mortality, decompensation of CHF and acute myocardial infarction (AMI) over 36 months. METHODS This is a prospective cohort study with 36 months of follow-up in individuals with T2DM and CHF. All participants completed a clinical assessment, followed by pulmonary function testing, echocardiography, and 6MST. The 6MST was performed on a 20 cm high step and cardiovascular responses were collected: heart rate, systemic blood pressure, oxygen saturation, BORG dyspnea and fatigue. The risk of mortality, acute myocardial infarction and decompensation of CHF was evaluated. RESULTS Eighty-six participants were included. The CHF-T2DM group had a significantly lower functional capacity than the CHF non-T2DM group (p < 0.05). Forced Expiratory Volume in one second (L), ejection fraction (%), gender and T2DM influence and are predictors of functional capacity (p < 0.05; adjusted R squared: 0.419). CHF-T2DM group presented a higher risk of mortality and acute myocardial infarction over the 36 months of follow-up (p < 0.05), but not to the risk of decompensation (p > 0.05). CONCLUSION T2DM negatively affects the functional performance of 6MST in patients with CHF. Gender, ejection fraction (%), FEV1 (L) and T2DM itself negatively influence exercise performance.
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Affiliation(s)
- Aldair Darlan Santos-de-Araújo
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de São Carlos, Federal University of Sao Carlos Rodovia Washington Luiz, São Carlos, SP, 13565-905, Brazil
| | - Daniela Bassi-Dibai
- Management in Health Programs and Services, Universidade CEUMA, São Luís, MA, Brazil
| | - Izadora Moraes Dourado
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de São Carlos, Federal University of Sao Carlos Rodovia Washington Luiz, São Carlos, SP, 13565-905, Brazil
| | | | - Renan Shida Marinho
- Inter-Units of Bioengineering, University of São Paulo, São Carlos, SP, Brazil
| | - Jaqueline de Almeida Mantovani
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de São Carlos, Federal University of Sao Carlos Rodovia Washington Luiz, São Carlos, SP, 13565-905, Brazil
| | - Gabriela Silva de Souza
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de São Carlos, Federal University of Sao Carlos Rodovia Washington Luiz, São Carlos, SP, 13565-905, Brazil
| | | | - Meliza Goi Roscani
- Department of Medicine, Universidade Federal de São Carlos (UFSCar), Sao Carlos, SP, Brazil
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de São Carlos, Federal University of Sao Carlos Rodovia Washington Luiz, São Carlos, SP, 13565-905, Brazil.
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Shi R, Xu W, Feng L, Ye D, Luo B, Liu Y, Cao H, Tang L. Value of Glycemic Dispersion Index in Predicting Major Adverse Cardiovascular Events in Diabetic Patients with Concomitant Acute Coronary Syndrome. Diabetes Metab Syndr Obes 2024; 17:3433-3445. [PMID: 39295645 PMCID: PMC11410034 DOI: 10.2147/dmso.s469436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 09/05/2024] [Indexed: 09/21/2024] Open
Abstract
Aim This investigation aims to assess the predictive value of the glycemic dispersion index (GDI), calculated by incorporating glycated hemoglobin, fasting plasma glucose, and 2-hour postprandial plasma glucose, in predicting major adverse cardiovascular events (MACE) within a 12-month timeframe for diabetic patients with concomitant acute coronary syndrome (ACS). Methods A retrospective study was conducted on 3261 diabetic patients with ACS who were hospitalized in the Department of Cardiology, the Sixth Affiliated Hospital of Kunming Medical University, from January 2016 to July 2022. Based on the inclusion and exclusion criteria, 512 patients were ultimately enrolled in the study. Their general information and laboratory test indicators were collected, and the occurrence of MACE within 12 months after admission was followed up and recorded for the enrolled patients, With the last follow-up having been concluded on July 31, 2023. The enrolled patients were stratified into four groups (Q1, Q2, Q3, Q4) based on their GDI values, from the lowest to the highest. Cox proportional hazards regression analysis and Kaplan-Meier survival analysis were employed to investigate the risk factors associated with MACE occurrence across these groups and to assess the cumulative risk of MACE over time within each group. Results The percentages of enrolled patients experiencing MACE in groups Q1 to Q4 were 10.16%, 12.50%, 15.63%, and 16.41%, respectively. GDI independently predicted the hazards for MACE in enrolled patients. The cumulative risk of MACE over time was considerably more significant in those with a GDI>4.21 than those with a GDI≤4.21. Conclusion The elevated GDI is correlated with an augmented risk of MACE in diabetic patients with concomitant ACS, thereby serving as an early indicator for assessing the unfavorable clinical prognosis of patients. This study offers novel insights into glycemic variability monitoring, enhancing prevention and treatment strategies for cardiovascular disease in people with diabetes.
