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Cai Y, Zhang G, Liang J, Jing Z, Zhang R, Lv L, Dang X. Causal Relationships Between Osteoarthritis and Senile Central Nerve System Dysfunction: A Bidirectional Two-Sample Mendelian Randomization Study. Front Aging Neurosci 2022; 13:793023. [PMID: 35317304 PMCID: PMC8934417 DOI: 10.3389/fnagi.2021.793023] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background The relationship between osteoarthritis (OA) and senile central nervous system dysfunctions (CNSDs), including Parkinson’s disease (PD), Alzheimer’s disease (AD), and ischemic stroke (IS) has gradually attracted attention. At present, the causal relationship between OA and CNSD remains unclear. The aim of this study was to assess the causal effects of CNSD and OA using Mendelian randomization (MR). Methods Genome-wide association study summary data for CNSD and OA were obtained. Single-nucleotide polymorphisms (SNPs) were selected as instrumental variables (IVs), and significant (P < 5.0 × 10–8) and independent (r2 < 0.1) SNPs were extracted for bidirectional MR analysis. Inverse variance weighted (IVW) was used to assess these causal relationships. The results are reported as odds ratios (ORs). Subsequently, heterogeneity was tested using the Cochran’s Q test, pleiotropy was tested using the MR-Egger intercept, and sensitivity analysis was performed using the leave-one-out sensitivity test. Results The MR results of the causal relationship between PD and OA showed that there was a positive causal effect of OA on PD, which was estimated by IVW (OR = 1.194, 95%CI = 1.036, 1.378; P = 0.0144). Moreover, the MR analysis by IVW also showed that IS had a positive effect on OA (OR = 1.033, 95%CI = 1.002, 1.066; P = 0.0355). These results are reliable and stable, as confirmed by sensitivity tests. Conclusion This study showed a positive causal effect of OA on PD, but there was a null effect of OA on AD and OA on IS.
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Donis N, Jiang Z, D'Emal C, Hulin A, Debuisson M, Dulgheru R, Nguyen ML, Postolache A, Lallemand F, Coucke P, Martinive P, Herzog M, Pamart D, Terrell J, Pincemail J, Drion P, Delvenne P, Nchimi A, Lancellotti P, Oury C. Differential Biological Effects of Dietary Lipids and Irradiation on the Aorta, Aortic Valve, and the Mitral Valve. Front Cardiovasc Med 2022; 9:839720. [PMID: 35295264 PMCID: PMC8918952 DOI: 10.3389/fcvm.2022.839720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/24/2022] [Indexed: 01/12/2023] Open
Abstract
Aims Dietary cholesterol and palmitic acid are risk factors for cardiovascular diseases (CVDs) affecting the arteries and the heart valves. The ionizing radiation that is frequently used as an anticancer treatment promotes CVD. The specific pathophysiology of these distinct disease manifestations is poorly understood. We, therefore, studied the biological effects of these dietary lipids and their cardiac irradiation on the arteries and the heart valves in the rabbit models of CVD. Methods and Results Cholesterol-enriched diet led to the thickening of the aortic wall and the aortic valve leaflets, immune cell infiltration in the aorta, mitral and aortic valves, as well as aortic valve calcification. Numerous cells expressing α-smooth muscle actin were detected in both the mitral and aortic valves. Lard-enriched diet induced massive aorta and aortic valve calcification, with no detectable immune cell infiltration. The addition of cardiac irradiation to the cholesterol diet yielded more calcification and more immune cell infiltrates in the atheroma and the aortic valve than cholesterol alone. RNA sequencing (RNAseq) analyses of aorta and heart valves revealed that a cholesterol-enriched diet mainly triggered inflammation-related biological processes in the aorta, aortic and mitral valves, which was further enhanced by cardiac irradiation. Lard-enriched diet rather affected calcification- and muscle-related processes in the aorta and aortic valve, respectively. Neutrophil count and systemic levels of platelet factor 4 and ent-8-iso-15(S)-PGF2α were identified as early biomarkers of cholesterol-induced tissue alterations, while cardiac irradiation resulted in elevated levels of circulating nucleosomes. Conclusion Dietary cholesterol, palmitic acid, and cardiac irradiation combined with a cholesterol-rich diet led to the development of distinct vascular and valvular lesions and changes in the circulating biomarkers. Hence, our study highlights unprecedented specificities related to common risk factors that underlie CVD.
