1251
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Monaghan TF, Michelson KP, Wu ZD, Gong F, Agudelo CW, George CD, Alwis US, Epstein MR, Mekki P, Flores VX, Bliwise DL, Everaert K, Vande Walle J, Weiss JP, Lazar JM. Sodium restriction improves nocturia in patients at a cardiology clinic. J Clin Hypertens (Greenwich) 2020; 22:633-638. [PMID: 32049435 PMCID: PMC8029872 DOI: 10.1111/jch.13829] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/30/2019] [Accepted: 12/31/2019] [Indexed: 10/15/2023]
Abstract
This study aims to determine whether dietary sodium restriction counseling decreases nocturnal voiding frequency in cardiology patients with concomitant nocturia. Patients who had established care at a cardiology clinic from 2015 to 2018 reporting ≥1 average nocturnal void(s) underwent a comprehensive sodium intake interview by their cardiologist, who provided them with individualized strategies for dietary sodium reduction and assessed adherence at follow-up. Average nocturnal voiding frequency and dietary adherence were documented in the medical record. A nocturia database was compiled for retrospective analysis. A total of 74 patients were included. Patients considered to be adherent with dietary sodium restriction at follow-up (n = 56) demonstrated a decrease in median nocturia frequency (2.5 [2.3-3.0] vs 1.0 [1.0-2.0] voids, P < .001). Among nonadherent patients (n = 18), median nocturia frequency did not significantly change from baseline to follow-up (2.0 [1.5-3.8] vs 2.0 [1.5-4.8] voids, P = .423). Median changes were significantly different between the adherent and nonadherent groups (P < .001). Examination of second follow-up available from 37 patients showed a continued effect. In conclusion, adherence with dietary sodium counseling appears to improve nocturia. Accordingly, dietary modification may represent an important adjunct therapy to lifestyle and pharmacologic interventions for decreasing nocturia frequency. Reduction in nocturnal voiding frequency may also reflect an additional benefit of dietary sodium restriction in accordance with best practice standards for cardiovascular disease.
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Affiliation(s)
- Thomas F. Monaghan
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Kyle P. Michelson
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Zhan D. Wu
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Fred Gong
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christina W. Agudelo
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Christopher D. George
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | | | - Matthew R. Epstein
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Pakinam Mekki
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Viktor X. Flores
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Donald L. Bliwise
- Department of NeurologyEmory University School of MedicineAtlantaGAUSA
| | - Karel Everaert
- Department of UrologyGhent University HospitalGhentBelgium
| | - Johan Vande Walle
- Department of Pediatric NephrologyGhent University HospitalGhentBelgium
| | - Jeffrey P. Weiss
- Department of UrologyState University of New York Downstate Health Sciences UniversityBrooklynNYUSA
| | - Jason M. Lazar
- Division of Cardiovascular MedicineDepartment of MedicineSUNY Downstate Health Sciences UniversityBrooklynNYUSA
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1252
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Tinkham TT, Vazquez SR, Jones AE, Witt DM. Direct oral anticoagulant plus antiplatelet therapy: prescribing practices and bleeding outcomes. J Thromb Thrombolysis 2020; 49:492-496. [PMID: 31776847 DOI: 10.1007/s11239-019-01999-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Concurrent antiplatelet therapy (APT) is common during warfarin therapy but is less well-documented during direct oral anticoagulant (DOAC) therapy. Combined anticoagulant and APT use has been associated with increased bleeding risk without providing additional protection against thrombosis. This study aimed to describe single-center prescribing rates of DOAC + APT as well as compare bleeding rates between DOAC monotherapy and DOAC + APT cohorts. Patients receiving DOAC therapy were evaluated for APT use at the time of hospital discharge. Patients were categorized into DOAC monotherapy and DOAC + APT cohorts. Primary outcomes included DOAC + APT prescribing rate as well as rates of major bleeding and clinically relevant non-major bleeding (CRNMB) within six months after hospital discharge. Secondary outcomes included rates of thromboembolism and all-cause mortality. Of 407 patients receiving DOAC therapy, 78 (19.2%) also received APT at hospital discharge. Common indications for APT included secondary cardiovascular event prevention (57.7%) and primary cardiovascular event prevention (29.5%). The indication for APT could not be determined in 12.8% of patients. The major bleeding rate was 1.3% for DOAC + APT and 1.2% for DOAC monotherapy (p = 0.95). The CRNMB rate was 10.2% for DOAC + APT and 6.4% for DOAC monotherapy (p = 0.23). Thromboembolism and mortality were infrequent in both cohorts. DOAC + APT was documented in approximately 1 of 5 patients. Adding APT to DOAC therapy did not significantly increase the major bleeding or CRNMB rates compared to DOAC monotherapy but the sample size limits drawing conclusions about the safety of these regimens. Targeting primary prevention or unclear indications for APT could be a focus of future interventions.
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Affiliation(s)
- Tyler T Tinkham
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Sara R Vazquez
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
- University of Utah Health Thrombosis Center, Salt Lake City, UT, USA.
- University of Utah Health Thrombosis Center, 50 N Medical Drive Room 1R211, Salt Lake City, UT, 84132, USA.
| | - Aubrey E Jones
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- University of Utah Health Thrombosis Center, Salt Lake City, UT, USA
| | - Daniel M Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- University of Utah Health Thrombosis Center, Salt Lake City, UT, USA
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1253
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Choi HY, Shin SJ, Yoo J, Lee K, Song D, Kim YD, Nam HS, Lee KY, Lee HS, Kim DJ, Heo JH. Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke. Front Neurol 2020; 11:206. [PMID: 32292387 PMCID: PMC7134382 DOI: 10.3389/fneur.2020.00206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: Many patients with ischemic stroke have concomitant coronary artery disease (CAD). However, it remains unclear which stroke patients should undergo evaluation for asymptomatic CAD, and which screening tools are appropriate. We investigated the role of coronary artery calcium (CAC) score as a screening tool for asymptomatic but severe CAD in acute stroke patients. We determined the selection criteria for CAC screening based on risk factors and cerebral atherosclerosis. Materials and Methods: The present study included consecutive patients with acute stroke who had undergone cerebral angiography and multi-detector computed tomography coronary angiography. Severe CAD was defined as left main artery disease or three-vessel disease. Enrolled patients were randomly assigned to two sets; a set for developing selection criteria and a set for validation. To develop selection criteria, we identified associated factors with severe CAD regarding clinical factors and cerebral atherosclerosis. CAD predictability of selection criteria with the CAC score was calculated. Results: Overall, 2,658 patients were included. Severe CAD was present in 360 patients (13.5%). CAC score was associated with CAD severity (P < 0.001). In the development set (N = 1,860), severe CAD was associated with age >65 years [odds ratio (95% confidence interval), 2.62 (1.93–3.55)], male sex (1.81 [1.33–2.46]), dyslipidemia (1.77 [1.25–2.61]), peripheral artery disease (2.64 [1.37–5.06]) and stenosis in the cervicocephalic branches, including the internal carotid (2.79 [2.06–3.78]) and vertebrobasilar arteries (2.08 [1.57–2.76]). We determined the combination of clinical and arterial factors as the selection criteria for CAC evaluation. The cut-off criterion was two or more elements of the selection criteria. The area under the curve (AUC) of the selection criteria was 0.701. The AUC significantly improved to 0.836 when the CAC score was added (P < 0.001). In the validation set (N = 798), the AUC of the selection criteria only was 0.661, and that of the CAC score was 0.833. The AUC of the selection criteria + CAC score significantly improved to 0.861(P < 0.001). Conclusion: The necessity for CAC evaluation could be determined based on the presence of risk factors and significant stenosis of the cervicocephalic arteries. CAC evaluation may be useful for screening for severe CAD in stroke patients.
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Affiliation(s)
- Hye-Yeon Choi
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Soo Jeong Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Kijeong Lee
- Department of Neurology, College of Medicine, Eunpyeong St. Mary Hospital, Catholic University of Korea, Seoul, South Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Yul Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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1254
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Kris-Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, O'Keefe JH, Williams K, Horn LV, Na M, Shay C, Douglass P, Katz DL, Freeman AM. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States. J Am Heart Assoc 2020; 9:e014433. [PMID: 32200727 PMCID: PMC7428614 DOI: 10.1161/jaha.119.014433] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD-related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population-wide basis.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Kristina S Petersen
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Gladys Velarde
- Division of Cardiology Department of Medicine University of Florida Jacksonville FL
| | - Neal D Barnard
- Adjunct Faculty George Washington University School of Medicine Physicians Committee for Responsible Medicine Washington DC
| | - Michael Miller
- Department of Medicine University of Maryland School of Medicine Baltimore MD
| | - Emilio Ros
- Lipid Clinic Endocrinology and Nutrition Service Institut d'Investigacions Biomediques August Pi Sunyer Hospital Clinic University of Barcelona, and Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos III Madrid Spain
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute School of Medicine University of Missouri-Kansas City MO
| | | | - Linda Van Horn
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Muzi Na
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Christina Shay
- Center for Health Metrics and Evaluation American Heart Association American Heart Association Dallas TX
| | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine Atlanta GA
| | - David L Katz
- Yale-Griffin Prevention Research Center Derby CT
| | - Andrew M Freeman
- Division of Cardiology Department of Medicine National Jewish Health Denver CO
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1255
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Dehmer GJ, Badhwar V, Bermudez EA, Cleveland JC, Cohen MG, D'Agostino RS, Ferguson TB, Hendel RC, Isler ML, Jacobs JP, Jneid H, Katz AS, Maddox TM, Shahian DM. 2020 AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization). Circ Cardiovasc Qual Outcomes 2020; 13:e000059. [PMID: 32202924 DOI: 10.1161/hcq.0000000000000059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Robert C Hendel
- Former Task Force Chair during this writing effort.,Task Force Liaison
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1256
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Huang H, Yu H, Lin L, Chen J, Zhu P. Protective effect of sonic hedgehog against oxidized low‑density lipoprotein‑induced endothelial apoptosis: Involvement of NF‑κB and Bcl‑2 signaling. Int J Mol Med 2020; 45:1864-1874. [PMID: 32186749 PMCID: PMC7169656 DOI: 10.3892/ijmm.2020.4542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
Sonic hedgehog (Shh) is pivotally important in embryonic and adult blood vessel development and homeostasis. However, whether Shh is involved in atherosclerosis and plays a role in endothelial apoptosis induced by oxidized low‑density lipoprotein (ox‑LDL) has not been reported. The present study used recombinant Shh‑N protein (rShh‑N) and a plasmid encoding the human Shh gene (phShh) to investigate the role of Shh in ox‑LDL‑mediated human umbilical vein endothelial cell (HUVEC) apoptosis. The present study found that ox‑LDL was able to induce apoptosis in HUVECs and that Shh protein expression was downregulated. Furthermore, pretreatment with rShh‑N or transfection with phShh increased anti‑apoptosis protein Bcl‑2 expression and decreased cell apoptosis. These protective effects of rShh‑N could be abolished by cyclopamine, which is a hedgehog signaling inhibitor. Furthermore, a co‑immunoprecipitation assay was performed to demonstrate that Shh interacted with NF‑κB p65 in HUVECs. Additionally, ox‑LDL upregulated the phosphorylation of NF‑κB p65 and inhibitor of NF‑κB‑α (IκBα), and these effects decreased notably following rShh‑N and phShh treatment. Together, the present findings suggested that Shh serves an important protective role in alleviating ox‑LDL‑mediated endothelial apoptosis by inhibiting the NF‑κB signaling pathway phosphorylation and Bcl‑2 mediated mitochondrial signaling.
