51
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Scarinci F, Patacchioli FR, Ghiciuc CM, Pasquali V, Bercea RM, Cozma S, Parravano M. Psychological Profile and Distinct Salivary Cortisol Awake Response (CAR) in Two Different Study Populations with Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC). J Clin Med 2020; 9:jcm9082490. [PMID: 32756367 PMCID: PMC7464438 DOI: 10.3390/jcm9082490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUCCAR) and the SLOPECAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients.
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Affiliation(s)
- Fabio Scarinci
- IRCCS—Fondazione Bietti, 00100 Rome, Italy; (F.S.); (M.P.)
| | | | - Cristina Mihaela Ghiciuc
- Department of Pharmacology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iaşi, Romania;
| | - Vittorio Pasquali
- Department of Psychology, Sapienza University of Rome, 00100 Rome, Italy;
| | - Raluca Mihaela Bercea
- Department of Pneumology, County Emergency Hospital of Ploieşti, 100248 Ploieşti, Romania;
| | - Sebastian Cozma
- Department of Otorhinolaryngology, School of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
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52
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Liu HX, Cheng YY, Tian Z, Gao X, Zhang M, Nan Q. Flow field study of radiofrequency ablation of renal sympathetic nerve: Numerical simulation and PIV experiments. Electromagn Biol Med 2020; 39:262-272. [DOI: 10.1080/15368378.2020.1793167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hong-Xing Liu
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Yan-Yan Cheng
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Zhen Tian
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Xiang Gao
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Meng Zhang
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Qun Nan
- College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
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53
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"Apple does not fall far from the tree" - subclinical atherosclerosis in children with familial hypercholesterolemia. Lipids Health Dis 2020; 19:169. [PMID: 32664969 PMCID: PMC7362468 DOI: 10.1186/s12944-020-01335-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) increases the risk of atherosclerosis in children and adults. Atherosclerotic cardiovascular disease in young patients FH is usually subclinical but recognition of children with more pronounced changes is crucial for adjusting effective management. Aim of this research was to use ultrasonography with two-dimensional speckle tracking (2DST) and tonometry to evaluate atherosclerotic changes in patients with FH (parents and their offspring). METHODS Applanation tonometry and carotid arteries sonography with evaluation of the intima-media complex thickness (IMCT) and application of the 2DST were performed in 20 families with FH (20 parents and 29 children). The same size control group (age and sex matched) was included. Results were compared between peers and between generations together with the correlation analysis. RESULTS Adults with FH, in comparison with healthy peers, presented significantly more atherosclerotic plaques (9 vs. 2, p = 0.0230), had significantly thicker IMC (0.84 ± 0.19 vs. 0.56 ± 0.06 mm, p < 0.0001) and had stiffer arterial wall (for stain: 6.25 ± 2.3 vs. 8.15 ± 2.46, p = 0.0103). In children from both groups there were no atherosclerotic plaques and IMCT did not differ significantly (0.42 ± 0.07 vs. 0.39 ± 0.04, p = 0.1722). However, children with FH had significantly stiffer arterial wall according to 2DST (for strain: 9.22 ± 3.4 vs. 11.93 ± 3.11, p = 0.0057) and tonometry (for the pulse wave velocity: 4.5 ± 0.64 vs.3.96 ± 0.62, p = 0.0047). These parameters correlated with atherosclerosis surrogates in their parents (p < 0.001) but were not significantly affected by presence of presumed pathogenic gene variant. CONCLUSIONS Children with FH presented subclinical atherosclerosis manifested as decreased arterial wall elasticity. Degree of stiffening was associated with advancement of atherosclerosis in their parents but did not present significant association with gene variants. Sonography with application of 2DST seems to be a good candidate for comprehensive evaluation of atherosclerosis in families with FH.
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54
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Lee J, Chen B, Kohl HW, Barlow CE, do Lee C, Radford NB, DeFina LF, Gabriel KP. The Association of Physical Activity With Carotid Intima Media Thickening in a Healthy Older Population: Cooper Center Longitudinal Study. J Aging Phys Act 2020; 28:448-454. [PMID: 31801110 PMCID: PMC7266725 DOI: 10.1123/japa.2019-0103] [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: 03/17/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to examine the association between self-reported physical activity (PA) and mean common carotid artery intima-media thickness (CCA IMT) among older adults. The data are from 1,811 Cooper Center Longitudinal Study participants, who were aged ≥60 years, with no history of cardiovascular disease. A medical history questionnaire was used to assess PA. Carotid ultrasound was performed to measure CCA IMT and the presence of plaque and stenosis. Logistic regression models were constructed to estimate the association between PA and CCA IMT after adjustment for covariates. The participants were aged 69.2 ± 5.9 years, and the majority were male (73.3%) and White (96.7%). The odds ratio of abnormal thickening of CCA IMT was 0.72 (95% confidence interval [0.54, 0.96]) in physically active participants (≥500 metabolic equivalent·min/week) after adjustment for covariates. In the current study, meeting PA guidelines in older adulthood was associated with lower odds of abnormal thickening of CCA IMT.
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55
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Kim SR, Lee SG, Kim SH, Kim JH, Choi E, Cho W, Rim JH, Hwang I, Lee CJ, Lee M, Oh CM, Jeon JY, Gee HY, Kim JH, Lee BW, Kang ES, Cha BS, Lee MS, Yu JW, Cho JW, Kim JS, Lee YH. SGLT2 inhibition modulates NLRP3 inflammasome activity via ketones and insulin in diabetes with cardiovascular disease. Nat Commun 2020; 11:2127. [PMID: 32358544 PMCID: PMC7195385 DOI: 10.1038/s41467-020-15983-6] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Abstract
Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce cardiovascular events in humans with type 2 diabetes (T2D); however, the underlying mechanism remains unclear. Activation of the NLR family, pyrin domain-containing 3 (NLRP3) inflammasome and subsequent interleukin (IL)-1β release induces atherosclerosis and heart failure. Here we show the effect of SGLT2 inhibitor empagliflozin on NLRP3 inflammasome activity. Patients with T2D and high cardiovascular risk receive SGLT2 inhibitor or sulfonylurea for 30 days, with NLRP3 inflammasome activation analyzed in macrophages. While the SGLT2 inhibitor’s glucose-lowering capacity is similar to sulfonylurea, it shows a greater reduction in IL-1β secretion compared to sulfonylurea accompanied by increased serum β-hydroxybutyrate (BHB) and decreased serum insulin. Ex vivo experiments with macrophages verify the inhibitory effects of high BHB and low insulin levels on NLRP3 inflammasome activation. In conclusion, SGLT2 inhibitor attenuates NLRP3 inflammasome activation, which might help to explain its cardioprotective effects. SGLT2 inhibitors, a class of type 2 diabetes medication, reduce cardiovascular events in patients beyond expectation from blood sugar control. Here the authors report a randomized controlled trial showing that SGLT2 inhibitors reduce inflammasome activation in peripheral macrophages, which may contribute to the cardiovascular protection.
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Affiliation(s)
- So Ra Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Graduate School, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, 16995, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Soo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eunhye Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Wonhee Cho
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, 03722, Republic of Korea
| | - John Hoon Rim
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, 03722, Republic of Korea
| | - Inhwa Hwang
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chan Joo Lee
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, 61005, Republic of Korea
| | - Justin Y Jeon
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, 03722, Republic of Korea
| | - Heon Yung Gee
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Medicine, Physician-Scientist Program, Yonsei University Graduate School of Medicine, Seoul, 03722, Republic of Korea
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Graduate School, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Graduate School, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Graduate School, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Myung-Shik Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Severance Biomedical Science Institute, Yonsei Biomedical Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Je-Wook Yu
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Department of Microbiology and Immunology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin Won Cho
- Department of Systems Biology, Glycosylation Network Research Center, Yonsei University, Seoul, 03722, Republic of Korea
| | - Jung-Sun Kim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Graduate School, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Institute of Endocrine Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Department of Systems Biology, Glycosylation Network Research Center, Yonsei University, Seoul, 03722, Republic of Korea.
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López-Padrós C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, Montsserrat M, Virgili MN, Rodríguez C, Pérez-Ramos S, López-Cadena E, Ramos MI, Dorca J, Monasterio C. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med 2020; 16:503-514. [PMID: 32003737 DOI: 10.5664/jcsm.8252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. METHODS Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. RESULTS Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027). CONCLUSIONS An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414.
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Affiliation(s)
- Carla López-Padrós
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Neus Salord
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Carolina Alves
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Núria Vilarrasa
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM-CIBER), Spain
| | - Merce Gasa
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Rosa Planas
- Department of Rehabilitation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Monica Montsserrat
- Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - M Nuria Virgili
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Rodríguez
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sandra Pérez-Ramos
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Esther López-Cadena
- Respiratory Medicine Department, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | | | - Jordi Dorca
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Monasterio
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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Soriano-Maldonado A, Martínez-Forte S, Ferrer-Márquez M, Martínez-Rosales E, Hernández-Martínez A, Carretero-Ruiz A, Villa-González E, Barranco-Ruiz Y, Rodríguez-Pérez MA, Torrente-Sánchez MJ, Carmona-Rodríguez L, Soriano-Maldonado P, Vargas-Hitos JA, Casimiro-Andújar AJ, Artero EG, Fernández-Alonso AM. Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99:e19427. [PMID: 32195937 PMCID: PMC7220774 DOI: 10.1097/md.0000000000019427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. METHODS This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. DISCUSSION This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery. TRIAL REGISTRATION NUMBER ISRCTN registry (ISRCTN27697878).
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Affiliation(s)
- Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | | | - Manuel Ferrer-Márquez
- Bariatric Surgery Department, Torrecárdenas University Hospital, Almería
- Obesidad Almería, Hospital Mediterráneo, Almería
| | - Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Alejandro Carretero-Ruiz
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Emilio Villa-González
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla
| | - Yaira Barranco-Ruiz
- Department of Physical and Sports Education, PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Sport and Health University Research Institute (iMUDS), Faculty of Education and Sport Sciences, University of Granada, Melilla
| | - Manuel A. Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | | | - Lorena Carmona-Rodríguez
- Department of Macromolecular Structures, Proteomics Unit, Centro Nacional de Biotecnología (CNB/CSIC)
| | | | - José A. Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Antonio J. Casimiro-Andújar
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
| | - Enrique G. Artero
- Department of Education, Faculty of Education Sciences; and SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería
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Höbaus C, Herz CT, Wrba T, Koppensteiner R, Schernthaner GH. Peripheral arterial disease and type 2 diabetes: Older patients still exhibit a survival benefit from glucose control. Diab Vasc Dis Res 2020; 17:1479164120914845. [PMID: 32308023 PMCID: PMC7510380 DOI: 10.1177/1479164120914845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate a possible beneficial effect of strict glycaemic control on all-cause mortality in patients with peripheral arterial disease and type 2 diabetes mellitus. METHODS A total of 367 mainly older peripheral arterial disease patients [age: 69 (62-78) years, 34% women, Fontaine stage I-II] were categorized according to glycaemic control, that is, (a) no type 2 diabetes mellitus, (b) strict glucose control (HbA1c < 53 mmol/mol) and (c) lenient glucose control (HbA1c ⩾ 53 mmol/mol) at inclusion and by mean HbA1c over the first study year. Mortality was analysed using Kaplan-Meier and Cox-regression analyses after 7 years. RESULTS The combination of type 2 diabetes mellitus and peripheral arterial disease reduced survival from 78.8% to 68.9% in comparison to patients without type 2 diabetes mellitus (p = 0.023). Patients with strict glucose control (75%) were associated with increased survival in comparison to patients with lenient glucose control (58.9%) stratified by mean HbA1c (p = 0.042). Baseline cardiovascular risk factors were similar in those type 2 diabetes mellitus patients. In this peripheral arterial disease cohort HbA1c (hazard ratio: 1.3, 1.04-1.63), age (hazard ratio: 1.7, 1.3-2.3) and C-reactive protein (hazard ratio: 1.5, 1.2-2.0) remained independent associates for mortality adjusted for cardiovascular risk factors and diabetes duration. CONCLUSION Older patients with peripheral arterial disease and type 2 diabetes mellitus still benefit from strict glucose control in a cohort of patients with similar distribution of cardiovascular risk factors.