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Affiliation(s)
- Nathalie Donis
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Zheshen Jiang
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Céline D'Emal
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Alexia Hulin
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Margaux Debuisson
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Raluca Dulgheru
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Mai-Linh Nguyen
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Adriana Postolache
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | | | | | - Philippe Martinive
- Department Radiation Oncology, Institut Jules Bordet, Université Libre Bruxelles, Brussels, Belgium
| | - Marielle Herzog
- Belgian Volition Société à Responsabilité Limitée, Gembloux, Belgium
| | - Dorian Pamart
- Belgian Volition Société à Responsabilité Limitée, Gembloux, Belgium
| | - Jason Terrell
- Department of Oncology and Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, TX, United States
- Volition America, Austin, TX, United States
| | | | - Pierre Drion
- Experimental Surgery Unit, Centre de Recherche du Département de Chrirurgie, Groupe Interdisciplinaire de Géno-Protéomique Appliquée Institute, University of Liège, Liège, Belgium
| | - Philippe Delvenne
- Department of Pathology, Centre Hospitalier Universitaire of Liège, Liège, Belgium
- Laboratory of Experimental Pathology, GIGA Institute, University of Liège, Liège, Belgium
| | - Alain Nchimi
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy
- Anthea Hospital, Bari, Italy
| | - Cécile Oury
- Laboratory of Cardiology, Department of Cardiology, GIGA Institute, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
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Canoy D, Harvey NC, Prieto-Alhambra D, Cooper C, Meyer HE, Åsvold BO, Nazarzadeh M, Rahimi K. Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions. Osteoporos Int 2022; 33:315-326. [PMID: 34642814 PMCID: PMC8813726 DOI: 10.1007/s00198-021-06190-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022]
Abstract
Blood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomised trials is insufficient to establish causal associations for blood pressure and use of blood pressure-lowering drugs with bone health outcomes, particularly with the risks of osteoporosis and fractures. The availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches provide opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical techniques, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on the risks of low bone mineral density and fractures. As elevated blood pressure is highly prevalent and blood pressure-lowering drugs are widely prescribed, even small effects of these exposures on bone health outcomes could be important at a population level.
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Affiliation(s)
- D Canoy
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK.
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - N C Harvey
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Cooper
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H E Meyer
- Department of Community Medicine and Global Health, Faculty of Medicine, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - B O Åsvold
- Department of Endocrinology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - M Nazarzadeh
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
| | - K Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Strange GA, Stewart S, Curzen N, Ray S, Kendall S, Braidley P, Pearce K, Pessotto R, Playford D, Gray HH. Uncovering the treatable burden of severe aortic stenosis in the UK. Open Heart 2022; 9:e001783. [PMID: 35082136 PMCID: PMC8739674 DOI: 10.1136/openhrt-2021-001783] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To estimate the population prevalence and treatable burden of severe aortic stenosis (AS) in the UK. METHODS We adapted a contemporary model of the population profile of symptomatic and asymptomatic severe AS in Europe and North America to estimate the number of people aged ≥55 years in the UK who might benefit from surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). RESULTS With a point prevalence of 1.48%, we estimate that 291 448 men and women aged ≥55 years in the UK had severe AS in 2019. Of these, 68.3% (199 059, 95% CI 1 77 201 to 221 355 people) would have been symptomatic and, therefore, more readily treated according to their surgical risk profile; the remaining 31.7% of cases (92 389, 95% CI 70 093 to 144 247) being asymptomatic. Based on historical patterns of intervention, 58.4% (116 251, 95% CI 106 895 to 1 25 606) of the 199 059 symptomatic cases would qualify for SAVR, with 7208 (95% CI 7091 to 7234) being assessed as being in a high, preoperative surgical risk category. Among the remaining 41.6% (82 809, 95% CI 73 453 to 92 164) of cases potentially unsuitable for SAVR, an estimated 61.7% (51 093, 95% CI 34 780 to 67 655) might be suitable for TAVI. We estimate that 172 859 out of 291 448 prevalent cases of severe AS (59.3%) will subsequently die within 5 years without proactive management. CONCLUSIONS These data suggest a high burden of severe AS in the UK requiring surgical or transcatheter intervention that challenges the ongoing capacity of the National Health Service to meet the needs of those affected.
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Affiliation(s)
- Geoffrey A Strange
- School of Medicine, University of Notre Dame, Freemantle, Western Australia, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simon Stewart
- Centre for Cardiopulmonary Health, Torrens University Australia, Adelaide, South Australia, Australia
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Nick Curzen
- Consultant Cardiologist, Faculty of Medicine, University of Southampton & Wessex Cardiothoracic Unit, University Hospital Southampton NHS Trust, Southampton, UK
| | - Simon Ray
- Consultant Cardiologist, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Simon Kendall
- President, Society of Cardiothoracic Surgeons of Great Britain & Ireland, UK
| | - Peter Braidley
- Consultant Cardiothoracic Surgeon, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Keith Pearce
- Consultant Cardiac Scientist, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Renzo Pessotto
- Consultant Cardiac Surgeon, Royal Infirmary, Edinburgh, UK
| | - David Playford
- School of Medicine, University of Notre Dame, Freemantle, Western Australia, Australia
| | - Huon H Gray
- Emeritus National Clinical Director for Heart Disease, NHS England, UK
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Hu H, Mei J, Lin M, Wu X, Lin H, Chen G. The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2022; 13:996863. [PMID: 36568121 PMCID: PMC9768473 DOI: 10.3389/fendo.2022.996863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Many observational studies have shown that obesity strongly affects skin and soft tissue infections (SSTIs). However, whether a causal genetic relationship exists between obesity and SSTIs is unclear. METHODS A two-sample Mendelian randomization (MR) study was used to explore whether obesity is causally associated with SSTIs using a publicly released genome-wide association study (GWAS). An inverse-variance weighted (IVW) analysis was used as the primary analysis, and the results are reported as the odds ratios (ORs). Heterogeneity was tested using Cochran's Q test and the I2 statistic, and horizontal pleiotropy was tested using the MR-Egger intercept and MR pleiotropy residual sum and outlier (MR-PRESSO). RESULTS The results of the MR analysis showed a positive effect of BMI on SSTIs (OR 1.544, 95% CI 1.399-1.704, P= 5.86 × 10-18). After adjusting for the effect of type 2 diabetes (T2D) and peripheral vascular disease (PVD), the positive effect still existed. Then, we further assessed the effect of BMI on different types of SSTIs. The results showed that BMI caused an increased risk of impetigo, cutaneous abscess, furuncle and carbuncle, cellulitis, pilonidal cyst, and other local infections of skin and subcutaneous tissues, except for acute lymphadenitis. However, the associations disappeared after adjusting for the effect of T2D and PVD, and the associations between BMI and impetigo or cellulitis disappeared. Finally, we assessed the effects of several obesity-related characteristics on SSTIs. Waist circumference, hip circumference, body fat percentage, and whole-body fat mass, excluding waist-to-hip ratio, had a causal effect on an increased risk of SSTIs. However, the associations disappeared after adjusting for the effect of BMI. CONCLUSION This study found that obesity had a positive causal effect on SSTIs. Reasonable weight control is a possible way to reduce the occurrence of SSTIs, especially in patients undergoing surgery.