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Affiliation(s)
- Rui Shi
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
| | - Wenbo Xu
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
| | - Lei Feng
- Clinical Laboratory, Yan'an Hospital of Kunming City, Kunming City, Yunnan Province, People's Republic of China
| | - Dan Ye
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
| | - Beibei Luo
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
| | - Yanmei Liu
- Clinical Laboratory, Yan'an Hospital of Kunming City, Kunming City, Yunnan Province, People's Republic of China
- Department of Laboratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, People's Republic of China
| | - Huiying Cao
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
| | - Lingtong Tang
- Department of Laboratory, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi City, Yunnan Province, People's Republic of China
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Valeanu A, Margina D, Weber D, Stuetz W, Moreno-Villanueva M, Dollé MET, Jansen EH, Gonos ES, Bernhardt J, Grubeck-Loebenstein B, Weinberger B, Fiegl S, Sikora E, Mosieniak G, Toussaint O, Debacq-Chainiaux F, Capri M, Garagnani P, Pirazzini C, Bacalini MG, Hervonen A, Slagboom PE, Talbot D, Breusing N, Frank J, Bürkle A, Franceschi C, Grune T, Gradinaru D. Development and validation of cardiometabolic risk predictive models based on LDL oxidation and candidate geromarkers from the MARK-AGE data. Mech Ageing Dev 2024; 222:111987. [PMID: 39284459 DOI: 10.1016/j.mad.2024.111987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/27/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
The predictive value of the susceptibility to oxidation of LDL particles (LDLox) in cardiometabolic risk assessment is incompletely understood. The main objective of the current study was to assess its relationship with other relevant biomarkers and cardiometabolic risk factors from MARK-AGE data. A cross-sectional observational study was carried out on 1089 subjects (528 men and 561 women), aged 40-75 years old, randomly recruited age- and sex-stratified individuals from the general population. A correlation analysis exploring the relationships between LDLox and relevant biomarkers was undertaken, as well as the development and validation of several machine learning algorithms, for estimating the risk of the combined status of high blood pressure and obesity for the MARK-AGE subjects. The machine learning models yielded Area Under the Receiver Operating Characteristic Curve Score ranging 0.783-0.839 for the internal validation, while the external validation resulted in an Under the Receiver Operating Characteristic Curve Score between 0.648 and 0.787, with the variables based on LDLox reaching significant importance within the obtained predictions. The current study offers novel insights regarding the combined effects of LDL oxidation and other ageing markers on cardiometabolic risk. Future studies might be extended on larger patient cohorts, in order to obtain reproducible clinical assessment models.
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Affiliation(s)
- Andrei Valeanu
- Carol Davila University of Medicine and Pharmacy, Faculty of Pharmacy, 6 Traian Vuia St., Bucharest 020956, Romania.
| | - Denisa Margina
- Carol Davila University of Medicine and Pharmacy, Faculty of Pharmacy, 6 Traian Vuia St., Bucharest 020956, Romania.
| | - Daniela Weber
- Department of Molecular Toxicology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal 14558, Germany; NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal 14458, Germany.
| | - Wolfgang Stuetz
- Department of Food Biofunctionality, Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart 70599, Germany.
| | - María Moreno-Villanueva
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz 78457, Germany; Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz 78457, Germany.
| | - Martijn E T Dollé
- Centre for Health Protection, National Institute for Public Health and the Environment, PO Box 1, Bilthoven 3720 BA, the Netherlands.
| | - Eugène Hjm Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment, PO Box 1, Bilthoven 3720 BA, the Netherlands.
| | - Efstathios S Gonos
- National Hellenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece.
| | | | - Beatrix Grubeck-Loebenstein
- Research Institute for Biomedical Aging Research, University of Innsbruck, Rennweg, 10, Innsbruck 6020, Austria.
| | - Birgit Weinberger
- Research Institute for Biomedical Aging Research, University of Innsbruck, Rennweg, 10, Innsbruck 6020, Austria.
| | - Simone Fiegl
- UMIT TIROL - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol 6060, Austria.
| | - Ewa Sikora
- Laboratory of the Molecular Bases of Ageing, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur street, Warsaw 02-093, Poland.
| | - Grazyna Mosieniak
- Laboratory of the Molecular Bases of Ageing, Nencki Institute of Experimental Biology, Polish Academy of Sciences, 3 Pasteur street, Warsaw 02-093, Poland.
| | - Olivier Toussaint
- URBC-NARILIS, University of Namur, Rue de Bruxelles, 61, Namur, Belgium
| | | | - Miriam Capri
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy; Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna 40126, Italy.
| | - Paolo Garagnani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Chiara Pirazzini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy.
| | | | - Antti Hervonen
- Medical School, University of Tampere, Tampere 33014, Finland.
| | - P Eline Slagboom
- Section of Molecular Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Duncan Talbot
- Department of Unilever Science and Technology, Beauty and Personal Care, Sharnbrook, UK.
| | - Nicolle Breusing
- Department of Applied Nutritional Science/Dietetics, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart 70599, Germany.
| | - Jan Frank
- Department of Food Biofunctionality, Institute of Nutritional Sciences (140), University of Hohenheim, Stuttgart 70599, Germany.
| | - Alexander Bürkle
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Konstanz 78457, Germany.
| | - Claudio Franceschi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna 40126, Italy; Laboratory of Systems Medicine of Healthy Aging, Institute of Biology and Biomedicine and Institute of Information Technology, Mathematics and Mechanics, Department of Applied Mathematics, N. I. Lobachevsky State University, Nizhny Novgorod 603005, Russia.
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal 14558, Germany; NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal 14458, Germany; German Center for Diabetes Research (DZD), München-Neuherberg 85764, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin 13347, Germany; University of Potsdam, Institute of Nutritional Science, Nuthetal 14458, Germany; University of Vienna, Department of Physiological Chemistry, Faculty of Chemistry, Vienna 1090, Austria.
| | - Daniela Gradinaru
- Carol Davila University of Medicine and Pharmacy, Faculty of Pharmacy, 6 Traian Vuia St., Bucharest 020956, Romania; Ana Aslan National Institute of Gerontology and Geriatrics, Bucharest, Romania.