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Affiliation(s)
- Huashan Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Huizhen Yu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Liang Lin
- Gynecology and Obstetrics, Fujian Provincial Hospital South Branch, Fuzhou, Fujian 350028, P.R. China
| | - Junming Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Pengli Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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1257
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Baumgartner L, Weberruß H, Oberhoffer-Fritz R, Schulz T. Vascular Structure and Function in Children and Adolescents: What Impact Do Physical Activity, Health-Related Physical Fitness, and Exercise Have? Front Pediatr 2020; 8:103. [PMID: 32266183 PMCID: PMC7096378 DOI: 10.3389/fped.2020.00103] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
A physically active lifestyle can prevent cardiovascular disease. Exercise intervention studies in children and adolescents that aim to increase physical activity have resulted in reduced vascular wall thickening and improve cardiovascular function. Here we review the literature that explores the correlations between physical activity, health-related physical fitness, and exercise interventions with various measures of vascular structure and function in children and adolescents. While several of these studies identified improvements in vascular structure in response to physical activity, these associations were limited to studies that relied on questionnaires. Of concern, these findings were not replicated in studies featuring quantitative assessment of physical activity with accelerometers. Half of the studies reviewed reported improved vascular function with increased physical activity, with the type of vascular measurement and the way physical activity was assessed having an influence on the reported relationships. Similary, most of the studies identified in the literature report a beneficial association of health-related physical fitness with vascular structure and function. Overall, it was difficult to compare the results of these studies to one another as different methodologies were used to measure both, health-related physical fitness and vascular function. Likewise, exercise interventions may reduce both arterial wall thickness and increased vascular stiffness in pediatric populations at risk, but the impact clearly depends on the duration of the intervention and varies depending on the target groups. We identified only one study that examined vascular structure and function in young athletes, a group of particular interest with respect to understanding of cardiovascular adaptation to exercise. In conclusion, future studies will be needed that address the use of wall:diameter or wall:lumen-ratio as part of the evaluation of arterial wall thickness. Furthermore, it will be critical to introduce specific and quantitative measurements of physical activity, as intensity and duration of participation likely influence the effectiveness of exercise interventions.
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Affiliation(s)
- Lisa Baumgartner
- Institute of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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1258
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Williams MC, Kwiecinski J, Doris M, McElhinney P, D'Souza MS, Cadet S, Adamson PD, Moss AJ, Alam S, Hunter A, Shah ASV, Mills NL, Pawade T, Wang C, Weir McCall J, Bonnici-Mallia M, Murrills C, Roditi G, van Beek EJR, Shaw LJ, Nicol ED, Berman DS, Slomka PJ, Newby DE, Dweck MR, Dey D. Low-Attenuation Noncalcified Plaque on Coronary Computed Tomography Angiography Predicts Myocardial Infarction: Results From the Multicenter SCOT-HEART Trial (Scottish Computed Tomography of the HEART). Circulation 2020; 141:1452-1462. [PMID: 32174130 PMCID: PMC7195857 DOI: 10.1161/circulationaha.119.044720] [Citation(s) in RCA: 350] [Impact Index Per Article: 87.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The future risk of myocardial infarction is commonly assessed using cardiovascular risk scores, coronary artery calcium score, or coronary artery stenosis severity. We assessed whether noncalcified low-attenuation plaque burden on coronary CT angiography (CCTA) might be a better predictor of the future risk of myocardial infarction. Methods: In a post hoc analysis of a multicenter randomized controlled trial of CCTA in patients with stable chest pain, we investigated the association between the future risk of fatal or nonfatal myocardial infarction and low-attenuation plaque burden (% plaque to vessel volume), cardiovascular risk score, coronary artery calcium score or obstructive coronary artery stenoses. Results: In 1769 patients (56% male; 58±10 years) followed up for a median 4.7 (interquartile interval, 4.0–5.7) years, low-attenuation plaque burden correlated weakly with cardiovascular risk score (r=0.34; P<0.001), strongly with coronary artery calcium score (r=0.62; P<0.001), and very strongly with the severity of luminal coronary stenosis (area stenosis, r=0.83; P<0.001). Low-attenuation plaque burden (7.5% [4.8–9.2] versus 4.1% [0–6.8]; P<0.001), coronary artery calcium score (336 [62–1064] versus 19 [0–217] Agatston units; P<0.001), and the presence of obstructive coronary artery disease (54% versus 25%; P<0.001) were all higher in the 41 patients who had fatal or nonfatal myocardial infarction. Low-attenuation plaque burden was the strongest predictor of myocardial infarction (adjusted hazard ratio, 1.60 (95% CI, 1.10–2.34) per doubling; P=0.014), irrespective of cardiovascular risk score, coronary artery calcium score, or coronary artery area stenosis. Patients with low-attenuation plaque burden greater than 4% were nearly 5 times more likely to have subsequent myocardial infarction (hazard ratio, 4.65; 95% CI, 2.06–10.5; P<0.001). Conclusions: In patients presenting with stable chest pain, low-attenuation plaque burden is the strongest predictor of fatal or nonfatal myocardial infarction. These findings challenge the current perception of the supremacy of current classical risk predictors for myocardial infarction, including stenosis severity. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01149590.
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Affiliation(s)
- Michelle C Williams
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Jacek Kwiecinski
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.)
| | - Mhairi Doris
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | - Michelle S D'Souza
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Sebastien Cadet
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - Philip D Adamson
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Christchurch Heart Institute, University of Otago, Christchurch, New Zealand (P.D.A)
| | - Alastair J Moss
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Shirjel Alam
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Amanda Hunter
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Anoop S V Shah
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Nicholas L Mills
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Tania Pawade
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Chengjia Wang
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | | | | | - Christopher Murrills
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom (M.B-M., C.M.)
| | - Giles Roditi
- Institute of Clinical Sciences, University of Glasgow, United Kingdom (G.R.)
| | - Edwin J R van Beek
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Leslee J Shaw
- Weill Cornell Medical College, New York, NY (L.J.S.)
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology; and the National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom (E.D.N.)
| | - Daniel S Berman
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - Piotr J Slomka
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
| | - David E Newby
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Marc R Dweck
- University/BHF Centre for Cardiovascular Science (M.C.W., J.K., M.D., M.S.D'S., P.D.A., A.J.M., S.A., A.H., A.S.V.S., N.L.M., T.P., C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom.,Edinburgh Imaging Facility QMRI (M.C.W., E.J.R.v.B., D.E.N., M.R.D.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Cedars-Sinai Medical Centre, Los Angeles, CA (P.M., S.C., P.J.S., D.S.B., D.D.)
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1259
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Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Triglycerides and Cardiovascular Outcomes-Can We REDUCE-IT ? Int J Angiol 2020. [PMID: 32132810 DOI: 10.1055/s-0040-1701639.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
The causal linkage between triglycerides and coronary artery disease has been controversial. Most of the trials hitherto have shown marginal or no beneficial effects of reduction of triglycerides (with fibrates) on top of low-density lipoprotein (LDL) reduction. But a significant residual cardiovascular risk remains even after use of high dose of statins. Omega-3 fatty acids have been shown to reduce triglyceride levels and some old trials have shown the benefits of fish oils in reducing cardiovascular events. However, barring a few trials most of the large trials of omega-3 fatty acids are negative. Recently, few large trials have been conducted to see the effects of high dose omega-3 fatty acids on cardiovascular outcomes and some of them have shown promising results on top of LDL reduction.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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1260
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Pradhan A, Bhandari M, Vishwakarma P, Sethi R. Triglycerides and Cardiovascular Outcomes-Can We REDUCE-IT ? Int J Angiol 2020; 29:2-11. [PMID: 32132810 DOI: 10.1055/s-0040-1701639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The causal linkage between triglycerides and coronary artery disease has been controversial. Most of the trials hitherto have shown marginal or no beneficial effects of reduction of triglycerides (with fibrates) on top of low-density lipoprotein (LDL) reduction. But a significant residual cardiovascular risk remains even after use of high dose of statins. Omega-3 fatty acids have been shown to reduce triglyceride levels and some old trials have shown the benefits of fish oils in reducing cardiovascular events. However, barring a few trials most of the large trials of omega-3 fatty acids are negative. Recently, few large trials have been conducted to see the effects of high dose omega-3 fatty acids on cardiovascular outcomes and some of them have shown promising results on top of LDL reduction.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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1261
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Zarei L, Karimzadeh I, Moradi N, Peymani P, Asadi S, Babar ZUD. Affordability Assessment from a Static to Dynamic Concept: A Scenario-Based Assessment of Cardiovascular Medicines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051710. [PMID: 32151039 PMCID: PMC7084506 DOI: 10.3390/ijerph17051710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Abstract
The out-of-pocket payments for prescription medications can impose a financial burden on patients from low- and middle- incomes and who suffer from chronic diseases. The present study aims at evaluating the affordability of cardiovascular disease (CVD) medication in Iran. This includes measuring affordability through World Health Organization/Health Action International (WHO/HAI) methodology. In this method, affordability is characterized as the number of days’ wages of the lowest-paid unskilled government worker. The different medication therapy scenarios are defined in mono-and combination therapy approaches. This method adds on to WHO/HAI methodology to discover new approaches to affordability assessments. The results show the differences in the medicines affordability when different approaches are used in mono-and combination therapy between 6 main sub-therapeutic groups of CVD. It indicates the medicine affordability is not a static concept and it changes dynamically between CVD therapeutic subgroups when it used alone or in combination with other medicines regarding patients’ characteristics and medical conditions. Hypertension and anti-arrhythmia therapeutic groups had the most non-affordability and hyperlipidemia had the most affordable medicines. Therefore, affordability can be considered as a dynamic concept, which not only affected by the medicine price but significantly affected by a patient’s characteristics, the number of medical conditions, and insurance coverage.
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Affiliation(s)
- Leila Zarei
- Pharmacoeconomics and Pharma Management, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Iman Karimzadeh
- Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Najmeh Moradi
- Pharmacoeconomics and Pharma Management, Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, Iran
- Correspondence: ; Tel.: +98-9127932540
| | - Payam Peymani
- Pharmacoepidemiology, Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
- Department of Clinical Pharmacology & Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sara Asadi
- Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran;
| | - Zaheer-Ud-Din Babar
- Medicines and Healthcare, Department of Pharmacy, University of Huddersfield, Queensgate, HD1 3DH Huddersfield, UK;
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1262
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McEvoy JW, Keane M, Ng J. Primary prevention aspirin among the elderly: challenges in translating trial evidence to the clinic. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:07. [PMID: 35747418 PMCID: PMC8793932 DOI: 10.5837/bjc.2020.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ASPirin in Reducing Events in the Elderly trial (ASPREE) contributed important knowledge about primary cardiovascular disease (CVD) prevention among healthy older adults. The finding that daily low-dose aspirin (LDA) does not statistically prevent disability or CVD among adults aged over 70 years when compared with placebo, but does significantly increase risk of haemorrhage, immediately influenced clinical practice guidelines. In this article, we discuss nuances of the trial that may impact the extrapolation of the ASPREE trial results to the everyday individual clinical care of older adults.