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Affiliation(s)
- Hongxin Hu
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Jian Mei
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Mei Lin
- Department of Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xianwei Wu
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Haibin Lin
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Guoli Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Putian University, Putian, China
- *Correspondence: Guoli Chen,
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Apolipoproteins and lipoprotein(a) as factors modulating fibrin clot properties in patients with severe aortic stenosis. Atherosclerosis 2022; 344:49-56. [DOI: 10.1016/j.atherosclerosis.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 01/29/2023]
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Li X, Peng S, Guan B, Chen S, Zhou G, Wei Y, Gong C, Xu J, Lu X, Zhang X, Liu S. Genetically Determined Inflammatory Biomarkers and the Risk of Heart Failure: A Mendelian Randomization Study. Front Cardiovasc Med 2021; 8:734400. [PMID: 34881299 PMCID: PMC8645870 DOI: 10.3389/fcvm.2021.734400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Positive associations between inflammatory biomarkers and the risk of heart failure (HF) have been reported in conventional observational studies. However, the causal effects of inflammatory biomarkers on HF have not been fully elucidated. We conducted a Mendelian randomization (MR) study to examine the possible etiological roles of inflammatory biomarkers in HF. Methods: Summary statistical data for the associations between single nucleotide polymorphisms (SNPs) and C-reactive protein (CRP), fibrinogen, and components of the interleukin-1 (IL-1)-interleukin-6 (IL-6) inflammatory signaling pathway, namely, interleukin-1β (IL-1β), IL-1 receptor antagonist (IL-1ra), IL-6, and soluble IL-6 receptor (sIL-6r), were obtained from genome-wide association studies (GWASs) for individuals of European descent. The GWAS dataset of 977,323 participants of European ancestry, which included 47,309 HF cases and 930,014 controls, was collected to identify genetic variants underlying HF. A two-sample Mendelian randomization framework was implemented to examine the causality of the association between these inflammatory biomarkers and HF. Results: Our MR analyses found that genetically determined CRP and fibrinogen were not causally associated with HF risk (odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.84-1.02, p = 0.15; OR = 0.94, 95% CI = 0.55-1.58, p = 0.80, respectively). These findings remained consistent using different Mendelian randomization methods and in sensitivity analyses. For the IL-1-IL-6 pathway, causal estimates for IL-6 (OR = 0.86, 95% CI 0.81-0.91, p < 0.001), but not for IL-1β, IL-1ra, or sIL-6r, were significant. However, the association between genetically determined IL-6 and HF risk became non-significant after excluding SNPs with potential pleiotropy (OR = 0.89, 95% CI = 0.77-1.03, p = 0.12). Conclusion: Our study did not identify convincing evidence to support that CRP and fibrinogen, together with their upstream IL-1-IL-6 signaling pathway, were causally associated with HF risk.
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Affiliation(s)
- Xintao Li
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi Peng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Guan
- Geriatric Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Gong
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Evaluating Medical Therapy for Calcific Aortic Stenosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:2354-2376. [PMID: 34857095 DOI: 10.1016/j.jacc.2021.09.1367] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Despite numerous promising therapeutic targets, there are no proven medical treatments for calcific aortic stenosis (AS). Multiple stakeholders need to come together and several scientific, operational, and trial design challenges must be addressed to capitalize on the recent and emerging mechanistic insights into this prevalent heart valve disease. This review briefly discusses the pathobiology and most promising pharmacologic targets, screening, diagnosis and progression of AS, identification of subgroups that should be targeted in clinical trials, and the need to elicit the patient voice earlier rather than later in clinical trial design and implementation. Potential trial end points and tools for assessment and approaches to implementation and design of clinical trials are reviewed. The efficiencies and advantages offered by a clinical trial network and platform trial approach are highlighted. The objective is to provide practical guidance that will facilitate a series of trials to identify effective medical therapies for AS resulting in expansion of therapeutic options to complement mechanical solutions for late-stage disease.