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Sharma P, Judy R, Yuan S, Gellatly C, Saxby KL, Bown MJ, Levin MG, Damrauer SM. Lipoprotein (a) is associated with increased risk of Abdominal Aortic Aneurysm. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.13.24313646. [PMID: 39314961 PMCID: PMC11419246 DOI: 10.1101/2024.09.13.24313646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Introduction Lipoprotein(a) (Lp(a)) is a circulating apolipoprotein B (ApoB) containing particle that has been observationally linked to atherosclerotic cardiovascular disease and is the target of emerging therapeutics. Recent work has highlighted the role of circulating lipoproteins in abdominal aortic aneurysm (AAA). We sought to triangulate human observational and genetic evidence to evaluate the role of Lp(a) in AAA. Methods We tested the association between circulating levels of Lp(a) and clinically diagnosed abdominal aortic aneurysms while controlling for traditional AAA risk factors and levels of ApoB using logistic regression among 795 individuals with and 374,772 individuals without AAA in the UK Biobank (UKB). Multivariable Mendelian randomization (MVMR) was used to test for putatively causal associations between Lp(a) and AAA controlling for ApoB. Genetic instruments for Lp(a) and ApoB were created from genome-wide association studies (GWAS) of Lp(a) and ApoB comprising 335,796 and 418,505 UKB participants, respectively. The instruments were tested for association with AAA using data from a GWAS of 39,221 individuals with and 1,086,107 without AAA. Results Elevated Lp(a) levels were observationally associated with an increased risk of AAA (OR 1.04 per 10 nmol/L Lp(a); 95%CI 1.02-1.05; P<0.01). Clinically elevated Lp(a) levels (>150nmol/L) were likewise associated with an increased risk of AAA (OR 1.47; 95% CI 1.15-1.88; P < 0.01) when compared to individuals with Lp(a) levels <150nmol/L. MVMR confirmed a significant, ApoB-independent association between increased Lp(a) and increased risk of AAA (OR 1.13 per SD increase in Lp(a); 95%CI 1.02-1.24; P<0.02). Conclusion Both observational and genetic analyses support an association between increased Lp(a) and AAA risk that is independent of ApoB. These findings suggest that Lp(a) may be a therapeutic target for AAA and drive the inclusion of AAA as an outcome in clinical trials of Lp(a) antagonists.
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90
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Ban JW, Abel L, Stevens R, Perera R. Research inefficiencies in external validation studies of the Framingham Wilson coronary heart disease risk rule: A systematic review. PLoS One 2024; 19:e0310321. [PMID: 39269949 DOI: 10.1371/journal.pone.0310321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/28/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND External validation studies create evidence about a clinical prediction rule's (CPR's) generalizability by evaluating and updating the CPR in populations different from those used in the derivation, and also by contributing to estimating its overall performance when meta-analysed in a systematic review. While most cardiovascular CPRs do not have any external validation, some CPRs have been externally validated repeatedly. Hence, we examined whether external validation studies of the Framingham Wilson coronary heart disease (CHD) risk rule contributed to generating evidence to their full potential. METHODS A forward citation search of the Framingham Wilson CHD risk rule's derivation study was conducted to identify studies that evaluated the Framingham Wilson CHD risk rule in different populations. For external validation studies of the Framingham Wilson CHD risk rule, we examined whether authors updated the Framingham Wilson CHD risk rule when it performed poorly. We also assessed the contribution of external validation studies to understanding the Predicted/Observed (P/O) event ratio and c statistic of the Framingham Wilson CHD risk rule. RESULTS We identified 98 studies that evaluated the Framingham Wilson CHD risk rule; 40 of which were external validation studies. Of these 40 studies, 27 (67.5%) concluded the Framingham Wilson CHD risk rule performed poorly but did not update it. Of 23 external validation studies conducted with data that could be included in meta-analyses, 13 (56.5%) could not fully contribute to the meta-analyses of P/O ratio and/or c statistic because these performance measures were neither reported nor could be calculated from provided data. DISCUSSION Most external validation studies failed to generate evidence about the Framingham Wilson CHD risk rule's generalizability to their full potential. Researchers might increase the value of external validation studies by presenting all relevant performance measures and by updating the CPR when it performs poorly.