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Affiliation(s)
- Clemens Höbaus
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
- Clemens Höbaus, Division of Angiology, Department of Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Carsten Thilo Herz
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Thomas Wrba
- IT4Science, IT-Systems & Communications, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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Qin Z, Zhou K, Li Y, Cheng W, Wang Z, Wang J, Gao F, Yang L, Xu Y, Wu Y, He H, Zhou Y. The atherogenic index of plasma plays an important role in predicting the prognosis of type 2 diabetic subjects undergoing percutaneous coronary intervention: results from an observational cohort study in China. Cardiovasc Diabetol 2020; 19:23. [PMID: 32085772 PMCID: PMC7035714 DOI: 10.1186/s12933-020-0989-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Many studies have reported the predictive value of the atherogenic index of plasma (AIP) in the progression of atherosclerosis and the prognosis of percutaneous coronary intervention (PCI). However, the utility of the AIP for prediction is unknown after PCI among type 2 diabetes mellitus (T2DM). Methods 2356 patients with T2DM who underwent PCI were enrolled and followed up for 4 years. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCEs), considered to be a combination of cardiogenic death, myocardial infarction, repeated revascularization, and stroke. Secondary endpoints included all-cause mortality, target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR). Multivariate Cox proportional hazards regression modelling found that the AIP was correlated with prognosis and verified by multiple models. According to the optimal cut-off point of the ROC curve, the population was divided into high/low-AIP groups. A total of 821 pairs were successfully matched using propensity score matching. Then, survival analysis was performed on both groups. Results The overall incidence of MACCEs was 20.50% during a median of 47.50 months of follow-up. The multivariate Cox proportional hazards regression analysis before matching suggested that the AIP was an independent risk factor for the prognosis of T2DM after PCI (hazard ratio [HR] 1.528, 95% CI 1.100–2.123, P = 0.011). According to the survival analysis of the matched population, the prognosis of the high AIP group was significantly worse than that of the low AIP group (HR (95% CI) 1.614 (1.303–2.001), P < 0.001), and the difference was mainly caused by repeat revascularization. The low-density lipoprotein-cholesterol (LDL-C) level did not affect the prognosis of patients with T2DM (P = 0.169), and the effect of the AIP on prognosis was also not affected by LDL-C level (P < 0.001). Conclusions The AIP, a comprehensive index of lipid management in patients with T2DM, affects prognosis after PCI. The prognosis of diabetic patients with high levels of the AIP included more MACCEs and was not affected by LDL-C levels. It is recommended to monitor the AIP for lipid management in diabetic patients after PCI and ensure that the AIP is not higher than 0.318. Trial registration This is an observational cohort study that does not involve interventions. So we didn’t register. We guarantee that the research is authentic and reliable, and hope that your journal can give us a chance.
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Affiliation(s)
- Zheng Qin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Kuo Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yueping Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Wanjun Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jianlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Fei Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Lixia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yingkai Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yafeng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Hua He
- Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotlic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Villena-Esponera MP, Moreno-Rojas R, Molina-Recio G. Food Insecurity and the Double Burden of Malnutrition of Indigenous Refugee Épera Siapidara. J Immigr Minor Health 2020; 21:1035-1042. [PMID: 30109533 DOI: 10.1007/s10903-018-0807-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The goal of this paper is to assess food and nutritional security status of an indigenous population who migrated from Colombia to Ecuador. We collected data about the perception of food insecurity, anthropometric and food intake (n = 104). An analysis multivariate (Generalized Linear Model) we used to know the adequacy to the Dietary Reference Intake (DRI). All the households were food insecure, stunting affected 45.1% of children and adolescents and the 60% were overweight or obese women. Significant differences were observed by gender for energy, lipid, carbohydrate, fiber, and iron (p < 0.001). No age group meets the DRI for fiber, calcium and potassium (except in children 24-59 months) and iron. There was a deficiency in vitamins A, D, folic acid and thiamine. The Epera Siapidara people in Ecuador experience acute food insecurity and a double burden of malnutrition, which may seriously affect their health and general progress.
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Affiliation(s)
- María Pilar Villena-Esponera
- Department of Food Science and Technology, University of Córdoba, Agrifood Campus of Excellence International CeiA3, Córdoba, Spain. .,Food Safety and Quality Research Group, Pontificial Catholic University of Ecuador in Esmeraldas (PUCESE), Esmeraldas, Ecuador.
| | - Rafael Moreno-Rojas
- Department of Food Science and Technology, University of Córdoba, Agrifood Campus of Excellence International CeiA3, Córdoba, Spain
| | - Guillermo Molina-Recio
- Department of Nursing, School of Medicine and Nursing, University of Córdoba, Córdoba, Spain
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Abstract
Objective: Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM) and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients. Methods: This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recorded ABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome, or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any of the following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke. Results: Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09–3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23; 95% CI=1.00–1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95% CI=1.01–1.21; p=0.04). Conclusion: Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS.
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Landi F, Salini S, Zazzara MB, Martone AM, Fabrizi S, Bianchi M, Tosato M, Picca A, Calvani R, Marzetti E. Relationship between pulmonary function and physical performance among community-living people: results from Look-up 7+ study. J Cachexia Sarcopenia Muscle 2020; 11:38-45. [PMID: 31800168 PMCID: PMC7015242 DOI: 10.1002/jcsm.12485] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While respiratory muscle strength is recognized to decline with aging process, the relationship between sarcopenia and pulmonary function remains to be studied. The present study was undertaken to provide a better insight into the comprehension of the relationship between pulmonary function and muscle function (strength and physical performance) using an unselected sample of subjects assessed during the Longevity Check-up 7+ project. METHODS Look-up 7+ is an ongoing cross-sectional survey started in June 2015 and conducted in unconventional settings (i.e. exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Muscle strength was assessed by handgrip strength test, and physical performance was evaluated by chair stand test. Spirometer analysis was performed using the AirSmart system, and the largest forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) values were collected. RESULTS The mean age of 925 subjects participating in the Longevity check-7+ surveys and receiving the spirometer evaluation was 55.6 years (range from 18 to 98 years), and 501 (54%) were women. Overall, both in male and female participants, FVC, FEV1 and PEF positively correlated with handgrip strength and chair stand tests. The receiver operator characteristic curve analysis revealed that the areas under the curves for FVC, FEV1, and PEF were 0.79, 0.80 and 0.80, respectively. CONCLUSIONS The results clearly show that pulmonary function was positively associated with handgrip strength and chair stand tests. Based on this observation, muscle strength, physical performance, and pulmonary function should be recommended as the method of choice for the early detection of individuals at risk of probable sarcopenia and at the same time to better characterized the severity of sarcopenia status.
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Affiliation(s)
- Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara Salini
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Beatrice Zazzara
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Sofia Fabrizi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Mariangela Bianchi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Tosato
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Picca
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
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Iana A, Sirbu E. Linking myeloperoxidase with subclinical atherosclerosis in adults with metabolic syndrome. Wien Klin Wochenschr 2020; 132:150-154. [PMID: 31974766 DOI: 10.1007/s00508-019-01602-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/17/2019] [Indexed: 01/09/2023]
Abstract
BACKROUND Myeloperoxidase (MPO) is a leukocyte-derived enzyme that has been associated with cardiovascular diseases in many studies. Together with hydrogen peroxide and a halogen, MPO forms a very strong antimicrobial system and there is evidence of links between MPO and inflammation in cardiovascular diseases. Brachial flow-mediated dilation (FMD) refers to a physiologic measure, and carotid intima-media thickness (IMT) is an anatomic structural measure of subclinical atherosclerosis. This research aimed to assess the correlation of MPO serum levels with subclinical atherosclerosis in patients with metabolic syndrome (MS) using the parameters FMD and IMT. METHODS A total of 88 patients with metabolic syndrome defined according to the International Diabetes Criteria (IDF) criteria were recruited in the study. Doppler ultrasound was used to determine the left and right common carotid artery thickness (left and right CCA IMT) and FMD of brachial artery. The MPO concentrations were measured using the Immundiagnostik MPO ELISA kit. RESULTS A significant inverse correlation between MPO and brachial FMD (r = -0.354, p < 0.001), a significant positive correlation between MPO and right CCA IMT (r = 0.327, p < 0.001), and a significant positive correlation between MPO and left CCA IMT (r = 0.301, p < 0.001) in patients with MS were obtained in this research study. CONCLUSION Serum MPO concentration is correlated with subclinical atherosclerosis in patients with MS. The MPO may be a potential therapeutic goal in patients with MS. This finding suggests that new biological markers for MS and subclinical atherosclerosis are helpful for understanding the mechanisms of the risk factors and their role as a considerable burden on the population.
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Affiliation(s)
- Andreea Iana
- Internal Medicine Private Office, Timișoara, Romania
| | - Elena Sirbu
- Physical Education and Sport Faculty, Department of Physical Therapy and Special Motility, West University of Timișoara, V. Parvan 5., 300233, Timișoara, Romania.
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64
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Miyashima M, Shoji T, Kakutani Y, Yamazaki Y, Ochi A, Morioka T, Shinohara-Mitsuki K, Fukumoto S, Shioi A, Inaba M, Emoto M. Inter-Arm Blood Pressure Difference in Diabetes Mellitus and Its Preferential Association with Peripheral Artery Disease. J Atheroscler Thromb 2019; 27:780-788. [PMID: 31813900 PMCID: PMC7458791 DOI: 10.5551/jat.52886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: Inter-arm blood pressure difference (IAD) is known to be associated with a composite of cardiovascular disease (CVD) and with CVD risk factors. However, only limited information is available regarding the contribution of diabetes mellitus to IAD and the association of IAD with individual CVDs, such as coronary artery disease (CAD), stroke, and peripheral artery disease (PAD). Methods: We addressed these issues in this cross-sectional study of 2580 participants who had simultaneous blood pressure measurements in both arms using an automated device. Results: Compared with 1,264 nondiabetic subjects, 1316 patients with diabetes mellitus had a greater IAD (P = 0.01) and a higher prevalence of IAD of ≥ 10 mmHg (8.4% vs. 5.4%, P = 0.002). However, such difference was not significant after the adjustment for potential confounders. Among CAD, stroke, and PAD, only PAD was significantly associated with IAD in a model adjusted for the CVD risk factors. Age was found to modify the association between IAD and PAD, with the association being more prominent in the younger subgroup. Conclusion: Thus, diabetes mellitus itself was not an independent factor associated with IAD. A larger IAD was preferentially associated with the presence of PAD, and this association was modified by age.