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Affiliation(s)
- J William McEvoy
- Professor of Preventive Cardiology National University of Ireland and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland
| | - Michael Keane
- Consultant Anaesthetist, Casey Hospital, Adjunct Associate Professor, Swinburne University, and Adjunct Senior Lecturer, Monash University Casey Hospital, Monash Health, 62 Kangan Drive, Berwick, Victoria 3806, Australia
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1263
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Lorenzon dos Santos J, Schaan de Quadros A, Weschenfelder C, Bueno Garofallo S, Marcadenti A. Oxidative Stress Biomarkers, Nut-Related Antioxidants, and Cardiovascular Disease. Nutrients 2020; 12:nu12030682. [PMID: 32138220 PMCID: PMC7146201 DOI: 10.3390/nu12030682] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
Atherosclerosis is related to fat accumulation in the arterial walls and vascular stiffening, and results in acute coronary syndrome which is commonly associated with acute myocardial infarction. Oxidative stress participates in the pathogenesis of atherosclerosis. Thus, the inclusion of food sources of dietary antioxidants, such as different kinds of nuts, may improve biomarkers related to oxidative stress, contributing to a possible reduction in atherosclerosis progression. This article has briefly highlighted the interaction between oxidative stress, atherosclerosis, and cardiovascular disease, in addition to the effect of the consumption of different nuts and related dietary antioxidants—like polyphenols and vitamin E—on biomarkers of oxidative stress in primary and secondary cardiovascular prevention. Studies in vitro suggest that nuts may exert antioxidant effects by DNA repair mechanisms, lipid peroxidation prevention, modulation of the signaling pathways, and inhibition of the MAPK pathways through the suppression of NF-κB and activation of the Nrf2 pathways. Studies conducted in animal models showed the ability of dietary nuts in improving biomarkers of oxidative stress, such as oxLDL and GPx. However, clinical trials in humans have not been conclusive, especially with regards to the secondary prevention of cardiovascular disease.
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Affiliation(s)
- Julia Lorenzon dos Santos
- Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, 90040-371 Rio Grande do Sul, Brazil; (J.L.d.S.); (A.S.d.Q.); (C.W.); (S.B.G.)
| | - Alexandre Schaan de Quadros
- Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, 90040-371 Rio Grande do Sul, Brazil; (J.L.d.S.); (A.S.d.Q.); (C.W.); (S.B.G.)
| | - Camila Weschenfelder
- Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, 90040-371 Rio Grande do Sul, Brazil; (J.L.d.S.); (A.S.d.Q.); (C.W.); (S.B.G.)
| | - Silvia Bueno Garofallo
- Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, 90040-371 Rio Grande do Sul, Brazil; (J.L.d.S.); (A.S.d.Q.); (C.W.); (S.B.G.)
| | - Aline Marcadenti
- Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, 90040-371 Rio Grande do Sul, Brazil; (J.L.d.S.); (A.S.d.Q.); (C.W.); (S.B.G.)
- HCor Research Institute, Coracao Hospital (IP-HCor), Abílio Soares Street, 250, 04004-05 São Paulo, Brazil
- Correspondence: ; Tel.: +55-(11)-3053-6611 (ext. 3558)
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1264
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Raggi P, Bellasi A, Bushinsky D, Bover J, Rodriguez M, Ketteler M, Sinha S, Salcedo C, Gillotti K, Padgett C, Garg R, Gold A, Perelló J, Chertow GM. Slowing Progression of Cardiovascular Calcification With SNF472 in Patients on Hemodialysis. Circulation 2020; 141:728-739. [DOI: 10.1161/circulationaha.119.044195] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background:
The high cardiovascular morbidity and mortality in patients with end-stage kidney disease could be partially caused by extensive cardiovascular calcification. SNF472, intravenous myo-inositol hexaphosphate, selectively inhibits the formation and growth of hydroxyapatite.
Methods:
This double-blind, placebo-controlled phase 2b trial compared progression of coronary artery calcium volume score and other measurements of cardiovascular calcification by computed tomography scan during 52 weeks of treatment with SNF472 or placebo, in addition to standard therapy, in adult patients with end-stage kidney disease receiving hemodialysis. Patients were randomized 1:1:1 to SNF472 300 mg (n=92), SNF472 600 mg (n=91), or placebo (n=91) by infusion in the hemodialysis lines thrice weekly during hemodialysis sessions. The primary end point was change in log coronary artery calcium volume score from baseline to week 52. The primary efficacy analysis combined the SNF472 treatment groups and included all patients who received at least 1 dose of SNF472 or placebo and had an evaluable computed tomography scan after randomization.
Results:
The mean change in coronary artery calcium volume score was 11% (95% CI, 7–15) for the combined SNF472 dose group and 20% (95% CI, 14–26) for the placebo group (
P
=0.016). SNF472 compared with placebo attenuated progression of calcium volume score in the aortic valve (14% [95% CI, 5–24] versus 98% [95% CI, 77–123];
P
<0.001) but not in the thoracic aorta (23% [95% CI, 16–30] versus 28% [95% CI, 19–38];
P
=0.40). Death occurred in 7 patients (4%) who received SNF472 and 5 patients (6%) who received placebo. At least 1 treatment-emergent adverse event occurred in 86%, 92%, and 87% of patients treated with SNF472 300 mg, SNF472 600 mg, and placebo, respectively. Most adverse events were mild. Adverse events resulted in discontinuation of SNF472 300 mg, SNF472 600 mg, and placebo for 14%, 29%, and 20% of patients, respectively.
Conclusions:
Compared with placebo, SNF472 significantly attenuated the progression of coronary artery calcium and aortic valve calcification in patients with end-stage kidney disease receiving hemodialysis in addition to standard care. Future studies are needed to determine the effects of SNF472 on cardiovascular events.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02966028.
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Affiliation(s)
- Paolo Raggi
- Department of Medicine, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Canada (P.R.)
| | - Antonio Bellasi
- Research, Innovation and Brand Reputation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy (A.B.)
| | - David Bushinsky
- Department of Medicine, University of Rochester Medical Center, NY (D.B.)
| | - Jordi Bover
- Department of Nephrology, Fundació Puigvert and Universitat Autònoma, IIB Sant Pau, REDinREN, Barcelona, Spain (J.B.)
| | - Mariano Rodriguez
- Nephrology Unit, Hospital Universitario Reina Sofia, IMIBIC, REDinREN, Córdoba, Spain (M.R.)
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany (M.K.)
| | - Smeeta Sinha
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, UK (S.S.)
| | - Carolina Salcedo
- Research and Development, Sanifit Therapeutics, Palma, Spain (C.S., J.P.)
| | - Kristen Gillotti
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Claire Padgett
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Rekha Garg
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
| | - Alex Gold
- Research and Development, Sanifit Therapeutics, San Diego, CA (K.G., C.P. R.G., A.G.)
- Department of Medicine, Stanford University, Palo Alto, CA (A.G., G.M.C.)
| | - Joan Perelló
- Research and Development, Sanifit Therapeutics, Palma, Spain (C.S., J.P.)
- University of the Balearic Islands, Palma, Spain (J.P.)
| | - Glenn M. Chertow
- Department of Medicine, Stanford University, Palo Alto, CA (A.G., G.M.C.)
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1265
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Misialek JR, Van't Hof JR, Oldenburg NC, Jones C, Eder M, Luepker RV, Duval S. Aspirin Use and Awareness for Cardiovascular Disease Prevention Among Hispanics: Prevalence and Associations with Health Behavior Beliefs. J Community Health 2020; 45:820-827. [PMID: 32112236 DOI: 10.1007/s10900-020-00798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease (CVD) persists as the leading cause of death and disability in many Americans including Hispanics. Primary prevention for CVD may be achieved through regular aspirin use in high risk individuals. This study examined regular aspirin use and specific attitudes and social norms toward CVD and aspirin use within an urban Hispanic population in Minnesota. A sample of primary prevention Hispanics aged 45-79 years were surveyed about CVD history and risk factors, aspirin use, demographic characteristics, and health beliefs and social norms in relation to CVD and aspirin. Relative risk estimation using Poisson regression with robust error variance was used to examine associations with aspirin use. In this sample of 152 Hispanics (55% women), the mean age was 53 years, 70% had a regular healthcare provider, and 22% used aspirin. Aspirin discussions with a regular healthcare provider were strongly associated with aspirin use (adjusted risk ratio 3.02, 95% CI 1.20-7.60). There was a positive association between health beliefs and social norms that affirm preventive behaviors and aspirin use (adjusted linear risk ratio 1.23, 95% CI 1.04-1.45) while uncertainty about the role of aspirin for individual use and in the community was negatively associated with aspirin use (adjusted linear risk ratio 0.85, 95% CI 0.70-1.03). This growing population may benefit from health education about CVD risk and the role of aspirin in prevention.
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Affiliation(s)
- Jeffrey R Misialek
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jeremy R Van't Hof
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Niki C Oldenburg
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | | | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Russell V Luepker
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
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1266
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Khera A, Baum SJ, Gluckman TJ, Gulati M, Martin SS, Michos ED, Navar AM, Taub PR, Toth PP, Virani SS, Wong ND, Shapiro MD. Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. Am J Prev Cardiol 2020; 1:100009. [PMID: 32835347 PMCID: PMC7194073 DOI: 10.1016/j.ajpc.2020.100009] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter physical activity and nutrition patterns. Virtually all facility based cardiac rehabilitation programs have temporarily closed. If not promptly addressed, these changes may result in delayed waves of vulnerable patients presenting for urgent and preventable CVD events. Here, we provide several recommendations to mitigate the adverse effects of these disruptions in outpatient care. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be continued in patients already taking these medications. Where possible, it is strongly preferred to continue visits via telehealth, and patients should be counselled about promptly reporting new symptoms. Barriers to medication access should be reviewed with patients at every contact, with implementation of strategies to ensure ongoing provision of medications. Team-based care should be leveraged to enhance the continuity of care and adherence to lifestyle recommendations. Patient encounters should include discussion of safe physical activity options and access to healthy food choices. Implementation of adaptive strategies for cardiac rehabilitation is recommended, including home based cardiac rehab, to ensure continuity of this essential service. While the practical implementation of these strategies will vary by local situation, there are a broad range of strategies available to ensure ongoing continuity of care and health preservation for those at higher risk of CVD during the COVID-19 pandemic.
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Affiliation(s)
- Amit Khera
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Seth J. Baum
- Florida Atlantic University, Department of Integrated Medical Sciences, Boca Raton, FL, USA
| | - Ty J. Gluckman
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine- Phoenix, Phoenix, AZ, USA
| | - Seth S. Martin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Marie Navar
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Pam R. Taub
- Division of Cardiovascular Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL, Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salim S. Virani
- Division of Cardiology, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Nathan D. Wong
- Division of Cardiology, UC Irvine School of Medicine, Irvine, CA, USA
| | - Michael D. Shapiro
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
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1267
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Liew CH, Flaherty GT. Experiences and Attitudes of International Travelers with Cardiovascular Disease: A Qualitative Analysis. Am J Trop Med Hyg 2020; 102:689-697. [PMID: 31933464 PMCID: PMC7056438 DOI: 10.4269/ajtmh.19-0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/06/2019] [Indexed: 07/27/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death among international travelers. It is unknown whether CVD is a barrier to international travel. The purpose of this study was to describe the travel experiences of a cohort of individuals with CVD, to identify their perceived barriers to travel, and to generate recommendations for CVD travelers, medical practitioners, and the travel industry. Semi-structured interviews were conducted with CVD patients who had attended either a regional, structured, multidisciplinary CVD prevention program or a cardiac rehabilitation program. Coding and thematic analysis of the transcripts were supported by NVivo® computer software. Peer debriefing with an independent researcher was undertaken. Demographic and clinical data such as gender, age, and types of cardiovascular condition were also recorded. Twelve patients (eight males), with a mean age of 68 ± 7.58 years, agreed to semi-structured interviews (26-78 minutes duration). The key themes emerging from the interviews included altered travel perception, accessing medical care overseas, issues with medications, medical device concerns at airports, restricted leisure travel activities, and optimal self-care. All interviewees perceived a health benefit to travel and did not regard CVD as a significant barrier to international travel. Certain cardiovascular conditions precipitated more travel anxiety. These findings highlight the unique experiences of CVD patients when engaging in international travel. Cardiovascular disease optimization and responsible travel health behaviors would facilitate medically uneventful overseas travel. The results may inform pretravel health advice given to CVD travelers. Further studies on issues relating to air travel in CVD are warranted.