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Abstract
PURPOSE OF REVIEW Degenerative aortic stenosis (AS) is one of the most prevalent heart valve diseases in the adult population. The understanding of AS pathophysiology and involved risk factors have recently undergone a great advance, with low-density lipoprotein cholesterol (LDL-C), lipoprotein (a) [Lp(a)] and other clinical conditions taking on a relevant role. Although little is known about the prevention of AS, we can progressively find more evidence of the possible use of drugs to control risk factors as tools that may delay the progression to severe AS and aortic valve replacement. RECENT FINDINGS Several factors have shown to be solid predictors of the development of AS. Mendelian randomization and observational studies on risk factors specifically lipid factors, such as hypercholesterolemia, Lp(a), proprotein convertase subtilisin/kexin type 9 and hypertension have provided meaningful new information. The SAFEHEART study has significantly contributed to define the role of LDL-C and Lp(a) in AS. SUMMARY In this review we discuss the interrelationship of dyslipidemia, especially hypercholesterolemia and Lp(a) in the development and prognosis of valvular AS. New imaging tools may contribute to its early detection. Future studies with proprotein convertase subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a) might contribute to delay AS development.
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Affiliation(s)
- Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
| | - Leopoldo Pérez de Isla
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid
| | - Lina Badimón
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
- Cardiovascular Program - ICCC, Institut de Recerca del Hospital Santa Creu i Sant Pau, IIB Sant Pau, Ciber CV, Barcelona, Spain
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Björnsson E, Thorgeirsson G, Helgadóttir A, Thorleifsson G, Sveinbjörnsson G, Kristmundsdóttir S, Jónsson H, Jónasdóttir A, Jónasdóttir Á, Sigurðsson Á, Guðnason T, Ólafsson Í, Sigurðsson EL, Sigurðardóttir Ó, Viðarsson B, Baldvinsson M, Bjarnason R, Danielsen R, Matthíasson SE, Thórarinsson BL, Grétarsdóttir S, Steinthórsdóttir V, Halldórsson BV, Andersen K, Arnar DO, Jónsdóttir I, Guðbjartsson DF, Hólm H, Thorsteinsdóttir U, Sulem P, Stefánsson K. Large-Scale Screening for Monogenic and Clinically Defined Familial Hypercholesterolemia in Iceland. Arterioscler Thromb Vasc Biol 2021; 41:2616-2628. [PMID: 34407635 PMCID: PMC8454500 DOI: 10.1161/atvbaha.120.315904] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023]
Abstract
Objective: Familial hypercholesterolemia (FH) is traditionally defined as a monogenic disease characterized by severely elevated LDL-C (low-density lipoprotein cholesterol) levels. In practice, FH is commonly a clinical diagnosis without confirmation of a causative mutation. In this study, we sought to characterize and compare monogenic and clinically defined FH in a large sample of Icelanders. Approach and Results: We whole-genome sequenced 49 962 Icelanders and imputed the identified variants into an overall sample of 166 281 chip-genotyped Icelanders. We identified 20 FH mutations in LDLR, APOB, and PCSK9 with combined prevalence of 1 in 836. Monogenic FH was associated with severely elevated LDL-C levels and increased risk of premature coronary disease, aortic valve stenosis, and high burden of coronary atherosclerosis. We used a modified version of the Dutch Lipid Clinic Network criteria to screen for the clinical FH phenotype among living adult participants (N=79 058). Clinical FH was found in 2.2% of participants, of whom only 5.2% had monogenic FH. Mutation-negative clinical FH has a strong polygenic basis. Both individuals with monogenic FH and individuals with mutation-negative clinical FH were markedly undertreated with cholesterol-lowering medications and only a minority attained an LDL-C target of <2.6 mmol/L (<100 mg/dL; 11.0% and 24.9%, respectively) or <1.8 mmol/L (<70 mg/dL; 0.0% and 5.2%, respectively), as recommended for primary prevention by European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines. Conclusions: Clinically defined FH is a relatively common phenotype that is explained by monogenic FH in only a minority of cases. Both monogenic and clinical FH confer high cardiovascular risk but are markedly undertreated.