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Affiliation(s)
- Masako Miyashima
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Yoshinori Kakutani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Yuko Yamazaki
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Akinobu Ochi
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Kayo Shinohara-Mitsuki
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Shinya Fukumoto
- Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine
| | - Atsushi Shioi
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, Nosalski R, Pelka P, Nowakowski D, Wilk G, Mikolajczyk TP, Schramm-Luc A, Furtak A, Matusik P, Koziol J, Drozdz M, Munoz-Aguilera E, Tomaszewski M, Evangelou E, Caulfield M, Grodzicki T, D'Aiuto F, Guzik TJ. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur Heart J 2019; 40:3459-3470. [PMID: 31504461 PMCID: PMC6837161 DOI: 10.1093/eurheartj/ehz646] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/25/2019] [Accepted: 08/21/2019] [Indexed: 01/07/2023] Open
Abstract
AIMS Inflammation is an important driver of hypertension. Periodontitis is a chronic inflammatory disease, which could provide a mechanism for pro-hypertensive immune activation, but evidence of a causal relationship in humans is scarce. We aimed to investigate the nature of the association between periodontitis and hypertension. METHODS AND RESULTS We performed a two-sample Mendelian randomization analysis in the ∼750 000 UK-Biobank/International Consortium of Blood Pressure-Genome-Wide Association Studies participants using single nucleotide polymorphisms (SNPs) in SIGLEC5, DEFA1A3, MTND1P5, and LOC107984137 loci GWAS-linked to periodontitis, to ascertain their effect on blood pressure (BP) estimates. This demonstrated a significant relationship between periodontitis-linked SNPs and BP phenotypes. We then performed a randomized intervention trial on the effects of treatment of periodontitis on BP. One hundred and one hypertensive patients with moderate/severe periodontitis were randomized to intensive periodontal treatment (IPT; sub- and supragingival scaling/chlorhexidine; n = 50) or control periodontal treatment (CPT; supragingival scaling; n = 51) with mean ambulatory 24-h (ABPM) systolic BP (SBP) as primary outcome. Intensive periodontal treatment improved periodontal status at 2 months, compared to CPT. This was accompanied by a substantial reduction in mean SBP in IPT compared to the CPT (mean difference of -11.1 mmHg; 95% CI 6.5-15.8; P < 0.001). Systolic BP reduction was correlated to periodontal status improvement. Diastolic BP and endothelial function (flow-mediated dilatation) were also improved by IPT. These cardiovascular changes were accompanied by reductions in circulating IFN-γ and IL-6 as well as activated (CD38+) and immunosenescent (CD57+CD28null) CD8+T cells, previously implicated in hypertension. CONCLUSION A causal relationship between periodontitis and BP was observed providing proof of concept for development of clinical trial in a large cohort of hypertensive patients. ClinicalTrials.gov: NCT02131922.
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Affiliation(s)
- Marta Czesnikiewicz-Guzik
- Department of Periodontology and Oral Sciences Research Group, University of Glasgow Dental School, Glasgow, UK
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Osmenda
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Mateusz Siedlinski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Richard Nosalski
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Piotr Pelka
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Daniel Nowakowski
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Grzegorz Wilk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Tomasz P Mikolajczyk
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Agata Schramm-Luc
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Aneta Furtak
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, 31-107 Poland
| | - Pawel Matusik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | - Joanna Koziol
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
| | | | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Mark Caulfield
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 31-107 Krakow, Poland
| | | | - Tomasz J Guzik
- Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, 31-107, Krakow, Poland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Schernthaner G, Saely CH, Schernthaner GH, Watschinger B, Drexel H. [Individualising antihypertensive therapy in patients with diabetes. A guideline by the Austrian Diabetes Association (Update 2019)]. Wien Klin Wochenschr 2019; 131:124-135. [PMID: 30980142 DOI: 10.1007/s00508-019-1460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hypertension is one of the most important comorbidities of diabetes, contributing significantly to death and leads to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. In the present review practical approaches to hypertension in diabetes, including individualized targets for preventing specific complications are discussed according to current studies and guidelines. According to recent studies, blood pressure values of about 130/80 mm Hg are associated with the best outcome. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are the most effective drugs for treating hypertension in diabetes. Calcium antagonists or diuretics are acceptable as second-line agents. Once the target is achieved, antihypertensive drugs should be continued. Newer antidiabetic medications such as SGLT-2-inhibitors or GLP1-receptor agonists have also antihypertensive effects.
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Affiliation(s)
- Guntram Schernthaner
- 1. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich. .,Universität Wien, Wien, Österreich.
| | - Christoph H Saely
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Gerit-Holger Schernthaner
- Klinische Abteilung für Angiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Wien, Österreich
| | - Bruno Watschinger
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Heinz Drexel
- VIVIT Institut, Landeskrankenhaus Feldkirch, Feldkirch, Österreich.,Private Universität im Fürstentum Liechtenstein, Liechtenstein, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA.,Abteilung für Angiologie, Universitätsspital Bern, Bern, Schweiz.,ESC-Working Group "Cardiovascular Pharmacotherapy", Sophia Antipolis, Frankreich
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67
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Yongtai L, Jinzhi L, Lixin Z, Feifei Z, Dingding Z, Zhuang T, Yanlin Z, Wei C, Hua B, Hui W, Yicheng Z, Liying C, Zhengyu J, Zhang S. Effect of different ranges of systolic blood pressure on left ventricular structure and diastolic function in a Chinese population: a cross-sectional population-based Shunyi study. BMJ Open 2019; 9:e028398. [PMID: 31481369 PMCID: PMC6731946 DOI: 10.1136/bmjopen-2018-028398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect of different ranges of systolic blood pressure (SBP) on left ventricular (LV) geometry and diastolic function in Chinese population. DESIGN Cross-sectional study. SETTING Peking Union Medical College Hospital in Beijing, China. PARTICIPANTS All inhabitants aged 35 years or older, living in five villages of Shunyi were invited. Exclusion criteria included individuals who declined participation, presence of moderate to severe valvular heart disease, persistent atrial fibrillation and suboptimal echocardiograms. INTERVENTIONS The baseline data of 1051 participants were analysed. The relationship between SBP and LV geometric and diastolic function assessed by echocardiography was analysed after adjusting for conventional cardiac risk factors. RESULTS The adjusted value of SBP was independently associated with LV hypertrophy (LVH) and LV diastolic dysfunction (LVDDF) (all p<0.01). Setting individuals with SBP <120 mm Hg as the reference group (group 1), those with SBP between 120 mm Hg and 140 mm Hg (group 2) had higher risk odds of LVH and those with SBP ≥140 mm Hg (group 3) had higher risk odds of LVH and LVDDF (all p<0.01). With the increase of SBP, LV mass index (LVMI) and E/e' stepwise increased and e' stepwise decreased significantly from group 1 to 3 (all p<0.05). In the whole population, SBP was independently correlated with LVMI, LVEDD, Left Atrial Volume Index, e', and E/e' (all p<0.01). CONCLUSIONS SBP was independently related to LVH and LVDDF, SBP between 120 and 140 mm Hg was independently related to worse LV remodelling and diastolic function, these findings indicated the potential benefit of intensive SBP control.
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Affiliation(s)
- Liu Yongtai
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Lai Jinzhi
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhou Lixin
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhai Feifei
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhang Dingding
- Central Research Laboratory, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Tian Zhuang
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhu Yanlin
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Chen Wei
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Bai Hua
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Wang Hui
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Zhu Yicheng
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Cui Liying
- Neurology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Jin Zhengyu
- Radiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
| | - Shuyang Zhang
- Cardiology, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, China
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Li Q, Lin F, Ke D, Cheng Q, Gui Y, Zhou Y, Wu Y, Wang Y, Zhu P. Combination of Endoglin and ASCVD Risk Assessment Improves Carotid Subclinical Atherosclerosis Recognition. J Atheroscler Thromb 2019; 27:331-341. [PMID: 31406054 PMCID: PMC7192815 DOI: 10.5551/jat.50898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: Our study investigated the association between soluble endoglin and carotid subclinical atherosclerosis. Methods: We used endoglin as an adjunct to atherosclerotic cardiovascular disease (ASCVD) risk, in recognition of carotid clinical atherosclerosis, in order to explore a new model to refine risk assessment. Out of 3,452 participants, 978 subjects with detected soluble endoglin were enrolled in a cross-sectional investigation in Fujian Province were enrolled. Soluble endoglin concentration in serum samples was evaluated using an enzyme-linked immunosorbent assay method. Carotid ultrasonography was used to detect intima-media thickness and carotid plaque. Results: The mean 10-year ASCVD risk by the new Pooled Cohort Equations accounted for 10.04% (± 12.35). The mean soluble endoglin level was 15.35 ng/ml (± 6.64). Multivariable regression demonstrated that age, systolic blood pressure, diastolic blood pressure, total cholesterol, high density lipoprotein cholesterol, and serum uric acid were independent determinants of soluble endoglin. Adding tests of ASCVD and endoglin together, in parallel, will increase the sensitivity and decrease specificity in recognizing carotid subclinical atherosclerosis. Evaluating the added value of endoglin to the ASCVD risk model showed significantly improved discrimination with analysis of C-statistics, continuous net reclassification index and integrated discrimination index. Both ASCVD risk and soluble endoglin showed positively linear correlation with carotid intima-media thickness (cIMT) (β = 0.006, P < 0.001; β = 0.485, P < 0.001). Even with adjustment for other factors, the relationship between log-transformed soluble endoglin with cIMT was still significant (β = 0.369, P < 0.001). Conclusions: The combination of ASCVD risk and endoglin levels increases carotid atherosclerosis recognition.
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Affiliation(s)
- Qiaowei Li
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Fan Lin
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Douli Ke
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Qiong Cheng
- Department of Neurology, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Shengli Clinical Medical College of Fujian Medical University
| | - Yongzhi Gui
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Yuyan Zhou
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Yicheng Wu
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
| | - Yinzhou Wang
- Department of Neurology, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Shengli Clinical Medical College of Fujian Medical University
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Institute of Clinical Geriatrics, Fujian Provincial Center for Geriatrics
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Kim KI, Ihm SH, Kim GH, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Park S, Pyun WB, Shin J, Chae SC. 2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations. Clin Hypertens 2019; 25:19. [PMID: 31388452 PMCID: PMC6670160 DOI: 10.1186/s40885-019-0123-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/14/2019] [Indexed: 01/05/2023] Open
Abstract
Treatment of hypertension improves cardiovascular, renal, and cerebrovascular outcomes. However, the benefit of treatment may be different according to the patients' characteristics. Additionally, the target blood pressure or initial drug choice should be customized according to the special conditions of the hypertensive patients. In this part III, we reviewed previous data and presented recommendations for some special populations such as diabetes mellitus, chronic kidney disease, elderly people, and cardio-cerebrovascular disease.