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Affiliation(s)
- Chee Hwui Liew
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Gerard Thomas Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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1268
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Husain M, Bain SC, Jeppesen OK, Lingvay I, Sørrig R, Treppendahl MB, Vilsbøll T. Semaglutide (SUSTAIN and PIONEER) reduces cardiovascular events in type 2 diabetes across varying cardiovascular risk. Diabetes Obes Metab 2020; 22:442-451. [PMID: 31903692 PMCID: PMC7064975 DOI: 10.1111/dom.13955] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 12/28/2022]
Abstract
AIM To investigate the effects of semaglutide versus comparators on major adverse cardiovascular events (MACE: cardiovascular [CV] death, nonfatal myocardial infarction [MI] and nonfatal stroke) and hospitalization for heart failure (HF) in the SUSTAIN (subcutaneous semaglutide) and PIONEER (oral semaglutide) trials across subgroups of varying CV risk. METHODS Post hoc analyses of individual patient-level data combined from SUSTAIN 6 and PIONEER 6 were performed to assess MACE and HF. MACE were analysed in subjects with and without: established CV disease and/or chronic kidney disease; prior MI or stroke; and prior HF. MACE in the SUSTAIN and PIONEER glycaemic efficacy trials were also assessed. RESULTS In SUSTAIN 6 and PIONEER 6 combined, the hazard ratio (HR) for effect of semaglutide versus placebo on overall MACE was 0.76 (95% CI 0.62, 0.92), which was mainly driven by the effect on nonfatal stroke (HR 0.65 [95% CI 0.43, 0.97]). The HR for hospitalization for HF was 1.03 (95% CI 0.75, 1.40). The HRs for MACE were <1.0 in all subgroups, except for those with prior HF (HR 1.06 [95% CI 0.72, 1.57]); P-values for interaction of subgroup on treatment effect were >0.05, except for HF (0.046). In the combined glycaemic efficacy trials, the HR for effect of semaglutide versus comparators on MACE was 0.85 (95% CI 0.55, 1.33). CONCLUSIONS In SUSTAIN and PIONEER combined, glucagon-like peptide-1 analogue semaglutide showed consistent effects on MACE versus comparators across varying CV risk. No effect of semaglutide on MACE was observed in subjects with prior HF.
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Affiliation(s)
- Mansoor Husain
- Ted Rogers Centre for Heart ResearchToronto General Hospital Research InstituteTorontoCanada
| | - Stephen C. Bain
- Swansea University Medical School, Diabetes Research Unit CymruSwanseaUK
| | | | - Ildiko Lingvay
- UT Southwestern Medical Center, Internal Medicine and Population and Data SciencesDallasTexas
| | | | | | - Tina Vilsbøll
- Steno Diabetes Center CopenhagenGentofte Hospital, University of CopenhagenCopenhagenDenmark
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1269
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Watanabe Y, Tatsuno I. Prevention of Cardiovascular Events with Omega-3 Polyunsaturated Fatty Acids and the Mechanism Involved. J Atheroscler Thromb 2020; 27:183-198. [PMID: 31582621 PMCID: PMC7113138 DOI: 10.5551/jat.50658] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
An epidemiological study of Greenlandic Inuit suggested that fish oil, or omega-3 polyunsaturated fatty acids (PUFA), was important in preventing atherosclerotic disease. After this landmark study, many large-scale epidemiological studies and meta-analyses have examined the health benefits of omega-3 PUFA as part of a fatty acid-rich diet to demonstrate its beneficial roles in the prevention of cardiovascular diseases. Recent research has also focused attention on the anti-inflammatory effects of omega-3 PUFA and on specialized pro-resolving mediators. Findings of these studies have led to the development of omega-3 PUFA preparations for the treatment of dyslipidemia, including a highly purified eicosapentaenoic acid (EPA)-ethyl ester product (Epadel®) in Japan and an EPA/docosahexaenoic acid (DHA) preparation (Lotriga®) in the United States and Europe. Although various large-scale clinical trials on the cardiovascular preventive effect of omega-3 PUFA were conducted and reported, the results were not always consistent. The issues of not targeting subjects with hypertriglyceridemia and using low dose of omega-3 PUFA have been suggested to contribute to the failure of demonstrating the preventive effect of omega-3 PUFA in these clinical trials. Taking into account the above issues, the REDUCE-IT trial evaluated a highly purified EPA preparation at a high dose of 4 g/day in patients with hypertriglyceridemia and high cardiovascular risk, and demonstrated an extraordinary outcome of 25% relative reduction in cardiovascular events. This article reviews studies on omega-3 fatty acids during the last 50 years, including the progress in elucidating molecular mechanisms and recent large-scale clinical studies.
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Affiliation(s)
- Yasuhiro Watanabe
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
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1270
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Chorath A, Choi Y, Turkbey EB, Ahlman MA, Sibley CT, Liu S, Bluemke DA, Sandfort V. Coronary CT Angiography and Carotid MRI Improve Phenotyping of Disease Extent Compared with ACC/AHA Risk Score Alone. Radiol Cardiothorac Imaging 2020; 2:e190068. [PMID: 32715300 PMCID: PMC7053177 DOI: 10.1148/ryct.2020190068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 06/11/2023]
Abstract
PURPOSE To determine the relationship between the American College of Cardiology/American Heart Association (ACC/AHA) risk score and plaque phenotype of the coronary and carotid arteries assessed directly using CT angiography and MRI. MATERIALS AND METHODS Asymptomatic subjects eligible for statin therapy by risk score were enrolled in a prospective study of disease burden using coronary artery calcium (CAC) scoring, coronary CT angiography, and MRI of the carotid arteries. Quartiles were calculated for noncalcified plaque, CAC, and average carotid wall volume and were compared with ACC/AHA risk quartiles. RESULTS Two hundred three subjects were studied (60% men; mean age, 65 years). There were weak correlations between risk and carotid wall volume (Kendall tau = 0.29), noncalcified plaque (tau = 0.16), and CAC (tau = 0.33). ACC/AHA risk alone misclassified plaque extent compared with measurement by carotid wall volume, CAC, and noncalcified plaque in 22.1%, 24.1%, and 29.6% of subjects, respectively. On average, 13% of the subjects were underclassified, and 12.5% were overclassified. CONCLUSION Approximately 25% of subjects had large discrepancies between ACC/AHA risk and plaque burden at imaging. These results suggest that clinical risk score models alone do not fully reflect the amount of atherosclerotic disease present.© RSNA, 2020See also the commentary by Truong and Villines in this issue.
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Truong QA, Villines TC. Risk Scores versus Atherosclerosis Imaging: Time to Embrace What Is in Plain Sight! Radiol Cardiothorac Imaging 2020; 2:e200019. [PMID: 33778541 DOI: 10.1148/ryct.2020200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, L-024, New York, NY 10065 (Q.A.T.); and Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System and School of Medicine, Charlottesville, Va (T.C.V.)
| | - Todd C Villines
- Department of Radiology, Weill Cornell Medicine, 525 E 68th St, L-024, New York, NY 10065 (Q.A.T.); and Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System and School of Medicine, Charlottesville, Va (T.C.V.)
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1272
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Butler T, Kerley CP, Altieri N, Alvarez J, Green J, Hinchliffe J, Stanford D, Paterson K. Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR). Heart 2020; 106:724-731. [PMID: 32098809 PMCID: PMC7229899 DOI: 10.1136/heartjnl-2019-315499] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022] Open
Abstract
Nutrition has a central role in both primary and secondary prevention of cardiovascular disease yet only relatively recently has food been regarded as a treatment, rather than as an adjunct to established medical and pharmacotherapy. As a field of research, nutrition science is constantly evolving making it difficult for patients and practitioners to ascertain best practice. This is compounded further by the inherent difficulties in performing double-blind randomised controlled trials. This paper covers dietary patterns that are associated with improved cardiovascular outcomes, including the Mediterranean Diet but also low-carbohydrate diets and the potential issues encountered with their implementation. We suggest there must be a refocus away from macronutrients and consideration of whole foods when advising individuals. This approach is fundamental to practice, as clinical guidelines have focused on macronutrients without necessarily considering their source, and ultimately people consume foods containing multiple nutrients. The inclusion of food-based recommendations aids the practitioner to help the patient make genuine and meaningful changes in their diet. We advocate that the cardioprotective diet constructed around the traditional Mediterranean eating pattern (based around vegetables and fruits, nuts, legumes, and unrefined cereals, with modest amounts of fish and shellfish, and fermented dairy products) is still important. However, there are other approaches that can be tried, including low-carbohydrate diets. We encourage practitioners to adopt a flexible dietary approach, being mindful of patient preferences and other comorbidities that may necessitate deviations away from established advice, and advocate for more dietitians in this field to guide the multi-professional team.
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Affiliation(s)
- Tom Butler
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK .,BACPR Diet Working Group
| | - Conor P Kerley
- BACPR Diet Working Group.,Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Nunzia Altieri
- BACPR Diet Working Group.,Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Joe Alvarez
- BACPR Diet Working Group.,Whittington Health NHS Trust, London, UK
| | - Jane Green
- BACPR Diet Working Group.,Doddington Hospital - Cambridgeshire and Peterborough NHS Foundation Trust, Doddington, UK
| | - Julie Hinchliffe
- BACPR Diet Working Group.,Salford Royal NHS Foundation Trust, Salford, UK
| | - Dell Stanford
- BACPR Diet Working Group.,Department of Community Cardiology, Central London Community NHS Trust, Berkhamstead, UK
| | - Katherine Paterson
- BACPR Diet Working Group.,Norfolk and Norwich University Hospital, Norwich, UK
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1273
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Marston NA, Kamanu FK, Nordio F, Gurmu Y, Roselli C, Sever PS, Pedersen TR, Keech AC, Wang H, Pineda AL, Giugliano RP, Lubitz SA, Ellinor PT, Sabatine MS, Ruff CT. Predicting Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease Using a Genetic Risk Score: Results From the FOURIER Trial. Circulation 2020; 141:616-623. [PMID: 31707849 PMCID: PMC8058781 DOI: 10.1161/circulationaha.119.043805] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The ability of a genetic risk score to predict risk in established cardiovascular disease and identify individuals who derive greater benefit from PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition has not been established. METHODS We studied 14 298 patients with atherosclerotic cardiovascular disease from the FOURIER trial (Further Cardiovascular Outcomes Researh With PCSK9 Inhibition in Subjects With Elevated Risk). A 27-single-nucleotide polymorphism genetic risk score defined low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk. Patients were also categorized by major atherosclerotic risk factors including diabetes mellitus, hypertension, low-density lipoprotein cholesterol ≥100 mg/dl, and smoking; multiple (≥2) risk factors was considered high clinical risk. Outcomes consisted of major coronary events (coronary heart death, myocardial infarction, or coronary revascularization) and major vascular events (major coronary events and ischemic stroke). Median follow-up was 2.3 years. RESULTS After we adjusted for clinical factors, the genetic risk score was associated with risk for both major vascular events (Ptrend=0.005) and major coronary events (Ptrend<0.0001). Individuals with intermediate and high genetic risk scores had 1.23- and 1.65-fold increased hazard for major coronary events, respectively. Elevated genetic risk was additive to major atherosclerotic risk factors and identified patients more likely to benefit from evolocumab. There was no benefit for major vascular events in patients without multiple clinical risk factors or high genetic risk (hazard ratio [HR], 1.02; absolute risk reduction [ARR], -0.2%, P=0.86). In contrast, there was a 13% relative risk reduction (HR, 0.87 [0.75-0.998], P=0.047) and a 1.4% ARR in patients with multiple clinical risk factors but without high genetic risk and a 31% relative risk reduction (HR, 0.69 [0.55-0.86], P=0.0012), and 4.0% ARR in patients with high genetic risk, irrespective of clinical risk (Ptrend for HR=0.017, ARR Ptrend=0.004). Patients with high genetic risk who received evolocumab had event rates similar to patients with a low burden of both genetic and clinical risk. CONCLUSION Patients without multiple clinical risk factors or high genetic risk had a low event rate and did not appear to derive benefit from evolocumab over 2.3 years. Conversely, patients with multiple clinical risk factors but without high genetic risk had intermediate risk and intermediate risk reduction. Patients with high genetic risk, regardless of clinical risk, had a high event rate and derived the greatest relative and absolute benefit from evolocumab, which mitigated this risk.
