101
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Nordestgaard BG, Langsted A. Lipoprotein(a) and cardiovascular disease. Lancet 2024:S0140-6736(24)01308-4. [PMID: 39278229 DOI: 10.1016/s0140-6736(24)01308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 09/18/2024]
Abstract
One in five people are at high risk for atherosclerotic cardiovascular disease and aortic valve stenosis due to high lipoprotein(a). Lipoprotein(a) concentrations are lowest in people from east Asia, Europe, and southeast Asia, intermediate in people from south Asia, the Middle East, and Latin America, and highest in people from Africa. Concentrations are more than 90% genetically determined and 17% higher in post-menopausal women than in men. Individuals at a higher cardiovascular risk should have lipoprotein(a) concentrations measured once in their lifetime to inform those with high concentrations to adhere to a healthy lifestyle and receive medication to lower other cardiovascular risk factors. With no approved drugs to lower lipoprotein(a) concentrations, it is promising that at least five drugs in development lower concentrations by 65-98%, with three currently being tested in large cardiovascular endpoint trials. This Review covers historical perspectives, physiology and pathophysiology, genetic evidence of causality, epidemiology, role in familial hypercholesterolaemia and diabetes, management, screening, diagnosis, measurement, prevention, and future lipoprotein(a)-lowering drugs.
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Affiliation(s)
- Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Langsted
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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102
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Naz M, Shafique H, Majeed MI, Nawaz H, Rashid N, Alshammari A, Albekairi NA, Amber A, Zohaib M, Shahid U, Zafar F, Ali M, Shahid H. Surface-enhanced Raman spectroscopy (SERS) for the diagnosis of acute myocardial infarction (AMI) using blood serum samples. RSC Adv 2024; 14:29151-29159. [PMID: 39282066 PMCID: PMC11393812 DOI: 10.1039/d4ra03816a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/26/2024] [Indexed: 09/18/2024] Open
Abstract
Acute myocardial infarction (AMI) is a serious medical condition generally known as heart attack, which is caused by the decreased or completely blocked blood flow to a part of the heart muscle. It is a significant cause of both mortality and morbidity throughout the world. Cardiac troponin-I (cTnI) is an important biomarker at different stages of AMI and is one of the most specific and widely used cardiac skeletal muscle proteins. Delays in medical treatment and inaccurate diagnosis might be the main cause of death of AMI patients. To overcome the death rate of AMI patients, early diagnosis of this disease is crucial. In the current study, surface-enhanced Raman spectroscopy (SERS) is employed for the characterization and diagnosis of this disease using blood serum samples from 49 clinically confirmed acute myocardial infarction (AMI) patients and 17 healthy persons. Silver nanoparticles (AgNPs) are used as the SERS substrate for the recognition of characteristic SERS spectral features, differentiating between healthy and AMI-positive samples. The acute myocardial infarction-positive blood serum samples reveal remarkable differences in spectral intensities at 534, 697, 744, 835, 927, 941, 988, 1221, 1303, 1403, 1481, 1541, 1588 and 1694 cm-1. For the differentiation and quantitative analysis of the SERS spectra, multivariate chemometric tools (including principal component analysis (PCA) and partial least squares regression (PLSR)) are employed. A PLSR model established on the basis of differentiating the SERS spectral features is found to be helpful in the prediction of the levels of cardiac troponin-I (cTnI) in the blood serum samples with the root mean square error of calibration (RMSEC) value of 2.98 ng mL-1 and root mean square errors of prediction (RMSEP) value of 3.98 ng mL-1 for S7.
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Affiliation(s)
- Maira Naz
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Hira Shafique
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Muhammad Irfan Majeed
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
- School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology Wuhan P. R. China
| | - Haq Nawaz
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Nosheen Rashid
- Department of Chemistry, University of Education, Faisalabad Campus Faisalabad 38000 Pakistan
| | - Abdulrahman Alshammari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University Post Box 2455 Riyadh 11451 Saudi Arabia
| | - Norah A Albekairi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University Post Box 2455 Riyadh 11451 Saudi Arabia
| | - Arooj Amber
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Muhammad Zohaib
- Department of Zoology, Wildlife and Fisheries, University of Agriculture Faisalabad Pakistan
| | - Urwa Shahid
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Fareeha Zafar
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Muhammad Ali
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
| | - Habiba Shahid
- Department of Chemistry, University of Agriculture Faisalabad Faisalabad 38000 Pakistan
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103
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Luo C, Zheng B. "One-stop" interventional therapy for quadricuspid aortic valve combined with severe coronary artery disease: a case report. J Cardiothorac Surg 2024; 19:526. [PMID: 39261924 PMCID: PMC11391761 DOI: 10.1186/s13019-024-02985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/13/2024] [Indexed: 09/13/2024] Open
Abstract
Congenital Quadricuspid Aortic Valve (QAV) malformation is a relatively rare cardiac valve malformation, especially with abnormal coronary opening and severe stenosis of Coronary Artery Disease (CAD). The patient underwent "one-stop" interventional treatment with transcatheter aortic valve replacement and percutaneous coronary stent implantation. Follow up for 12-month with good outcomes.
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Affiliation(s)
- Cheng Luo
- Cardiovascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Baoshi Zheng
- Cardiovascular Surgery Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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104
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Satheesh G, Dhurjati R, Alston L, Tesfay F, Pant R, Bahiru E, Bambs C, Agarwal A, Peters SAE, Salam A, Johansson I. Use of Guideline-Recommended Heart Failure Drugs in High-, Middle-, and Low-Income Countries: A Systematic Review and Meta-Analysis. Glob Heart 2024; 19:74. [PMID: 39281002 PMCID: PMC11396255 DOI: 10.5334/gh.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/27/2024] [Indexed: 09/18/2024] Open
Abstract
Optimal use of guideline-directed medical therapy (GDMT) can prevent hospitalization and mortality among patients with heart failure (HF). We aimed to assess the prevalence of GDMT use for HF across geographic regions and country-income levels. We systematically reviewed observational studies (published between January 2010 and October 2020) involving patients with HF with reduced ejection fraction. We conducted random-effects meta-analyses to obtain summary estimates. We included 334 studies comprising 1,507,849 patients (31% female). The majority (82%) of studies were from high-income countries, with Europe (45%) and the Americas (33%) being the most represented regions, and Africa (1%) being the least. Overall prevalence of GDMT use was 80% (95% CI 78%-81%) for β-blockers, 82% (80%-83%) for renin-angiotensin-system inhibitors, and 41% (39%-43%) for mineralocorticoid receptor antagonists. We observed an exponential increase in GDMT use over time after adjusting for country-income levels (p < 0.0001), but significant gaps persist in low- and middle-income countries. Multi-level interventions are needed to address health-system, provider, and patient-level barriers to GDMT use.
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Affiliation(s)
| | | | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- Global Centre for Preventive Health, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Fisaha Tesfay
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
| | - Rashmi Pant
- The George Institute for Global Health, Hyderabad, India
| | - Ehete Bahiru
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - Claudia Bambs
- Department of Public Health, Advanced Center for Chronic Diseases (ACCDiS, Fondap 15130011) and Center for Cancer Prevention and Control (CECAN, Fondap 152220002), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Anubha Agarwal
- Cardiovascular Division, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Sanne A E Peters
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Abdul Salam
- The George Institute for Global Health, Hyderabad, India
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Isabelle Johansson
- Division of Cardiology, Department of Medicine K2, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden
- Population Health Research Institute, McMaster University, Hamilton, Canada
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105
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Cakmak S, Lukina A, Dales R. The association between neighbourhood walkability and blood lipids: a Canadian population study. Lipids Health Dis 2024; 23:298. [PMID: 39267049 PMCID: PMC11391640 DOI: 10.1186/s12944-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024] Open
Abstract
We examined the association between walkability and blood lipids in a nationally representative sample of 29,649 participants aged 3-79 years who participated in the Canadian Health Measures Survey (CHMS) cycles 1 to 6. We focused on seven lipid biomarkers: apolipoprotein A (Apo A), apolipoprotein B (Apo B), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), total cholesterol (TC), and TC/HDL. Cross-sectional associations were analyzed using generalized linear mixed models incorporating survey-specific sampling weights. An increase in the Canadian Active Living Environments Index, a measure of neighborhood walkability, equivalent to the magnitude of its interquartile range (IQR) was associated with the following percentage (95% confidence intervals (CI)) changes in lipids: decreased TG, -2.85 (-4.77, -0.93) and TC/HDL, -1.68 (-2.80, -0.56), and increased HDL, 1.68 (0.93, 2.42). Significant effects were largely restricted to adults (aged 17 to 79). In the younger age group there were no significant associations between walkability and lipids in the fully adjusted model. Significant associations were more frequently seen in females than males. For females, fully adjusted significant inverse associations were observed for TG, LDL, and TC/HDL, and there were positive associations with HDL and Apo A. Canadians living in more walkable neighborhoods have more favorable lipid profiles, suggesting that the built environment has the potential to influence the risk profile for cardiovascular health, especially among adults and females.
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Affiliation(s)
- Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Anna Lukina
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederic Banting Driveway, Ottawa, ON, K1A 0K9, Canada.
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada.
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106
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Ma L, Chen K, Li J, Xie L, Zhang Z, Zarif M, Chai T, Wu Q, Chen L, Qiu Z. Identification of potential therapeutic targets from bioinformatics analysis of necroptosis and immune infiltration in acute myocardial infarction. J Cardiothorac Surg 2024; 19:524. [PMID: 39261934 PMCID: PMC11389343 DOI: 10.1186/s13019-024-03038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a serious, deadly disease with a high incidence. However, it remains unclear how necroptosis affects the pathophysiology of AMI. Using bioinformatic analyses, this study investigated necroptosis in AMI. METHODS We obtained the GSE66360 dataset related to AMI by the GEO database. Venn diagrams were used to identify necroptosis-related differential genes (NRDEGs). The genes with differential expression in AMI were analyzed using gene set enrichment analysis, and a PPI network was established. A transcription factor prediction and enrichment analysis were conducted for the NRDEGs, and the relationships between AMI, NRDEGs, and immune cells were determined. Finally, in the additional dataset, NRDEG expression levels, immune infiltration, and ROC curve analysis were confirmed, and gene expression levels were further verified experimentally. RESULTS GSEA revealed that necroptosis pathways were significantly enriched in AMI. We identified 10 NRDEGs, including TNF, TLR4, FTH1 and so on. Enrichment analysis indicated that the NOD-like receptor and NF-kappa B signaling pathways were significantly enriched. Four NRDEGs, FTH1, IFNGR1, STAT3, and TLR4, were identified; however, additional datasets and further experimental validation are required to confirm their roles. In addition, we determined that a high abundance of macrophages and neutrophils prompted AMI development. CONCLUSIONS In this study, four potential genes that affect the development of AMI through necroptosis (FTH1, IFNGR1, STAT3, and TLR4) were identified. In addition, we found that a high abundance of macrophages and neutrophils affected AMI. This helps determine the pathological mechanism of necroptosis and immune cells that influence AMI and provides a novel strategy for targeted therapy.
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Affiliation(s)
- Likang Ma
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Keyuan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Jiakang Li
- The Key Laboratory of Fujian Province Universities on Ion Channel and Signal Transduction in Cardiovascular Diseases, Department of Physiology and Pathophysiology, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Linfeng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Zhaofeng Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Mohammad Zarif
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Tianci Chai
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Qingsong Wu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
| | - Zhihuang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, China.
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107
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Johner N, Gencer B, Roffi M. Routine beta-blocker therapy after acute coronary syndromes: The end of an era? Eur J Clin Invest 2024:e14309. [PMID: 39257189 DOI: 10.1111/eci.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Beta-blocker therapy, a treatment burdened by side effects including fatigue, erectile dysfunction and depression, was shown to reduce mortality and cardiovascular events after acute coronary syndromes (ACS) in the pre-coronary reperfusion era. Potential mechanisms include protection from ventricular arrhythmias, increased ischaemia threshold and prevention of left ventricular (LV) adverse remodelling. With the advent of early mechanical reperfusion and contemporary pharmacologic secondary prevention, the benefit of beta-blockers after ACS in the absence of LV dysfunction has been challenged. METHODS The present narrative review discusses the contemporary evidence based on searching the PubMed database and references in identified articles. RESULTS Recently, the REDUCE-AMI trial-the first adequately powered randomized trial in the reperfusion era to test beta-blocker therapy after myocardial infarction with preserved left ventricular ejection fraction (LVEF)-showed no benefit on the composite of all-cause death or myocardial infarction over a median 3.5-year follow-up. While the benefit of beta-blockers in patients with reduced LVEF remains undisputed, their value in post-ACS patients with mildly reduced systolic function (LVEF 41%-49%) has not been studied in contemporary randomized trials; in this setting, observational studies have suggested a reduction in cardiovascular events with these agents. The adequate duration of beta-blocker therapy remains unknown, but observational data suggests that any mortality benefit may be lost beyond 1-12 months after ACS in patients with LVEF >40%. CONCLUSION We believe that there is sufficient evidence to abandon routine beta-blocker prescription in post-ACS patients with preserved LV systolic function.
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Affiliation(s)
- Nicolas Johner
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Baris Gencer
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
- Institute of Primary Healthcare (BIHAM), University of Bern, Bern, Switzerland
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Roffi
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
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108
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Wu W, Chen Y, Zhang C, Wu K, Zheng H, Cai Z, Wang Y, Fu P, Lan Y, Chen S, Wu S, Chen Y. Remnant cholesterol is superior to other lipid-related parameters for the prediction of cardiometabolic disease risk in individuals with hypertension: The Kailuan study. Int J Cardiol 2024; 417:132541. [PMID: 39265790 DOI: 10.1016/j.ijcard.2024.132541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/20/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND It is uncertain which lipid-related parameter is most suitable for predicting the risk of cardiometabolic disease (CMD) in individuals with hypertension. AIMS To explore which lipid-related parameter is most suitable for predicting the risk of CMD. METHODS AND RESULTS We studied 30,378 patients with hypertension who completed the 2006-2007 Kailuan health examination and followed up until December 31, 2021. In the constructed model, the utilities of lipid-related parameters for the prediction of CMD were compared using the C-index, NRI, and IDI. The best predictor (remnant cholesterol, RC) was identified and the participants were grouped according to RC quartile. Cox proportional hazard analysis was then used to evaluate the relationship between RC and the risk of CMD. During a median follow-up period of 14.7 years (IQR 5.3-15.1), 9502 (31.27 %) participants with hypertension developed CMD. The C-index, NRI, and IDI values for RC were higher than those for the other lipid parameters. After adjustment for multiple potential confounding factors, compared with the quartile (Q)1 RC group, the adjusted hazard ratios for CMD of the Q2-Q4 groups were 1.09 (1.03-1.16), 1.17 (1.11-1.24), and 1.25 (1.18-1.33) (P < 0.0001). Restrictive cubic spline analysis revealed dose-dependent relationships of lipid parameters with the risk of CMD. CONCLUSIONS RC is superior to other lipid parameters for the prediction of the risk of CMD in individuals with hypertension. As the concentration of RC increases, the risk of CMD in such individuals also increases.