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Affiliation(s)
- Kwang-il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hyun Ihm
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Department of Internal Medicine, School of Medicine, Chonnam University, GwangJu, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University, School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu, Korea
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Deşer SB, Yucel SM, Demirag MK, Kolbakir F, Keceligil HT. Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy. Braz J Cardiovasc Surg 2019; 34:136-141. [PMID: 30916122 PMCID: PMC6436778 DOI: 10.21470/1678-9741-2018-0257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/07/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction The aim of this study was to examine the association of inter-arm systolic
blood pressure difference (IASBPD) with carotid artery stenosis, subclavian
artery stenosis and vertebral artery stenosis in patients who underwent
carotid endarterectomy. Methods A total of 141 patients (29 females, 112 males; mean age 71.2±10.4
years; range 47 to 92 years) who underwent carotid endarterectomy between
September 2010 and December 2017 were retrospectively evaluated. We
classified patients into four groups according to the IASBPD ˂ 10 mmHg,
≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of
both subclavian and vertebral arteries was considered as ≥ 50%. Results Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥
20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%)
were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of
them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD
≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery
stenosis. We found a significant correlation between preoperative symptoms
and subclavian artery stenosis (P=0.018) and overall
perioperative stroke was seen more frequently in patients with subclavian
artery stenosis (P=0.041). A significant positive
correlation was observed between vertebral artery stenosis and subclavian
artery stenosis (P=0.01). Conclusion Patients who were diagnosed with both subclavian artery stenosis and IASBPD
(≥ 20 mmHg) had a higher risk of postoperative stroke and death, had
higher total cholesterol, LDL-C, blood creatinine level, and were more
symptomatic.
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Affiliation(s)
- Serkan Burç Deşer
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Semih Murat Yucel
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Mustafa Kemal Demirag
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fersat Kolbakir
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Tahsin Keceligil
- Department of Cardiovascular Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
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71
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Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:354-361. [PMID: 31105756 PMCID: PMC6503475 DOI: 10.11909/j.issn.1671-5411.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs, as monotherapy or dual combination therapy, to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg; daytime mean BP < 135/85 mmHg; and nighttime mean BP < 120/70 mmHg), as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients' mean age was 71 years, and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy, and renin-angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52, P = 0.05 and OR = 0.41, P = 0.007, respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45, P = 0.004). Compared with RAS/diuretic therapy, BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27, P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP, whereas diuretic-based therapies provided lower nighttime BP, compared with other antihypertensive regimens.
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72
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Whelton PK. Evolution of Blood Pressure Clinical Practice Guidelines: A Personal Perspective. Can J Cardiol 2019; 35:570-581. [PMID: 31030860 PMCID: PMC6494109 DOI: 10.1016/j.cjca.2019.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 02/07/2023] Open
Abstract
Before the second half of the 20th century, most clinical decision making was based on expert opinion. By the 1960s, experience in actuarial and research cohort studies had provided strong evidence that blood pressure was an important risk factor for cardiovascular disease. The landmark 1967 and 1970 Veterans Administration Cooperative Study trials confirmed the value of antihypertensive drug therapy in preventing stroke, myocardial infarction, and heart failure in adults with high levels of diastolic blood pressure. They also provided an impetus to develop the first blood-pressure-related clinical practice guideline in 1977. In subsequent years, more structured and comprehensive blood-pressure guidelines have evolved to become a major resource in clinical and public health practice. Despite some limitations, these guidelines provide useful evidence-based guidance for diagnosis and management of high blood pressure. The core advice in most of the current comprehensive blood pressure guidelines is more similar than different. Modelling studies suggest that better adherence to guideline recommendations would result in a lower average blood pressure and substantial improvement in public health.
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Affiliation(s)
- Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Relevance of Targeting the Distal Renal Artery and Branches with Radiofrequency Renal Denervation Approaches-A Secondary Analysis from a Hypertensive CKD Patient Cohort. J Clin Med 2019; 8:jcm8050581. [PMID: 31035604 PMCID: PMC6572309 DOI: 10.3390/jcm8050581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
We searched for an association between changes in blood pressure (BP) at 12 and 24 months after renal denervation (RDN) and the different patterns of ablation spots placement along the renal artery vasculature. We performed a post-hoc analysis of a 24-month follow-up evaluation of 30 patients who underwent RDN between 2011 and 2012 using our previous database. Patients who had (i) resistant hypertension, as meticulously described previously, and (ii) Chronic kidney disease (CKD) stages 2, 3 and 4. Correlations were assessed using the Pearson or Spearman correlation tests as appropriate. The mean change in systolic ambulatory BP monitoring (ABPM) compared to baseline was −19.4 ± 12.7 mmHg at the 12th (p < 0.0001) and −21.3 ± 14.1 mmHg at the 24th month (p < 0.0001). There was no correlation between the ABPM Systolic Blood Pressure (SBP)-lowering effect and the total number of ablated spots in renal arteries (17.7 ± 6.0) either at 12 (r = −0.3, p = 0.1542) or at 24 months (r = −0.2, p = 0.4009). However, correlations between systolic BP-lowering effect and the number of ablation spots performed in the distal segment and branches were significant at the 12 (r = −0.7, p < 0.0001) and 24 months (r = −0.8, p < 0.0001) follow-up. Our findings indicate a substantial correlation between the numbers of ablated sites in the distal segment and branches of renal arteries and the systolic BP-lowering effect in the long-term.
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Grant AD, Wolf GI. Free-Living Humans Cross Cardiovascular Disease Risk Categories Due to Daily Rhythms in Cholesterol and Triglycerides. J Circadian Rhythms 2019; 17:3. [PMID: 31065289 PMCID: PMC6484367 DOI: 10.5334/jcr.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease risk assessment relies on single time-point measurement of risk factors. Although significant daily rhythmicity of some risk factors (e.g., blood pressure and blood glucose) suggests that carefully timed samples or biomarker timeseries could improve risk assessment, such rhythmicity in lipid risk factors is not well understood in free-living humans. As recent advances in at-home blood testing permit lipid data to be frequently and reliably self-collected during daily life, we hypothesized that total cholesterol, HDL-cholesterol or triglycerides would show significant time-of-day variability under everyday conditions. To address this hypothesis, we worked with data collected by 20 self-trackers during personal projects. The dataset consisted of 1,319 samples of total cholesterol, HDL-cholesterol and triglycerides, and comprised timeseries illustrating intra and inter-day variability. All individuals crossed at least one risk category in at least one output within a single day. 90% of fasted individuals (n = 12) crossed at least one risk category in one output during the morning hours alone (06:00-08:00) across days. Both individuals and the aggregated group show significant, rhythmic change by time of day in total cholesterol and triglycerides, but not HDL-cholesterol. Two individuals collected additional data sufficient to illustrate ultradian (hourly) fluctuation in triglycerides, and total cholesterol fluctuation across the menstrual cycle. Short-term variability of sufficient amplitude to affect diagnosis appears common. We conclude that cardiovascular risk assessment may be augmented via further research into the temporal dynamics of lipids. Some variability can be accounted for by a daily rhythm, but ultradian and menstrual rhythms likely contribute additional variance.
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Affiliation(s)
- Azure D. Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, US
| | - Gary I. Wolf
- Hanze University of Applied Sciences, Groningen, NL
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Regional variations in trajectories of long-term readmission rates among patients in England with heart failure. BMC Cardiovasc Disord 2019; 19:86. [PMID: 30954063 PMCID: PMC6451209 DOI: 10.1186/s12872-019-1057-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to compare the characteristics and types of heart failure (HF) patients termed "high-impact users", with high long-term readmission rates, in different regions in England. This will allow clinical factors to be identified in areas with potentially poor quality of care. METHODS Patients with a primary diagnosis of heart failure (HF) in the period 2008-2009 were identified using nationally representative primary care data linked to national hospital data and followed up for 5 years. Group-based trajectory models and sequence analysis were applied to their readmissions. RESULTS In each of the 8 NHS England regions, multiple discrete groups were identified. All the regions had high-impact users. The group with an initially high readmission rate followed by a rapid decline in the rate ranged from 2.5 to 11.3% across the regions. The group with constantly high readmission rate compared with other groups ranged from 1.9 to 12.1%. Covariates that were commonly found to have an association with high-impact users among most of the regions were chronic respiratory disease, chronic renal disease, stroke, anaemia, mood disorder, and cardiac arrhythmia. Respiratory tract infection, urinary infection, cardiopulmonary signs and symptoms and exacerbation of heart failure were common causes in the sequences of readmissions among high-impact users in all regions. CONCLUSION There is regional variation in England in readmission and mortality rates and in the proportions of HF patients who are high-impact users.
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Annoni EM, Van Helden D, Guo Y, Levac B, Libbus I, KenKnight BH, Osborn JW, Tolkacheva EG. Chronic Low-Level Vagus Nerve Stimulation Improves Long-Term Survival in Salt-Sensitive Hypertensive Rats. Front Physiol 2019; 10:25. [PMID: 30766489 PMCID: PMC6365472 DOI: 10.3389/fphys.2019.00025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022] Open
Abstract
Chronic hypertension (HTN) affects more than 1 billion people worldwide, and is associated with an increased risk of cardiovascular disease. Despite decades of promising research, effective treatment of HTN remains challenging. This work investigates vagus nerve stimulation (VNS) as a novel, device-based therapy for HTN treatment, and specifically evaluates its effects on long-term survival and HTN-associated adverse effects. HTN was induced in Dahl salt-sensitive rats using a high-salt diet, and the rats were randomly divided into two groups: VNS (n = 9) and Sham (n = 8), which were implanted with functional or non-functional VNS stimulators, respectively. Acute and chronic effects of VNS therapy were evaluated through continuous monitoring of blood pressure (BP) and ECG via telemetry devices. Autonomic tone was quantified using heart rate (HR), HR variability (HRV) and baroreflex sensitivity (BRS) analysis. Structural cardiac changes were quantified through gross morphology and histology studies. VNS significantly improved the long-term survival of hypertensive rats, increasing median event-free survival by 78% in comparison to Sham rats. Acutely, VNS improved autonomic balance by significantly increasing HRV during stimulation, which may lead to beneficial chronic effects of VNS therapy. Chronic VNS therapy slowed the progression of HTN through an attenuation of SBP and by preserving HRV. Finally, VNS significantly altered cardiac structure, increasing heart weight, but did not alter the amount of fibrosis in the hypertensive hearts. These results suggest that VNS has the potential to improve outcomes in subjects with severe HTN.