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Affiliation(s)
- Jong-Wook Ban
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Lavens A, De Block C, Oriot P, Crenier L, Philips JC, Vandenbroucke M, Vanherwegen AS, Nobels F, Mathieu C. Metabolic health in people living with type 1 diabetes in Belgium: a repeated cross-sectional study. Diabetologia 2024:10.1007/s00125-024-06273-7. [PMID: 39271516 DOI: 10.1007/s00125-024-06273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/24/2024] [Indexed: 09/15/2024]
Abstract
AIMS/HYPOTHESIS Metabolic abnormalities such as central obesity, insulin resistance, dyslipidaemia and hypertension, often referred to as 'the metabolic syndrome' (or 'combined metabolic abnormalities'), are increasingly being identified in people living with type 1 diabetes, accelerating the risk for CVD. As a result, in recent years, treatment in people living with type 1 diabetes has shifted to improving overall metabolic health rather than glucose control alone. In Belgium, diabetes care for people living with type 1 diabetes is centrally organised. The Initiative for Quality Improvement and Epidemiology in Diabetes, imposed by the Belgian health insurance system, has systematically collected data from patients on intensive insulin therapy treated in all 101 diabetes clinics in Belgium since 2001. The aim of this real-world study is to describe the evolution of treatment and metabolic health, including the prevalence of obesity and combined metabolic abnormalities, in people living with type 1 diabetes over the past 20 years, and to compare the treatment and prevalence of complications between those with and without combined metabolic abnormalities. METHODS We analysed data on adults (≥16 years old) living with type 1 diabetes, who were diagnosed at age ≤45 years and who had a diabetes duration ≥1 year, collected between 2001 and 2022. The evolution of HbA1c, BMI, LDL-cholesterol, systolic BP, lipid-lowering therapy and antihypertensive therapy over time was analysed. The prevalence of individual and multiple metabolic abnormalities according to various definitions of the metabolic syndrome/combined metabolic abnormalities was analysed, and the association between combined metabolic abnormalities and metabolic health indicators, complications and treatment was investigated in the 2022 data. RESULTS The final dataset consisted of 26,791 registrations of adults living with type 1 diabetes collected between 2001 and 2022. Although glycaemic and lipid control generally improved over time, the prevalence of obesity strongly increased (12.1% in 2001 vs 21.7% in 2022, p<0.0001), as did the presence of combined metabolic abnormalities (WHO criteria: 26.9% in 2001 vs 42.9% in 2022 in women, p<0.0001; 30.4% in 2001 vs 52.1% in 2022 in men, p<0.0001; WHO criteria without albuminuria: 22.3% in 2001 vs 40.6% in 2022 in women, p<0.0001; 25.1% in 2001 vs 49.2% in 2022 in men, p<0.0001; NCEP-ATPIII criteria: 39.9% in 2005 vs 57.2% in 2022 in women, p<0.0001; 40.8% in 2005 vs 60.9% in 2022 in men, p<0.0001; IDF criteria: 43.9% in 2005 vs 59.3% in 2022 in women, p<0.001; 33.7% in 2005 vs 50.0% in 2022 in men, p<0.0001). People with combined metabolic abnormalities had higher glucose levels compared to those without combined metabolic abnormalities (HbA1c >58 mmol in men: 48.9% vs 36.9%; HbA1c >58 mmol in women: 53.3% vs 41.1%, p<0.0001). People with combined metabolic abnormalities were more often treated with adjunct therapies such as metformin, sodium-glucose transport protein 2 inhibitors and glucagon-like peptide-1 receptor agonists. In both men and women, the presence of combined metabolic abnormalities was strongly related to the presence of eye complications, peripheral neuropathy, chronic kidney disease and CVD, corrected for age, diabetes duration and HbA1c. CONCLUSIONS/INTERPRETATION Overweight, obesity and combined metabolic abnormalities are increasingly being identified in people living with type 1 diabetes, further accelerating the risk of microvascular and macrovascular complications. Early identification of the presence of combined metabolic abnormalities should enable therapeutic interventions to be modified towards multifactorial approaches, with attention to education on avoidance of overweight (e.g. dietary counselling) in addition to strict glycaemic control and intensification of use of antihypertensive agents and statins. Use of adjunct therapies in this population as a tool should be explored more thoroughly to reduce risk of complications.
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Affiliation(s)
- Astrid Lavens
- Health Services Research, Sciensano, Brussels, Belgium.
| | | | | | - Laurent Crenier
- Hôpital Universitaire de Bruxelles/Hôpital Erasme, Brussels, Belgium
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92
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Bellosta S, Corsini A. Drug interactions in cardiology: focus on statins and their combination with other lipid-lowering drugs. Expert Opin Drug Metab Toxicol 2024:1-9. [PMID: 39252198 DOI: 10.1080/17425255.2024.2402493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/12/2024] [Accepted: 09/05/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Statins are the primary therapeutic approach for treating hypercholesterolemia in hyperlipidemic high cardiovascular-risk patients, as stated by the recent European and American guidelines. However, in some patients, statin treatment is not sufficient to achieve the recommended plasma LDL-C levels, and the addition of a second hypolipidemic drug becomes mandatory. Concomitant administration of multiple medications may increase the risk of adverse events, potentially leading to statin-associated muscle or liver symptoms and non-adherence or discontinuation of statin therapy, such as in women. The addition of a second hypolipidemic drug (such as ezetimibe, anti-PCSK9 monoclonal antibodies, bempedoic acid, and inclisiran) may lead to drug-drug interactions (DDIs). The evaluation of the different pharmacokinetic profiles may improve and personalize the treatment. AREAS COVERED We aimed to give an update on the potential DDIs between statins and other hypolipidemic drugs currently used to treat high-risk hyperlipidemic patients. EXPERT OPINION It is fundamental to understand the risk associated with DDIs to manage better the addition of a concomitant hyperlipidemic drug to a statin-treated patient. Many health agencies have published specific guidelines for assessing DDIs, but these mainly apply to in vitro studies. New predictive approaches are being proposed and may help evaluate and manage DDIs.