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Affiliation(s)
- Weiqiang Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China; Shantou University Medical College, Shantou, China
| | - Yanjuan Chen
- Department of Endocrinology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Changyi Zhang
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Kuangyi Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Huancong Zheng
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiwei Cai
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yuxian Wang
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Peng Fu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yulong Lan
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China.
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, China.
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Jung C, Bruno RR, Jumean M, Price S, Krychtiuk KA, Ramanathan K, Dankiewicz J, French J, Delmas C, Mendoza AA, Thiele H, Soussi S. Management of cardiogenic shock: state-of-the-art. Intensive Care Med 2024:10.1007/s00134-024-07618-x. [PMID: 39254735 DOI: 10.1007/s00134-024-07618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 08/18/2024] [Indexed: 09/11/2024]
Abstract
The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory support including recently published randomized-controlled trials as well as future directions of research, integrating this within an international group of authors to provide a global perspective. Finally, we explore the need for individualization, especially in the face of neutral randomized trials which may be related to a dilution of a potential benefit of an intervention (i.e., average effect) in this heterogeneous clinical syndrome, including the use of novel biomarkers, artificial intelligence, and machine learning approaches to identify specific endotypes of cardiogenic shock (i.e., subclasses with distinct underlying biological/molecular mechanisms) to support a more personalized medicine beyond the syndromic approach of cardiogenic shock.
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Affiliation(s)
- Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
- Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | | | - Susanna Price
- Division of Heart, Lung and Critical Care, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Konstantin A Krychtiuk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Josef Dankiewicz
- Department of Clinical Sciences Lund, Lund University, Cardiology, Lund, Sweden
| | - John French
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia
| | - Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France
- REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France
| | | | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sabri Soussi
- Department of Anesthesia and Pain Management, University Health Network (UHN), Women's College Hospital, University of Toronto, Toronto Western Hospital, Toronto, Canada
- University of Paris Cité, Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France
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Pikkemaat M, Woodward M, Af Geijerstam P, Harrap S, Hamet P, Mancia G, Marre M, Poulter N, Chalmers J, Harris K. Lipids and apolipoproteins and the risk of vascular disease and mortality outcomes in women and men with type 2 diabetes in the ADVANCE study. Diabetes Obes Metab 2024. [PMID: 39256935 DOI: 10.1111/dom.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024]
Abstract
AIM Whether apolipoproteins (apolipoprotein A1, apolipoprotein B, apolipoprotein B/apolipoprotein A1 [ApoB/ApoA1] ratio) or very-low-density lipoprotein (VLDL) cholesterol are better risk predictors than established lipid risk markers, and whether there are sex differences, is uncertain, both in general populations and in patients with diabetes. The aim of this study was to assess the association between established risk markers, apolipoproteins and the risk of macro- and microvascular disease and death in a large study of women and men with diabetes and to assess the potential sex differences in the associations. MATERIALS AND METHODS Established lipid risk markers were studied in 11 140 individuals with type 2 diabetes from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial, and apolipoproteins (A1, B, ApoB/ApoA1 ratio) and VLDL cholesterol from nuclear magnetic resonance (NMR) lipid analyses in biobanked samples from 3586 individuals included in the ADVANCE case-cohort study (ADVANCE CC). Primary outcomes were major macro- and microvascular events and death. Cox proportional hazards models adjusted for confounders were used to quantify the associations (hazard ratio [HR] and 95% confidence intervals [CIs]) between established lipid risk markers and apolipoproteins with study outcomes. To address potential effect modification by sex, we investigated the association between the lipid risk markers and outcomes in subgroup analyses by sex. RESULTS There was a lower risk of macrovascular complications for high-density lipoprotein (HDL) cholesterol (HR [95%CI] 0.88 [0.82-0.95]), a higher risk for total cholesterol (1.10 [1.04-1.17]), low-density lipoprotein (LDL) cholesterol (1.15 [1.08-1.22]), non-HDL cholesterol (1.13 [1.07-1.20]) and the total cholesterol/HDL ratio (1.20 [1.14-1.27]) but no significant associations with triglycerides from ADVANCE. There was a higher risk of macrovascular complications for the ApoB/ApoA1 ratio (1.13 [1.03-1.24]) from the ADVANCE CC. Only the ApoB/ApoA1 ratio (1.19 [1.06-1.34]), but none of the established lipid risk markers, was associated with a higher risk of microvascular complications. There were no statistically significant sex differences for any of the established lipid risk markers or apolipoproteins with any outcome. Using C-statistics and net reclassification improvement (NRI) did not detect significant improvement in predicting all outcomes by adding lipids or apolipoproteins to the models with confounding factors only. CONCLUSIONS/INTERPRETATION All established lipid risk markers, except triglycerides, were predictors of macrovascular complications, but not microvascular complications, in patients with type 2 diabetes. The ApoB/ApoA1 ratio was associated with major macro- and microvascular complications, but there was no evidence that apolipoproteins are better than established lipid risk markers in predicting cardiovascular complications in patients with type 2 diabetes.
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Affiliation(s)
- Miriam Pikkemaat
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Center for Primary Health Care Research, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
- University Clinic Primary Care Skåne, Malmö, Sweden
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Peder Af Geijerstam
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Stephen Harrap
- Department of Anatomy and Physiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Pavel Hamet
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | | | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
- Institut Necker-Enfants Malades, INSERM, Université Paris Cité, Paris, France
| | - Neil Poulter
- School of Public Health, Imperial College London, London, UK
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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111
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Choi SE, Bucci T, Huang JY, Yiu KH, Tsang CT, Lau KK, Hill A, Irving G, Lip GY, Abdul-Rahim AH. Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: A propensity-matched analysis of a global federated health database. Eur Stroke J 2024:23969873241274213. [PMID: 39254367 DOI: 10.1177/23969873241274213] [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: 09/11/2024] Open
Abstract
INTRODUCTION Statins reduce recurrent stroke and cardiovascular events in patients with non-cardioembolic stroke. The benefits of statins in patients with AF and recent IS remain unclear. We aimed to investigate the benefits of statins in patients with AF and recent IS. PATIENTS AND METHODS This retrospective, cohort study was conducted using deidentified electronic medical records within TriNetX platform. Patients with AF and recent IS, who received statins within 28 days of their index stroke were propensity score-matched with those who did not. Patients were followed up for up to 2 years. Primary outcomes were the 2-year risk of recurrent IS, all-cause mortality and the composite outcome of all-cause mortality, recurrent IS, transient ischaemic attack (TIA), and acute myocardial infarction (MI). Secondary outcomes were the 2-year risk of TIA, intracranial haemorrhage (ICH), acute MI, and hospital readmission. Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals (95%CI). RESULTS Of 20,902 patients with AF and recent IS, 7500 (35.9%) received statins within 28 days of their stroke and 13,402 (64.1%) did not. 11,182 patients (mean age 73.7 ± 11.5; 5277 (47.2%) female) remained after propensity score matching. Patients who received early statins had significantly lower risk of recurrent IS (HR: 0.45, 95%CI: 0.41-0.48, p < 0.001), mortality (HR: 0.75, 95%CI: 0.66-0.84, p < 0.001), the composite outcome (HR: 0.48, 95%CI: 0.45-0.52, p < 0.001), TIA (HR: 0.37, 95%CI: 0.30-0.44, p < 0.001), ICH (HR: 0.59, 95%CI: 0.47-0.72, p < 0.001 ), acute MI (HR: 0.35, 95%CI: 0.30-0.42, p < 0.001) and hospital readmission (HR: 0.46, 95%CI: 0.42-0.50, <0.001). Beneficial effects of early statins were evident in the elderly, different ethnic groups, statin dose intensity, and AF subtypes, large vessel occlusion and embolic strokes and within the context of statin lipophilicity, optimal LDL-cholesterol levels, various cardiovascular comorbidities, treatment with intravenous thrombolysis or endovascular thrombectomy, and NIHSS 0-5 and NIHSS > 5 subgroups. DISCUSSION AND CONCLUSION Patients with AF and recent IS, who received early statins, had a lower risk of recurrent stroke, death, and other cardiovascular outcomes including ICH, compared to those who did not.
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Affiliation(s)
- Sylvia E Choi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Jia-Yi Huang
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong Shen Zhen Hospital, Shen Zhen, China
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Christopher Tw Tsang
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Andrew Hill
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| | - Greg Irving
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Health Research Institute, Edge Hill University Faculty of Health and Social Care, Ormskirk, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
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112
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Gogos C, Anastasiou V, Papazoglou AS, Daios S, Didagelos M, Kamperidis N, Moschovidis V, Papadopoulos SF, Iatridi F, Sarafidis P, Giannakoulas G, Sachpekidis V, Ziakas A, Kamperidis V. Direct Oral Anticoagulants versus Vitamin K Antagonists for the Management of Left Ventricular Thrombus after Myocardial Infarction: A Meta-analysis. Am J Cardiol 2024:S0002-9149(24)00686-6. [PMID: 39265798 DOI: 10.1016/j.amjcard.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/26/2024] [Accepted: 09/05/2024] [Indexed: 09/14/2024]
Abstract
Left ventricular (LV) thrombus formation remains a post-acute myocardial infarction (AMI) complication even in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario is poorly defined. The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with Vitamin K antagonists (VKAs) for the management of LV thrombus following AMI. A systematic literature review was conducted in electronic databases to identify studies reporting efficacy and safety outcome data regarding the use of DOACs versus VKAs for patients with LV thrombus after AMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and random-effects meta-analyses were conducted to synthesize pooled ORs. Eight studies comprising a total of 605 patients were included. DOACs were associated with an almost 2-fold higher likelihood of thrombus resolution compared to VKAs (pooled OR 1.95 [1.25-3.04]; p =0.003, I2 =0 %), and decreased the risk of systemic embolism by 70% (pooled OR 0.30 [0.12-0.75]; p =0.01, I2 =0 %). The use of DOACs was associated with a 54% lower risk of bleeding compared to VKAs (pooled OR 0.46 [0.26-0.84]; p =0.01, I2 =0 %). Overall, patients receiving DOACs had a 63% lower risk to reach the composite outcome of safety and efficacy compared with patients using VKAs (pooled OR 0.37 [0.23-0.60]; p <0.0001, I2 =0 %). In conclusion, DOACs appear to have a more favorable efficacy and safety profile compared to VKAs for the management of LV thrombus related to AMI.
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Affiliation(s)
- Christos Gogos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasileios Anastasiou
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | | | - Stylianos Daios
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | | | | | - Spyridon Filippos Papadopoulos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | | | - Antonios Ziakas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Vasileios Kamperidis
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
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113
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Zahger D, Schwartz GG, Du W, Szarek M, Bhatt DL, Bittner VA, Budaj AJ, Diaz R, Goodman SG, Jukema JW, Kiss RG, Harrington RA, Moriarty PM, Scemama M, Manvelian G, Pordy R, White HD, Zeiher AM, Fazio S, Geba GP, Steg PG. Triglyceride Levels, Alirocumab Treatment, and Cardiovascular Outcomes After an Acute Coronary Syndrome. J Am Coll Cardiol 2024; 84:994-1006. [PMID: 39232634 DOI: 10.1016/j.jacc.2024.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND It is unknown whether clinical benefit of proprotein convertase subtilisin/kexin type 9 inhibitors is associated with baseline or on-treatment triglyceride concentrations. OBJECTIVES This study sought to examine relations between triglyceride levels and the effect of alirocumab vs placebo on cardiovascular outcomes using prespecified and post hoc analyses of the ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial. METHODS Patients with recent acute coronary syndrome (ACS) (n = 18,924) and elevated atherogenic lipoproteins despite optimized statin therapy were randomized to alirocumab 75 to 150 mg or matching placebo every 2 weeks subcutaneously. Major adverse cardiovascular events (MACE) were examined in relation to continuous or dichotomous triglyceride concentrations. RESULTS Median baseline triglyceride concentration was 129 mg/dL. In both treatment groups, a 10-mg/dL higher baseline concentration was associated with an adjusted MACE HR of 1.008 (95% CI: 1.003-1.013; P < 0.005). Baseline triglycerides ≥150 vs <150 mg/dL were associated with a HR of 1.184 (95% CI: 1.080-1.297; P < 0.005). Versus placebo, alirocumab reduced low-density lipoprotein cholesterol from baseline (average, 54.7%) and reduced MACE (HR: 0.85; 95% CI: 0.78-0.93). At month 4, triglyceride levels were reduced from baseline by median 17.7 mg/dL (P < 0.001) and 0.9 mg/dL (P = NS) with alirocumab and placebo, respectively. A 10-mg/dL decline from baseline in triglycerides was associated with lower subsequent risk of MACE with placebo (HR: 0.988; 95% CI: 0.982-0.995; P < 0.005) but not with alirocumab (HR: 0.999; 95% CI: 0.987-1.010; P = 0.82). CONCLUSIONS Among patients with recent ACS on optimized statin therapy, baseline triglycerides was associated with cardiovascular risk. However, the reduction in triglycerides with alirocumab did not contribute to its clinical benefit. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402).