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Affiliation(s)
- Elizabeth M Annoni
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Dusty Van Helden
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, United States
| | - Yugene Guo
- Department of Biology, University of Minnesota, Minneapolis, MN, United States
| | - Brett Levac
- Department of Electrical Engineering, University of Minnesota, Minneapolis, MN, United States
| | | | | | - John W Osborn
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, United States
| | - Elena G Tolkacheva
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
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Kimani S, Mirie W, Chege M, Okube OT, Muniu S. Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. BMJ Open 2019; 9:e023995. [PMID: 30782721 PMCID: PMC6340423 DOI: 10.1136/bmjopen-2018-023995] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya. DESIGN Descriptive, cross-sectional. SETTING Medical wards and outpatient clinic of a national referral hospital. PARTICIPANTS Patients (n=229) diagnosed with primary hypertension for at least 6 months. PRIMARY OUTCOMES Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information. RESULTS Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled. CONCLUSION Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.
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Affiliation(s)
- Samuel Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Margaret Chege
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Aortic-to-brachial artery stiffness gradient is not blood pressure independent. J Hum Hypertens 2019; 33:385-392. [PMID: 30631127 DOI: 10.1038/s41371-018-0154-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/08/2018] [Accepted: 12/04/2018] [Indexed: 11/08/2022]
Abstract
Aortic stiffness predicts cardiovascular mortality but is limited as a risk marker because it is dependent on blood pressure (BP). A potential solution is provided from the ratio of aortic-to-brachial artery stiffness (ab-ratio), which has been shown to be a BP-independent risk marker among patients with renal dysfunction (RD). We sought to determine the BP independence of the ab-ratio in patients with disease, including RD, and healthy populations. The ab-ratio (aortic/brachial pulse wave velocity) and mean arterial pressure (MAP) were recorded in patients with RD (n = 119, aged 65 ± 7 years), hypertension (n = 140, aged 62 ± 9 years), type 2 diabetes mellitus (n = 77, aged 60 ± 9 years) and healthy subjects (n = 99, aged 51 ± 8 years). Multiple-regression analysis was performed to test the independent association of MAP with the ab-ratio adjusted for age, sex, body mass index, glucose and heart rate. There was no significant relationship between the ab-ratio and MAP in patients with RD (β = 0.08, p = 0.34), hypertension (β = 0.04, p = 0.62) or diabetes (β = 0.22, p = 0.11). However, among healthy subjects the ab-ratio was significantly and independently associated with MAP (β = 0.31, p = 0.003). There was a significant difference in the strength of association between the ab-ratio and MAP between patients with disease and healthy subjects (z > 2.2, p < 0.05 all). Although ab-ratio is purported to be a risk marker that is independent of BP, this was observed only among patient populations, and not among healthy subjects. As a result, the ab-ratio has limited potential as a screening tool for the clinical assessment of arterial stiffness in otherwise healthy individuals.
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Impact of high- and low-intensity resistance training on arterial stiffness and blood pressure in adults across the lifespan: a review. Pflugers Arch 2018; 471:467-478. [DOI: 10.1007/s00424-018-2235-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 12/24/2022]
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Xu G, Wang C, Ying X, Kong F, Ji H, Zhao J, Zhang X, Duan S, Han L, Li L. Serine hydroxymethyltransferase 1 promoter hypermethylation increases the risk of essential hypertension. J Clin Lab Anal 2018; 33:e22712. [PMID: 30411815 DOI: 10.1002/jcla.22712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Serine hydroxymethyltransferase 1 (SHMT1) is an enzyme involved in folic acid metabolism and is known to contribute to the development of hypertension. We evaluated the relationship between SHMT1 promoter methylation and essential hypertension (EH). METHODS Quantitative methylation-specific polymerase chain reaction was used to measure the SHMT1 promoter methylation level in 241 EH patients and 288 age- and gender-matched healthy individuals. The diagnostic value of SHMT1 promoter hypermethylation was analyzed using a receiver operating characteristic (ROC) curve. The Gene Expression Omnibus (GEO) database and dual-luciferase reporter assay were used to validate our findings. RESULTS Compared with the control group, significant differences in SHMT1 promoter methylation were found in both EH and hyperhomocysteinemia groups (P < 0.001 and P = 0.029, respectively). The area under the curve of the diagnosis of SHMT1 promoter hypermethylation for EH was 0.808, with a sensitivity and specificity of 73.9% and 77.8%, respectively. The risk of SHMT1 promoter hypermethylation was significantly higher in the >65-year group than in the ≤65-year group (odds ratio = 3.925; 95% confidence interval = 2.141-7.196). In addition, GEO database analysis showed that 5-aza-deoxycytidine increased gene expression in several carotid endothelial cell lines. A dual-luciferase reporter assay revealed that the target sequence in the SHMT1 promoter upregulated gene expression. CONCLUSION Our findings indicate that SHMT1 promoter hypermethylation increases the risk of EH and may be a promising biomarker for EH.
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Affiliation(s)
- Guodong Xu
- Department of Preventive Medicine and Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Changyi Wang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiuru Ying
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, China
| | - Fanqian Kong
- Department of Preventive Medicine and Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Huihui Ji
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, China
| | - Jinshun Zhao
- Department of Preventive Medicine and Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Xiaohong Zhang
- Department of Preventive Medicine and Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Shiwei Duan
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, China
| | - Liyuan Han
- Department of Preventive Medicine and Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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Landi F, Calvani R, Picca A, Tosato M, D'Angelo E, Martone AM, Serafini E, Ortolani E, Savera G, Salini S, Acampora N, Bernabei R, Marzetti E. Relationship between cardiovascular health metrics and physical performance in community-living people: Results from the Longevity check-up (Lookup) 7+ project. Sci Rep 2018; 8:16353. [PMID: 30397361 PMCID: PMC6218517 DOI: 10.1038/s41598-018-34746-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular health metrics (CHMs) may predict disability independent of vascular events. Though, the link between CHMs and physical performance is unclear. This relationship was explored using data from the Longevity check-up (Lookup) 7+ project. Lookup 7+ is an ongoing cross-sectional survey conducted in unconventional settings across Italy. People who are at least 18-year-old and provide written informed consent are eligible. CHMs [i.e., smoking status, healthy diet, body mass index (BMI), blood pressure, blood cholesterol, and diabetes status] are assessed through closed questions and objective measurements. Physical performance is measured via the 5-repetition chair-stand test. Analyses included 7446 participants (55.5 ± 14.9 years; 56% women). Physical performance positively correlated with CHMs scores, such that participants who scored higher (6-7 points) completed the chair-stand test about 2 s faster than those scoring lower (1-2 points). In fully adjusted analysis, better physical performance was more frequently observed in younger, non-smoking, physically active men, with ideal BMI, and no diabetes. Our findings indicate a gradient of better physical function with increasing CHMs scores. Future investigations should establish the longitudinal effect of unhealthy behaviours and cardiovascular risk factors on physical performance and verify whether implementation of large-scale primordial cardiovascular prevention may positively impact physical fitness.
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Affiliation(s)
- Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy.
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Emanuela D'Angelo
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Anna Maria Martone
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Elisabetta Serafini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Elena Ortolani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Giulia Savera
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Sara Salini
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Nicola Acampora
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Roberto Bernabei
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, 00168, Italy
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Jeong JS, Kim MK, Han KD, Hong OK, Baek KH, Song KH, Chung DJ, Lee JM, Kwon HS. The Association between Pancreatic Steatosis and Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients. Diabetes Metab J 2018; 42:425-432. [PMID: 30113148 PMCID: PMC6202568 DOI: 10.4093/dmj.2017.0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/18/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Whether pancreatic steatosis has a local or systemic effect, like ectopic fat of other major organs, remains unknown. Data on the influence of pancreatic steatosis on microvascular complication are rare. Therefore, we investigated the relationship between pancreatic steatosis and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). METHODS The attenuation of three pancreatic regions (head, body, and tail) and the spleen (S) in 186 patients with T2DM was measured using non-enhanced computed tomography imaging. We used three parameters for the assessment of pancreatic steatosis ('P' mean: mean attenuation of three pancreatic regions; P-S: difference between 'P' mean and 'S'; P/S: the 'P' mean to 'S' ratio). The presence of DR was assessed by an expert ophthalmologist using dilated fundoscopy. RESULTS The average P mean was 29.02 Hounsfield units (HU), P-S was -18.20 HU, and P/S was 0.61. The three pancreatic steatosis parameters were significantly associated with the prevalence of DR in non-obese T2DM patients. In the non-obese group, the odds ratios of P mean, P-S, and P/S for the prevalence of DR, after adjustment for age, sex, and glycosylated hemoglobin level, were 2.449 (P=0.07), 2.639 (P=0.04), and 2.043 (P=0.02), respectively. CONCLUSION In this study, pancreatic steatosis was significantly associated with DR in non-obese patients with T2DM. Further studies are necessary to clarify the causal relationship between pancreatic steatosis and the development of DR.
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Affiliation(s)
- Jee Sun Jeong
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee Kyung Kim
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Oak Kee Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Hyun Baek
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Ho Song
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Min Lee
- Department of Internal Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hyuk Sang Kwon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Jia G, Aroor AR, Hill MA, Sowers JR. Role of Renin-Angiotensin-Aldosterone System Activation in Promoting Cardiovascular Fibrosis and Stiffness. Hypertension 2018; 72:537-548. [PMID: 29987104 PMCID: PMC6202147 DOI: 10.1161/hypertensionaha.118.11065] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Guanghong Jia
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
| | - Annayya R. Aroor
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
| | - Michael A. Hill
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65211, USA
| | - James R. Sowers
- Diabetes and Cardiovascular Research Center, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, 65212, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, 65211, USA
- Research Service, Truman Memorial Veterans Hospital, Columbia, MO, 65201, USA
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84
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Aslan NA, Vural Ç, Yılmaz AA, Alanoğlu Z. Propofol Versus Thiopental for Rapid-Sequence Induction in Isolated Systolic Hypertensive Patients: A Factorial Randomized Double-Blind Clinical Trial. Turk J Anaesthesiol Reanim 2018; 46:367-372. [PMID: 30263860 DOI: 10.5152/tjar.2018.44442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/22/2022] Open
Abstract
Objective We investigated the effects of four different anaesthesia induction protocols on the haemodynamic response to laryngoscopy and tracheal intubation during rapid-sequence induction (RSI) in systolic hypertensive patients. Methods One hundred and twenty hypertensive adult patients (systolic pressure >140 mmHg and diastolic pressure <90 mmHg), classified according to the American Association of Anesthesiologists as Class II and III were randomized into four groups. After pre-oxygenation for 3 minutes, induction and tracheal intubation were performed by blinded investigators, who also scored the intubation. Study groups composed of 30 patients each received lidocaine 1 mg kg-1+thiopental 5 mg kg-1 or remifentanil 1 μg kg-1+thiopental 5 mg kg-1 or lidocaine 1 mg kg-1+propofol 2 mg kg-1 or remifentanil 1 μg kg-1+propofol 2 mg kg-1. Succinylcholine was the muscle relaxant. Haemodynamic data were obtained before (baseline) and after induction, at intubation, and at 1, 3, 5 and 10 minutes after intubation. A rise or drop in the arterial blood pressure and heart rate >20% were considered to be significant. Results Patients receiving remifentanil+propofol had a reduction in the systolic and mean blood pressure >20% when compared to patients receiving remifentanil and thiopental: systolic values were 125±27 mmHg in the remifentanil+propofol group versus 153±35 mmHg in the remifentanil+thiopental group 1 minute after intubation (p<0.01); the mean arterial pressure values were 87±18 mmHg in the remifentanil+propofol group versus 105±25 mmHg in the remifentanil+thiopental group 1 minute after intubation (p<0.05). Conclusion Propofol was not superior to thiopental for the attenuation of the response to laryngoscopy and intubation during RSI in systolic hypertensive patients, whereas propofol+remifentanil combination appears to be so in terms of the heart rate stability.