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Affiliation(s)
- Nicholas A. Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Frederick K. Kamanu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Francesco Nordio
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Yared Gurmu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Carolina Roselli
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Peter S. Sever
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Terje R. Pedersen
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Anthony C. Keech
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Huei Wang
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Armando Lira Pineda
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Robert P. Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Steven A. Lubitz
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (N.A.M., F.K.K., F.N., Y.G., R.P.G., M.S.S., C.T.R.). Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard Cambridge, MA (C.R., S.A.L., P.T.E.). University Medical Center Groningen, University of Groningen, the Netherlands (C.R.). National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.). Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.). Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.). Amgen, Thousand Oaks, CA (H.W., A.L.P.). Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
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1274
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Mehta A, Desai SR, Ko YA, Liu C, Dhindsa DS, Nayak A, Hooda A, Martini MA, Ejaz K, Sperling LS, Reiser J, Hayek SS, Quyyumi AA. Sex Differences in Circulating Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Adverse Outcomes in Coronary Artery Disease. J Am Heart Assoc 2020; 9:e015457. [PMID: 32089048 PMCID: PMC7335555 DOI: 10.1161/jaha.119.015457] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Women have higher circulating levels of soluble urokinase‐type plasminogen activator receptor (suPAR), and elevated suPAR is associated with cardiovascular risk. The independent association of sex with suPAR and the impact of sex on its association with cardiovascular risk are unknown. Methods and Results Plasma suPAR was measured using ELISA in 2 cohorts of 666 asymptomatic individuals (49 years, 65% women) and 4184 patients with coronary artery disease (63 years, 37% women). Independent association of sex with suPAR was studied using linear regression models adjusted for demographics, risk factors, and visceral adiposity in asymptomatic participants. Impact of sex on association of suPAR with all‐cause mortality was studied in patients with coronary artery disease using multivariable‐adjusted Cox models. Sex‐specific suPAR cutoffs for predicting all‐cause mortality were calculated. Asymptomatic women had 10% higher suPAR compared with men after adjusting for confounders, and visceral adiposity partly accounted for this association. Over a median follow‐up of 5.2 years, 795 deaths were recorded in patients with coronary artery disease. Log2‐transformed suPAR was independently associated with mortality (hazard ratio per 1‐SD 1.72, 95% CI 1.60–1.85) and an interaction with sex was noted (P=0.005). Association of suPAR with mortality was slightly weaker in women (hazard ratio 1.61, 95% CI 1.41–1.83) compared with men (hazard ratio 1.83, 95% CI 1.67–2.00). However, using sex‐specific suPAR cut‐offs (4392 pg/mL for women and 3187 pg/mL for men), a similar mortality incidence was observed for both sexes (38.5% and 35.5%, respectively, P=0.3). Conclusions Women have 10% higher plasma suPAR levels compared with men. Elevated sex‐specific plasma suPAR levels are equally predictive of risk of adverse events in both sexes.
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Affiliation(s)
- Anurag Mehta
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Shivang R Desai
- Department of Medicine Emory University School of Medicine Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics Emory University Atlanta GA
| | - Devinder S Dhindsa
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Aditi Nayak
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Ananya Hooda
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Mohamed A Martini
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Kiran Ejaz
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Laurence S Sperling
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
| | - Jochen Reiser
- Department of Internal Medicine Rush University Medical Center Chicago IL
| | - Salim S Hayek
- Frankel Cardiovascular Center University of Michigan Ann Arbor MI
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory Clinical Cardiovascular Research Institute Emory University School of Medicine Atlanta GA
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1275
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Vanden Wyngaert K, Van Craenenbroeck AH, Holvoet E, Calders P, Van Biesen W, Eloot S. Composite Uremic Load and Physical Performance in Hemodialysis Patients: A Cross-Sectional Study. Toxins (Basel) 2020; 12:toxins12020135. [PMID: 32098304 PMCID: PMC7076769 DOI: 10.3390/toxins12020135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
Impaired physical performance is common in patients on hemodialysis (HD) and is associated with poor prognosis. A patient relevant marker of adequacy of dialysis is lacking. Previous studies evaluated uremic toxicity by assessing the impact of different uremic toxins separately. However, such an approach is most likely not reflective of true uremic toxicity. Therefore, this cross-sectional study aimed to examine if the uremic syndrome, estimated as one composite of different uremic toxins (facilitated by ridge regression method) to reflect the kinetic behavior during dialysis, is associated with physical performance in patients on HD. Levels of p-cresyl glucuronide and sulfate, indole-acetic acid, indoxyl sulfate, uric acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid were assessed and associated by ridge regression to muscle strength, functional exercise capacity, and measures of balance and coordination. 75 HD patients were included (mean age 68 years, 57% male). The composite of different uremic toxins (i.e., uremic load) explained 22% of the variance in handgrip strength. Although there was an association between full body muscle strength and the composite uremic load independent of nutritional status, age and gender, the predictive power of composite uremic load for muscle weakness is limited. Single uremic toxins as well as composite uremic load were not associated with exercise capacity, coordination, and balance, indicating that the degree of uremia does not predict physical performance in patients on HD.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium;
- Correspondence: ; Tel.: +32-9-332-0528
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, B-2650 Antwerp, Belgium;
- Department of Nephrology, University Hospitals Leuven, B-3001 Leuven, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, B-9000 Ghent, Belgium; (E.H.); (W.V.B.); (S.E.)
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium;
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, B-9000 Ghent, Belgium; (E.H.); (W.V.B.); (S.E.)
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, B-9000 Ghent, Belgium; (E.H.); (W.V.B.); (S.E.)
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1276
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Agarwala A, Michos ED, Samad Z, Ballantyne CM, Virani SS. The Use of Sex-Specific Factors in the Assessment of Women's Cardiovascular Risk. Circulation 2020; 141:592-599. [PMID: 32065772 PMCID: PMC7032610 DOI: 10.1161/circulationaha.119.043429] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.
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Affiliation(s)
- Anandita Agarwala
- Division of Cardiology, Washington University School of Medicine, 660 S. Euclid, Campus Box 8086, St. Louis, MO
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christie M. Ballantyne
- Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston TX
| | - Salim S. Virani
- The Aga Khan University, Karachi, Pakistan
- Sections of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
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1277
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Eisenberg E, McElhinney PA, Commandeur F, Chen X, Cadet S, Goeller M, Razipour A, Gransar H, Cantu S, Miller RJH, Slomka PJ, Wong ND, Rozanski A, Achenbach S, Tamarappoo BK, Berman DS, Dey D. Deep Learning-Based Quantification of Epicardial Adipose Tissue Volume and Attenuation Predicts Major Adverse Cardiovascular Events in Asymptomatic Subjects. Circ Cardiovasc Imaging 2020; 13:e009829. [PMID: 32063057 DOI: 10.1161/circimaging.119.009829] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Epicardial adipose tissue (EAT) volume (cm3) and attenuation (Hounsfield units) may predict major adverse cardiovascular events (MACE). We aimed to evaluate the prognostic value of fully automated deep learning-based EAT volume and attenuation measurements quantified from noncontrast cardiac computed tomography. METHODS Our study included 2068 asymptomatic subjects (56±9 years, 59% male) from the EISNER trial (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) with long-term follow-up after coronary artery calcium measurement. EAT volume and mean attenuation were quantified using automated deep learning software from noncontrast cardiac computed tomography. MACE was defined as myocardial infarction, late (>180 days) revascularization, and cardiac death. EAT measures were compared to coronary artery calcium score and atherosclerotic cardiovascular disease risk score for MACE prediction. RESULTS At 14±3 years, 223 subjects suffered MACE. Increased EAT volume and decreased EAT attenuation were both independently associated with MACE. Atherosclerotic cardiovascular disease risk score, coronary artery calcium, and EAT volume were associated with increased risk of MACE (hazard ratio [95%CI]: 1.03 [1.01-1.04]; 1.25 [1.19-1.30]; and 1.35 [1.07-1.68], P<0.01 for all) and EAT attenuation was inversely associated with MACE (hazard ratio, 0.83 [95% CI, 0.72-0.96]; P=0.01), with corresponding Harrell C statistic of 0.76. MACE risk progressively increased with EAT volume ≥113 cm3 and coronary artery calcium ≥100 AU and was highest in subjects with both (P<0.02 for all). In 1317 subjects, EAT volume was correlated with inflammatory biomarkers C-reactive protein, myeloperoxidase, and adiponectin reduction; EAT attenuation was inversely related to these biomarkers. CONCLUSIONS Fully automated EAT volume and attenuation quantification by deep learning from noncontrast cardiac computed tomography can provide prognostic value for the asymptomatic patient, without additional imaging or physician interaction.
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Affiliation(s)
- Evann Eisenberg
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Priscilla A McElhinney
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Frederic Commandeur
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Xi Chen
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sebastien Cadet
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Markus Goeller
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA.,Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (M.G., S.A.)
| | - Aryabod Razipour
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Heidi Gransar
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephanie Cantu
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert J H Miller
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Piotr J Slomka
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nathan D Wong
- Department of Medicine, University of California at Irvine, CA (N.D.W.)
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St Lukes Hospital, New York, NY (A.R.)
| | - Stephan Achenbach
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Faculty of Medicine, Department of Cardiology, Erlangen, Germany (M.G., S.A.)
| | - Balaji K Tamarappoo
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S Berman
- Department of Imaging and Medicine and the Smidt Heart Institute (E.E., S.C., H.G., S.C., R.J.H.M., P.J.S., B.K.T., D.S.B.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Damini Dey
- Biomedical Imaging Research Institute (P.A.M., F.C., X.C., M.G., A.R., D.D.), Cedars-Sinai Medical Center, Los Angeles, CA
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1278
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Abstract
PURPOSE OF REVIEW The burden of cardiovascular disease (CVD) in the USA remains unacceptably high. The associated morbidity and mortality of CVD has important implications on our healthcare system and society. With much of CVD considered preventable an increase emphasis on primary prevention is important. To review the evidence for pharmacists providing CVD primary prevention, particularly as a part of employer-based programs. RECENT FINDINGS A recent study evaluated the impact of a pharmacist-led 12-month preventative health program in 178 at-risk employees at University of British Columbia (UBC). Cardiovascular Assessment and Medication Management by Pharmacists at UBC (CAMMPUS) resulted in improved Framingham risk scores (FRS) from 11.7 to 10.7 (p = 0.0017), improvement in quality of life (p = 0.023), and medication adherence (p = 0.019). Findings are consistent with improvements observed in other pharmacist-led intervention trials but offer the unique perspective as an employer-based intervention. Pharmacists-led interventions prevent CVD through improvement in health markers and medication adherence. The ability of pharmacists to provide these as part of an employer-sponsored benefit might be favorable as other billing models for pharmacist can be challenging to be justified in a fee-for-service payment structure; further, there is incentive for employers to lower healthcare cost and improve productivity. Future studies defining the impact of pharmacists in this and other settings may have important public health implications.