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Affiliation(s)
- Doron Zahger
- Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Gregory G Schwartz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Weiming Du
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Michael Szarek
- CPC Clinical Research, Aurora, Colorado, USA; Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA; State University of New York, Downstate Health Sciences University, Brooklyn, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Vera A Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrzej J Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Rafael Diaz
- Estudios Cardiológicos Latinoamérica, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Shaun G Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Robert G Kiss
- Military Hospital, Budapest, Hungary; Heart and Vascular Centre, Department of Cardiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Robert A Harrington
- Stanford Center for Clinical Research, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | | | - Robert Pordy
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Harvey D White
- Green Lane Cardiovascular Services, Te Whatu Ora-Health New Zealand, Te Toka Tumai, Auckland, New Zealand
| | - Andreas M Zeiher
- Department of Medicine III, Goethe University, Frankfurt am Main, Germany
| | - Sergio Fazio
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gregory P Geba
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Ph Gabriel Steg
- INSERM U-1148, Université de Paris-Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France; FACT (French Alliance for Cardiovascular Trials), Paris, France
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114
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Lund LH, Crespo-Leiro MG, Laroche C, Zaliaduonyte D, Saad AM, Fonseca C, Čelutkienė J, Zdravkovic M, Bielecka-Dabrowa AM, Agostoni P, Xuereb RG, Neronova KV, Lelonek M, Cavusoglu Y, Gellen B, Abdelhamid M, Hammoudi N, Anker SD, Chioncel O, Filippatos G, Lainscak M, McDonagh TA, Mebazaa A, Piepoli M, Ruschitzka F, Seferović PM, Savarese G, Metra M, Rosano GMC, Maggioni AP. Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction - the ESC EORP Heart Failure III Registry. Eur J Heart Fail 2024. [PMID: 39257278 DOI: 10.1002/ejhf.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/01/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
AIMS We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in the European Society of Cardiology (ESC) Heart Failure (HF) III Registry. METHODS AND RESULTS Between 1 November 2018 and 31 December 2020, 10 162 patients with acute HF (AHF, 39%, age 70 [62-79], 36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%), mildly reduced (HFmrEF, 17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41 European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most by a general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized for HF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation of GDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. After the AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85% in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. CONCLUSION Use and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohorts and registries including more primary care and general medicine and regions more local or outside of Europe and ESC-affiliated countries.
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Affiliation(s)
- Lars H Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Generosa Crespo-Leiro
- Cardiology, Hospital Universitario A Coruña (CHUAC), INIBIC (Institute investigacion Biomedica A Coruña), A Coruña, Spain
- CIBERCV, A Coruña, Spain
- Universidad de A Coruña (UDC), A Coruña, Spain
| | - Cécile Laroche
- European Society of Cardiology, Sophia-Antipolis, France
| | - Diana Zaliaduonyte
- Academy of Medicine, Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Kaunas Hospital, Kaunas, Lithuania
| | - Aly M Saad
- Cardiovascular Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Candida Fonseca
- Heart Failure Clinic, Internal Medicine Department, Hospital Sao Francisco Xavier, ULSLO, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Personalized Medicine, Centre of Innovative Medicine, Vilnius, Lithuania
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, Non-Invasive Cardiovascular Imaging, CMR Lab, Belgrade, Serbia
| | - Agata M Bielecka-Dabrowa
- Department of Cardiology and Congenital Heart Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Kseniya V Neronova
- Department of Faculty Therapy Named after M.E. Volsky-M.M. Mirrakhimov, I.K. Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Malgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Yuksel Cavusoglu
- Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Barnabas Gellen
- Department of Cardiology, Heart Failure, ELSAN-Polyclinique de Poitiers, Poitiers, France
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Kasr AlAiny, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Naima Hammoudi
- Department of Cardiology, EHS Maouche Hospital-Benaknoun, Algiers, Algeria
| | - Stefan D Anker
- Department of Cardiology (CVK), German Heart Center Charité, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Charité Universitätsmedizin, Berlin, Germany
| | - Ovidiu Chioncel
- Department of Cardiology, Emergency Institute for Cardiovascular Diseases 'C.C. Iliescu', Bucharest, Romania
- University of Medicine Carol Davila, Bucharest, Romania
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Cardiology, Athens University Hospital Attikon, Chaidari, Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Rakičan, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Alexandre Mebazaa
- Anesthesia and Critical Care Medicine, Université Paris Cité, Paris, France
| | - Massimo Piepoli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, Zürich, Switzerland
| | - Petar M Seferović
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
- University Medical Center, University of Belgrade - Faculty of Medicine, Belgrade, Serbia
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe M C Rosano
- Cardiac Academic Group, Chair of Cardiology, St George's University Medical School, London, UK
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, Rome, Italy
- Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Aldo P Maggioni
- ANMCO Research Center - Heart Care Foundation, Florence, Italy
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Xiang J, Cao J, Wang X, Shao S, Huang J, Zhang L, Tang B. Neutrophil extracellular traps and neutrophil extracellular traps-related genes are involved in new-onset atrial fibrillation in LPS-induced sepsis. Int Immunopharmacol 2024; 138:112550. [PMID: 38941671 DOI: 10.1016/j.intimp.2024.112550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/04/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Sepsis is considered a high risk factor for new-onset atrial fibrillation (NOAF), with neutrophil extracellular traps (NETs) being implicated in the pathogenesis of numerous diseases. However, the precise role of NETs and NETs-related genes (NRGs) in the occurrence of NOAF in sepsis remains inadequately elucidated. The objective of this study was to identify hub NRGs connecting sepsis and AF, and to investigate the potential association between NETs and NOAF in sepsis. METHODS The AF and sepsis microarray datasets were retrieved from the Gene Expression Omnibus (GEO) database for analysis of shared pathophysiological mechanisms and NRGs implicated in both sepsis and AF using bioinformatics techniques. The CIBERSORT algorithm was employed to assess immune cell infiltration and identify common immune characteristics in these diseases. Additionally, a rat model of lipopolysaccharide (LPS)-induced sepsis was utilized to investigate the association between NETs, NRGs, and sepsis-induced AF. Western blotting, enzyme-linked immunosorbent assay, hematoxylin-eosin staining, immunohistochemistry, and immunofluorescence were employed to assess the expression of NRGs, the formation of NETs, and the infiltration of neutrophils. Electrophysiological analysis and multi-electrode array techniques were utilized to examine the vulnerability and conduction heterogeneity of AF in septic rats. Furthermore, intervention was conducted in LPS-induced sepsis rats using DNase I, a pharmacological agent that specifically targets NETs, in order to assess its impact on neutrophil infiltration, NETs formation, hub NRGs protein expression, and AF vulnerability. RESULTS A total of 61 commonly differentially expressed genes (DEGs) and four hub DE-NRGs were identified in the context of sepsis and AF. Functional enrichment analysis revealed that these DEGs were predominantly associated with processes related to inflammation and immunity. Immune infiltration analysis further demonstrated the presence of immune infiltrating cells, specifically neutrophil infiltration, in both sepsis and AF. Additionally, a positive correlation was observed between the relative expression of the four hub DE-NRGs and neutrophil infiltration. In rats with LPS-induced sepsis, we observed a notable upregulation in the expression of four DE-NRGs, the formation of NETs, and infiltration of neutrophils in atrial tissue. Through electrophysiological assessments, we identified heightened vulnerability to AF, reduced atrial surface conduction velocity, and increased conduction heterogeneity in LPS-induced sepsis rats. Notably, these detrimental effects can be partially ameliorated by treatment with DNase I. CONCLUSIONS Through bioinformatics analysis and experimental validation, we identified four hub NRGs in sepsis and AF. Subsequent experiments indicated that the formation of NETs in the atria may contribute to the pathogenesis of NOAF in sepsis. These discoveries offer potential novel targets and insights for the prevention and treatment of NOAF in sepsis.
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Affiliation(s)
- Jie Xiang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Jiaru Cao
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Xiaoyan Wang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Shijie Shao
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Jie Huang
- Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.
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Bjöhle S, Vicente V, Eriksson C, Bohm K, Dodd M, R Wahlin R, Lederman J. Prehospital emergency nurses' experiences of caring for patients with suspected acute myocardial infarction: an interview study. BMJ Open 2024; 14:e088754. [PMID: 39260870 PMCID: PMC11409269 DOI: 10.1136/bmjopen-2024-088754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVE Despite the prevalence of emergency medical service assignments related to chest discomfort, limited research delves into nurses' experiences of caring for such patients. This study aimed to illuminate prehospital emergency nurses' (PENs') experiences of caring for patients with suspected acute myocardial infarction (AMI). DESIGN A qualitative interview study. SETTING Two Swedish emergency medical service organisations in two different regions. PARTICIPANTS Consecutive inclusion of 12 PENs. DATA ANALYSIS An inductive content analysis according to Elo and Kyngäs. RESULTS The results underline the active role of PENs in providing care for patients with AMI in the emergency medical service. They emphasise the ability to identify classic symptoms and the need for an open-minded approach to diffuse presentations. Ensuring patient security, projecting knowledge and composure are decisive for instilling a sense of safety. Healthcare providers feel profound responsibility and a fear of errors, especially in critical situations with potential patient deterioration. Prioritisation in time-sensitive cases leans towards medical interventions and immediate transportation. Continuing education is essential to enhance patient management and safety. Effective communication and trust are vital for urgent patient care, and prompt activation of the ST-elevation myocardial infarction pathway is recognised as imperative. Malfunctions result in frustration, underlining the importance of pathway functionality. CONCLUSIONS PENs have immense responsibility for the swift and knowledgeable management of patients with suspected AMI. Balancing patient involvement and urgent medical measures is challenging, emphasising the critical role of mental preparedness and comprehensive education. The study underlines the significance of effective communication and trust between healthcare providers, particularly in time-sensitive scenarios. Establishing feedback mechanisms for prehospital staff is important for advancing prehospital emergency care in this patient category.
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Affiliation(s)
- Sebastian Bjöhle
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- AISAB Ambulance Care in Greater Stockholm Ltd, Stockholm, Sweden
| | - Veronica Vicente
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- AISAB Ambulance Care in Greater Stockholm Ltd, Stockholm, Sweden
| | - Caroline Eriksson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Maja Dodd
- Department of Medicine, Karolinska Institute, Huddinge, Sweden
| | - Rebecka R Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- AISAB Ambulance Care in Greater Stockholm Ltd, Stockholm, Sweden
| | - Jakob Lederman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
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Devoldere J, Droogmans S, Heggermont WA, Van Craenenbroeck E. Implementation of guideline-directed medical therapy for heart failure patients with reduced ejection fraction in Belgium: a Delphi panel approach. Acta Cardiol 2024:1-12. [PMID: 39254605 DOI: 10.1080/00015385.2024.2396767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/17/2024] [Accepted: 08/21/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND The 2021 European Society of Cardiology (ESC) guidelines recommended a shift from a traditional hierarchical treatment for heart failure with reduced ejection fraction (HFrEF) to a four-pillar medical therapy strategy intended for near-simultaneous initiation. However, practical guidance for implementation in clinical practice is lacking. To address this, a Delphi Panel of 12 Belgian heart failure experts aimed to obtain consensus on integrating guideline-directed medical therapy (GDMT) in HFrEF patients in Belgian clinical practice, considering local specificities, including reimbursement criteria. METHODS A geographically representative sample of 12 Belgian cardiologists engaged in a three-round Delphi process, evolving from 20 open-ended questions to 39 statements. A qualitative analysis after the first round resulted in expert statements for the subsequent questionnaire, categorised into treatment for newly diagnosed and chronic HFrEF patients. RESULTS The Delphi consensus revealed four key findings: (i) Agreement on initiating the four medical cornerstones within 7-14 days of HFrEF diagnosis, prioritising initiation over individual class up-titration; (ii) Lack of consensus on a fixed sequence for initiation due to patient variability and national reimbursement criteria; (iii) Emphasis on treatment adjustment based on the patient's clinical presentation and comorbidities; (iv) Recognition of the crucial role of regular follow-up visits, allowing optimisation of medical therapy where appropriate. CONCLUSION This national Delphi consensus addresses clinical implementation of GDMT in HFrEF patients for Belgian cardiologists. The consensus highlights the importance of swift implementation of the four cornerstone medical therapies in newly diagnosed HFrEF patients, individualising treatment sequencing, and ensuring regular follow-up to optimise therapy.
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Affiliation(s)
- Joke Devoldere
- Medical Affairs, BioPharmaceuticals, AstraZeneca, Groot-Bijgaarden, Belgium
| | - Steven Droogmans
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZB), Centrum voor Hart- en Vaatziekten (CHVZ), Brussels, Belgium
| | - Ward A Heggermont
- Cardiovascular Research Center, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Emeline Van Craenenbroeck
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
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Aragona CO, Bianco A, Caruso R, Cerulli M, Cosentino N, Cittadini A, Gabriele M, Mallardo M, Marini R, Miserrafiti B, Palermo P, Galati A. Lipid-lowering therapy in patients with coronary heart disease: an Italian real-life survey. Results from the Survey on Risk FactOrs and CardiovascuLar secondary prEvention and drug strategieS (SOFOCLES) in Italy. Monaldi Arch Chest Dis 2024. [PMID: 39259232 DOI: 10.4081/monaldi.2024.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/17/2024] [Indexed: 09/12/2024] Open
Abstract
In patients at high cardiovascular risk, a low-density lipoprotein cholesterol (LDL-C) reduction of ≥50% from baseline and an LDL-C goal of <70 mg/dL (or <55 mg/dL in very high-risk patients) are recommended. Multiple registry and retrospective studies have shown that patients with high atherosclerotic cardiovascular risk often do not reach the targets defined by the European Society of Cardiology guidelines as a result of suboptimal management of LDL-C. Here, we report the data on lipid-lowering therapy and lipid targets from the Survey on Risk FactOrs and CardiovascuLar secondary prEvention and drug strategieS (SOFOCLES), an observational, prospective study designed to collect data on patients with ischemic heart disease treated at cardiac outpatient clinics across the Italian national territory. We included patients with known coronary heart disease (CHD) who underwent follow-up visits at various outpatient cardiology clinics. A total of 2532 patients were included (mean age: 67±17 years, 80% male). Among patients with available laboratory data (n=1712), 995 (58%) had LDL-C<70 mg/dL, 717 (42%) had LDL-C≥70 mg/dL, and 470 (27%) had LDL-C<55 mg/dL. Patients who more frequently achieved the recommended LDL-C levels were male, had diabetes, had a higher educational level, and performed intense physical activity. Statins were used in 2339 (92%) patients, high-intensity statins (e.g., rosuvastatin 20/40 mg or atorvastatin 40/80 mg) in 1547 patients (61% of the whole population and 66% of patients on statins), and ezetimibe in 891 patients (35%). Patients receiving high-intensity statins tended to be younger, not to have diabetes, and to have been included in a cardiac rehabilitation program. In a real-world sample of Italian patients with CHD, adherence to lipid-lowering therapy fell markedly short of optimal levels. Many patients did not achieve the LDL-C target of 70 mg/dL, and even fewer reached the LDL-C target of 55 mg/dL. Notably, patients with a lower educational level had a greater likelihood of being undertreated. Strategies aimed at improving preventive interventions for CHD and overcoming social disparities should be evaluated and optimized.