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Affiliation(s)
- Nesrin Ahu Aslan
- Clinic of Anaesthesiology and Reanimation, Derindere Hospital, İstanbul, Turkey
| | - Çağıl Vural
- Department of Oral and Maxillofacial Surgery, Division of Anaesthesiology, Ankara University Faculty of Dentistry, Ankara, Turkey
| | - Ali Abbas Yılmaz
- Department of Anaesthesiologu and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Zekeriyya Alanoğlu
- Department of Anaesthesiologu and Reanimation, Ankara University School of Medicine, Ankara, Turkey
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Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2018; 7:CD010315. [PMID: 30027631 PMCID: PMC6513382 DOI: 10.1002/14651858.cd010315.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This is the first update of the review published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. OBJECTIVES To determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2018: Cochrane Hypertension Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. SELECTION CRITERIA We included randomized controlled trials (RCTs) that included more than 50 participants per group and provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (≤ 135/85 mmHg) compared with standard targets for blood pressure (≤ 140 to 160/90 to 100 mmHg).Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. MAIN RESULTS We included six RCTs that involved a total of 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data.We found no change in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; moderate-quality evidence). Similarly, we found no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; low-quality evidence). Studies reported more participant withdrawals due to adverse effects in the lower target arm (RR 8.16, 95% CI 2.06 to 32.28; very low-quality evidence). Blood pressures were lower in the lower target group by 8.9/4.5 mmHg. More drugs were needed in the lower target group, but blood pressure targets were achieved more frequently in the standard target group. AUTHORS' CONCLUSIONS We found no evidence of a difference in total mortality, serious adverse events, or total cardiovascular events between people with hypertension and cardiovascular disease treated to a lower or to a standard blood pressure target. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on adverse events, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to examine this topic.
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Affiliation(s)
- Luis Carlos Saiz
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
| | - Javier Gorricho
- General Directorate of Health, Government of NavarrePlanning, Evaluation and Management ServicePamplonaNavarraSpain
| | - Javier Garjón
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaNavarraSpain31002
| | - Mª Concepción Celaya
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaNavarraSpain31002
| | - Juan Erviti
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
| | - Leire Leache
- Navarre Health ServiceUnit of Innovation and OrganizationPamplonaNavarreSpain
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Abstract
PURPOSE OF REVIEW Increased arterial stiffness, an abnormal structural and functional change in the vascular wall, is a precursor for hypertension, coronary heart disease, stroke, and associated cardiovascular disease (CVD). The aim of this paper is to review the etiology of arterial stiffening and potential therapeutic approaches to modulate arterial fibrosis and stiffness. RECENT FINDINGS The Framingham Heart Study demonstrated that arterial stiffness is an independent predictor of CVD and related morbidity and mortality. Dysfunction of endothelial cells, vascular smooth muscle cells, extracellular matrix, and other functional elements of the vessel wall contribute to underlying pathophysiology of increased arterial stiffness. An activated renin-angiotensin-aldosterone system, oxidative stress, abnormal peri-vascular adipose tissue, inflammation, and increased sympathetic nervous system activity are associated with the development and progression of arterial fibrosis, stiffening, and associated CVD. In this review, we will discuss the structural and function changes and mechanisms of the vessel wall in arterial stiffness and provide potential therapeutic strategies.
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87
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Lin FJ, Zhang X, Huang LS, Ji G, Huang HD, Xie Y, Jiang GR, Zhou X, Lu W. Impact of hemoglobin variability on cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 2018; 50:1703-1712. [PMID: 29974406 DOI: 10.1007/s11255-018-1919-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/20/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Although the association between anemia and cardiovascular mortality in hemodialysis patients is well established, whether hemoglobin variability (Hgb-Var) affects the prognosis remains unclear. We aimed to evaluate the association between Hgb-Var and cardiovascular mortality in Chinese hemodialysis patients. METHODS This retrospective study included 252 patients starting hemodialysis in Xin Hua Hospital between January 2009 and December 2015. Patients were divided into three tertiles based on Hgb-Var, as reflected by SD Hgbmean, SD Hgbrange, and Hgbdeflection during a 12-month evaluation period after hemodialysis initiation. Left ventricular ejection fraction (EF) and left ventricular mass index (LVMI) were evaluated by echocardiography. Information on cardiovascular deaths occurred by December 2017 was collected. Multivariate Cox regression models were constructed to evaluate the association between Hgb-Var and cardiovascular mortality. RESULTS A total of 75 deaths and 52 cardiovascular deaths occurred during the 47-month follow-up (range 29.5-70). Under multivariate regression, the subgroup with the highest Hgb-Var had a higher risk of cardiovascular mortality after adjusting for relevant factors (HR vs. lowest SD Hgbmean: 9.15, 95% CI 2.82, 29.693, P < 0.0001; HR vs. lowest SD Hgbrange: 3.81, 95% CI 1.40, 10.38, P = 0.005). Per 1 SD of Hgbmean and Hgbrange elevations were both related to a 10% increase in the cardiovascular mortality risk. Baseline EF% and LVMI did not differ across the Hgb-Var subgroups. EF% upon the last patient visit to the clinic was lower in the subgroup with the highest SD Hgbmean (P = 0.02). CONCLUSIONS High Hgb-Var is an independent risk factor for cardiovascular mortality in hemodialysis patients and might influence the cardiac function.
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Affiliation(s)
- Fu-Jun Lin
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-Sheng Huang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Gang Ji
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Hai-Dong Huang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Yun Xie
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Geng-Ru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China
| | - Xin Zhou
- Clinical Research Unit, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
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Marzetti E, Calvani R, Picca A, Sisto A, Tosato M, Martone AM, Ortolani E, Salini S, Pafundi T, Santoliquido A, Santoro L, Bernabei R, Landi F. Prevalence of dyslipidaemia and awareness of blood cholesterol levels among community-living people: results from the Longevity check-up 7+ (Lookup 7+) cross-sectional survey. BMJ Open 2018; 8:e021627. [PMID: 29961030 PMCID: PMC6045760 DOI: 10.1136/bmjopen-2018-021627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the prevalence of abnormal cholesterol levels and to explore awareness of cholesterol values in an unselected sample of community-living adults. DESIGN Cross-sectional survey. SETTING Exhibitions, malls and health promotion campaigns across Italy. PARTICIPANTS 3535 community dwellers aged 18-98 years were enrolled between September 2016 and June 2017. Analyses were conducted in 3040 participants, after excluding 495 enrolees on cholesterol-lowering medications. MAIN OUTCOME MEASURES Total blood cholesterol levels and awareness of cholesterol values. RESULTS Abnormal blood cholesterol values were found in 1961 (64.5%) of participants with no differences between genders (p=0.06). Among those who believed they had normal cholesterol levels, only 48% had values below 200 mg/dL. More than 40% had cholesterol values between 200 and 240 mg/dL, and around 10% had values >240 mg/dL. More than one-third of participants had not measured cholesterol in the last year. Among them, only 36% had normal cholesterol levels. CONCLUSIONS Abnormal blood cholesterol is highly prevalent in our sample of Italian community dwellers, with less than half of participants being aware of their cholesterol levels.
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Affiliation(s)
- Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Picca
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Alex Sisto
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Matteo Tosato
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Elena Ortolani
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara Salini
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Teodosio Pafundi
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Angelo Santoliquido
- Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Santoro
- Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
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Wanitschek M, Edlinger M, Dörler J, Alber HF. Cohort profile: the Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort. BMJ Open 2018; 8:e021808. [PMID: 29880572 PMCID: PMC6009632 DOI: 10.1136/bmjopen-2018-021808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort is aimed to gain a better understanding of cardiovascular risk factors and their relation to the diagnosis and severity of coronary artery disease, as well as to the long-term prognosis in consecutive (including revascularised) patients referred for elective coronary angiography. PARTICIPANTS The included patients visited the University Clinic of Cardiology at Innsbruck (Austria), which fulfils a secondary and tertiary hospital function. Inclusion took place in the period between February 2004 and April 2008 and resulted in a total of 8296 patients aged 18-91 years; 65% of them were men. FINDINGS TO DATE There was one follow-up round on vital status through record linkage for 84% of the cohort (those with residence in Tyrol), resulting in a follow-up duration of over 5.5 to nearly 10.0 years among survivors. The data contain basic patient characteristics, cardiovascular risk factors, laboratory measurements, medications, detailed information on the extent and severity of coronary artery disease, revascularisation history, treatment strategy and mortality specifics. A few studies have already been published. FUTURE PLANS Various diagnostic and prognostic studies are planned, also concerning complications, competing risks and cost-effectiveness. Collaboration with other research groups is welcomed.
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Affiliation(s)
- Maria Wanitschek
- University Clinic of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Dörler
- University Clinic of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannes F Alber
- Department of Internal Medicine and Cardiology, Clinic Klagenfurt at Wörthersee, Klagenfurt, Austria
- Karl Landsteiner Institute for Interdisciplinary Science, Rehabilitation Centre Münster in Tyrol, Münster, Austria
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Zeigler ZS, Birchfield N, Moreno K, James D, Swan P. Fatness and Fluctuating Body Weight: Effect on Central Vasculature. Biores Open Access 2018; 7:90-100. [PMID: 29892497 PMCID: PMC5994146 DOI: 10.1089/biores.2017.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Weight Cycling (WC) is a prevalent behavior associated with adverse cardiovascular (CV) health. However, a 2010 review on the effects of WC and blood pressure (BP) determined that there was not enough evidence to draw definitive conclusions. Central BP is the principal predictor of CV risk compared to peripheral BP. The influence that WC may have specifically on central BP is unknown. Cross-sectional observation of self-reported history of WC on measures of CV health was undertaken. Seventy-five women completed a Weight and Lifestyle Inventory questionnaire, which is considered a reliable index of WC (r = 0.87, p < 0.001). Measures of visceral fat, BP, arterial stiffness, and VO2peak were taken. Regression equations were used to assess primary predictors of these outcomes. Seventy-five middle aged (39 ± 11 years), obese (32 ± 7 kg/m2), and relatively unfit (24 ± 8 ml·kg-1 min-1) women completed the study. Visceral fat was the strongest predictor of brachial systolic blood pressure (SBP; r2 = 0.283), brachial diastolic blood pressure (DBP; r2 = 0.176), central SBP (r2 = 0.375), and augmentation index (AIx; r2 = 0.535, all p < 0.001). VO2peak was the strongest predictor of central DBP (r2 = 0.062, p = 0.036) and augmentation pressure (AP; r2 = 0.491, p < 0.001). Weight cycling index was associated with visceral fat (r = 0.521, p < 0.001). Visceral fat was a mediator between WC and central SBP (confidence interval [CI] = 0.0053-0.0602), AP (CI = 0.0507-0.4915), AIx (CI = 0.0025-0.0699), and carotid-femoral pulse wave velocity (CI = 0.0115-0.1227; all p < 0.05). WC may increase visceral fat accumulation, which was associated with increased central SBP and measures of arterial stiffness.