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1279
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Williams SK, Johnson BA, Tobin JN, Luque AE, Sanders M, Carroll JK, Cassells A, Holder T, Fiscella K. Protocol paper: Stepped wedge cluster randomized trial translating the ABCS into optimizing cardiovascular care for people living with HIV. Prog Cardiovasc Dis 2020; 63:125-133. [PMID: 32035124 DOI: 10.1016/j.pcad.2020.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/29/2022]
Abstract
People living with HIV (PWH) are at higher risk for cardiovascular disease (CVD) and stroke in comparison to their non-infected counterparts. The ABCS (aspirin-blood pressure control-cholesterol control-smoking cessation) reduce atherosclerotic (ASCVD) risk in the general population, but little is known regarding strategies for promoting the ABCS among PWH. Guided by the Consolidated Framework for Implementation Research (CFIR), we designed multilevel implementation strategies that target PWH and their clinicians to promote appropriate use of the ABCS based on a 10-year estimated ASCVD risk. Implementation strategies include patient coaching, automated texting, peer phone support, academic detailing and audit and feedback for the patient's clinician. We are evaluating implementation through a stepped wedge cluster randomized trial based on the Reach-Effectiveness-Adoption-Maintenance/Qualitative-Evaluation-for-Systematic-Translation (RE-AIM/QuEST) mixed methods framework that integrates quantitative and qualitative assessments. The primary outcome is change in ASCVD risk. Findings will have important implications regarding strategies for reducing ASCVD risk among PWH.
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Affiliation(s)
- Stephen K Williams
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Jonathan N Tobin
- Clinical Directors Network (CDN), Community-Engaged Research, The Rockefeller University Center for Clinical and Translational Science, New York, NY
| | - Amneris Esther Luque
- Infectious Diseases and Geographic Medicine, HIV Program at Parkland Health and Hospital System, Community Prevention and Intervention Unit, UT Southwestern Medical Center, Dallas, TX
| | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY
| | | | | | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, NY
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY.
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1280
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Feigin VL, Brainin M, Norrving B, Gorelick PB, Dichgans M, Wang W, Pandian JD, Martins SCO, Owolabi MO, Wood DA, Hankey GJ. What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? J Am Heart Assoc 2020; 9:e014494. [PMID: 31983323 PMCID: PMC7033901 DOI: 10.1161/jaha.119.014494] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied NeurosciencesSchool of Public Health and Psychosocial StudiesFaculty of Health and Environmental SciencesAUT UniversityAucklandNew Zealand
| | - Michael Brainin
- Department of Neuroscience and Preventive MedicinePresident of the World Stroke OrganizationDanube University KremsAustria
| | - Bo Norrving
- Department of Clinical SciencesDepartment of NeurologySkåne University HospitalLund UniversityLundSweden
| | - Philip B. Gorelick
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIL
- Population Health Research InstituteMcMaster University of Health Sciences and Hamilton UniversityHamiltonOntarioCanada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD)University HospitalLudwig‐Maximilians‐Universität LMUMunichGermany
- Munich Cluster of Systems Neurology (SyNergy)MunichGermany
| | - Wenzhi Wang
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingPeople's Republic of China
- National Office for CVD Prevention and ControlNational Health CommissionBeijingChina
| | | | | | - Mayowa O. Owolabi
- Center for Genomic and Precision MedicineUniversity of IbadanIbadanOyoNigeria
- University College HospitalIbadanOyoNigeria
- Blossom Center for NeurorehabilitationIbadanNigeria
| | - David A. Wood
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
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1281
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Nixdorff U. [Meaningful diagnostics: imaging]. Herz 2020; 45:17-23. [PMID: 32002564 DOI: 10.1007/s00059-020-04890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Imaging of subclinical atherosclerosis is an integrated component of a preventive medicine algorithm; i.e. on the basis of a cardiovascular risk stratification patients with a low and intermediate risk qualify for further imaging (cave: Bayes' theorem). Imaging procedures for subclinical atherosclerosis have one thing in common: atherosclerosis is detected and localized directly, for which cardiac multidetector computed tomography (MDCT; coronary calcium scoring, CACS) and vascular ultrasound (carotid and/or femoral arteries) are used to measure the plaque burden. The result is viewed as a risk modifier. The risk assessment is not related to symptoms. In addition to the detection and localization of atherosclerosis this also enables assessment of the "risk age" according to the tables of the European Society of Cardiology (ESC) and even the biological age, which can be estimated based on nomograms. This knowledge can be used to promote patient compliance and adherence to medication.
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Affiliation(s)
- Uwe Nixdorff
- European Prevention Center (EPC) im Medical Center Düsseldorf (GrandArc), Luise-Rainer-Str. 6-10, 40235, Düsseldorf, Deutschland.
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1282
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Qian F, Riddle MC, Wylie-Rosett J, Hu FB. Red and Processed Meats and Health Risks: How Strong Is the Evidence? Diabetes Care 2020; 43:265-271. [PMID: 31959642 PMCID: PMC6971786 DOI: 10.2337/dci19-0063] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prevailing dietary guidelines have widely recommended diets relatively low in red and processed meats and high in minimally processed plant foods for the prevention of chronic diseases. However, an ad hoc research group called the Nutritional Recommendations (NutriRECS) consortium recently issued "new dietary guidelines" encouraging individuals to continue their current meat consumption habits due to "low certainty" of the evidence, difficulty of altering meat eaters' habits and preferences, and the lack of need to consider environmental impacts of red meat consumption. These recommendations are not justified, in large part because of the flawed methodologies used to review and grade nutritional evidence. The evidence evaluation was largely based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria, which are primarily designed to grade the strength of evidence for clinical interventions especially pharmacotherapy. However, the infeasibility for conducting large, long-term randomized clinical trials on most dietary, lifestyle, and environmental exposures makes the criteria inappropriate in these areas. A separate research group proposed a modified and validated system for rating the meta-evidence on nutritional studies (NutriGRADE) to address several limitations of the GRADE criteria. Applying NutriGRADE, the evidence on the positive association between red and processed meats and type 2 diabetes was rated to be of "high quality," while the evidence on the association between red and processed meats and mortality was rated to be of "moderate quality." Another important limitation is that inadequate attention was paid to what might be replacing red meat, be it plant-based proteins, refined carbohydrates, or other foods. In summary, the red/processed meat recommendations by NutriRECS suffer from important methodological limitations and involve misinterpretations of nutritional evidence. To improve human and planetary health, dietary guidelines should continue to emphasize dietary patterns low in red and processed meats and high in minimally processed plant foods such as fruits and vegetables, whole grains, nuts, and legumes.
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Affiliation(s)
- Frank Qian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, University of Chicago, Chicago, IL
| | - Matthew C Riddle
- Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, The Bronx, NY
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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1283
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4793] [Impact Index Per Article: 1198.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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1284
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Siedler M, Murad MH, Falck-Ytter Y, Dahm P, Mustafa RA, Sultan S, Morgan RL. Guidelines about physical activity and exercise to reduce cardiometabolic risk factors: protocol for a systematic review and critical appraisal. BMJ Open 2020; 10:e032656. [PMID: 31980508 PMCID: PMC7044951 DOI: 10.1136/bmjopen-2019-032656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/30/2019] [Accepted: 01/10/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Physical activity can prevent a wide range of diseases, including highly prevalent conditions such as heart disease, diabetes and associated cardiometabolic disorders. Numerous guidelines for the prescription of physical activity and exercise to promote general health and prevent disease are released each year, but the quality of these guidelines is currently unknown. This systematic review and critical appraisal of physical activity and exercise guidelines aims to summarise the current status and quality of these guidelines to provide suggestions to improve the development of future guidelines in this area. METHODS AND ANALYSIS We will conduct a systematic review of guidelines in Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus databases published from database 2000 through 23 October 2019, written in English for the use of physical activity and exercise for the prevention of cardiometabolic disease and related risk factors in otherwise healthy individuals. We will also search the grey literature for additional eligible documents. We will use the Appraisal of Guidelines for Research and Evaluation II tool to assess the quality of eligible recommendations from all included guidelines, as well as perform exploratory analyses on guideline development variables. ETHICS AND DISSEMINATION As a protocol for the review and critical appraisal of published documents, no potential ethical considerations are discussed. The protocol will guide the development of the review, which will be disseminated to relevant journals for publication. PROSPERO REGISTRATION NUMBER CRD42019126364.
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Affiliation(s)
- Madelin Siedler
- Physical Education and Exercise Science, University of South Florida, Tampa, Florida, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yngve Falck-Ytter
- Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Philipp Dahm
- Urology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Reem A Mustafa
- Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shahnaz Sultan
- Gastroenterology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca L Morgan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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1285
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Carson JAS, Lichtenstein AH, Anderson CA, Appel LJ, Kris-Etherton PM, Meyer KA, Petersen K, Polonsky T, Van Horn L. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation 2020; 141:e39-e53. [DOI: 10.1161/cir.0000000000000743] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]–style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.
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1286
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Camara Planek MI, Silver AJ, Volgman AS, Okwuosa TM. Exploratory Review of the Role of Statins, Colchicine, and Aspirin for the Prevention of Radiation-Associated Cardiovascular Disease and Mortality. J Am Heart Assoc 2020; 9:e014668. [PMID: 31960749 PMCID: PMC7033839 DOI: 10.1161/jaha.119.014668] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Adam J. Silver
- Rush Heart Center for WomenRush University Medical CenterChicagoIL
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1287
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Capodanno D, Bhatt DL, Eikelboom JW, Fox KAA, Geisler T, Michael Gibson C, Gonzalez-Juanatey JR, James S, Lopes RD, Mehran R, Montalescot G, Patel M, Steg PG, Storey RF, Vranckx P, Weitz JI, Welsh R, Zeymer U, Angiolillo DJ. Dual-pathway inhibition for secondary and tertiary antithrombotic prevention in cardiovascular disease. Nat Rev Cardiol 2020; 17:242-257. [PMID: 31953535 DOI: 10.1038/s41569-019-0314-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 12/24/2022]
Abstract
Advances in antiplatelet therapies for patients with cardiovascular disease have improved patient outcomes over time, but the challenge of balancing the risks of ischaemia and bleeding remains substantial. Moreover, many patients with cardiovascular disease have a residual risk of ischaemic events despite receiving antiplatelet therapy. Therefore, novel strategies are needed to prevent clinical events through mechanisms beyond platelet inhibition and with an acceptable associated risk of bleeding. The advent of non-vitamin K antagonist oral anticoagulants, which attenuate fibrin formation by selective inhibition of factor Xa or thrombin, has renewed the interest in dual-pathway inhibition strategies that combine an antiplatelet agent with an anticoagulant drug. In this Review, we highlight the emerging pharmacological rationale and clinical development of dual-pathway inhibition strategies for the prevention of atherothrombotic events in patients with different manifestations of cardiovascular disease, such as coronary artery disease, cerebrovascular disease and peripheral artery disease.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, C.A.S.T., P.O. 'G. Rodolico', Azienda Ospedaliero-Universitaria 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - John W Eikelboom
- Population Health Research Institute, Hamilton General Hospital and McMaster University, Hamilton, ON, Canada
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital of Tübingen, Tübingen, Germany
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical, Harvard Medical School, Boston, MA, USA
| | | | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Renato D Lopes
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Pitié Salpêtrière Hôpital (AP-HP), Paris, France
| | - Manesh Patel
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - P Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris University, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, and Faculty of Medicine and Life Sciences at the University of Hasselt, Hasselt, Belgium
| | - Jeffrey I Weitz
- Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster University and the Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Robert Welsh
- Cardiac Sciences Department, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, AL, Canada
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA.