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Affiliation(s)
| | | | - Roberto Caruso
- Divison of Cardiac Rehabilitation, I.O.M.I. Franco Scalabrino, Messina.
| | | | | | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples.
| | | | - Mario Mallardo
- Rehabilitation Unit, "San Gennaro" Hospital, ASL Napoli 1 Centro, Naples.
| | | | - Bruna Miserrafiti
- Cardiopulmonary Rehabilitation Unit, "T. Evoli" Hospital, Melito Porto Salvo (RC).
| | - Pietro Palermo
- Cardiac Rehabilitation Unit, Centro Cardiologico Monzino, IRCSS, Milan.
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Belobrajdic DP, Brook H, James-Martin G, Stonehouse W. β-Glucan content and in vitro bile-acid binding capacity of Agaricus bisporus and Pleurotus spp. Food Funct 2024. [PMID: 39253896 DOI: 10.1039/d4fo02416h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
The cholesterol lowering properties of oats and barley, attributed to their high β-glucan content, are well established, but it remains unclear whether mushrooms, also rich in β-glucan, exhibit a similar functionality. We aimed to quantify the β-glucan content of commonly consumed Australian mushrooms and evaluated their bile acid binding capacity, the primary cholesterol lowering mechanism of β-glucan. Raw, boiled and fried Australian grown Agaricus bisporus (button, cup, flat and brown mushrooms) and Pleurotus spp. (shimeji and oyster) along with oats were freeze-dried and the β-glucan content was determined. The bile acid binding capacity of these samples was assessed using an in vitro digestion assay. The β-glucan content of freeze-dried raw A. bisporus mushrooms (4.5-8.1 g per 100 g) was similar to that of oats (7.6 g per 100 g, all p > 0.05), whereas Pleurotus mushrooms contained ∼5 times more β-glucan (32.5-37.4 g, p < 0.05). Boiling increased the β-glucan content of oyster, button, flat and brown mushrooms by 3-7% (p < 0.05), but did not affect the β-glucan content of shimeji or cup mushrooms. Frying had no effect on any mushroom type. The bile acid binding capacity of A. bisporus mushrooms (29-36%) was equivalent to that of raw oats (36%, p > 0.05), whereas the bile acid binding capacity of oyster mushrooms (22%) was lower than that of oats (p < 0.05). Both boiling and frying increased the bile acid binding capacity. The cholesterol lowering effects of A. bisporus mushrooms and the acceptability of consumption at the required levels need to be confirmed by clinical trials.
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Affiliation(s)
- Damien Paul Belobrajdic
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, South Australia, Australia.
- College of Medicine and Public Health, Health Flinders University, Bedford Park, SA 5042, Australia
| | - Henri Brook
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, South Australia, Australia.
| | - Genevieve James-Martin
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, South Australia, Australia.
| | - Welma Stonehouse
- Commonwealth Scientific Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, South Australia, Australia.
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Mohammed SA, Akram HM. Evaluating the Efficacy of Resveratrol-Containing Mouthwash as an Adjunct Treatment for Periodontitis: A Randomized Clinical Trial. Eur J Dent 2024. [PMID: 39251207 DOI: 10.1055/s-0044-1788686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of resveratrol mouthwash as an adjunct to nonsurgical periodontal treatment of periodontitis. MATERIALS AND METHODS This study was a randomized, double-blind clinical trial study. The study included 57 participants with periodontitis. Clinical parameters (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PPD], and clinical attachment loss [CAL]) were examined at the baseline visit, after 7 days, and after 30 days of using resveratrol mouthwash as an adjunct to nonsurgical periodontal treatment. The salivary levels of (interleukin [IL]-6) and RANKL (receptor activator of nuclear factor-kappa B ligand) were measured and compared before and after treatment. The participants answered the visual analog scale-based assessment questionnaire at the last visit. STATISTICAL ANALYSIS A one-way ANOVA (analysis of variance) test was used to compare the means of multiple groups (test, positive control, negative control) at baseline and after treatment. A paired t-test was also used to compare the means of a single group before and after treatment. In addition, Tukey's multiple comparisons test was used to identify specific pairwise differences between the three groups after finding significant differences with ANOVA. The Chi-square test was also used to compare the distribution of categorical variables like sex between the groups. RESULTS All interventions significantly reduced PI, BOP, PPD, and CAL, but resveratrol and chlorhexidine had a higher significant effect than placebo except for CAL without a significant difference between them. All mouthwashes significantly reduced the salivary concentration of IL-6. However, resveratrol and chlorhexidine had a significantly higher effect than placebo, while the concentration of RANKL was decreased in all groups without a significant difference between them. The participants' responses to the mouthwash questionnaire showed that resveratrol and chlorhexidine had the same feedback without significant differences. CONCLUSION Resveratrol-containing mouthwash could be used as an alternative to chlorhexidine as an adjunct to nonsurgical periodontal treatment of periodontitis.
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Affiliation(s)
- Sura A Mohammed
- Department of Periodontology, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Hadeel Mazin Akram
- Department of Periodontology, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Sbrana F, Dal Pino B. When "old" lipid lowering therapies not should be discontinued. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024:S0214-9168(24)00078-0. [PMID: 39256153 DOI: 10.1016/j.arteri.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Francesco Sbrana
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Beatrice Dal Pino
- Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Santoro F, Stiermaier T, Gil IJN, El-Battrawy I, Pätz T, Cacciotti L, Guerra F, Novo G, Musumeci B, Volpe M, Mariano E, Caldarola P, Montisci R, Ragnatela I, Cetera R, Vazirani R, Lluch C, Uribarri A, Corbi-Pascual M, Cardona DAC, Akin I, Barbato E, Thiele H, Brunetti ND, Eitel I, Arcari L. Renin angiotensin system inhibitors and outcome in patients with Takotsubo syndrome: a propensity score analysis of the GEIST registry. Am Heart J 2024:S0002-8703(24)00222-9. [PMID: 39260785 DOI: 10.1016/j.ahj.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/27/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi). METHODS TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Median follow-up was 31 (Interquartile range 12-56) months. Comparison of RASi treated vs. untreated patients was performed within the overall population and after 1:1 propensity score matching for age, sex, comorbidities, type of trigger and in-hospital complications. REGISTRATION clinicaltrials.gov, NCT04361994, https://clinicaltrials.gov/study/NCT04361994 RESULTS: Of the 2453 TTS patients discharged alive, 1683 (68%) received RASi therapy. Patients with RASi were older (age 71±11 vs 69±13 years, p=0.01), with higher prevalence of hypertension (74%vs53%, p<0.01) and diabetes (19%vs15%, p=0.01), higher admission left ventricular ejection fraction (LVEF) (41±11% vs 39±12%, p<0.01) and lower rates of in-hospital complications (18.9% vs 29.6%, p<0.01). At multivariable analysis, RASi therapy at discharge was independently associated with lower mortality (HR 0.63, 95%CI 0.45-0.87, p<0.01). Survival analysis showed that at long term, patients treated with RASi had lower mortality rates in the overall cohort (log-rank p=0.001). However, this benefit was not found among patients treated with RASi in the matched cohort (log-rank p=0.168). Potential survival benefit of RASi were present, both in the overall and matched cohort, in two subgroups: patients with admission LVEF ≤40% (HR 0.54 95%CI 0.38-0.78, p=0.001; HR 0.59, 95%CI 0.37-0.95, p=0.030) and diabetes (HR 0.41, 95%CI 0.23-0.73, p= 0.002; HR 0.41, 95%CI 0.21-0.82, p=0.011). CONCLUSIONS Long-term therapy with RASi after a TTS episode was not associated with lower mortality rates at propensity score analysis. However, potential survival benefit can be found among patients with admission LVEF ≤40% or diabetes.
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Affiliation(s)
- Francesco Santoro
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy.
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Iván J Núñez Gil
- Interventional; Cardiology. Cardiovascular Institute. Hospital Clínico Universitario San Carlos, Madrid. Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain.
| | - Ibrahim El-Battrawy
- Department of Cardiology, University of Mannheim, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Mannheim, Germany; Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.
| | - Toni Pätz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Luca Cacciotti
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit, University of Palermo, University Hospital P. Giaccone, Palermo, Italy.
| | - Beatrice Musumeci
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Massimo Volpe
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCSS San Raffaele, Rome, Italy.
| | - Enrica Mariano
- University of Rome Tor Vergata, Division of Cardiology, Rome, Italy.
| | | | - Roberta Montisci
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
| | - Ilaria Ragnatela
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy.
| | - Rosa Cetera
- University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy.
| | - Ravi Vazirani
- Interventional; Cardiology. Cardiovascular Institute. Hospital Clínico Universitario San Carlos, Madrid. Spain.
| | - Carmen Lluch
- Cardiology Department, Hospital Juan Ramon Jimenez, Huelva,Spain.
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | - Ibrahim Akin
- Department of Cardiology, University of Mannheim, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Mannheim, Germany.
| | - Emanuele Barbato
- Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Department of Internal Medicine/Cardiology, Leipzig, Germany.
| | | | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Luca Arcari
- Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy.
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Elnaggar M, Miller AM, Sil A, Viljoen A. The journey to LDL-C goal in the era of combination lipid lowering therapy and why it matters for ASCVD patients: a UK perspective. Curr Med Res Opin 2024:1-11. [PMID: 39225341 DOI: 10.1080/03007995.2024.2400273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE We aim to explore the concept of distance and journey to goal, and consideration of these 2 elements a priori when choosing LLT. METHODS Modelling of expected % LDL-C reductions was carried out on a range of hypothetical patients' baseline LDL-C values prior to any LLT being commenced. Therapies were then added in a stepwise manner based on the pathway demonstrated in current national guidance and compared with goal achievement on a novel LLT optimization pathway implemented in Morecambe Bay NHS Trust. RESULTS Modelling of a stepwise lipid management pathway shows that high-intensity statin monotherapy is not sufficient in most modelled baseline LDL-C scenarios to achieve guideline-recommended goals. Furthermore, ezetimibe second line may preclude 3rd line injectable prescribing and lead to "ezetimibe limbo" where the patient is now below the reimbursement threshold for injectable prescribing but still not achieving their LDL-C target. Overall goal achievement is poor across the spectrum of modelled LDL-C levels. In contrast, by following the Morecambe Bay pathway all patients on statin for the range of hypothetical baseline LDL-C levels can reach an LDL-C target of < 1.8 mmol/L. CONCLUSIONS This study identifies a therapeutic gap when following a stepwise approach highlighted by recent national guidance. Our proposal of a novel pathway highlights that the order in which drugs are added is important in the context of national reimbursement thresholds and allows LDL-C goal to be reached in a timely manner, regardless of the starting baseline LDL-C level.
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Affiliation(s)
- Mohamed Elnaggar
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | | | | | - Adie Viljoen
- Borthwick Research Unit, Lister Hospital, Stevenage, UK
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Mennini FS, Scortichini M, Colivicchi F, Maggioni AP, Sciattella P. The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy. Clin Drug Investig 2024:10.1007/s40261-024-01365-z. [PMID: 39249736 DOI: 10.1007/s40261-024-01365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact. OBJECTIVES This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs. METHODS We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents. RESULTS Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757). CONCLUSIONS This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.
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Affiliation(s)
- Francesco S Mennini
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
| | - Matteo Scortichini
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy
| | | | - Aldo P Maggioni
- ANMCO Research Center-Heart Care Foundation, Florence, Italy
| | - Paolo Sciattella
- Faculty of Economics, Centre for Economics and International Studies, Economic Evaluation and Health Technology Assessment, University of Rome "Tor Vergata", Via Columbia, 2, 00133, Rome, Italy.
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125
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Fewkes JJ, Dordevic AL, Murray M, Williamson G, Kellow NJ. Association between endothelial function and skin advanced glycation end-products (AGEs) accumulation in a sample of predominantly young and healthy adults. Cardiovasc Diabetol 2024; 23:332. [PMID: 39251982 PMCID: PMC11386354 DOI: 10.1186/s12933-024-02428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/31/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND In populations with chronic disease, skin autofluorescence (SAF), a measure of long-term fluorescent advanced glycation end-products (AGEs) accumulation in body tissues, has been associated with vascular endothelial function, measured using flow-mediated dilation (FMD). The primary aim of this study was to quantify the relationship between endothelial function and tissue accumulation of AGEs in adults from the general population to determine whether SAF could be used as a marker to predict early impairment of the endothelium. METHODS A cross-sectional study was conducted with 125 participants (median age: 28.5 y, IQR: 24.4-36.0; 54% women). Endothelial function was measured by fasting FMD. Skin AGEs were measured as SAF using an AGE Reader. Participant anthropometry, blood pressure, and blood biomarkers were also measured. Associations were evaluated using multivariable regression analysis and were adjusted for significant covariates. RESULTS FMD was inversely correlated with SAF (ρ = -0.50, P < 0.001) and chronological age (ρ = -0.51, P < 0.001). In the multivariable analysis, SAF, chronological age, and male sex were independently associated with reduced FMD (B [95% CI]; -2.60 [-4.40, -0.80]; -0.10 [-0.16, -0.03]; 1.40 [0.14, 2.67], respectively), with the multivariable model adjusted R2 = 0.31, P < 0.001. CONCLUSIONS Higher skin AGE levels, as measured by SAF, were associated with lower FMD values, in a predominantly young, healthy population. Additionally, older age and male participants exhibited significantly lower FMD values, corresponding with compromised endothelial function. These results suggest that SAF, a simple and inexpensive marker, could be used to predict endothelial impairment before the emergence of any structural artery pathophysiology or classic cardiovascular disease risk markers. TRIAL REGISTRATION The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000821897) and concurrently entered into the WHO International Clinical Trials Registry Platform under the same ID number.