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Affiliation(s)
- Eythór Björnsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Department of Internal Medicine (E.B.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Guðmundur Thorgeirsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Anna Helgadóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Guðmar Thorleifsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Garðar Sveinbjörnsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Snaedís Kristmundsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Hákon Jónsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Aðalbjörg Jónasdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Áslaug Jónasdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Ásgeir Sigurðsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | | | - Ísleifur Ólafsson
- Department of Clinical Biochemistry (I.O.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Emil L. Sigurðsson
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Development Centre for the Primary Care, Reykjavík, Iceland (E.L.S.)
| | | | - Brynjar Viðarsson
- Department of Hematology (B.V.), Landspítali-The National University Hospital of Iceland, Reykjavík
- The Laboratory in Mjódd, Reykjavík, Iceland (B.V.)
| | | | - Ragnar Bjarnason
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Children’s Medical Center (R.B.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Ragnar Danielsen
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | | | - Björn L. Thórarinsson
- Department of Neurology (B.L.T.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Sólveig Grétarsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Valgerður Steinthórsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Bjarni V. Halldórsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Karl Andersen
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Davíð O. Arnar
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
- Division of Cardiology, Department of Internal Medicine (G. Thorgeirsson, R.D., K.A., D.O.A.), Landspítali-The National University Hospital of Iceland, Reykjavík
| | - Ingileif Jónsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
| | - Daníel F. Guðbjartsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- School of Engineering and Natural Sciences, University of Iceland, Reykjavík (D.F.G.)
| | - Hilma Hólm
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Unnur Thorsteinsdóttir
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
| | - Patrick Sulem
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
| | - Kári Stefánsson
- deCODE genetics/Amgen, Inc, Reykjavík, Iceland (E.B., G. Thorgeirsson, A.H., G. Thorleifsson, G.S., S.K., H.J., Aðalbjörg Jónasdóttir, Áslaug Jónasdóttir, A.S., S.G., V.S., B.V.H., D.O.A., I.J., D.F.G., H.H., U.T., P.S., K.S.)
- Faculty of Medicine, University of Iceland, Reykjavík (E.B., E.L.S., R.B., K.A., D.O.A., I.J., U.T., K.S.)
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Age at Natural Menopause and Blood Pressure Traits: Mendelian Randomization Study. J Clin Med 2021; 10:jcm10194299. [PMID: 34640315 PMCID: PMC8509463 DOI: 10.3390/jcm10194299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 01/10/2023] Open
Abstract
Observational studies suggest that early onset of menopause is associated with increased risk of hypertension. Whether this association is causal or due to residual confounding and/or reverse causation remains undetermined. We aimed to evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure traits in Caucasian women. A cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from the CoLaus and Rotterdam studies. Regression models were built with observational data to study the associations of ANM with systolic and diastolic blood pressure (SBP/DBP) and hypertension. One-sample MR analysis was performed by calculating a genetic risk score of 54 ANM-related variants, previously identified in a genome-wide association study (GWAS) on ANM. In the two-sample MR analysis we used the estimates from the ANM-GWAS and association estimates from 168,575 women of the UK Biobank to evaluate ANM-related variants and their causal association with SBP and DBP. Pooled analysis from both cohorts showed that a one-year delay in menopause onset was associated with 2% (95% CI 0; 4) increased odds of having hypertension, and that early menopause was associated with lower DBP (β = −1.31, 95% CI −2.43; −0.18). While one-sample MR did not show a causal association between ANM and blood pressure traits, the two-sample MR showed a positive causal association of ANM with SBP; the last was driven by genes related to DNA damage repair. The present study does not support the hypothesis that early onset of menopause is associated with higher blood pressure. Our results suggest different ANM-related genetic pathways could differently impact blood pressure.
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Stewart S, Chan YK, Playford D, Strange GA. Incident aortic stenosis in 49 449 men and 42 229 women investigated with routine echocardiography. Heart 2021; 108:875-881. [PMID: 34433635 DOI: 10.1136/heartjnl-2021-319697] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We addressed the paucity of data describing the characteristics and consequences of incident aortic stenosis (AS). METHODS Adults undergoing echocardiography with a native aortic valve (AV) and no AS were studied. Subsequent age-specific and sex-specific incidence of AS were derived from echocardiograms conducted a median of 2.8 years apart. Progressive AV dysfunction and individually linked mortality were examined per AS category. RESULTS 49 449 men (53.9%, 60.9±15.8 years) and 42 229 women (61.6±16.9 years) with no initial evidence of AS were identified. Subsequently, 6293 (6.9%) developed AS-comprising 5170 (5.6%), 636 (0.7%), 339 (0.4%) and 148 (0.2%) cases of mild, moderate, severe low-gradient and severe high-gradient AS, respectively. Age-adjusted incidence rates of all grades of AS were 17.5 cases per 1000 men/annum and 18.7 cases per 1000 women/annum: rising from ~5 to ~40 cases per 1000/annum in those aged <30 years vs >80 years. Median peak AV velocity increased by +0.57 (+0.36 to +0.80) m/s in mild AS compared with +2.75 (+2.40 to +3.19) m/s in severe high-gradient AS cases between first and last echocardiograms. During subsequent median 7.7 years follow-up, 24 577 of 91 678 cases (26.8%) died. Compared with no AS, the adjusted risk of all-cause mortality was 1.42-fold higher in mild AS, 1.92-fold higher in moderate AS, 1.95-fold higher in severe low-gradient AS and 2.27-fold higher in severe, high-gradient AS cases (all p<0.001). CONCLUSIONS New onset AS is a common finding among older patients followed up with echocardiography. Any grade of AS is associated with higher mortality, reinforcing the need for proactive vigilance.