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Affiliation(s)
- Stefano Bellosta
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Centro di Ricerca Coordinata sulle Interazioni Farmacologiche, Università degli Studi di Milano, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Centro di Ricerca Coordinata sulle Interazioni Farmacologiche, Università degli Studi di Milano, Milan, Italy
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93
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Li L, Lai J, Zhang J, Van Spall HGC, Thabane L, Lip GYH, Li G. Remnant cholesterol and risk of premature mortality: an analysis from a nationwide prospective cohort study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:543-551. [PMID: 38100387 DOI: 10.1093/ehjqcco/qcad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
AIMS To explore the relationship between remnant cholesterol (RC) and the risk of premature mortality as well as life expectancy in the general population. METHODS We included a total of 428 804 participants from the UK Biobank for analyses. Equivalent population percentiles approach based on the low-density lipoprotein cholesterol cut-off points was performed to categorize participants into three RC groups: low (with a mean RC of 0.34 mmol/L), moderate (0.53 mmol/L), and high (1.02 mmol/L). We used multivariable Cox proportional hazards models to evaluate the relationship between RC groups and the risk of premature mortality (defined as death before age 75 years). Life table methods were used to estimate life expectancy by RC groups. RESULTS During a median follow-up of 12.1 years (Q1-Q3 11.0-13.0), there were 23 693 all-cause premature deaths documented, with an incidence of 4.83 events per 1000 person-years [95% confidence interval (CI): 4.77-4.89]. Compared with the low RC group, the moderate RC group was associated with a 9% increased risk of all-cause premature mortality [hazard ratio (HR) = 1.09, 95% CI: 1.05-1.14], while the high RC group had an 11% higher risk (HR = 1.11, 95% CI: 1.07-1.16). At the age of 50 years, high RC group was associated with an average 2.2 lower years of life expectancy for females, and an average 0.1 lower years of life expectancy for males when compared with their counterparts in the low RC group. CONCLUSIONS Elevated RC was significantly related to an increased risk of premature mortality and a reduced life expectancy. Premature death in the general population would benefit from measurement to aid risk stratification and proactive management of RC to improve cardiovascular risk prevention efforts.
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Affiliation(s)
- Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Jun Lai
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, L8N 3Z5 ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, L8L 2X2 ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, L8S 4L8 ON, Canada
- Centre for Evaluation of Medicines, St Joseph's Health Care, Hamilton, L8N 4A6 ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2094, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou 510317, China
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, L8S 4L8 ON, Canada
- Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, L8N 4A6 ON, Canada
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94
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Pape DJ, Falls-Hubert KC, Merrill RA, Ahmed A, Qian Q, McGivney GR, Sobieralski P, Rauckhorst AJ, Yang L, Taylor EB. The mitochondrial dicarboxylate carrier mediates in vivo hepatic gluconeogenesis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.12.612761. [PMID: 39314408 PMCID: PMC11419125 DOI: 10.1101/2024.09.12.612761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Hepatic gluconeogenesis (GNG) is essential for maintaining euglycemia during prolonged fasting. However, GNG becomes pathologically elevated and drives chronic hyperglycemia in type 2 diabetes (T2D). Lactate/pyruvate is a major GNG substrate known to be imported into mitochondria for GNG. Yet, the subsequent mitochondrial carbon export mechanisms required to supply the extra-mitochondrial canonical GNG pathway have not been genetically delineated. Here, we evaluated the role of the mitochondrial dicarboxylate carrier (DiC) in mediating GNG from lactate/pyruvate. We generated liver-specific DiC knockout (DiC LivKO) mice. During lactate/pyruvate tolerance tests, DiC LivKO decreased plasma glucose excursion and 13 C-lactate/-pyruvate flux into hepatic and plasma glucose. In a Western diet (WD) feeding model of T2D, acute DiC LivKO after induction of obesity decreased lactate/pyruvate-driven GNG, hyperglycemia, and hyperinsulinemia. Our results show that mitochondrial carbon export through the DiC mediates GNG and that the DiC contributes to impaired glucose homeostasis in a mouse model of T2D.