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Affiliation(s)
- Juanita J Fewkes
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, 3168, Australia
- Victorian Heart Institute, Victoria Heart Hospital, 631 Blackburn Road, Clayton, VIC, 3168, Australia
| | - Aimee L Dordevic
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, 3168, Australia
- Victorian Heart Institute, Victoria Heart Hospital, 631 Blackburn Road, Clayton, VIC, 3168, Australia
| | - Margaret Murray
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, 3168, Australia
- School of Chemistry, Faculty of Science, Monash University, Clayton, VIC, 3800, Australia
| | - Gary Williamson
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, 3168, Australia
- Victorian Heart Institute, Victoria Heart Hospital, 631 Blackburn Road, Clayton, VIC, 3168, Australia
| | - Nicole J Kellow
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, 3168, Australia.
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia.
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126
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Ferrer P, López L, Pérez J, Cabello N, Núñez MJ, Sagastagoitia I, Cotarelo M, de Isla LP, Estrada V. Subclinical atherosclerosis burden in carotid and femoral territories in HIV subjects: relationships with HIV and non-HIV related factors. BMC Infect Dis 2024; 24:932. [PMID: 39251924 PMCID: PMC11382418 DOI: 10.1186/s12879-024-09850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity in an aging HIV population. However, risk estimation with the most frequent equations usually classifies HIV patients as having a low or moderate risk. Several studies have described a very high prevalence of subclinical atherosclerosis in a middle-aged, non-HIV population. There is insufficient body of knowledge to understand if this is the case in people living with HIV (PLWH). We aim to calculate the proportion of patients with subclinical atherosclerosis in a single site cohort of HIV-infected subjects. METHODS We have analyzed chronically HIV infected adults (≥ 18 years) who were on active follow-up in an HIV unit specialized in the care of cardiovascular health. The most recent clinical visit and vascular ultrasonography were used to assess the objectives of our research. Our primary objective was to describe the proportion of participants with subclinical atherosclerosis (focal protrusion into the lumen > 0.5 mm or > 50% of the surrounding IMT or a diffuse thickness > 1.5 mm) in a single site cohort of PLWH. Carotid and iliofemoral territories were evaluated. As a secondary objective we have run a multivariate analysis to determine which HIV and non-HIV factors might be related with the presence of atherosclerotic plaques. Findings We included a total of 463 participants between November 2017 to October 2019. Subjects were predominantly male (84.2%) with a mean age of 48.8 years (SD 10.7). Hypercholesterolemia (36%) was the most prevalent comorbidity followed by Hypertension (18%) and Hypertriglyceridemia (16%). Mean duration of HIV infection is 12.3 years. Overall, participants had been receiving cART for a median of 9.5 years. Subclinical atherosclerosis was found in 197 subjects (42.5%; CI 95% [38.0-47.2]). The disease was found more frequently in the femoral arteries (37.8%) than in the carotid vascular bed (18.6%). Despite some HIV factors correlated with the presence of plaques in a univariate analysis (e.g., time with HIV-1 RNA > 50 copies/mL or time from HIV diagnosis), the only two explanatory factors that remained associated with the presence of atherosclerotic plaques in the multivariate analysis were smoking (OR 5.47, 95% CI 3.36 - 8.90) and age (OR 1.13, 95%CI 1.10 - 1.16). Interpretation We have found a very high prevalence of subclinical atherosclerosis among our cohort of PLWH. Despite having analyzed several HIV factors, age and smoking have been found to be the only factors associated with the development of atherosclerotic plaques.
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Affiliation(s)
| | - Laura López
- Internal Medicine Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Juncal Pérez
- Internal Medicine Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Noemi Cabello
- Internal Medicine Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - María José Núñez
- Internal Medicine Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Vicente Estrada
- Internal Medicine Unit, Hospital Clínico San Carlos, Madrid, Spain
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127
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Liu R, Xu T, Gan L, Chang C, Peng Y, Yao W, Zhai A, Fang M, Shang X, Chang S, Guo J, Zhang J. Influence of remnant cholesterol levels on carotid intima thickness in type 2 diabetes patients. Sci Rep 2024; 14:20893. [PMID: 39245669 PMCID: PMC11381536 DOI: 10.1038/s41598-024-71780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024] Open
Abstract
Investigate the impact of remnant cholesterol (RC) levels on carotid artery intima thickness (CIT) in type 2 diabetes mellitus (T2DM) patients. From September 2021 to September 2023, a prospective multicenter study involved 158 T2DM patients. They were divided into a higher RC group (n = 80) and a lower RC group (n = 78) based on median RC levels. Additionally, 92 healthy volunteers served as the control group. CIT, carotid media thickness (CMT), and carotid intima-media thickness (CIMT) were measured. General clinical data, lab results, CIMT, CIT, and CMT differences among the three groups were compared. Multiple regression analysis explored CIT factors in T2DM patients. 1. No significant sex, age, BMI, high-density lipoprotein cholesterol (HDL-C), T2DM duration, fasting blood glucose, or glycated hemoglobin differences were found among the groups (p > 0.05). 2. CIMT and CIT were significantly higher in T2DM than the control group (p < 0.05). 3. The higher RC group had thicker CIT than the lower RC group (p < 0.05), while CIMT differences were not significant (p > 0.05). Multiple linear regression analysis showed RC as an influencing CIT factor in T2DM patients (β = 0.473, p = 0.005). CIT is significantly thicker in T2DM patients with higher RC than in those with lower RC, and RC is the influence factor of CIT, which suggests that more attention should be paid to the detection of RC in T2DM patients.
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Affiliation(s)
- Rong Liu
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Tao Xu
- Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Wuxi, 214200, Jiangsu, China
| | - Ling Gan
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Caihong Chang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Yao Peng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Wenlin Yao
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Aihua Zhai
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Ming Fang
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Xinan Shang
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Shuai Chang
- Depatment of Ultrasound, First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Jianfeng Guo
- Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Wuxi, 214200, Jiangsu, China.
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China.
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128
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Canfora I, Pierno S. Hypertriglyceridemia Therapy: Past, Present and Future Perspectives. Int J Mol Sci 2024; 25:9727. [PMID: 39273674 PMCID: PMC11395432 DOI: 10.3390/ijms25179727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/31/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
Hypertriglyceridemia therapy is essential for preventing cardiovascular diseases. Fibrates belong to an important class of lipid-lowering drugs useful for the management of dyslipidaemia. By acting on the peroxisome proliferator-activated receptor (PPAR)-α, these drugs lower serum triglyceride levels and raise high-density lipoprotein cholesterol. Fibrate monotherapy is associated with a risk of myopathy and this risk is enhanced when these agents are administered together with statins. However, whereas gemfibrozil can increase plasma concentrations of statins, fenofibrate has less influence on the pharmacokinetics of statins. Pemafibrate is a new PPAR-α-selective drug considered for therapy, and clinical trials are ongoing. Apart from this class of drugs, new therapies have emerged with different mechanisms of action to reduce triglycerides and the risk of cardiovascular diseases.
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Affiliation(s)
- Ileana Canfora
- Section of Pharmacology, Department of Pharmacy and Drug Sciences, University of Bari "Aldo Moro", 70121 Bari, Italy
| | - Sabata Pierno
- Section of Pharmacology, Department of Pharmacy and Drug Sciences, University of Bari "Aldo Moro", 70121 Bari, Italy
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129
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Sun F, Zou S, Li X, Liu X. Abnormal expression of circ_0013958 in patients with acute myocardial infarction (AMI) and its influence on prognosis. J Cardiothorac Surg 2024; 19:517. [PMID: 39243066 PMCID: PMC11378589 DOI: 10.1186/s13019-024-03036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the diagnostic value of circ_0013958 in acute myocardial infarction (AMI) patients and its influence on the prognosis of AMI patients. METHODS The GSE160717 dataset was downloaded from the NCBI database and differentially expressed genes were analyzed between the control group and the AMI group. The up-regulated genes included circ_0013958. The expression of circ_0013958 in both groups was further verified by RT-qPCR. The Receiver Operating Characteristic curve was used to evaluate the diagnostic value of circ_0013958 in AMI. Pearson correlation analysis was used to examine the correlation between circ_0013958 levles and biochemical indicators. Binary logistic regression was used to analyze the risk factors affecting the occurrence of AMI. Prognostic analysis was performed using COX regression analysis and the Kaplan-Meier Curve. RESULTS Compared to the control group, the level of circ_0013958 in AMI patients increased. Circ_0013958 can effectively distinguish AMI patients from non-AMI patients. Circ_0013958 levels were positively correlated with cTnI, LDH, CRP and TC levels. The elevated level of circ_0013958 was an independent risk factor for the occurrence of AMI. Higher circ_0013958 levels were also associated with the occurrence of major adverse cardiac events (MACEs) in AMI patients. Additionally, elevated circ_0013958 levels reduced the survival probability of AMI patients. CONCLUSION Circ_0013958 levels were up-regulated in AMI patients. It can be used as a diagnosis biomarker for AMI. The level of circ_0013958 was correlated with the disease severity and was an independent risk factor for the occurrence of AMI. Elevated circ_0013958 levels were associated with poor prognosis in AMI patients.
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Affiliation(s)
- Fei Sun
- Department of Cardiology, DeltaHealth Hospital•Shanghai, No. 109, Xule Road, Xujing Town, Qingpu District, Shanghai, 201702, China.
| | - Shenglan Zou
- Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou, 225001, China
| | - Xiaomin Li
- Department of Cardiology, DeltaHealth Hospital•Shanghai, No. 109, Xule Road, Xujing Town, Qingpu District, Shanghai, 201702, China
| | - Xueya Liu
- Department of Cardiology, DeltaHealth Hospital•Shanghai, No. 109, Xule Road, Xujing Town, Qingpu District, Shanghai, 201702, China
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130
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Wei FF, Pellicori P, Ferreira JP, González A, Mariottoni B, An DW, Verdonschot JAJ, Liu C, Ahmed FZ, Petutschnigg J, Rossignol P, Heymans S, Cuthbert J, Girerd N, Clark AL, Li Y, Nawrot TS, Díez J, Zannad F, Cleland JGF, Staessen JA. Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial. Hypertens Res 2024:10.1038/s41440-024-01843-z. [PMID: 39242826 DOI: 10.1038/s41440-024-01843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/13/2024] [Accepted: 07/23/2024] [Indexed: 09/09/2024]
Abstract
None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25-50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were -8.00 mm Hg (95% CI, -11.6 to -4.43)/-0.85 mm Hg (-2.96 to 1.26) at month 1 and -9.58 mm Hg (-14.0 to -5.19)/-3.84 mm Hg (-6.22 to -1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were -8.08 mm Hg (-14.2 to -2.01)/-2.07 mm Hg (-5.79 to 1.65) and -13.3 mm Hg (-19.9 to -6.75)/-4.62 mm Hg (-8.07 to -1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (-0.10 to 4.40) and 2.49 (-0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL.
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Affiliation(s)
- Fang-Fei Wei
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - João Pedro Ferreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto Portugal, Porto, Portugal
- Portugal Heart Failure Clinics, Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA. Universidad de Navarra and IdiSNA, Pamplona, Spain CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | | | - De-Wei An
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Fozia Z Ahmed
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Johannes Petutschnigg
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, Berlin Institute of Health and German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Patrick Rossignol
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joe Cuthbert
- Department of Cardiology, University of Hull, Castle Hill Hospital, Cottingham, East Riding of Yorkshire, Hull, UK
| | - Nicolas Girerd
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Andrew L Clark
- Department of Cardiology, University of Hull, Castle Hill Hospital, Cottingham, East Riding of Yorkshire, Hull, UK
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tim S Nawrot
- Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Javier Díez
- Program of Cardiovascular Diseases, CIMA. Universidad de Navarra and IdiSNA, Pamplona, Spain CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique 1433, U1116, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - John G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Jan A Staessen
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium.
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Biomedical Science Group, University of Leuven, Leuven, Belgium.
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Elliott AD, Middeldorp ME, McMullen JR, Fatkin D, Thomas L, Gwynne K, Hill AP, Shang C, Hsu MP, Vandenberg JI, Kalman JM, Sanders P. Research Priorities for Atrial Fibrillation in Australia: A Statement From the Australian Cardiovascular Alliance Clinical Arrhythmia Theme. Heart Lung Circ 2024:S1443-9506(24)01800-6. [PMID: 39244450 DOI: 10.1016/j.hlc.2024.08.008] [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: 09/09/2024]
Abstract
Atrial fibrillation (AF) is highly prevalent in the Australian community, ranking amongst the highest globally. The consequences of AF are significant. Stroke, dementia and heart failure risk are increased substantially, hospitalisations are amongst the highest for all cardiovascular causes, and Australians living with AF suffer from substantial symptoms that impact quality of life. Australian research has made a significant impact at the global level in advancing the care of patients living with AF. However, new strategies are required to reduce the growing incidence of AF and its associated healthcare demand. The Australian Cardiovascular Alliance (ACvA) has led the development of an arrhythmia clinical theme with the objective of tackling major research priorities to achieve a reduction in AF burden across Australia. In this summary, we highlight these research priorities with particular focus on the strengths of Australian research and the strategies needed to move forward in reducing incident AF and improving outcomes for those who live with this chronic condition.
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Affiliation(s)
- Adrian D Elliott
- Centre for Heart Rhythm Disorders, The University of Adelaide; South Australian Health and Medical Research Institute; and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, The University of Adelaide; South Australian Health and Medical Research Institute; and Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Julie R McMullen
- Heart Research Institute, Sydney, NSW, Australia, and Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia; Cardiology Department, St Vincent's Hospital, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Western Sydney Local Health District; Westmead Clinical School, The University of Sydney; and South West Clinical School, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Sydney, NSW, Australia
| | - Adam P Hill
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Catherine Shang
- Australian Cardiovascular Alliance, Melbourne, Vic, Australia
| | - Meng-Ping Hsu
- Australian Cardiovascular Alliance, Melbourne, Vic, Australia
| | - Jamie I Vandenberg
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital; and University of Melbourne, Melbourne, Vic, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, The University of Adelaide; South Australian Health and Medical Research Institute; and Royal Adelaide Hospital, Adelaide, SA, Australia.