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Affiliation(s)
- Simon Stewart
- Centre for Cardiopulmonary Health, Torrens University Australia, Adelaide, South Australia, Australia.,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Geoffrey A Strange
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia .,Clinical Research Group, Heart Research Institute, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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63
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Strange G, Scalia GM, Playford D, Simon S. Uncovering the treatable burden of severe aortic stenosis in Australia: current and future projections within an ageing population. BMC Health Serv Res 2021; 21:790. [PMID: 34376198 PMCID: PMC8356417 DOI: 10.1186/s12913-021-06843-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aimed to address the paucity of information describing the treatable burden of disease associated with severe aortic stenosis (AS) within Australia's ageing population. METHODS A contemporary model of the population prevalence of symptomatic, severe AS and treatment pathways in Europe and North America was applied to the 2019 Australian population aged ≥ 55 years (7 million people) on an age-specific basis. Applying Australian-specific data, these estimates were used to further calculate the total number of associated deaths and incident cases of severe AS per annum. RESULTS Based on an overall point prevalence of 1.48 % among those aged ≥ 55 years, we estimate that a minimum of 97,000 Australians are living with severe AS. With a 2-fold increased risk of mortality without undergoing aortic valve replacement (AVR), more than half of these individuals (∼56,000) will die within 5-years. From a clinical management perspective, among those with concurrent symptoms (68.3 %, 66,500 [95 % CI 59,000-74,000] cases) more than half (58.4 %, 38,800 [95 % CI 35,700 - 42,000] cases) would be potentially considered for surgical AVR (SAVR) - comprising 2,400, 5,400 and 31,000 cases assessed as high-, medium- or low peri-operative mortality risk, respectively. A further 17,000/27,700 (41.6 % [95 % CI 11,600 - 22,600]) of such individuals would be potentially considered to a transthoracic AVR (TAVR). During the subsequent 5-year period (2020-2024), each year, we estimate an additional 9,300 Australians aged ≥ 60 years will subsequently develop severe AS (6,300 of whom will experience concurrent symptoms). Of these symptomatic cases, an estimated 3,700 and 1,600 cases/annum, will be potentially suitable for SAVR and TAVR, respectively. CONCLUSIONS These data suggest there is likely to be a substantive burden of individuals living with severe AS in Australia. Many of these cases may not have been diagnosed and/or received appropriate treatment (based on the evidence-based application of SAVR and TAVR) to reduce their high-risk of subsequent mortality.
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Affiliation(s)
- Geoff Strange
- School of Medicine, University of Notre Dame, 32 Mouat St, WA, 6160, Freemantle, Australia. .,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. .,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. .,Heart Research Institute, Sydney, Australia.
| | - Gregory M Scalia
- Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - David Playford
- School of Medicine, University of Notre Dame, 32 Mouat St, WA, 6160, Freemantle, Australia
| | - Stewart Simon
- Torrens University Australia, Adelaide, SA, Australia.,University of Glasgow, Glasgow, Scotland
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64
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Myasoedova VA, Genovese S, Cavallotti L, Bonomi A, Chiesa M, Campodonico J, Rondinelli M, Cosentino N, Baldassarre D, Veglia F, Pepi M, Alamanni F, Colombo GI, Marenzi G, Poggio P. Aortic Valve Sclerosis in High-Risk Coronary Artery Disease Patients. Front Cardiovasc Med 2021; 8:711899. [PMID: 34386534 PMCID: PMC8354333 DOI: 10.3389/fcvm.2021.711899] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Current knowledge regarding the relationship between aortic valve sclerosis (AVSc), cardiovascular risk factors, and mortality in patients with known coronary artery disease (CAD) is still unclear. The present study aimed at investigating the prevalence of AVSc as well as its association with long-term all-cause mortality in high-risk CAD patients that has never been explored in large cohorts thus far. Methods and Results: In this retrospective and observational cohort study we enrolled high-risk CAD patients, hospitalized at Centro Cardiologico Monzino (CCM), Milan, Italy, between January 2006 and December 2016. The morphology and function of the aortic valve were assessed from the recorded echocardiographic images to evaluate the presence of AVSc, defined as a non-uniform thickening of the aortic leaflets with no consequences on hemodynamics. Data on 5-year all-cause mortality was retrieved from a Regional database. Of the 5,489 patients initially screened, 4,938 (mean age 67 ± 11 years, 3,954 [80%] men) were enrolled in the study. In the overall population, AVSc was detected in 2,138 (43%) patients. Multivariable LASSO regression revealed that age, female gender, diabetes mellitus, previous MI, and left ventricular ejection fraction were independently associated with AVSc. All-cause mortality (adjusted hazard ratio: 1.29, 95%CI: 1.05–1.58) was significantly higher in AVSc than in non-AVSc patients. Conclusions: AVSc is frequently detected in high-risk CAD patients and is associated with long-term mortality. Our findings corroborate the hypothesis that AVSc is an underestimated marker of systemic cardiovascular risk. Thus, AVSc detection may be used to improve long-term risk stratification of high-risk CAD patients.