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95
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Hyun SJ, Park S, Kang DO, Cho JR, Kim MW, Park JY, Park SH, Jeong MH. Three-year outcomes following non-ST-segment elevation myocardial infarction and new-generation drug-eluting stent implantation, stratified by patient age (under and over 75 years) and left ventricular ejection fraction: A prospective cohort study. Medicine (Baltimore) 2024; 103:e39606. [PMID: 39287301 PMCID: PMC11404945 DOI: 10.1097/md.0000000000039606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Due to limited published data, we investigated 3-year outcomes according to left ventricular ejection fraction (LVEF) in patients older and younger than 75 years with non-ST-segment elevation myocardial infarction (NSTEMI) who underwent successful newer-generation drug-eluting stent (DES) implantation. This research analyzed the data of 4558 patients (1032 older adults [≥75 years] and 3526 younger adults [<75 years]) from the Korea Acute MI Registry-NIH. We further divided the older group based on LVEF: heart failure (HF) with reduced EF (HFrEF, ≤40%, n = 196; group A), HF with mildly reduced EF (HFmrEF, 41-49%, n = 228; group B), and HF with preserved EF (HFpEF, ≥50%, n = 608; group C). Similarly, the younger group was divided into HFrEF (group D, n = 353), HFmrEF (group E, n = 577), and HFpEF (group F, n = 2596). The primary outcome was a composite of major adverse cardiac events (MACE) at 3 years, including all-cause death, recurrent MI, any repeat revascularization, or hospitalization for HF. MACE rates were highest in the HFrEF groups (A and D), followed by the HFmrEF groups (B and E), and lowest in the HFpEF groups (C and F) for both age groups. All-cause death, cardiac death (CD), all-cause death or MI, and hospitalization for HF rates were higher in group A than in groups B and C, and higher in group D than in groups E and F. Across all LVEF categories, MACE, all-cause death, CD, and non-CD, and all-cause death or MI rates were higher in the older group. This multicenter cohort study demonstrates that older patients have higher mortality rates compared to younger patients. Additionally, MACE rates were highest in the HFrEF group, followed by the HFmrEF group, and lowest in the HFpEF group across both age groups. Further research is needed to confirm these findings.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Department of Biomedical Laboratory Science, Honam University, Gwangju, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Su Jin Hyun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Min-Woong Kim
- Department of Cardiology, Changwon Hanmaeum Hospital, Hanyang University College of Medicine, Changwon, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Center, Gwangju Veterans Hospital, Gwangju, Republic of Korea
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Rodrigues KP, Aguilar BA, Sánchez-Delgado JC, da Veiga AC, Velasco TE, Chinellato NT, Dilarri ME, de Souza HCD. Chronic acetylcholinesterase inhibition reduces the effects of physical training on ventricular contractility and coronary bed reactivity in hypertensive rats. Sci Rep 2024; 14:21434. [PMID: 39271709 PMCID: PMC11399348 DOI: 10.1038/s41598-024-69387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
Systemic arterial hypertension is accompanied by autonomic impairments that, if not contained, promotes cardiac functional and morphological damages. Pyridostigmine bromide (PYR) treatment results in positive effects on autonomic control and beneficial cardiac remodeling. These findings were also observed after aerobic physical training (APT). However, little is known about PYR effects on left ventricular contractility, mainly when it is combined with APT. We aimed to investigate the effects of chronic acetylcholinesterase inhibition on cardiac autonomic tone balance, coronary bed reactivity, and left ventricular contractility in spontaneously hypertensive rats (SHR) submitted to APT. Male SHR (18 weeks) were divided into two groups (N = 16): untrained and submitted to APT for 14 weeks (18th to 32nd week). Half of each group was treated with PYR (15 mg/kg/day) for two weeks (31st to 32nd week). The experimental protocol consisted of recording hemodynamic parameters, double autonomic blockade with atropine and propranolol, and assessment of coronary bed reactivity and ventricular contractility in isolated hearts using the Langendorff technique. PYR and APT reduced blood pressure, heart rate, and sympathetic influence on the heart. The Langendorff technique showed that APT increased coronary perfusion pressure and left ventricle contractility in response to coronary flow and β-agonist administration. However, treatment with PYR annulled the effects of APT. In conclusion, although chronic treatment with PYR reduces cardiac sympathetic tonic influence, it does not favor coronary bed reactivity and cardiac contractility gains. PYR treatment in the trained SHR group nullified the coronary vascular reactivity and cardiac contractility gains.
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Affiliation(s)
- Karine Pereira Rodrigues
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Bruno Augusto Aguilar
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | | | - Ana Catarine da Veiga
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Tallys Eduardo Velasco
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Naiara Teixeira Chinellato
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Maria Eduarda Dilarri
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Health Science, Ribeirão Preto Medical School of the University of São Paulo, Av. Bandeirantes, 3900-Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
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97
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Lv B, Wang Z, Suo Y, Shao S, Yuan M, Zhang Y, Wang L, Li G, Bao Q. IL-2Rα is a potential biomarker for heart failure diagnosis of patients with end-stage renal disease and haemodialysis. ESC Heart Fail 2024. [PMID: 39263807 DOI: 10.1002/ehf2.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 08/05/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024] Open
Abstract
AIMS Heart failure (HF) is a leading cause of mortality in patients with end-stage renal disease (ESRD) undergoing haemodialysis. Identifying novel predictors of HF is essential for improving diagnostic precision and enhancing patient outcomes. METHODS This study included 68 participants from the Haemodialysis Centre at the Second Hospital of Tianjin Medical University. Clinical characteristics and echocardiographic data were collected and analysed. We measured the plasma of 44 cytokines to investigate their correlation with cardiac function and their potential as HF biomarkers. RESULTS In the HF with reduced ejection fraction (HFrEF) group, the levels of several cytokines, including stem cell growth factor-β (SCGF-β), C-X-C motif chemokine 10 (CXCL10), interleukin-1α (IL-1α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-16 (IL-16), interleukin-1 receptor antagonist protein (IL-1Ra), interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), leukaemia inhibitory factor (LIF), C-C motif chemokine 3 (CCL3), interleukin-10 (IL-10), interleukin-2 receptor subunit alpha (IL-2Rα), tumour necrosis factor ligand superfamily member 10 (TNFSF10), macrophage colony-stimulating factor (M-CSF), granulocyte colony-stimulating factor (G-CSF) and stem cell factor (SCF), were significantly increased, while C-C motif chemokine 11 (CCL11)/eotaxin levels were decreased compared with those in the control group (P < 0.05). Receiver operating characteristic (ROC) curve analysis highlighted TNF-α [area under the ROC curve (AUC) = 0.85, odds ratio (OR) = 1.080, 95% confidence interval (CI): 1.033-1.128, P = 0.001], IFN-γ (AUC = 0.84, OR = 1.836, 95% CI: 1.289-2.615, P = 0.003) and IL-2Rα (AUC = 0.82, OR = 1.022, 95% CI: 1.009-1.035, P = 0.001) as excellent predictors for HFrEF in haemodialysis patients with ESRD, and they outperformed soluble suppression of tumourigenicity-2 (sST2) but slightly underperformed N-terminal pro-brain natriuretic peptide (NT-proBNP). IL-2Rα (AUC = 0.77, OR = 1.018, 95% CI: 1.007-1.030, P = 0.001) demonstrated superior diagnostic capabilities when distinguishing patients with HF with left ventricular ejection fraction (LVEF) <50% from controls. IL-2Rα emerged as a robust biomarker for left ventricular HF, while TNF-α (AUC = 0.89, OR = 1.140, 95% CI: 1.039-1.250, P = 0.005) showed promise in assessing HF severity in patients with ESRD. IL-2Rα (AUC = 0.80, OR = 1.017, 95% CI: 1.007-1.027, P = 0.001) also significantly predicted right ventricular systolic dysfunction. During a median follow-up of 14 months, 10 patients (14.7%) experienced all-cause mortality. Multivariate Cox regression analysis confirmed that plasma IL-2Rα was an independent predictor of all-cause death [hazard ratio (HR): 1.010, 95% CI: 1.001-1.020, P = 0.039] after adjusting for other variables. CONCLUSIONS This study underscores the potential of IL-2Rα as a valuable biomarker for HF diagnosis and management in haemodialysis patients with ESRD and contributes to our understanding of this high-risk population.