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132
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▼Icosapent ethyl for CV risk reduction. Drug Ther Bull 2024; 62:135-140. [PMID: 39242154 DOI: 10.1136/dtb.2024.000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
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Kordi N, Sanaei M, Akraminia P, Yavari S, Saydi A, Abadi FK, Heydari N, Jung F, Karami S. PANoptosis and cardiovascular disease: The preventive role of exercise training. Clin Hemorheol Microcirc 2024:CH242396. [PMID: 39269827 DOI: 10.3233/ch-242396] [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: 09/15/2024]
Abstract
Regulated cell death, including pyroptosis, apoptosis, and necroptosis, is vital for the body's defense system. Recent research suggests that these three types of cell death are interconnected, giving rise to a new concept called PANoptosis. PANoptosis has been linked to various diseases, making it crucial to comprehend its mechanism for effective treatments. PANoptosis is controlled by upstream receptors and molecular signals, which form polymeric complexes known as PANoptosomes. Cell death combines necroptosis, apoptosis, and pyroptosis and cannot be fully explained by any of these processes alone. Understanding pyroptosis, apoptosis, and necroptosis is essential for understanding PANoptosis. Physical exercise has been shown to suppress pyroptotic, apoptotic, and necroptotic signaling pathways by reducing inflammatory factors, proapoptotic factors, and necroptotic factors such as caspases and TNF-alpha. This ultimately leads to a decrease in cardiac structural remodeling. The beneficial effects of exercise on cardiovascular health may be attributed to its ability to inhibit these cell death pathways.
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Affiliation(s)
- Negin Kordi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | | | - Peyman Akraminia
- Department of Sports Physiology, Faculty of Physical Education and Sports Sciences, Islamic Azad University, South Tehran Branch, Iran
| | - Sajad Yavari
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Ali Saydi
- Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Fatemeh Khamis Abadi
- Department of Sport Physiology, Faculty of Human Sciences, Islamic Azad University, Borujerd, Iran
| | - Naser Heydari
- Faculty of Physical Education and Sport Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
| | - Friedrich Jung
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Sajad Karami
- Faculty of Physical Education and Sport Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
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Rubio-Ruíz ME, Plata-Corona JC, Soria-Castro E, Díaz-Juárez JA, Sánchez-Aguilar M. Pleiotropic Effects of Peroxisome Proliferator-Activated Receptor Alpha and Gamma Agonists on Myocardial Damage: Molecular Mechanisms and Clinical Evidence-A Narrative Review. Cells 2024; 13:1488. [PMID: 39273057 PMCID: PMC11394383 DOI: 10.3390/cells13171488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
Cardiovascular diseases remain the leading cause of death in the world, and that is why finding an effective and multi-functional treatment alternative to combat these diseases has become more important. Fibrates and thiazolidinediones, peroxisome proliferator-activated receptors alpha and gamma are the pharmacological therapies used to treat dyslipidemia and type 2 diabetes, respectively. New mechanisms of action of these drugs have been found, demonstrating their pleiotropic effects, which contribute to preserving the heart by reducing or even preventing myocardial damage. Here, we review the mechanisms underlying the cardioprotective effects of PPAR agonists and regulating morphological and physiological heart alterations (metabolic flexibility, mitochondrial damage, apoptosis, structural remodeling, and inflammation). Moreover, clinical evidence regarding the cardioprotective effect of PPAR agonists is also addressed.
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Affiliation(s)
- María Esther Rubio-Ruíz
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, México City 14080, Mexico
| | - Juan Carlos Plata-Corona
- Department of Interventional Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, México City 14080, Mexico
| | - Elizabeth Soria-Castro
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, México City 14080, Mexico
| | - Julieta Anabell Díaz-Juárez
- Department of Pharmacology "Dr. Rafael Méndez Martínez", Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, México City 14080, Mexico
| | - María Sánchez-Aguilar
- Department of Pharmacology "Dr. Rafael Méndez Martínez", Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, México City 14080, Mexico
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135
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Soffer DE, Marston NA, Maki KC, Jacobson TA, Bittner VA, Peña JM, Thanassoulis G, Martin SS, Kirkpatrick CF, Virani SS, Dixon DL, Ballantyne CM, Remaley AT. Role of apolipoprotein B in the clinical management of cardiovascular risk in adults: An expert clinical consensus from the national lipid association. J Clin Lipidol 2024:S1933-2874(24)00240-X. [PMID: 39256087 DOI: 10.1016/j.jacl.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024]
Abstract
This National Lipid Association (NLA) Expert Clinical Consensus provides an overview of the physiologic and clinical considerations regarding the role of apolipoprotein B (apoB) measurement to guide clinical care based on the available scientific evidence and expert opinion. ApoB represents the total concentration of atherogenic lipoprotein particles in the circulation and more accurately reflects the atherogenic burden of lipoproteins when compared to low-density lipoprotein cholesterol (LDL-C). ApoB is a validated clinical measurement that augments the information found in a standard lipoprotein lipid panel; therefore, there is clinical value in using apoB in conjunction with a standard lipoprotein lipid profile when assessing risk and managing lipid-lowering therapy (LLT). ApoB has been shown to be superior to LDL-C in risk assessment both before and during treatment with LLT. In individuals, there can be discordance between levels of LDL-C and apoB, as well as LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C), despite high levels of population-wide correlation. When there is discordance between LDL-C and apoB, or LDL-C and non-HDL-C, atherosclerotic cardiovascular disease risk generally aligns better with apoB or non-HDL-C. Additionally, apoB can be used in tandem with standard lipoprotein lipid measurements to diagnose distinct lipoprotein phenotypes. ApoB testing can inform clinical prognosis and care, as well as enable family cascade screening, when an inherited lipoprotein syndrome is identified. The NLA and other organizations will continue to educate clinicians about the role of apoB measurement in improving clinical risk assessment and dyslipidemia management. An urgent need exists to improve access and reimbursement for apoB testing.
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Affiliation(s)
- Daniel E Soffer
- Clinical Lipidology, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA (Dr Soffer).
| | - Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (Dr Marston)
| | - Kevin C Maki
- Midwest Biomedical Research, Addison, IL, USA (Drs Maki and Kirkpatrick); Indiana University School of Public Health, Department of Applied Health Science, Bloomington, IN, USA (Dr Maki)
| | - Terry A Jacobson
- Lipid Clinic and Cardiovascular Risk Reduction Program, Emory Department of Medicine, Emory University, Atlanta, GA, USA (Dr Jacobson)
| | - Vera A Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA (Dr Bittner)
| | - Jessica M Peña
- Departments of Medicine and Radiology, Weill Cornell Medicine, New York, NY, USA (Dr Peña)
| | - George Thanassoulis
- Preventive and Genomic Cardiology, Department of Medicine, McGill University, and the McGill University Health Center Research Institute, Montréal, Québec, Canada (Dr Thanassoulis)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA (Dr Martin)
| | - Carol F Kirkpatrick
- Midwest Biomedical Research, Addison, IL, USA (Drs Maki and Kirkpatrick); Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA (Dr Kirkpatrick)
| | - Salim S Virani
- Department of Medicine, The Aga Khan University, Karachi, Pakistan (Dr Virani); Texas Heart Institute and Baylor College of Medicine, Houston, TX, USA (Dr Virani)
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA (Dr Dixon)
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA (Dr Ballantyne)
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA (Dr Remaley)
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Magon A, Hendriks JM, Conte G, Caruso R. Description of self-care behaviours in patients with non-valvular atrial fibrillation on oral anticoagulant therapy: a scoping review. Eur J Cardiovasc Nurs 2024; 23:582-591. [PMID: 38267024 DOI: 10.1093/eurjcn/zvae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
AIMS The primary aim of this scoping review was to explore and categorize the medication-related self-care behaviours exhibited by patients with non-valvular atrial fibrillation (NVAF) who are on oral anticoagulant (OAC) therapy. METHODS AND RESULTS A scoping review was performed, and the systematic search of the literature yielded an initial 887 records. After deduplication and screening, 61 studies were included in the analysis, ranging from 2003 to 2023. The studies represented a wide geographical distribution and diverse methodologies. The results identified 16 self-care behaviours: a higher focus of the included literature on self-care monitoring (60.65% of studies), followed by self-care management and self-care maintenance (each 16.39%). These behaviours ranged from regular blood testing to consulting healthcare providers and lifestyle changes. The results also highlighted the relationship between treatment satisfaction, self-efficacy, and adherence. Several studies emphasized the critical role of healthcare providers in influencing medication adherence. Furthermore, patient knowledge, quality of life, and psychological factors were identified as key elements affecting self-care behaviours. CONCLUSION The review provides a comprehensive landscape of medication-related self-care behaviours among NVAF patients on OAC therapy. It underscores the predominance of self-care monitoring behaviours and the critical roles of healthcare providers, psychological factors, and patient knowledge in influencing these behaviours. The findings also highlight the necessity for an integrated, patient-centred approach to improving self-care and self-management in OAC treatment. Future research should focus on addressing the identified gaps, including the relative lack of studies on lifestyle modification, emotional well-being, and technology-assisted interventions. REGISTRATION This review is part of a broader project and is documented at ClinicalTrials.gov: NCT05820854.
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Affiliation(s)
- Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Centre for Heart Rhythm Disorders, The University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy
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Lacaita PG, Senoner T, Bilgeri V, Rauch S, Barbieri F, Kindl B, Plank F, Dichtl W, Deeg J, Widmann G, Feuchtner GM. The interaction of lipomatous hypertrophy of the interatrial septum with pericardial adipose tissue biomarkers by computed tomography. Eur Radiol 2024:10.1007/s00330-024-11061-3. [PMID: 39237769 DOI: 10.1007/s00330-024-11061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE Novel pericardial adipose tissue imaging biomarkers are currently under investigation for cardiovascular risk stratification. However, a specific compartment of the epicardial adipose tissue (EAT), lipomatous hypertrophy of the interatrial septum (LHIS), is included in the pericardial fat volume (PCFV) quantification software. Our aim was to evaluate LHIS by computed tomography angiography (CTA), to elaborate differences to other pericardial adipose tissue components (EAT) and paracardial adipose tissue (PAT), and to compare CT with [18F]FDG-PET. MATERIALS AND METHODS Of 6983 patients screened who underwent coronary CTA for clinical indications, 190 patients with LHIS were finally included (age 62.8 years ± 9.6, 31.6% females, BMI 28.5 kg/cm2 ± 4.7) in our retrospective cohort study. CT images were quantified for LHIS, EAT, and PAT density (HU), and total PCFV, with and without LHIS, was calculated. CT was compared with [18F]FDG-PET if available. RESULTS CT-density of LHIS was higher (- 22.4 HU ± 22.8) than all other pericardial adipose tissue components: EAT right and left (97.4 HU ± 13 and - 95.1 HU ± 13) PAT right and left (- 107.5 HU ± 13.4 and - 106.3 HU ± 14.5) and PCFV density -83.3 HU ± 5.6 (p < 0.001). There was a mild association between LHIS and PAT right (Beta 0.338, p = 0.006, 95% CI: 0.098-577) and PAT left (Beta 0.249, p = 0.030; 95% CI: 0.024-0.474) but not EAT right (p = 0.325) and left (p = 0.351), and not with total PCFV density (p = 0.164). The segmented LHIS volume comprised 3.01% of the total PCFV, and 4.3% (range, 2.16-11.7%) in those with LHIS > 9 mm. [18F]FDG-PET: LHIS was tracer uptake positive in 83.3% (37.5%: mild and 45.8%: minimal) of 24 patients. CONCLUSIONS LHIS is a distinct compartment of PCFV with higher density suggesting brown fat and has no consistent association with EAT, but rather with PAT. CLINICAL RELEVANCE STATEMENT LHIS should be recognized as a distinct compartment of the EAT, when using EAT for cardiovascular risk stratification. KEY POINTS LHIS is currently included in EAT quantification software. LHIS density is relatively high, it is not associated with EAT, and has a high [18F]FDG-PET positive rate suggesting brown fat. LHIS is a distinct compartment of the EAT, and it may act differently as an imaging biomarker for cardiovascular risk stratification.
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Affiliation(s)
- Pietro G Lacaita
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Senoner
- Department of Anaesthesiology and Intensive Care, Medical University Innsbruck, Innsbruck, Austria
| | - Valentin Bilgeri
- Department of Internal Medicine, Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Rauch
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Barbieri
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Benedikt Kindl
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Plank
- Department of Internal Medicine, Tyrol Clinicum Hall, Hall, Austria
| | - Wolfgang Dichtl
- Department of Internal Medicine, Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gudrun M Feuchtner
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
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Lin D, Lu Y, Qiu B, Feng M, Luo Y, Xue F, Zhou T, Zhu J, Zhang J, Wang L, Xia Q, Wan P. The therapeutic effect of liver transplantation in 14 children with homozygous familial hypercholesterolemia: a prospective cohort: Liver transplant for familial hypercholesterolemia. J Clin Lipidol 2024:S1933-2874(24)00235-6. [PMID: 39294020 DOI: 10.1016/j.jacl.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 07/19/2024] [Accepted: 08/23/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVES Homozygous familial hypercholesterolemia (HoFH) is characterized by elevated low-density lipoprotein cholesterol (LDL-C) and early-onset cardiovascular disease. To assess the therapeutic effects of liver transplantation (LT) on HoFH patients, we observed and analyzed the outcomes of HoFH children after LT. STUDY DESIGN This prospective cohort study included all LT candidates under 18 years old diagnosed with HoFH at Ren Ji Hospital between November 2017 and July 2021. The patients were followed until October 2023. They were treated according to the standard protocol at our center. We collected data on changes in lipid profiles, clinical manifestations, and cardiovascular complications at different time points, and recorded postoperative recipient and graft survival. RESULTS Fourteen HoFH patients with a median age of 7 (2-12) years were included. Preoperatively, xanthomas and arcus corneas occurred in 14 and 3 patients, respectively, with 10 patients showing mild cardiovascular disease. All patients underwent LT. Recipient and graft survival rates were 100 % over a median follow-up duration of 35 (27-71) months. Median LDL-C levels dropped from 11.83 (7.99-26.14) mmol/L preoperatively to 2.3 (1.49-3.39) mmol/L postoperative at the last measurement. Thirteen patients discontinued lipid-lowering treatment after LT, while only one patient resumed statins 6 months post-operation. Xanthomas and arcus corneas significantly improved. Cardiovascular complications regressed in five patients, with no progression observed in the others. CONCLUSIONS LT is a safe and effective treatment for severe HoFH patients beyond lipid-lowering control. Early LT improves prognosis and quality of life while minimizing the risk of cardiovascular complications.