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1288
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Brown SA. Preventive Cardio-Oncology: The Time Has Come. Front Cardiovasc Med 2020; 6:187. [PMID: 31998754 PMCID: PMC6965025 DOI: 10.3389/fcvm.2019.00187] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Sherry-Ann Brown
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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1289
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Kinnear FJ, Wainwright E, Bourne JE, Lithander FE, Hamilton-Shield J, Searle A. The development of a theory informed behaviour change intervention to improve adherence to dietary and physical activity treatment guidelines in individuals with familial hypercholesterolaemia (FH). BMC Health Serv Res 2020; 20:27. [PMID: 31914998 PMCID: PMC6950899 DOI: 10.1186/s12913-019-4869-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is a genetic condition characterised by elevated levels of low-density lipoprotein cholesterol (LDL-C) and an increased risk of cardiovascular disease (CVD). Following dietary and physical activity guidelines could help minimise this risk but adherence is low. Interventions to target these behaviours are therefore required. A comprehensive understanding of the target behaviours and behaviour change theory should drive the process of intervention development to increase intervention effectiveness and scalability. This paper describes the application of a theoretical framework to the findings of a qualitative evidence synthesis (QES) to inform the content and delivery of an intervention to improve adherence to dietary and physical activity guidelines in individuals with FH. METHODS The Behaviour Change Wheel (BCW) was used to guide intervention development. Factors influencing dietary and physical activity behaviours were identified from an earlier QES and mapped onto factors within the BCW. A comprehensive behavioural diagnosis of these factors was conducted through application of the theoretical domains framework (TDF). Using these data, the most appropriate intervention functions and behaviour change techniques (BCTs) for inclusion in the intervention were identified. Decision making was guided by evaluation criteria recommended by BCW guidance and feedback from individuals with FH. RESULTS Factors influencing dietary and physical activity behaviours mapped onto twelve of the fourteen TDF domains, with seven intervention functions deemed suitable to target the domains' theoretical constructs. Twenty-six BCTs were identified as being appropriate for delivery within these functions and were included in the intervention. For instance, within the enablement intervention function, the BCT problem solving was incorporated by inclusion of a 'barriers and solutions' section. Guided by evaluation criteria and feedback from individuals with FH, the intervention will be delivered as an hour-long family-based appointment, followed up with four telephone calls. CONCLUSIONS The novel application of the BCW and TDF to the results of a QES has enabled the development of a theory and evidence informed behaviour change intervention. This systematic approach facilitates evaluation of the intervention as part of an ongoing feasibility trial. The transparent approach taken can be used to guide intervention development by researchers in other fields.
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Affiliation(s)
- F J Kinnear
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.
| | - E Wainwright
- Psychology Department, Bath Spa University and Honorary Research Fellow, Department for Health, University of Bath, Bath, UK
| | - J E Bourne
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - F E Lithander
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J Hamilton-Shield
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - A Searle
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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1290
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Parker WAE, Schulte C, Barwari T, Phoenix F, Pearson SM, Mayr M, Grant PJ, Storey RF, Ajjan RA. Aspirin, clopidogrel and prasugrel monotherapy in patients with type 2 diabetes mellitus: a double-blind randomised controlled trial of the effects on thrombotic markers and microRNA levels. Cardiovasc Diabetol 2020; 19:3. [PMID: 31910903 PMCID: PMC6945631 DOI: 10.1186/s12933-019-0981-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite increased atherothrombotic risk in type 2 diabetes mellitus, (T2DM) the best preventative antithrombotic strategy remains undetermined. We defined the effects of three antiplatelet agents on functional readout and biomarker kinetics in platelet activation and coagulation in patients with T2DM. MATERIALS AND METHODS 56 patients with T2DM were randomised to antiplatelet monotherapy with aspirin 75 mg once daily (OD), clopidogrel 75 mg OD or prasugrel 10 mg OD during three periods of a crossover study. Platelet aggregation (PA) was determined by light-transmittance aggregometry and P-selectin expression by flow cytometry. Markers of fibrin clot dynamics, inflammation and coagulation were measured. Plasma levels of 14 miRNA were assessed by quantitative polymerase chain reactions. RESULTS Of the 56 patients, 24 (43%) were receiving aspirin for primary prevention of ischaemic events and 32 (57%) for secondary prevention. Prasugrel was the strongest inhibitor of ADP-induced PA (mean ± SD maximum response to 20μmol/L ADP 77.6 ± 8.4% [aspirin] vs. 57.7 ± 17.6% [clopidogrel] vs. 34.1 ± 14.1% [prasugrel], p < 0.001), P-selectin expression (30 μmol/L ADP; 45.1 ± 21.4% vs. 27.1 ± 19.0% vs. 14.1 ± 14.9%, p < 0.001) and collagen-induced PA (2 μg/mL; 62.1 ± 19.4% vs. 72.3 ± 18.2% vs. 60.2 ± 18.5%, p < 0.001). Fibrin clot dynamics and levels of coagulation and inflammatory proteins were similar. Lower levels of miR-24 (p = 0.004), miR-191 (p = 0.019), miR-197 (p = 0.009) and miR-223 (p = 0.014) were demonstrated during prasugrel-therapy vs. aspirin. Circulating miR-197 was lower in those cardiovascular disease during therapy with aspirin (p = 0.039) or prasugrel (p = 0.0083). CONCLUSIONS Prasugrel monotherapy in T2DM provided potent platelet inhibition and reduced levels of a number of platelet-associated miRNAs. miR-197 is a potential marker of cardiovascular disease in this population. Clinical outcome studies investigating prasugrel monotherapy are warranted in individuals with T2DM. Trial registration EudraCT, 2009-011907-22. Registered 15 March 2010, https://www.clinicaltrialsregister.eu/ctr-search/trial/2009-011907-22/GB.
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Affiliation(s)
- William A E Parker
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Christian Schulte
- King's British Heart Foundation Centre, King's College London, London, UK.,Department of General and Interventional Cardiology, University Heart Centre Hamburg Eppendorf, Hamburg, Germany
| | - Temo Barwari
- King's British Heart Foundation Centre, King's College London, London, UK
| | - Fladia Phoenix
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sam M Pearson
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Manuel Mayr
- King's British Heart Foundation Centre, King's College London, London, UK
| | - Peter J Grant
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Robert F Storey
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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1292
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Jacobsen AP, McEvoy JW. Changing place for aspirin in primary prevention of cardiovascular disease. Drug Ther Bull 2020; 58:3-4. [PMID: 31666246 DOI: 10.1136/dtb.2019.000043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Alan P Jacobsen
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John W McEvoy
- Department of Medicine, Division of Cardiology, National University of Ireland Galway School of Medicine, Galway, Ireland
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1293
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For Primary Prevention, Should All Moderate- to High-Risk Patients Be Considered Candidates for Acetylsalicylic Acid? Can J Hosp Pharm 2020; 73:58-61. [PMID: 32109962 PMCID: PMC7023933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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1294
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Gaviria-Mendoza A, Zapata-Carmona JA, Restrepo-Bastidas AA, Betancur-Pulgarín CL, Machado-Alba JE. Prior Use of Medication for Primary Prevention in Patients with Coronary Syndrome. J Prim Care Community Health 2020; 11:2150132720946949. [PMID: 32755281 PMCID: PMC7543101 DOI: 10.1177/2150132720946949] [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] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Cardiovascular disease, especially coronary disease, represents one of the main causes of morbidity and mortality. Objective: To determine the drug prescription profile for primary cardiovascular prevention prior to a first acute coronary syndrome event. Methods: Cross-sectional study. We included adult patients of any sex affiliated with one healthcare insurer of the Colombian Health System, with a diagnosis of a first episode of acute coronary syndrome that occurred during the period of 2015 to 2016. Sociodemographic, clinical and pharmacological variables were evaluated from clinical records. The cardiovascular risk score prior to the event was calculated, and the need for the use of statins and aspirin in primary prevention was defined according to the recommendations of clinical practice guidelines. Results: Clinical records of 322 patients were reviewed with mean age of 61.9 ± 10.8 years, and 77.3% were men. The most frequent comorbidities were dyslipidemia (64.3%), arterial hypertension (62.7%) and diabetes mellitus (30.1%); 22% of the patients were obese, and 33.5% were smokers. The cardiovascular risk score was calculated in 211 patients (65.5%) who had the necessary variables complete. The median 10-year risk according to Framingham risk score was 21.4%, and it was 16.3% according to the American Heart Association. From the 211 patients with risk scores, there were 179 (84.8%) who needed statins (175 of high intensity, 97.8%), and 88 (27.3%) required aspirin as a primary prevention; however, 56 of these patients (31.3%) did not receive any statins, 127 (72.6%) did not receive the high intensity statin they needed, and 38 (43.2% of those with indication) lacked aspirin. Conclusion: Real-life data show that among a group of patients with high cardiovascular risk, a substantial proportion were not receiving medications for primary prevention necessary to reduce their risk and finally suffered an acute coronary event.
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Affiliation(s)
- Andrés Gaviria-Mendoza
- Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Julián Andrés Zapata-Carmona
- Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia
| | - Andrés Alirio Restrepo-Bastidas
- Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia
| | - Carmen Luisa Betancur-Pulgarín
- Grupo ZIPATEFI (Zona de investigaciones posgrados Andina Terapia respiratoria y Fisioterapia), Fundación Universitaria del Área Andina, Pereira, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
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1295
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Miller VM, Jayachandran M, Barnes JN, Mielke MM, Kantarci K, Rocca WA. Risk factors of neurovascular ageing in women. J Neuroendocrinol 2020; 32:e12777. [PMID: 31397036 PMCID: PMC6982564 DOI: 10.1111/jne.12777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Abstract
Biological sex and changes in sex hormones throughout life influence all aspects of health and disease. In women, changes in sex hormonal status reflect ovarian function, pregnancy and the use of exogenous hormonal treatments. Longitudinal data from defined cohorts of women will help to identify mechanisms by which the hormonal milieu contributes to cerebrovascular ageing, brain structure and ultimately cognition. This review summarises the phenotypes of three cohorts of women identified through the medical records-linkage system of the Rochester Epidemiology Project and the Mayo Clinic Specialized Center of Research Excellence (SCORE) on Sex Differences: (i) menopausal women with histories of normotensive or hypertensive pregnancies; (ii) women who had bilateral oophorectomy ≤45 years of age; and (iii) women who experienced natural menopause and used menopausal hormone treatments for 4 years. Data from these cohorts will influence the design of follow-up studies concerning how sex hormonal status affects neurovascular ageing in women.