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Affiliation(s)
- Bingya Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhe Wang
- Department of Kidney Disease and Blood Purification Centre, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ya Suo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuai Shao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Meng Yuan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yue Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lihua Wang
- Department of Kidney Disease and Blood Purification Centre, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qiankun Bao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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98
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Qamar U, Naeem F, Maqsood MT, Khan MZ, Imtiaz Z, Saeed F, Gupta N, Brohi FZ, Mkpozi C, Sattar Y. Efficacy and safety of ticagrelor monotherapy following a brief DAPT vs. prolonged 12-month DAPT in ACS patients post-PCI: a meta-analysis of RCTs. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03747-w. [PMID: 39264445 DOI: 10.1007/s00228-024-03747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND As per current guidelines, acute coronary syndrome (ACS) patients who undergo percutaneous coronary intervention (PCI) should be started on dual antiplatelet therapy (DAPT) for a period of 12 months. OBJECTIVE To assess the efficacy and safety of brief DAPT (up to 3 months) succeeded by ticagrelor monotherapy compared with a 12-month DAPT in ACS patients following PCI. METHODS We systematically searched Cochrane, Embase, and PubMed to find relevant randomized clinical trials. Examined outcomes included the incidence of major adverse cerebrovascular and cardiovascular events (MACCE), bleeding events, and the composite incidence of net adverse clinical events (NACE). RESULTS Our primary analysis included 21,927 ACS patients from six RCTs. Our pooled results indicate that following PCI in individuals with ACS, brief DAPT followed by ticagrelor did not increase the risk of MACCE (OR 0.92, 95% CI 0.79-1.07) but significantly reduced the risk of minor or major bleeding (OR 0.52, 95% CI 0.44-0.62) and NACE (OR 0.71, 95% CI 0.59-0.86) compared with a long-term DAPT within a follow-up of 12 months. CONCLUSION Brief DAPT followed by ticagrelor monotherapy is superior to a 12-month DAPT in offering a net clinical advantage in ACS patients following PCI.
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Affiliation(s)
- Usama Qamar
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Farhan Naeem
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Maleeka Zamurad Khan
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Zeeshan Imtiaz
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Fatima Saeed
- Department of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Neelesh Gupta
- Department of Cardiology, Kirk Kerkorian School of Medicine at the, University of Nevada, Las Vegas, USA
| | | | - Celestine Mkpozi
- Department of Internal Medicine and Department of Cardiology, West Virginia University, 1 Medical Ctr Dr., Morgantown, WV, 26506, USA
| | - Yasar Sattar
- Department of Internal Medicine and Department of Cardiology, West Virginia University, 1 Medical Ctr Dr., Morgantown, WV, 26506, USA.
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99
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Saenz-Pipaon G, Cenarro A, Zazpe J, Goñi-Oloriz M, Martinez-Aguilar E, Machado FJD, Marchese FP, Orbe J, López-Andrés N, Civeira F, Paramo JA, Lara-Astiaso D, Roncal C. Novel protocol for the transcriptomic analysis of endothelial extracellular vesicles in atherosclerosis. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(24)00079-2. [PMID: 39271430 DOI: 10.1016/j.arteri.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/16/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Despite the key role of the endothelium in atherosclerosis, there are no direct techniques for its analysis. The study of extracellular vesicles of endothelial origin (EEVs), might lead to the identification of molecular signatures and early biomarkers of atherosclerosis. The aim of this work was to set up the methods for EEVs separation and transcriptomic analysis. METHODS We adapted an antibody-magnetic-bead based immunocapture protocol for plasma EEVs separation from control (G1), subclinical atherosclerosis (G2) and peripheral artery disease subjects (PAD) (G3), and modified an ultra-low input RNASeq method (n=5/group). By bioinformatics analysis we compared the transcriptome of plasma EEVs with that of human aortic endothelial cells (TeloHAECs), and then, searched for differentially expressed genes (DEG) among EEVs of G1, G2 and G3. From those DEG, UCP2 was selected for further validation in plasma EVs (qPCR), and in vitro, in stimulated TeloHAECs (IL-1β, TNFα, oxLDL and hypoxia). RESULTS The RNASeq analysis of plasma EEVs rendered 1667 genes enriched in transcripts expressed by TeloHAECs (NES: 1.93, p adjust=1.4e-73). One hundred seventy DEGs were identified between G2 vs G1, and 180 between G3 vs G1, of which 17 were similarly expressed in G2 and G3 vs control, including UCP2. IL-1β and TNFα (10ng/mL, p<0.05), hypoxia (1% O2, p=0.05) and oxLDL (100μg/mL, p=0.055) reduced UCP2 expression in TeloHAECs. CONCLUSIONS We set up a protocol for EEVs separation and sequencing that might be useful for the identification of early markers of endothelial dysfunction in atherosclerosis.