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Affiliation(s)
- Dongni Lin
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Yefeng Lu
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Bijun Qiu
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Mingxuan Feng
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Yi Luo
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Feng Xue
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Tao Zhou
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jianjun Zhu
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jianjun Zhang
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
| | - Lvya Wang
- Beijing Institute of Heart Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China; Department of Cardiology, Beijing Anzhen Hospital Affiliated with Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
| | - Qiang Xia
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China; Shanghai Institute of Organ Transplantation, 1630 Dongfang Road, Shanghai, 200127, China; Shanghai Research Center of Organ Transplantation & Immune Engineering Technology, 1630 Dongfang Road, Shanghai, 200127, China.
| | - Ping Wan
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China.
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Di Fiore V, Del Punta L, De Biase N, Pellicori P, Gargani L, Dini FL, Armenia S, Li Vigni M, Maremmani D, Masi S, Taddei S, Pugliese NR. Integrative assessment of congestion in heart failure using ultrasound imaging. Intern Emerg Med 2024:10.1007/s11739-024-03755-9. [PMID: 39235709 DOI: 10.1007/s11739-024-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/24/2024] [Indexed: 09/06/2024]
Abstract
In heart failure (HF), congestion is a key pathophysiologic hallmark and a major contributor to morbidity and mortality. However, the presence of congestion is often overlooked in both acute and chronic settings, particularly when it is not clinically evident, which can have important clinical consequences. Ultrasound (US) is a widely available, non-invasive, sensitive tool that might enable clinicians to detect and quantify the presence of (subclinical) congestion in different organs and tissues and guide therapeutic strategies. In particular, left ventricular filling pressures and pulmonary pressures can be estimated using transthoracic echocardiography; extravascular lung water accumulation can be evaluated by lung US; finally, systemic venous congestion can be assessed at the level of the inferior vena cava or internal jugular vein. The Doppler evaluation of renal, hepatic and portal venous flow can provide additional valuable information. This review aims to describe US techniques allowing multi-organ evaluation of congestion, underlining their role in detecting, monitoring, and treating volume overload more objectively.
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Affiliation(s)
- Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Luna Gargani
- Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Frank Lloyd Dini
- Istituto Auxologico IRCCS, Centro Medico Sant'Agostino, Via Temperanza, 6, 20127, Milan, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Myriam Li Vigni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Davide Maremmani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy.
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Wei J, Hou S, Hei P, Wang G. Thyroid dysfunction and sarcopenia: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1378757. [PMID: 39301320 PMCID: PMC11410624 DOI: 10.3389/fendo.2024.1378757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024] Open
Abstract
Objective Observational studies have shown positive associations between thyroid dysfunction and risk of sarcopenia. However, the causality of this association remains unknown. This study aimed to evaluate the potential causal relationship between thyroid dysfunction and sarcopenia using Mendelian randomization (MR). Methods This study collected pooled data from genome-wide association studies focusing on thyroid dysfunction and three sarcopenia-related features: low hand grip strength, appendicular lean mass (ALM), and walking pace, all in individuals of European ancestry. The primary analytical method used was inverse-variance weighted, with weighted median and MR-Egger serving as complementary methods to assess causal effects. Heterogeneity and pleiotropy tests were also performed, and the stability of the results was evaluated using the Leave-one-out. Results The MR analysis indicated that hyperthyroidism could lead to a significant decrease in ALM in the extremities (OR = 1.03; 95% CI = 1.02 to 1.05; P < 0.001). The analysis also found that hypothyroidism could cause a notable reduction in grip strength (OR = 2.03; 95% CI = 1.37 to 3.01; P < 0.001) and walking pace (OR = 0.83; 95% CI = 0.77 to 0.90; P < 0.001). There was a significant association between subclinical hyperthyroidism and a reduced walking pace (OR = 1.00; 95% CI = 0.99 to 1.00; P = 0.041). Conclusion This study provides evidence that hyperthyroidism, hypothyroidism, and subclinical hyperthyroidism can all increase the risk of sarcopenia.
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Affiliation(s)
- Jiaxin Wei
- Department of Sport Rehabilitation, School of Graduate, Xi'an Physical Education University, Xi'an, Shaanxi, China
| | - Shuanglong Hou
- Department of Sport Rehabilitation, School of Graduate, Xi'an Physical Education University, Xi'an, Shaanxi, China
| | - Peng Hei
- Department of Sport Rehabilitation, School of Graduate, Xi'an Physical Education University, Xi'an, Shaanxi, China
| | - Gang Wang
- School of Sports and Health Science, Xi'an Physical Education University, Xi'an, Shaanxi, China
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141
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Xu D, Shen R, Hu M, Fan Q, Wu J. Prognostic impact of CONUT score in older patients with chronic heart failure. BMC Geriatr 2024; 24:738. [PMID: 39237869 PMCID: PMC11378522 DOI: 10.1186/s12877-024-05330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Malnutrition is common in older patients with chronic heart failure (HF) and often accompanies a deterioration of their condition. The Controlling Nutritional Status (CONUT) score is used as an objective indicator to evaluate nutritional status, but relevant research in this area is limited. This study aimed to report the prevalence, clinical correlates, and outcomes of malnutrition in elder patients hospitalized with chronic HF. METHODS A retrospective analysis was conducted on 165 eligible patients admitted to the Department of Cardiology at Huadong Hospital from January 2021 to December 2022. Patients were categorized based on their CONUT score into three groups: normal nutrition status, mild risk of malnutrition, and moderate to severe risk of malnutrition. The study examined the nutritional status of this population and its relationship with clinical outcomes. RESULTS Findings revealed that malnutrition affected 82% of the older patients, with 28% experiencing moderate to severe risk. Poor nutritional scores were significantly associated with prolonged hospital stay, increased in-hospital mortality and all-cause mortality during readmissions within one year (P < 0.05). The multivariable analysis indicated that moderate to severe malnutrition (CONUT score of 5-12) was significantly associated with a heightened risk of prolonged hospitalization (aOR: 9.17, 95%CI: 2.02-41.7). CONCLUSIONS Malnutrition, as determined by the CONUT score, is a common issue among HF patients. Utilizing the CONUT score upon admission can effectively predict the potential for prolonged hospital stays.
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Affiliation(s)
- Danfeng Xu
- Department of Clinical Nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Renrui Shen
- Department of Clinical Nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
- Division of Medicine, University College London, London, UK
| | - Ming Hu
- Department of Clinical Nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Qing Fan
- Department of Clinical Nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Jiang Wu
- Department of Clinical Nutrition, Huadong Hospital affiliated to Fudan University, Shanghai, China.
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Telesca M, De Angelis A, Donniacuo M, Bellocchio G, Riemma MA, Mele E, Canonico F, Cianflone E, Torella D, D'Amario D, Patti G, Liantonio A, Imbrici P, De Luca A, Castaldo G, Rossi F, Cappetta D, Urbanek K, Berrino L. Effects of sacubitril-valsartan on aging-related cardiac dysfunction. Eur J Pharmacol 2024; 978:176794. [PMID: 38968980 DOI: 10.1016/j.ejphar.2024.176794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
Heart failure (HF) remains a huge medical burden worldwide, with aging representing a major risk factor. Here, we report the effects of sacubitril/valsartan, an approved drug for HF with reduced EF, in an experimental model of aging-related HF with preserved ejection fraction (HFpEF). Eighteen-month-old female Fisher 344 rats were treated for 12 weeks with sacubitril/valsartan (60 mg/kg/day) or with valsartan (30 mg/kg/day). Three-month-old rats were used as control. No differential action of sacubitril/valsartan versus valsartan alone, either positive or negative, was observed. The positive effects of both sacubitril/valsartan and valsartan on cardiac hypertrophy was evidenced by a significant reduction of wall thickness and myocyte cross-sectional area. Contrarily, myocardial fibrosis in aging heart was not reduced by any treatment. Doppler echocardiography and left ventricular catheterization evidenced diastolic dysfunction in untreated and treated old rats. In aging rats, both classical and non-classical renin-angiotensin-aldosterone system (RAAS) were modulated. In particular, with respect to untreated animals, both sacubitril/valsartan and valsartan showed a partial restoration of cardioprotective non-classical RAAS. In conclusion, this study evidenced the favorable effects, by both treatments, on age-related cardiac hypertrophy. The attenuation of cardiomyocyte size and hypertrophic response may be linked to a shift towards cardioprotective RAAS signaling. However, diastolic dysfunction and cardiac fibrosis persisted despite of treatment and were accompanied by myocardial inflammation, endothelial activation, and oxidative stress.
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Affiliation(s)
- Marialucia Telesca
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Antonella De Angelis
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Maria Donniacuo
- Department of Experimental Medicine, University of Salento, Via Lecce-Monteroni, 73047, Lecce, Italy
| | - Gabriella Bellocchio
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Maria Antonietta Riemma
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Elena Mele
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Francesco Canonico
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Eleonora Cianflone
- Department of Medical and Surgical Sciences, Magna Graecia University, Viale Europa, 88100, Catanzaro, Italy
| | - Daniele Torella
- Department of Experimental and Clinical Medicine, Magna Graecia University, 88100, Catanzaro, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, via Solaroli, 17, 28100, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, via Solaroli, 17, 28100, Novara, Italy
| | - Antonella Liantonio
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Via Orabona 4, 70125, Bari, Italy
| | - Paola Imbrici
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Via Orabona 4, 70125, Bari, Italy
| | - Annamaria De Luca
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Via Orabona 4, 70125, Bari, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Via A. Pansini 5, 80131, Naples, Italy; CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80131, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
| | - Donato Cappetta
- Department of Experimental Medicine, University of Salento, Via Lecce-Monteroni, 73047, Lecce, Italy.
| | - Konrad Urbanek
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Via A. Pansini 5, 80131, Naples, Italy; CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80131, Naples, Italy
| | - Liberato Berrino
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
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Cirin L, Crișan S, Luca CT, Buzaș R, Lighezan DF, Văcărescu C, Cozgarea A, Tudoran C, Cozma D. Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function. J Clin Med 2024; 13:5265. [PMID: 39274478 PMCID: PMC11396218 DOI: 10.3390/jcm13175265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/24/2024] [Accepted: 09/03/2024] [Indexed: 09/16/2024] Open
Abstract
Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing.
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Affiliation(s)
- Liviu Cirin
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Simina Crișan
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Roxana Buzaș
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniel Florin Lighezan
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cristina Văcărescu
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Andreea Cozgarea
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- County Emergency Hospital "Pius Brinzeu", L. Rebreanu, Nr. 156, 300723 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of the University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
| | - Dragoș Cozma
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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Roccabruna A, Fortuni F, Comuzzi A, Armani I, Bolzan B, Franchi E, Piccoli A, Benfari G, Morani G, Tomasi L, Ribichini FL, Mugnai G. Right ventricular-pulmonary artery coupling in patients undergoing cardiac resynchronization therapy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03233-5. [PMID: 39235726 DOI: 10.1007/s10554-024-03233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION The ratio between tricuspid annular plane systolic excursion (TAPSE) and estimated pulmonary artery systolic pressure (PASP) has been shown to be a reliable, non-invasive surrogate of the right ventricular-pulmonary artery (RV-PA) coupling. The present study analysed the association between TAPSE/PASP and response to cardiac resynchronization therapy (CRT) and the prognostic role of RV-PA in patients undergoing CRT implantation. The primary endpoints were: the association between baseline TAPSE/PASP and CRT response/cardiovascular and all-cause death. METHODS AND RESULTS All patients having undergone CRT implantation in our Center from 2016 to 2020 were included in our retrospective analysis. The RV-PA coupling was assessed by echocardiography at baseline and 1 year follow up in CRT recipients. The cut-off value of TAPSE/PASP resulted from ROC curve analysis (i.e.<0.33 mm/mmHg). A total of 229 patients (age 69.9 ± 10.1 years; 77.7% men) were included. During a mean follow-up of 44.2 ± 17.9 months, 40 (17.5%) patients died. The baseline value of TAPSE/PASP was not significantly associated with CRT response. Patients with a more impaired TAPSE/PASP ratio had significantly worse survival rates. On multivariate Cox regression, only TAPSE/PASP ratio and estimated glomerular filtration rate were independently associated with all-cause death. Finally, the TAPSE/PASP ratio significantly increased after CRT implantation in the group of "responders" whereas it did not change in 'non-responders'. CONCLUSIONS The baseline value of TAPSE/PASP ratio was not associated with CRT response. However, the TAPSE/PASP ratio was a strong predictor of both all-cause and cardiovascular death in CRT recipients.
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Affiliation(s)
- Alessandra Roccabruna
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
| | - Alberto Comuzzi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Ilaria Armani
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Elena Franchi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Anna Piccoli
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giovanni Benfari
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giovanni Morani
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
- Department of Cardiology, Ospedale Santorso, Santorso, VI, Italy
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Giacomo Mugnai
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
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145
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Cox E, Faria R, Saramago P, Haralambos K, Watson M, Humphries SE, Qureshi N, Woods B. Challenges and opportunities for identifying people with Familial hypercholesterolaemia in the UK: Evidence from the National FH PASS database. J Clin Lipidol 2024:S1933-2874(24)00234-4. [PMID: 39317596 DOI: 10.1016/j.jacl.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/02/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Familial Hypercholesterolaemia (FH) is a monogenic disorder that causes high levels of low-density lipoprotein (LDL) cholesterol. Cascade testing, where relatives of known individuals with FH ('index') are genetically tested, is effective and cost-effective, but implementation in the UK varies. OBJECTIVE This study aims to provide evidence on current UK FH cascade yields and to identify common obstacles cascade services face and individual- and service-level predictors of success. METHODS Electronic health records from 875 index families and 5,958 linked relatives in the UK's Welsh and Wessex FH services (2019) were used to explore causes for non-testing and to estimate testing rates, detection yields, and how relative characteristics and contact methods relate to the probability of relatives being tested (using logistic regression). RESULTS In Wales (Wessex), families included 7.35 (7.01) members on average, with 2.41 (1.66) relatives tested and 1.35 (0.96) diagnosed with FH per index. Cascade testing is limited by individualised circumstances (too young, not at-risk, etc.) and FH services' reach, with approximately one in four relatives out-of-area. In Wales, first-degree relatives (odds ratio (OR):1.55 [95 % confidence interval (CI):1.28,1.88]) and directly contacted relatives (OR:2.11 [CI:1.66,2.69]) were more likely to be tested. In Wales and Wessex, women were more likely to be tested than men (ORs:1.53 [CI:1.28,1.85] and 1.74 [CI:1.32,2.27]). CONCLUSION In Wales and Wessex less than a third of relatives of an index are tested for FH. Improvements are likely possible by integrating geographically dispersed families into cascade testing, services directly contacting relatives where possible, and finding new ways to encourage participation, particularly amongst men.