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Affiliation(s)
- Zachary S. Zeigler
- College of Science, Engineering, and Technology, Grand Canyon University, Phoenix, Arizona
| | - Natasha Birchfield
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Karen Moreno
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Darith James
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Pamela Swan
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
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Agabiti-Rosei C, Paini A, De Ciuceis C, Withers S, Greenstein A, Heagerty AM, Rizzoni D. Modulation of Vascular Reactivity by Perivascular Adipose Tissue (PVAT). Curr Hypertens Rep 2018; 20:44. [PMID: 29736674 DOI: 10.1007/s11906-018-0835-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW In this review, we discuss the role of perivascular adipose tissue (PVAT) in the modulation of vascular contractility and arterial pressure, focusing on the role of the renin-angiotensin-aldosterone system and oxidative stress/inflammation. RECENT FINDINGS PVAT possesses a relevant endocrine-paracrine activity, which may be altered in several pathophysiological and clinical conditions. During the last two decades, it has been shown that PVAT may modulate vascular reactivity. It has also been previously demonstrated that inflammation in adipose tissue may be implicated in vascular dysfunction. In particular, adipocytes secrete a number of adipokines with various functions, as well as several vasoactive factors, together with components of the renin-angiotensin system which may act at local or at systemic level. It has been shown that the anti-contractile effect of PVAT is lost in obesity, probably as a consequence of the development of adipocyte hypertrophy, inflammation, and oxidative stress. Adipose tissue dysfunction is interrelated with inflammation and oxidative stress, thus contributing to endothelial dysfunction observed in several pathological and clinical conditions such as obesity and hypertension. Decreased local adiponectin level, macrophage recruitment and infiltration, and activation of renin-angiotensin-aldosterone system could play an important role in this regard.
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Affiliation(s)
- Claudia Agabiti-Rosei
- Department of Medicine, Manchester University, Manchester, UK. .,Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.
| | - Anna Paini
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy
| | - Sarah Withers
- Department of Medicine, Manchester University, Manchester, UK
| | - Adam Greenstein
- Department of Medicine, Manchester University, Manchester, UK
| | | | - Damiano Rizzoni
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy
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Cheddani L, Radulescu C, Chaignon M, Karras A, Neuzillet Y, Duong JP, Tabibzadeh N, Letavernier E, Delahousse M, Haymann JP. From arterial stiffness to kidney graft microvasculature: Mortality and graft survival within a cohort of 220 kidney transplant recipients. PLoS One 2018; 13:e0195928. [PMID: 29723212 PMCID: PMC5933694 DOI: 10.1371/journal.pone.0195928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/02/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aortic stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) is a predictor of mortality in several populations. However, little is known in kidney transplant recipients. Our objectives were to evaluate the ability of CF-PWV measured 3 months following transplantation to predict mortality, graft loss and its potential links to measured Glomerular Filtration Rate (mGFR) or kidney graft microvasculature parameters. METHODS The study is based on a monocentric retrospective cohort including 220 adult kidney graft recipients evaluated three months after transplantation. CF-PWV measures, clinical, laboratory and histological data performed at 3 (M3) and 12 months (M12) following transplantation were retrospectively collected. The two primary endpoints were all-cause mortality and occurrence of end stage renal disease (ESRD) defined by initiation of dialysis. RESULTS After a median follow up of 5.5 years [1.9; 8.8], death and graft loss occurred in 10 and 12 patients respectively. M3 CF-PWV was an independent mortality risk factor (HR = 1.29 [1.03; 1.61]; p = 0.03), despite no aortic stiffness variation during the first year of transplantation. Of notice, M3 CF-PWV was not associated with M12 mGFR or ESRD outcome. Graft microcirculation assessed by Banff vascular fibrous intimal thickening score (cv) worsened between M3 and M12 (p = 0.01), but no link was found with CF-PWV, mGFR or ESRD outcome. Surprisingly, acute rejections at M3 were associated after adjustment with mortality (p = 0.03) but not ESRD. CONCLUSION Aortic stiffness measured 3 months after kidney transplantation is a strong predictor of mortality with no obvious influence on kidney graft microvasculature or graft loss.
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Affiliation(s)
- Lynda Cheddani
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | | | - Michel Chaignon
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - Alexandre Karras
- Service de Néphrologie, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Université Paris Descartes, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U970- PARCC, Paris, France
| | | | - Jean-Paul Duong
- Service d’Anatomopathologie, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Necker, Paris, France
| | - Nahid Tabibzadeh
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
| | - Michel Delahousse
- Service de Néphrologie et Transplantation rénale, Hôpital Foch, Suresnes, France
- INSERM U-1018; CESP Team 5 (EpReC, Renal and Cardiovascular Epidemiology), Villejuif, France
| | - Jean-Philippe Haymann
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, AP-HP, Hôpital Tenon, Paris, France
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93
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Suyu H, Liu Y, Jianyu X, Luo G, Cao L, Long X. Prevalence and Predictors of Silent Gastroesophageal Reflux Disease in Patients with Hypertension. Gastroenterol Res Pract 2018; 2018:7242917. [PMID: 29849598 PMCID: PMC5937384 DOI: 10.1155/2018/7242917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) without symptoms or silent GERD can be easily missed in patients with hypertension. We aimed to investigate the prevalence of GERD, specifically the prevalence of silent GERD in hypertensive patients, and to explore its possible predictors. METHODS Consecutive patients with hypertension referred to the cardiovascular clinic of Suining Central Hospital in 2016 were screened for this study. A Reflux Disease Questionnaire (RDQ) and an esophagogastroduodenoscopy (EGD) were employed for the evaluation of silent GERD. Included patients were divided into silent-GERD group and non-GERD control group. The demographic characteristics and antihypertensive agent prescriptions were collected and compared between the two groups. RESULTS The prevalence of silent GERD and GERD in patients with hypertension was 15.1% and 31.4%, respectively. 66 patients were included in the silent-GERD group, and 298 patients were included in the non-GERD control group. Abdominal obesity and untreated hypertension were positive predictors, while controlled hypertension was a negative predictor for silent GERD. The prescription of calcium channel blockers was not a predictor for it. CONCLUSIONS High prevalence of GERD, specifically silent GERD, could be found in patients with hypertension. Abdominal obesity and untreated hypertension were positive predictors for silent GERD, while controlled hypertension was a negative predictor for it.
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Affiliation(s)
- He Suyu
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, China
| | - Yijun Liu
- The Third Department of the Cardiology and Vascular Disease Center, Suining Central Hospital, Suining, Sichuan 629000, China
| | - Xu Jianyu
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, China
| | - Guiquan Luo
- The Third Department of the Cardiology and Vascular Disease Center, Suining Central Hospital, Suining, Sichuan 629000, China
| | - Lipeng Cao
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Suining, Sichuan 629000, China
| | - Xiaoqi Long
- The Endoscopy Center, Suining Central Hospital, Suining, Sichuan 629000, China
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94
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Tomasic I, Tomasic N, Trobec R, Krpan M, Kelava T. Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput 2018; 56:547-569. [PMID: 29504070 PMCID: PMC5857273 DOI: 10.1007/s11517-018-1798-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/30/2018] [Indexed: 01/03/2023]
Abstract
Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.
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Affiliation(s)
- Ivan Tomasic
- Division of Intelligent Future Technologies, Mälardalen University, Högskoleplan 1, 72123, Västerås, Sweden.
| | - Nikica Tomasic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Trobec
- Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Miroslav Krpan
- Department of Cardiology, University Hospital Centre, Zagreb, Croatia
| | - Tomislav Kelava
- Department of Physiology, School of Medicine, University of Zagreb, Zagreb, Croatia
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95
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Assuncao N, Sudo FK, Drummond C, de Felice FG, Mattos P. Metabolic Syndrome and cognitive decline in the elderly: A systematic review. PLoS One 2018; 13:e0194990. [PMID: 29579115 PMCID: PMC5868841 DOI: 10.1371/journal.pone.0194990] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 12/30/2022] Open
Abstract
Background Metabolic Syndrome (MetS) refers to a cluster of metabolic disturbances which is associated with increased risk for vascular and degenerative conditions in general population. Although the relationship between vascular risk factors and dementia is undisputable, additional hazard for cognitive decline in older population with concurrent metabolic disorders still waits to be demonstrated. The present review aims to analyze data on MetS and risk for cognitive decline in elderly persons. Methods Database searches were performed in Medline, ISI and PsycINFO for articles assessing cognitive performances of older subjects with MetS. Results Of a total of 505 studies, 25 were selected for the review. Risk of selection biases was identified in all the studies. Although all articles followed recognized diagnostic recommendations for MetS, minor criteria modifications were detected in most of them. Hyperglycemia was consistently associated with impaired cognitive performances in older individuals, but the role of MetS for cognitive decline and for the onset of dementia showed heterogeneous results. Discussion Current available data in the literature concerning the impact of MetS on the cognition of older population is inconclusive and based on inconsistent evidence. Differential effects of individual MetS components and factors associated with the age of the sample may have accounted for divergent findings among articles, but larger and higher quality studies in this field are still needed.
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Affiliation(s)
- Naima Assuncao
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe Kenji Sudo
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Claudia Drummond
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Speech and Hearing Pathology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Guarino de Felice
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Mattos
- Memory Clinic, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute of Biomedical Sciences–Morphological Sciences Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Forensic Medicine, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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96
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Fekete ÁA, Giromini C, Chatzidiakou Y, Givens DI, Lovegrove JA. Whey protein lowers systolic blood pressure and Ca-caseinate reduces serum TAG after a high-fat meal in mildly hypertensive adults. Sci Rep 2018; 8:5026. [PMID: 29568003 PMCID: PMC5864936 DOI: 10.1038/s41598-018-23333-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/09/2018] [Indexed: 11/16/2022] Open
Abstract
Epidemiological studies show an inverse association between dairy consumption and blood pressure (BP) but there are few data on the postprandial effects of milk proteins. This study examined their effects, compared to maltodextrin, on postprandial BP and other CVD risk markers in volunteers with mild and pre-hypertension over an 8 h period. In this double-blinded, randomised, cross-over, controlled study 27 adults ingested a high-fat, isoenergetic breakfast and lunch with 28 g whey protein, 28 g Ca-caseinate or 27 g maltodextrin. Whey protein reduced systolic BP compared with Ca-caseinate (−15.2 ± 13.6 mmHg) and maltodextrin (−23.4 ± 10.5 mmHg) up to 5 h post-ingestion. There was an improvement in arterial stiffness after whey protein compared with maltodextrin (incremental Area Under the Curve- iAUC0–8h: +14.4 ± 6.2%). Despite similar glucose levels after both whey protein and Ca-caseinate, whey protein induced a higher insulin response than Ca-caseinate (iAUC0–8h: +219.5 ± 54.6 pmol/L). Ca-caseinate induced less suppression of non-esterified fatty acids than whey protein (iAUC0–5h: −58.9 ± 135.5 μmol/L) and maltodextrin (iAUC0–5h: −106.9 ± 89.4 μmol/L) and induced a smaller postprandial triacylglycerol response than whey protein (iAUC0–8h: −1.68 ± 0.6 mmol/L). Milk proteins co-ingestion with high-fat meals may have the potential to maintain or improve CVD risk factors.