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Affiliation(s)
- Goren Saenz-Pipaon
- Laboratorio de Aterotrombosis, Programa de Enfermedades Cardiovasculares, Cima Universidad de Navarra, Pamplona, Spain; IdiSNA, Pamplona, Spain
| | - Ana Cenarro
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain; CIBERCV, Madrid, Spain
| | - Jon Zazpe
- IdiSNA, Pamplona, Spain; Plataforma de Genómica, Cima Universidad de Navarra, Pamplona, Spain
| | - Miriam Goñi-Oloriz
- IdiSNA, Pamplona, Spain; Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Spain
| | - Esther Martinez-Aguilar
- IdiSNA, Pamplona, Spain; Departamento de Angiología y Cirugía Vascular, Hospital Universitario de Navarra, Pamplona, Spain
| | - Florencio J D Machado
- Laboratorio de Aterotrombosis, Programa de Enfermedades Cardiovasculares, Cima Universidad de Navarra, Pamplona, Spain
| | - Francesco P Marchese
- IdiSNA, Pamplona, Spain; Plataforma de Genómica, Cima Universidad de Navarra, Pamplona, Spain
| | - Josune Orbe
- Laboratorio de Aterotrombosis, Programa de Enfermedades Cardiovasculares, Cima Universidad de Navarra, Pamplona, Spain; IdiSNA, Pamplona, Spain; Ricors Ictus, Madrid, Spain
| | - Natalia López-Andrés
- IdiSNA, Pamplona, Spain; Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Spain
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain; CIBERCV, Madrid, Spain
| | - Jose A Paramo
- Laboratorio de Aterotrombosis, Programa de Enfermedades Cardiovasculares, Cima Universidad de Navarra, Pamplona, Spain; IdiSNA, Pamplona, Spain; CIBERCV, Madrid, Spain; Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Carmen Roncal
- Laboratorio de Aterotrombosis, Programa de Enfermedades Cardiovasculares, Cima Universidad de Navarra, Pamplona, Spain; IdiSNA, Pamplona, Spain; CIBERCV, Madrid, Spain.
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Luo Z, Li Y, Xie M, Yi S, Xu S, Luo J. Soluble suppression of tumorigenicity 2 associated with contrast-induced acute kidney injury in patients with STEMI. Int Urol Nephrol 2024:10.1007/s11255-024-04204-4. [PMID: 39264493 DOI: 10.1007/s11255-024-04204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 09/09/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is associated with AKI. However, the relationship between sST2 and CI-AKI is unclear. This study aimed to investigate the relationship between sST2 and CI-AKI in patients with STEMI. METHODS This was a single-center retrospective observational study. Patients diagnosed with STEMI in the Yichun People's Hospital from February 2020 to May 2024 were continuously included. CI-AKI was defined as an increase in serum creatinine of at least 50% or 0.3 mg/dL from baseline within 48-72 h after contrast exposure. RESULTS The incidence of CI-AKI after PCI was 12.4% (98/791). Univariate analysis showed that age, fasting plasma glucose, diabetes mellitus, Killip class, left ventricular ejection fraction, estimated glomerular filtration rate, high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and sST2 were associated with CI-AKI. The above factors were included in a multivariate analysis, which showed that sST2 was an independent factor for CI-AKI after PCI. The restricted cubic splines showed a nonlinear dose-response relationship between sST2 and CI-AKI (P < 0.001). The integration of the sST2 could significantly improve the ability of the model to identify CI-AKI (NRI 0.681, 95% CI 0.474-0.887; IDI 0.063, 95% CI 0.038-0.099). CONCLUSION Elevated sST2 is an independent risk factor for CI-AKI after PCI in patients with STEMI. Integration of sST2 can significantly improve the risk model for CI-AKI.
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Affiliation(s)
- Ziyun Luo
- Department of Nephrology, Yichun People's Hospital, Yichun, 336000, Jiangxi, China
| | - Yong Li
- Department of Cardiology, The First People's Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China
| | - Minjuan Xie
- Department of Medicine, Yichun University, Yichun, 336000, Jiangxi, China
| | - Song Yi
- Department of Cardiology, Yichun People's Hospital, Yichun, 336000, Jiangxi, China
| | - Shizhang Xu
- Department of Nephrology, Yichun People's Hospital, Yichun, 336000, Jiangxi, China
| | - Jun Luo
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
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