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Affiliation(s)
- Edward Cox
- Centre for Health Economics, University of York, UK, YO10 5DD; Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK, NG7 2RD.
| | - Rita Faria
- Centre for Health Economics, University of York, UK, YO10 5DD
| | - Pedro Saramago
- Centre for Health Economics, University of York, UK, YO10 5DD
| | - Kate Haralambos
- Wales Familial Hypercholesterolaemia (FH) Service, Monmouth House, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW
| | - Melanie Watson
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Rayne Building, 5 University Street, University College London, London WC1E 6JJ
| | - Nadeem Qureshi
- Primary Care Stratified Medicine Research Group, University of Nottingham, Nottingham, UK
| | - Beth Woods
- Centre for Health Economics, University of York, UK, YO10 5DD
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146
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Greene SJ, Böhm M, Bozkurt B, Butler J, Cleland JG, Coats AJ, Desai NR, Grobbee DE, Kelepouris E, Pinto F, Rosano G, Morin I, Szecsödy P, Fabien S, Waechter S, Crespo-Leiro MG, Hülsmann M, Kempf T, Pfister O, Pouleur AC, Sauer AJ, Saxena M, Schulz M, Volterrani M, Anker SD, Kosiborod MN. Cardiovascular and Renal Treatment in Heart Failure Patients with Hyperkalemia or High Risk of Hyperkalemia: Rationale and Design of the CARE-HK in HF Registry. J Card Fail 2024:S1071-9164(24)00368-3. [PMID: 39277029 DOI: 10.1016/j.cardfail.2024.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/07/2024] [Accepted: 08/26/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Despite guideline recommendations, many patients with heart failure (HF) do not receive target doses of renin-angiotensin-aldosterone system inhibitors (RAASis) in clinical practice due, in part, to concerns about hyperkalemia (HK). METHODS AND RESULTS This non-interventional, multinational, multicenter registry (NCT04864795; 111 sites in Europe and the USA) enrolled 2,558 eligible adults with chronic HF (mostly with reduced ejection fraction [HFrEF]). Eligibility criteria included use of angiotensin-converting-enzyme inhibitor / angiotensin-II receptor blocker / angiotensin-receptor-neprilysin inhibitor, candidate for or treatment with mineralocorticoid receptor antagonist, and increased risk of HK (eg, current serum potassium >5.0 mmol/L], history of HK in the previous 24 months, or estimated glomerular filtration rate <45 mL/min/1.73 m2). Information on RAASi and other guideline-recommended therapies was collected retrospectively and prospectively (≥6 months). Patients were followed according to local clinical practice, without study-specific visits or interventions. The main objectives were to characterize RAASi treatment patterns compared with guideline recommendations, describe RAASi modifications following episodes of HK, and describe RAASi treatment in patients treated with patiromer. Baseline characteristics for the first 1,000 patients are presented. CONCLUSIONS CARE-HK is a multinational prospective HF registry designed to report on the management and outcomes of patients with HF at high risk for HK in routine clinical practice.
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Affiliation(s)
- Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC; USA and Duke Clinical Research Institute, Durham, NC, USA.
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg (Saar), Germany
| | - Biykem Bozkurt
- Winters Center for Heart Failure Research, Baylor College of Medicine, Cardiovascular Research Institute, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; University of Mississippi Medical Center, Jackson, MS, USA
| | - John Gf Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ellie Kelepouris
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, PA, USA
| | - Fausto Pinto
- Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte - EPE, Centro Académico Medicina de Lisboa, Lisboa, Portugal
| | - Giuseppe Rosano
- Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy; Cardiology, San Raffaele Cassino Hospital, Cassino, Italy; Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | | | | | | | | | - Maria G Crespo-Leiro
- Cardiology Department, Hospital Universitario A Coruna (CHUAC), Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto Investigación Biomedica A Coruña (INIBIC) University of A Coruña (UDC), A Coruna, Spain
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medizinische Universität Wien, Vienna, Austria
| | - Tibor Kempf
- Department of Cardiology & Angiology, Hannover Medical School, Hannover, Germany
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Andrew J Sauer
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; Department of Cardiology, The Healthcare Institute for Innovations in Quality (HI-IQ) at the University of Missouri-Kansas City, Kansas City, MO, USA
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Martin Schulz
- Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany; Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Maurizio Volterrani
- Cardio-Pulmonary Department, IRCCS San Raffaele Roma, Rome, Italy; Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin, Berlin, Germany
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri, Kansas City, MO, USA
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Vroomen M, Franke U, Senges J, Friedrich I, Fischlein T, Lewalter T, Ouarrak T, Niemann B, Liebold A, Hanke T, Doll N, Albert M. Outcomes of surgical ablation for atrial fibrillation in on- versus off-pump coronary artery bypass grafting. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae139. [PMID: 39120119 PMCID: PMC11401745 DOI: 10.1093/icvts/ivae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/10/2024] [Accepted: 08/06/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES A considerable number of patients undergoing coronary artery bypass grafting surgery suffer from atrial fibrillation and should be treated concomitantly. This manuscript evaluates the impact of on-pump versus off-pump bypass grafting on the applied lesion set and rhythm outcome. METHODS Between January 2017 and April 2020, patients who underwent combined bypass grafting and surgical ablation for atrial fibrillation were consecutively enrolled in the German CArdioSurgEry Atrial Fibrillation registry (CASE-AF, 17 centres). Data were prospectively collected. Follow-up was planned after one year. RESULTS A total of 224 patients were enrolled. No differences in baseline characteristics were seen between on- and off-pump bypass grafting, especially not in type of atrial fibrillation and left atrial size. In the on-pump group (n = 171, 76%), pulmonary vein isolation and an extended left atrial lesion set were performed more often compared to off-pump bypass grafting (58% vs 26%, 33 vs 9%, respectively, P < 0.001). In off-pump bypass grafting a box isolating the atrial posterior wall was the dominant lesion (72% off-pump vs 42% on-pump, P < 0.001). Left atrial appendage management was comparable in on-pump versus off-pump bypass grafting (94% vs 91%, P = 0.37). Sinus rhythm at follow-up was confirmed in 61% in the on-pump group and in 65% in the off-pump group (P = 0.66). No differences were seen in in-hospital or follow-up complication-rates between the two groups. CONCLUSIONS In coronary artery bypass grafting patients undergoing concomitant atrial fibrillation ablation, our data suggests that the technique applied for myocardial revascularization (off-pump vs on-pump) leads to differences in the ablation lesion set, but not in safety and effectiveness.
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Affiliation(s)
- Mindy Vroomen
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Ulrich Franke
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Ivar Friedrich
- Department of Cardiothoracic Surgery, Herzzentrum Trier, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg-Paracelsus Medical University, Nürnberg, Germany
| | - Thorsten Lewalter
- Peter Osypka Herzzentrum, Internistisches Klinikum München Süd, München, Germany
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Bernd Niemann
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Justus-Liebig-Universität, Gießen, Germany
| | - Andreas Liebold
- Department of Cardiothoracic and Vascular Surgery, Ulm University Hospital, Ulm, Germany
| | - Thorsten Hanke
- Department for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Nicolas Doll
- Department of Cardiac Surgery, Schuechtermann-Klinik, Bad Rothenfelde, Germany
| | - Marc Albert
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
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Chalitsios CV, Ley H, Gao J, Turner MR, Thompson AG. Apolipoproteins, lipids, lipid-lowering drugs and risk of amyotrophic lateral sclerosis and frontotemporal dementia: a meta-analysis and Mendelian randomisation study. J Neurol 2024:10.1007/s00415-024-12665-x. [PMID: 39230722 DOI: 10.1007/s00415-024-12665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) have clinical, pathological and genetic overlapping. Lipid pathways are implicated in ALS. This study examined the effect of blood lipid levels on ALS, FTD risk, and survival in ALS. METHODS A systematic review and meta-analysis of high and low-density lipoprotein cholesterol (HDL-c and LDL-c), total cholesterol, triglycerides, apolipoproteins B and A1 levels with ALS was performed. Two-sample Mendelian randomisation (MR) analysis sought the causal effects of these exposures on ALS, FTD, and survival in ALS. The effect of lipid-lowering drugs was also examined using genetic proxies for targets of lipid-lowering medications. RESULTS Three cohort studies met the inclusion criteria for meta-analysis. Meta-analysis indicated an association between higher LDL-c (HRper mmol/L = 1.07, 95%CI:1.02-1.12;I 2 =18%) and lower HDL-c (HRper mmol/L = 0.83, 95%CI:0.74-0.94;I 2 =0%) with an increased risk of ALS. MR suggested causal effects of higher LDL-c (ORIVW = 1.085, 95%:CI 1.008-1.168, pFDR = 0.0406), total cholesterol (ORIVW = 1.081, 95%:CI 1.013-1.154, pFDR = 0.0458) and apolipoprotein B (ORIVW = 1.104, 95%:CI 1.041-1.171, pFDR = 0.0061) increasing ALS risk, and higher apolipoprotein B level increasing FTD risk (ORIVW = 1.424, 95%CI 1.072-1.829, pFDR = 0.0382). Reducing LDL-c through APOB inhibition was associated with lower ALS (ORIVW = 0.84, 95%CI 0.759-0.929, pFDR = 0.00275) and FTD risk (ORIVW = 0.581, 95%CI 0.387-0.874, pFDR = 0.0362). CONCLUSION These data support the influence of LDL-c and total cholesterol on ALS risk and apolipoprotein B on the risk of ALS and FTD. Potential APOB inhibition might decrease the risk of sporadic ALS and FTD. Further work in monogenic forms of ALS and FTD is necessary to determine whether blood lipids influence penetrance and phenotype.
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Affiliation(s)
- Christos V Chalitsios
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6, West Wing, Oxford, OX3 9DU, UK
| | - Harriet Ley
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6, West Wing, Oxford, OX3 9DU, UK
| | - Jiali Gao
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6, West Wing, Oxford, OX3 9DU, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6, West Wing, Oxford, OX3 9DU, UK
| | - Alexander G Thompson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Level 6, West Wing, Oxford, OX3 9DU, UK.
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149
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Ramesh J, Selvarajan S, Krishnamurthy S, Kopula Sathyamoorthy S, Senthil Kumar D. Evaluation of 13 Formulae for Calculated LDL-C Using Direct Homogenous Assay in a South Indian Population. J Appl Lab Med 2024; 9:963-977. [PMID: 38809754 DOI: 10.1093/jalm/jfae048] [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: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND LDL cholesterol (LDL-C) is regarded as a significant therapeutic target and a known risk factor for atherosclerosis. It can be calculated using the results of the other lipid tests or tested directly. Despite its shortcomings, the Friedewald formula is most frequently utilized since it is simple and practical. Until now, several formulae have been proposed for calculating LDL-C; however, their accuracy has not been evaluated across different populations. We sought to evaluate the validity of calculated LDL-C by comparing the findings with values acquired by the direct homogeneous technique, utilizing 13 distinct formulae from the literature. METHODS This study was a retrospective observational study conducted for a year at SRIHER, Chennai, Tamil Nadu, India. From the total 25 043 patients who had their serum lipid profile tested, 16 314 participants had their fasting blood sugar and fasting lipid profile measured simultaneously, and they were chosen for the research. RESULTS The de Cordova, Chen, Martin/Hopkins (initial), and Teerakanchana equations correlated well with the direct LDL-C assay. When the dataset was stratified according to triglycerides, the Chen and Martin/Hopkins initial equations had the better measurement of agreement compared to other equations. The Martin/Hopkins initial equation outperformed all the other equations when the whole dataset irrespective of the triglyceride population was considered. CONCLUSIONS Our study suggests that the Martin/Hopkins initial equation outperformed all the other equations and can be used as an alternative to direct LDL-C measurement in a South Indian population.
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Affiliation(s)
- Janani Ramesh
- ESIC Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Sathya Selvarajan
- Department of Laboratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sowmya Krishnamurthy
- Department of Biochemistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sridharan Kopula Sathyamoorthy
- Department of Laboratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Dhivya Senthil Kumar
- Department of Laboratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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150
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Cao J, Donato L, El-Khoury JM, Goldberg A, Meeusen JW, Remaley AT. ADLM Guidance Document on the Measurement and Reporting of Lipids and Lipoproteins. J Appl Lab Med 2024; 9:1040-1056. [PMID: 39225455 DOI: 10.1093/jalm/jfae057] [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: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The accurate measurement of blood lipids and lipoproteins is crucial for the clinical management of atherosclerotic disease risk. Despite progress in standardization, there are still significant variations in pre-analytical requirements, methods, nomenclature, and reporting work flows. CONTENT The guidance document aims to improve standardization of clinical lipid testing work flows. It provides recommendations for the components of the lipid panel, fasting requirements, reporting of results, and specific recommendations for non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], apolipoprotein B (apo B), point-of-care lipid testing, and LDL subfraction testing. SUMMARY Lipid panels should always report non-HDL-C and LDL-C calculations if possible. Fasting is not routinely required except in specific cases. Modern equations should be utilized for LDL-C calculation. These equations allow for LDL-C reporting at elevated concentrations of triglycerides and obviate the need for direct measured LDL-C in most cases.
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Affiliation(s)
- Jing Cao
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Leslie Donato
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Anne Goldberg
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey W Meeusen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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