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Affiliation(s)
- Veronika A Myasoedova
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stefano Genovese
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Cavallotti
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Alice Bonomi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mattia Chiesa
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maurizio Rondinelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Nicola Cosentino
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Damiano Baldassarre
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Fabrizio Veglia
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gualtiero I Colombo
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paolo Poggio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Elevated Apolipoprotein B/A-1 Ratio is Associated With an Increased Risk of Aortic Stenosis: Experience From the AMORIS Cohort. Heart Lung Circ 2021; 30:1050-1057. [DOI: 10.1016/j.hlc.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/29/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022]
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66
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Jiang Q, Qin D, Yang L, Lin Y, Zhai L, Zhang Y, Yang G, Wang K, Tong D, Li X, Chen Z, Huang K, Yu T, Xiang X, Cui C, Cai C, Shi J, Li M, Chen M. Causal effects of plasma lipids on the risk of atrial fibrillation: A multivariable mendelian randomization study. Nutr Metab Cardiovasc Dis 2021; 31:1569-1578. [PMID: 33814236 DOI: 10.1016/j.numecd.2021.02.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/15/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Observational studies have suggested that plasma lipids contribute substantially to cardiovascular disease, but "cholesterol paradox" in atrial fibrillation (AF) remains. We sought to investigate the causal effects of lipid profiles on the risk of AF. METHODS AND RESULTS Two-sample Mendelian randomization (MR) framework was implemented to examine the causality of association. Summary estimations of genetic variants associated with low density lipoprotein (LDL)-cholesterol, high density lipoprotein (HDL)-cholesterol, total cholesterol, triglycerides, lipoprotein-a [Lp(a)], apolipoprotein A1 (ApoA 1), and apolipoprotein B (ApoB) were 81, 99, 96, 61, 30, 10, and 23 single nucleotide polymorphisms, respectively. Genetic association with AF were retrieved from a genome-wide association study that included 1,030,836 individuals. The complications for AF were predefined as cardioembolic stroke (CES) and heart failure (HF). In the multivariable MR, the odds ratios for AF per standard deviation (SD) increase were 1.030 (95% confidence interval (CI) 0.979-1.083; P = 0.257) for LDL-cholesterol, 0.986 (95% CI 0.931-1.044; P = 0.622) for HDL-cholesterol, 0.965 (95% CI 0.896-1.041; P = 0.359) for triglycerides, 1.001 (95% CI 1.000-1.003; P = 0.023) for Lp(a), 1.017 (95% CI 0.966-1.070; P = 0.518) for ApoA1, and 1.002 (95% CI 0.963-1.043; P = 0.923) for ApoB. There was no evidence that other lipid components were causally associated with AF, CES, or HF, other than for a marginal association between triglycerides and HF. CONCLUSIONS This MR study provides robust evidence that high Lp(a) increases the risk of AF, suggesting that interventions targeting Lp(a) may contribute to the primary prevention of AF.
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Affiliation(s)
- Qi Jiang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Dingxin Qin
- Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yongping Lin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lishang Zhai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuli Zhang
- Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kexin Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Debing Tong
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xintao Li
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zijun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Kai Huang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Tianhong Yu
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xue Xiang
- Department of Cardiology, The Seventh People's Hospital of Changzhou, Changzhou, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaojiao Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Bermejo J, Postigo A, Baumgartner H. The year in cardiovascular medicine 2020: valvular heart disease. Eur Heart J 2021; 42:647-656. [PMID: 33388778 PMCID: PMC7878012 DOI: 10.1093/eurheartj/ehaa1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Weisell J, Ruotsalainen AK, Näpänkangas J, Jauhiainen M, Rysä J. Menaquinone 4 increases plasma lipid levels in hypercholesterolemic mice. Sci Rep 2021; 11:3014. [PMID: 33542347 PMCID: PMC7862223 DOI: 10.1038/s41598-021-82724-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
In calcific aortic valve disease (CAVD) progressive valvular calcification causes aortic valve dysfunction. CAVD has several risk factors such as age and dyslipidemia. Vitamin K was shown to inhibit vascular calcification in mice and valvular calcification in patients with CAVD. We studied the effect of menaquinone 4 (MK4/vitamin K2) on valvular calcification in the hypercholesterolemic mouse model of CAVD. LDLr−/−ApoB100/100 male mice were fed with a Western diet for 5 months, with (n = 10) or without (n = 10) added 0.2 mg/g MK4. Body weight gain was followed weekly. Morphology of aortic valves and liver was assessed with immunohistochemistry. Plasma cholesterol levels and cytokines from hepatic tissue were assessed in the end of the study. Hepatic gene expression of lipid metabolism regulating genes were assessed after 18 h diet. MK4 exacerbated the lipoprotein lipid profile without affecting aortic valve morphology in hypercholesterolemic LDLr−/− ApoB100/100 mice. The MK4-containing WD diet increased plasma levels of LDL and triglycerides, hepatic steatosis, and mRNA expression of genes required for triglyceride and cholesterol synthesis. MK4 diminished levels of several cytokines and chemokines in liver, including IL-6, TNFα and MCP1, as measured by hepatic cytokine array. Consequently, MK4 may exert non-beneficial effects on circulating lipid levels, especially in hypercholesterolemic individuals.