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Affiliation(s)
- Virginia M. Miller
- Departments of Surgery and Physiology and Biomedical EngineeringMayo ClinicRochesterMNUSA
| | - Muthuvel Jayachandran
- Department of Physiology and Biomedical EngineeringMayo ClinicRochesterMNUSA
- Division of Nephrology and Hematology ResearchDepartment of Internal MedicineMayo ClinicRochesterMNUSA
| | - Jill N. Barnes
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Michelle M. Mielke
- Division of EpidemiologyDepartment of Health Sciences Research and Department of NeurologyMayo ClinicRochesterMNUSA
| | | | - Walter A. Rocca
- Division of EpidemiologyDepartment of Health Sciences Research and Department of NeurologyMayo ClinicRochesterMNUSA
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1296
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Wirawan IMA, Griffiths RF, Larsen PD. Cardiovascular Risk Factor Modification in Asymptomatic Adults and Implications for Pilots. J UOEH 2020; 42:187-201. [PMID: 32507842 DOI: 10.7888/juoeh.42.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to examine the available evidence that supports a more aggressive approach to managing asymptomatic people with low to intermediate cardiovascular risks; to evaluate the appropriate threshold for initiating pharmacologic interventions to treat hyperglycaemia, hyperlipidaemia, and hypertension; and to describe the implications for airline pilots. A systematic search was performed employing an OvidSP interface, including all EBM Reviews, EMBASE, and Ovid MEDLINE databases. Data, including sixteen randomised controlled trials, on the appropriate threshold for initiating pharmacologic interventions were extracted. Studies on the treatment of hyperlipidaemia indicated that the threshold for initiation of intervention in intermediate-risk people is a LDL-C level of 3.36 mmol/l (130 mg/dl). There was no lower limit or optimal LDL-C level below which further reduction was no longer beneficial. Studies on the treatment of hyperglycaemia suggested that a threshold of fasting plasma glucose of ≥5.3 mmol/l (95 mg/dl) and 2-hour postprandial glucose level of 7.8 mmol/l (140 mg/dl) is reasonable for initiating pharmacologic intervention. Initiating treatment to people with a blood pressure of ≥130/≤89 mmHg or ≤139/≥85 mmHg significantly reduced the risk of developing stage 1 hypertension. Multifactorial intervention studies showed that, in hypertensive patients (BP ≥160/≥100 mmHg), initiating treatment to those with a total cholesterol of 6.5 mmol/l (251.35 mg/dl) or higher resulted in a significant reduction in the risk of developing fatal and non-fatal cardiovascular events. The available evidence from large quality trials supports a more aggressive approach to managing hyperglycaemia, hyperlipidaemia, and hypertension in asymptomatic pilots with a 5-year CVD risk of 5-10% and 10-15%.
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Affiliation(s)
- I Made Ady Wirawan
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University
| | - Robin F Griffiths
- Occupational and Aviation Medicine Unit, Department of Medicine, University of Otago Wellington
| | - Peter D Larsen
- Occupational and Aviation Medicine Unit, Department of Medicine, University of Otago Wellington
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1297
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Yamaguchi D, Izawa A, Matsunaga Y. The Association of Depression with Type D Personality and Coping Strategies in Patients with Coronary Artery Disease. Intern Med 2020; 59:1589-1595. [PMID: 32612062 PMCID: PMC7402968 DOI: 10.2169/internalmedicine.3803-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective Depression in patients with coronary artery disease (CAD) has been a risk factor for adverse cardiovascular events. However, personality types, strategies for coping with stressors, and their associations with depression have not been fully elucidated in patients with CAD. This study explored depression in patients with CAD and examined its association with personality types and coping strategies. Methods A prospective observational study of 89 patients with CAD was conducted between August 2016 and July 2018. The presence of depression and type D personality and types of coping strategies were measured one month after percutaneous coronary intervention. A logistic regression analysis was performed to identify characteristics associated with depression. Results Generally, the incidence of depression and type D personality was 55.1% and 44.9%, respectively. The incidence of depression in patients with type D and non-type D personality was 72.5% and 40.8%, respectively. Patients with type D personality coped less frequently using a planning strategy but frequently using a responsibility-shifting strategy. A logistic regression analysis showed that the presence of depression was significantly associated with type D personality and inversely associated with a planning strategy. Conclusion The high prevalence of depression in patients with CAD was associated with type D personality and a low rate of adoption of a planning strategy. Specific coping interventions in patients with CAD with type D personality may be potential targets for improving coping skills and preventing the development of depression.
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Affiliation(s)
| | - Atsushi Izawa
- School of Health Sciences, Shinshu University, Japan
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1298
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Khalili M, Lepeytre F, Guertin JR, Goupil R, Troyanov S, Bouchard J, Madore F. Impact of updated recommendations on acetylsalicylic acid use for primary prevention of cardiovascular disease in Canada: a population-based survey. CMAJ Open 2020; 8:E41-E47. [PMID: 31992558 PMCID: PMC6996036 DOI: 10.9778/cmajo.20190105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The debate over acetylsalicylic acid (ASA) therapy for primary prevention of cardiovascular disease (CVD) has recently resurfaced, but scarce data are available on prophylactic ASA use in Canada for this purpose. This study aimed to evaluate the prevalence and factors associated with ASA use, and the potential impact of implementing the most recent (2016) US Preventive Services Task Force recommendations for primary CVD prevention in a Canadian setting. METHODS We performed a cross-sectional analysis using data from the CARTaGENE study, which included a representative sample (n = 20 004) of the 2018 general population of the province of Quebec. We assessed eligibility for ASA treatment using US Preventive Services Task Force criteria (age 50-69 yr, no past history of myocardial infarction or stroke, and 10-year risk of CVD of at least 10%). We extrapolated to the entire 2018 Quebec population the number of people who would need to start ASA treatment. RESULTS A total of 6231 respondents in the CARTaGENE study (54.2% of those aged 50-69 yr with no prior history of CVD) were found to be potentially eligible for ASA use for primary CVD prevention. Of the 6231, 1379 (22.1%) were receiving prophylactic ASA treatment. Factors found to be related to ASA use included age, male sex, regular medical visits, lower education level, obesity, hypertension, diabetes and dyslipidemia. Income and smoking status were not found to be significantly associated with ASA use. Our results indicate that 885 261 people would potentially have started ASA treatment if the US Preventive Services Task Force recommendations had been implemented in Quebec in 2018. INTERPRETATION Prevalent ASA use for primary CVD prevention was low. Implementation of the 2016 US Preventive Services Task Force recommendations would require initiating ASA treatment in a substantial proportion of people, with undetermined potential benefits.
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Affiliation(s)
- Myriam Khalili
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Fanny Lepeytre
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Jason Robert Guertin
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Rémi Goupil
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Stéphan Troyanov
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - Josée Bouchard
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que
| | - François Madore
- Faculty of Medicine (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Université de Montréal; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (Khalili, Lepeytre, Goupil, Troyanov, Bouchard, Madore), Montréal, Que.; Département de médecine sociale et preventive (Guertin), Faculty of Medicine, Université Laval; Centre de recherche du Centre hospitalier universitaire de Québec (Guertin), Québec, Que.
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Chiva-Blanch G, Badimon L. Benefits and Risks of Moderate Alcohol Consumption on Cardiovascular Disease: Current Findings and Controversies. Nutrients 2019; 12:nu12010108. [PMID: 31906033 PMCID: PMC7020057 DOI: 10.3390/nu12010108] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 02/06/2023] Open
Abstract
Alcohol has a hormetic physiological behavior that results in either increased or decreased cardiovascular risk depending on the amount consumed, drinking frequency, pattern of consumption, and the outcomes under study or even the type of alcoholic beverage consumed. However, the vast majority of studies elucidating the role of alcohol in cardiovascular and in the global burden of disease relies on epidemiological studies of associative nature which carry several limitations. This is why the cardiovascular benefits of low–moderate alcohol consumption are being questioned and perhaps might have been overestimated. Thus, the aim of this review was to critically discuss the current knowledge on the relationship between alcohol intake and cardiovascular disease. Besides new evidence associating low and moderate alcohol consumption with decreased risk of cardiovascular disease, several questions remain unanswered related to the concrete amount of safe consumption, the type of alcoholic beverage, and the age-, sex-, and genetic/ethnical-specific differences in alcohol consumption.
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Affiliation(s)
- Gemma Chiva-Blanch
- Cardiovascular Program ICCC; Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
| | - Lina Badimon
- Cardiovascular Program ICCC; Institut de Recerca Hospital Santa Creu i Sant Pau—IIB Sant Pau, Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain
- CIBER Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-935565882
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1300
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Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL, Scott NS, Natarajan P. Association of Premature Natural and Surgical Menopause With Incident Cardiovascular Disease. JAMA 2019; 322:2411-2421. [PMID: 31738818 PMCID: PMC7231649 DOI: 10.1001/jama.2019.19191] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Recent guidelines endorse using history of menopause before age 40 years to refine atherosclerotic cardiovascular disease risk assessments among middle-aged women. Robust data on cardiovascular disease risk in this population are lacking. OBJECTIVE To examine the development of cardiovascular diseases and cardiovascular risk factors in women with natural and surgical menopause before age 40 years. DESIGN, SETTING, AND PARTICIPANTS Cohort study (UK Biobank), with adult residents of the United Kingdom recruited between 2006 and 2010. Of women who were 40 to 69 years old and postmenopausal at study enrollment, 144 260 were eligible for inclusion. Follow-up occurred through August 2016. EXPOSURES Natural premature menopause (menopause before age 40 without oophorectomy) and surgical premature menopause (bilateral oophorectomy before age 40). Postmenopausal women without premature menopause served as the reference group. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of incident coronary artery disease, heart failure, aortic stenosis, mitral regurgitation, atrial fibrillation, ischemic stroke, peripheral artery disease, and venous thromboembolism. Secondary outcomes included individual components of the primary outcome, incident hypertension, hyperlipidemia, and type 2 diabetes. RESULTS Of 144 260 postmenopausal women included (mean [SD] age at enrollment, 59.9 [5.4] years), 4904 (3.4%) had natural premature menopause and 644 (0.4%) had surgical premature menopause. Participants were followed up for a median of 7 years (interquartile range, 6.3-7.7). The primary outcome occurred in 5415 women (3.9%) with no premature menopause (incidence, 5.70/1000 woman-years), 292 women (6.0%) with natural premature menopause (incidence, 8.78/1000 woman-years) (difference vs no premature menopause, +3.08/1000 woman-years [95% CI, 2.06-4.10]; P < .001), and 49 women (7.6%) with surgical premature menopause (incidence, 11.27/1000 woman-years) (difference vs no premature menopause, +5.57/1000 woman-years [95% CI, 2.41-8.73]; P < .001). For the primary outcome, natural and surgical premature menopause were associated with hazard ratios of 1.36 (95% CI, 1.19-1.56; P < .001) and 1.87 (95% CI, 1.36-2.58; P < .001), respectively, after adjustment for conventional cardiovascular disease risk factors and use of menopausal hormone therapy. CONCLUSIONS AND RELEVANCE Natural and surgical premature menopause (before age 40 years) were associated with a small but statistically significant increased risk for a composite of cardiovascular diseases among postmenopausal women. Further research is needed to understand the mechanisms underlying these associations.
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Affiliation(s)
- Michael C. Honigberg
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Seyedeh Maryam Zekavat
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
- Yale University School of Medicine, New Haven,
Connecticut
| | - Krishna Aragam
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Phoebe Finneran
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
| | - Derek Klarin
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Division of Vascular Surgery and Endovascular
Therapy, University of Florida College of Medicine, Gainesville
| | - Deepak L. Bhatt
- Cardiovascular Division, Brigham and
Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James L. Januzzi
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Nandita S. Scott
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General
Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston
- Program in Medical and Population Genetics,
Broad Institute of Harvard, Cambridge, Massachusetts
- Cardiovascular Research Center and Center for
Genomic Medicine, Massachusetts General Hospital, Boston
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