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Affiliation(s)
- Ágnes A Fekete
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), School of Chemistry, Food and Pharmacy, University of Reading, Reading, RG6 6AP, United Kingdom.,Institute for Food, Nutrition and Health, University of Reading, Reading, RG6 6AP, United Kingdom
| | - Carlotta Giromini
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Via Trentacoste, 2, 20134, Milan, Italy
| | - Yianna Chatzidiakou
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), School of Chemistry, Food and Pharmacy, University of Reading, Reading, RG6 6AP, United Kingdom
| | - D Ian Givens
- Institute for Food, Nutrition and Health, University of Reading, Reading, RG6 6AP, United Kingdom
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences and Institute for Cardiovascular and Metabolic Research (ICMR), School of Chemistry, Food and Pharmacy, University of Reading, Reading, RG6 6AP, United Kingdom. .,Institute for Food, Nutrition and Health, University of Reading, Reading, RG6 6AP, United Kingdom.
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97
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Elias MF, Crichton GE, Dearborn PJ, Robbins MA, Abhayaratna WP. Associations between Type 2 Diabetes Mellitus and Arterial Stiffness: A Prospective Analysis Based on the Maine-Syracuse Study. Pulse (Basel) 2018; 5:88-98. [PMID: 29761082 PMCID: PMC5939695 DOI: 10.1159/000479560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/15/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate prospective associations between type 2 diabetes mellitus status and the gold standard non-invasive method for ascertaining arterial stiffness, carotid femoral pulse wave velocity. METHODS The prospective analysis employed 508 community-dwelling participants (mean age 61 years, 60% women) from the Maine-Syracuse Longitudinal Study. Pulse wave velocity at wave 7 (2006-2010) was compared between those with type 2 diabetes mellitus at wave 6 (2001-2006) (n = 52) and non-diabetics at wave 6 (n = 456), with adjustment for demographic factors, cardiovascular risk factors and lifestyle- and pulse wave velocity-related factors. RESULTS Type 2 diabetes mellitus status was associated with a significantly higher pulse wave velocity (12.5 ± 0.36 vs. 10.4 ± 0.12 m/s). Multivariate adjustment for other cardiovascular risk factors and lifestyle- and pulse wave velocity-related variables did not attenuate the findings. The risk of an elevated pulse wave velocity (≥12 m/s) was over 9 times higher for those with uncontrolled type 2 diabetes mellitus than for those without diabetes (OR 9.14, 95% CI 3.23-25.9, p < 0.001). CONCLUSIONS Type 2 diabetes mellitus, particularly if uncontrolled, is significantly associated with risk of arterial stiffness later in life. Effective management of diabetes mellitus is an important element of protection from arterial stiffness.
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Affiliation(s)
- Merrill F. Elias
- Department of Psychology, University of Maine, Orono, ME, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Georgina E. Crichton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | | | - Michael A. Robbins
- Department of Psychology, University of Maine, Orono, ME, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, ME, USA
| | - Walter P. Abhayaratna
- College of Medicine, Biology, and Environment, Australian National University, Canberra, ACT, Australia
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Patti AM, Al-Rasadi K, Giglio RV, Nikolic D, Mannina C, Castellino G, Chianetta R, Banach M, Cicero AF, Lippi G, Montalto G, Rizzo M, Toth PP. Natural approaches in metabolic syndrome management. Arch Med Sci 2018; 14:422-441. [PMID: 29593818 PMCID: PMC5868676 DOI: 10.5114/aoms.2017.68717] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/25/2022] Open
Abstract
Metabolic syndrome (MetS) is characterized as a group of cardiometabolic risk factors that raise the risk for heart disease and other health problems, such as diabetes mellitus and stroke. Treatment strategies include pharmacologic interventions and supplementary (or "alternative") treatments. Nutraceuticals are derived from food sources (isolated nutrients, dietary supplements and herbal products) that are purported to provide health benefits, in addition to providing basic nutritional value. Nutraceuticals are claimed to prevent chronic diseases, improve health, delay the aging process, increase life expectancy, and support the structure and function of the body. The study of the beneficial effects of nutraceuticals in patients with MetS, including product standardization, duration of supplementation and definition of optimal dosing, could help better define appropriate treatment. This review focuses on widely marketed nutraceuticals (namely polyphenols, omega-3 fatty acids, macroelements and vitamins) with clinically demonstrated effects on more than one component of MetS.
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Affiliation(s)
- Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University, Muscat, Oman
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Carlo Mannina
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Giuseppa Castellino
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Roberta Chianetta
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gallo-Villegas J, Aristizabal JC, Estrada M, Valbuena LH, Narvaez-Sanchez R, Osorio J, Aguirre-Acevedo DC, Calderón JC. Efficacy of high-intensity, low-volume interval training compared to continuous aerobic training on insulin resistance, skeletal muscle structure and function in adults with metabolic syndrome: study protocol for a randomized controlled clinical trial (Intraining-MET). Trials 2018; 19:144. [PMID: 29482601 PMCID: PMC5828481 DOI: 10.1186/s13063-018-2541-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background Evidence of the efficacy of high-intensity, low-volume interval training (HIIT-low volume) in treating insulin resistance (IR) in patients with metabolic disorders is contradictory. In addition, it is unknown whether this effect is mediated through muscle endocrine function, which in turn depends on muscle mass and fiber type composition. Our aims were to assess the efficacy of HIIT-low volume compared to continuous aerobic exercise (CAE) in treating IR in adults with metabolic syndrome (MS) and to establish whether musclin, apelin, muscle mass and muscle composition are mediators of the effect. Methods This is a controlled, randomized, clinical trial using the minimization method, with blinding of those who will evaluate the outcomes and two parallel groups for the purpose of showing superiority. Sixty patients with MS and IR with ages between 40 and 60 years will be included. A clinical evaluation will be carried out, along with laboratory tests to evaluate IR (homeostatic model assessment (HOMA)), muscle endocrine function (serum levels of musclin and apelin), thigh muscle mass (by dual energy x-ray absorptiometry (DXA) and thigh muscle composition (by carnosine measurement with proton magnetic resonance spectroscopy (1H–MRS)), before and after 12 weeks of a treadmill exercise program three times a week. Participants assigned to the intervention (n = 30) will receive HIIT-low volume in 22-min sessions that will include six intervals at a load of 90% of maximum oxygen consumption (VO2 max) for 1 min followed by 2 min at 50% of VO2 max. The control group (n = 30) will receive CAE at an intensity of 60% of VO2 max for 36 min. A theoretical model based on structural equations will be proposed to estimate the total, direct and indirect effects of training on IR and the proportion explained by the mediators. Discussion Compared with CAE, HIIT-low volume can be effective and efficient at improving physical capacity and decreasing cardiovascular risk factors, such as IR, in patients with metabolic disorders. Studies that evaluate mediating variables of the effect of HIIT-low volume on IR, such as endocrine function and skeletal muscle structure, are necessary to understand the role of skeletal muscle in the pathophysiology of MS and their regulation by exercise. Trial registration NCT03087721. High-intensity Interval, Low Volume Training in Metabolic Syndrome (Intraining-MET). Registered on 22 March 2017, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13063-018-2541-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaime Gallo-Villegas
- GRINMADE Group, University of Antioquia, Medellín, Colombia. .,Epidemiology Group, University of Antioquia, Medellín, Colombia. .,GRAEPIC Group, University of Antioquia, Medellín, Colombia. .,SICOR Clinical and Research Center, Medellín, Colombia.
| | - Juan Carlos Aristizabal
- Physiology and Biochemistry Research Group-PHYSIS, University of Antioquia, Medellín, Colombia
| | | | - Luis H Valbuena
- Physiology and Biochemistry Research Group-PHYSIS, University of Antioquia, Medellín, Colombia.,Indeportes Antioquia, Medellín, Colombia
| | - Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group-PHYSIS, University of Antioquia, Medellín, Colombia
| | - Jorge Osorio
- GRINMADE Group, University of Antioquia, Medellín, Colombia
| | | | - Juan C Calderón
- Physiology and Biochemistry Research Group-PHYSIS, University of Antioquia, Medellín, Colombia
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Abstract
Undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is an acknowledged obstacle to CVD prevention. The vasculature's functional robustness against risk factor derailment may serve as a novel discriminator of mortality risk under similar risk factor loads. To test this assumption, we hypothesized that the expected inverse robustness-mortality association is verifiable as a significant trend along the age spectrum of risk factor-challenged cohorts. This is a retrospective cohort study of 372 adults (mean age 56.1 years, range 21–92; 45% female) with a variety of CV risk factors. An arterial model (VascAssist 2, iSYMED GmbH, Germany) was used to derive global parameters of arterial function from non-invasively acquired pulse pressure waves. Participants were stratified by health status: apparently healthy (AH; n = 221); with hypertension and/or hypercholesterolemia (CC; n = 61); with history of CV event(s) (CVE; n = 90). Multivariate linear regression was used to derive a robustness score which was calibrated against the CVD mortality hazard rate of a sub-cohort of the LURIC study (n = 1369; mean age 59.1 years, range 20–75; 37% female). Robustness correlated linearly with calendar age in CC (F(1, 59) = 10.42; p < 0.01) and CVE (F(1, 88) = 40.34; p < 0.0001) but not in the AH strata, supporting the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges. Vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality. Vascular robustness is proposed as parameter to improve CV risk prediction. Vascular robustness may be expressed as a correction factor to calendar age. A vascular robustness score identifies hidden risk in young adults. Validation studies are warranted to assess the discriminatory power of robustness.
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Key Words
- AH, apparently healthy group
- ATH, athletic group
- BA, vascular biological age
- CA, calendar age
- CC, chronic condition group
- CVD, cardiovascular disease
- CVE, cardiovascular endpoint group
- Cardiovascular diseases
- FMD, flow mediated vasodilation
- PWV, pulse wave velocity
- Prevention
- RCR, retrospective chart review
- Risk factors
- Robustness
- UN, United Nations
- VA2, VascAssist 2
- aoPWV, aortic pulse wave velocity
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Affiliation(s)
- Lutz E Kraushaar
- Adiphea (Alliance for Disease Prevention & Healthy Aging) GmbH, Werbach, Germany
| | - Alexander Dressel
- CaRe High Cascade Screening and Registry for High Cholesterol, D-A-CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e.V., Industriestr. 41, 68169 Mannheim, Germany
| | - Alexander Maßmann
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, 66421 Homburg, Saar, Germany
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