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Affiliation(s)
- Jonna Weisell
- School of Pharmacy, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Anna-Kaisa Ruotsalainen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha Näpänkangas
- Department of Pathology, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Matti Jauhiainen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Jaana Rysä
- School of Pharmacy, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
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Farnier M, Zeller M, Masson D, Cottin Y. Triglycerides and risk of atherosclerotic cardiovascular disease: An update. Arch Cardiovasc Dis 2021; 114:132-139. [PMID: 33546998 DOI: 10.1016/j.acvd.2020.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022]
Abstract
Low-density lipoprotein cholesterol is a well-known causal factor for atherosclerotic cardiovascular disease, and is the primary target of lipid-lowering therapy. There is, however, still a substantial risk of atherosclerotic cardiovascular disease events despite intensive statin therapy, and data from clinical trials suggest that an elevated concentration of triglycerides is a marker of residual cardiovascular risk on low-density lipoprotein-lowering therapy. Serum triglycerides are a biomarker for triglyceride-rich lipoproteins, and several lines of evidence indicate that triglyceride-rich lipoproteins and their cholesterol-enriched remnant particles are associated with atherogenesis. Moreover, genetic data in humans strongly suggest that the remnants of triglyceride-rich lipoproteins are a causal cardiovascular risk factor. Although lifestyle changes remain the cornerstone of management of hypertriglyceridaemia, a recent trial with high doses of the omega-3 fatty acid icosapent ethyl showed a significant reduction in cardiovascular events that was not explained by the reduction in triglycerides alone. In patients with elevated triglycerides, several novel drugs are in development to reduce the residual risk on statin therapy linked to an excess of atherogenic triglyceride-rich lipoproteins. In this review, we provide an update on the biology, epidemiology and genetics of triglycerides, and the risk of atherosclerotic cardiovascular disease.
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Affiliation(s)
- Michel Farnier
- PEC2, EA 7460, University of Bourgogne Franche-Comté, 21000 Dijon, France; Cardiology Department, University Hospital Centre of Dijon Bourgogne, 21000 Dijon, France.
| | - Marianne Zeller
- PEC2, EA 7460, University of Bourgogne Franche-Comté, 21000 Dijon, France; Cardiology Department, University Hospital Centre of Dijon Bourgogne, 21000 Dijon, France
| | - David Masson
- Inserm, LNC UMR 1231, FCS Bourgogne Franche-Comté, LipSTIC LabEx, 21078 Dijon, France
| | - Yves Cottin
- PEC2, EA 7460, University of Bourgogne Franche-Comté, 21000 Dijon, France; Cardiology Department, University Hospital Centre of Dijon Bourgogne, 21000 Dijon, France
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Abstract
PURPOSE OF REVIEW The current review describes the fundamentals of the Mendelian randomization framework and its current application for causal inference in human nutrition and metabolism. RECENT FINDINGS In the Mendelian randomization framework, genetic variants that are strongly associated with the potential risk factor are used as instrumental variables to determine whether the risk factor is a cause of the disease. Mendelian randomization studies are less susceptible to confounding and reverse causality compared with traditional observational studies. The Mendelian randomization study design has been increasingly used in recent years to appraise the causal associations of various nutritional factors, such as milk and alcohol intake, circulating levels of micronutrients and metabolites, and obesity with risk of different health outcomes. Mendelian randomization studies have confirmed some but challenged other nutrition-disease associations recognized by traditional observational studies. Yet, the causal role of many nutritional factors and intermediate metabolic changes for health and disease remains unresolved. SUMMARY Mendelian randomization can be used as a tool to improve causal inference in observational studies assessing the role of nutritional factors and metabolites in health and disease. There is a need for more large-scale genome-wide association studies to identify more genetic variants for nutritional factors that can be utilized for Mendelian randomization analyses.
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Affiliation(s)
- Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Crea F. Dyslipidaemias and cardiovascular diseases: beyond cholesterol and atherosclerotic plaques. Eur Heart J 2020; 41:3865-3869. [PMID: 33175144 DOI: 10.1093/eurheartj/ehaa889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Nienaber CA, Yuan X. Lipid levels linked to symptomatic aortic valve stenosis: evidence from Mendelian randomization? Eur Heart J 2020; 41:3921-3924. [PMID: 32350526 DOI: 10.1093/eurheartj/ehaa225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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Affiliation(s)
- Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Xun Yuan
- Department of Cardiology, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Abstract
Abstract
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Affiliation(s)
- Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Western University, London, Ontario N6A 5B7, Canada
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Nazarzadeh M, Rahimi K. Limitations of subgroup analysis of underpowered clinical trials for making causal inference about treatment effects. Eur Heart J 2020; 41:1942. [PMID: 32380525 DOI: 10.1093/eurheartj/ehaa355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Milad Nazarzadeh
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- The Collaboration Center of Meta-Analysis Research, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, 1st Floor, Hayes House, 75 George Street, Oxford OX1 2BQ, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lüscher TF. From TAVI to tricuspid cliping: fine-tuning the management of valvular heart disease. Eur Heart J 2020; 41:1863-1866. [PMID: 33216904 DOI: 10.1093/eurheartj/ehaa459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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