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Wu A, Coresh J, Selvin E, Tanaka H, Heiss G, Hirsch AT, Jaar BG, Matsushita K. Lower Extremity Peripheral Artery Disease and Quality of Life Among Older Individuals in the Community. J Am Heart Assoc 2017; 6:JAHA.116.004519. [PMID: 28108464 PMCID: PMC5523635 DOI: 10.1161/jaha.116.004519] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Evidence regarding the association of lower extremity peripheral arterial disease with quality of life (QOL) is mainly from selected clinical populations or relatively small clinical cohorts. Thus, we investigated this association in community‐derived populations. Methods and Results Using data of 5115 participants aged 66 to 90 years from visit 5 (2011‐2013) of the Atherosclerosis Risk in Communities Study, we quantified the associations of ankle‐brachial index (ABI) with several QOL parameters, including 12‐item Short‐Form Health Survey (SF‐12), after accounting for potential confounders using linear and logistic regression models. Peripheral arterial disease defined by an ABI <0.90 (n=402), was independently associated with a low SF‐12 Physical Component Summary score (−3.26 [95% CI −5.60 to −0.92]), compared to the ABI reference 1.10 to 1.19 (n=1900) but not with the Mental Component Summary score (−0.07 [−2.21 to 2.06]). A low ABI was significantly associated with poorer status of all SF‐12 physical domains (physical functioning, role‐physical, bodily pain, and general health) but only vitality out of 4 mental domains. Similarly, low ABI values were more consistently associated with other physically related QOL parameters (leisure‐time exercise/activity/walking) than mentally related parameters (significant depressive symptoms and hopeless feeling). Lower physical QOL was observed even in individuals with borderline low ABI (0.90 to 0.99; n=426). Conclusions Low ABI (even borderline) was independently associated with poor QOL, especially for physical components, in community‐dwelling older adults. QOL is a critical element for older adults, and thus, further studies are warranted to assess whether peripheral arterial disease‐specific management can improve QOL in older populations.
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Affiliation(s)
- Aozhou Wu
- Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Alan T Hirsch
- University of Minnesota Medical School and Lillehei Heart Institute, Minneapolis, MN
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Predictors of Cardiac Rehabilitation Initiation and Adherence in a Multiracial Urban Population. J Cardiopulm Rehabil Prev 2017; 37:30-38. [DOI: 10.1097/hcr.0000000000000226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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103
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Stam-Slob MC, Visseren FLJ, Wouter Jukema J, van der Graaf Y, Poulter NR, Gupta A, Sattar N, Macfarlane PW, Kearney PM, de Craen AJM, Trompet S. Personalized absolute benefit of statin treatment for primary or secondary prevention of vascular disease in individual elderly patients. Clin Res Cardiol 2017; 106:58-68. [PMID: 27554244 PMCID: PMC5226996 DOI: 10.1007/s00392-016-1023-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/25/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To estimate the absolute treatment effect of statin therapy on major adverse cardiovascular events (MACE; myocardial infarction, stroke and vascular death) for the individual patient aged ≥70 years. METHODS Prediction models for MACE were derived in patients aged ≥70 years with (n = 2550) and without (n = 3253) vascular disease from the "PROspective Study of Pravastatin in Elderly at Risk" (PROSPER) trial and validated in the "Secondary Manifestations of ARTerial disease" (SMART) cohort study (n = 1442) and the "Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm" (ASCOT-LLA) trial (n = 1893), respectively, using competing risk analysis. Prespecified predictors were various clinical characteristics including statin treatment. Individual absolute risk reductions (ARRs) for MACE in 5 and 10 years were estimated by subtracting on-treatment from off-treatment risk. RESULTS Individual ARRs were higher in elderly patients with vascular disease [5-year ARRs: median 5.1 %, interquartile range (IQR) 4.0-6.2 %, 10-year ARRs: median 7.8 %, IQR 6.8-8.6 %] than in patients without vascular disease (5-year ARRs: median 1.7 %, IQR 1.3-2.1 %, 10-year ARRs: 2.9 %, IQR 2.3-3.6 %). Ninety-eight percent of patients with vascular disease had a 5-year ARR ≥2.0 %, compared to 31 % of patients without vascular disease. CONCLUSIONS With a multivariable prediction model the absolute treatment effect of a statin on MACE for individual elderly patients with and without vascular disease can be quantified. Because of high ARRs, treating all patients is more beneficial than prediction-based treatment for secondary prevention of MACE. For primary prevention of MACE, the prediction model can be used to identify those patients who benefit meaningfully from statin therapy.
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Affiliation(s)
- Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- University Medical Center Utrecht, F02.224, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Neil R Poulter
- Department of Vascular Medicine, ICCH, Imperial College London, White City, London, W12 0NN, UK
| | - Ajay Gupta
- Department of Vascular Medicine, ICCH, Imperial College London, White City, London, W12 0NN, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - Peter W Macfarlane
- Institute of Cardiovascular and Medical Sciences, Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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104
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Rocca B, Husted S. Safety of Antithrombotic Agents in Elderly Patients with Acute Coronary Syndromes. Drugs Aging 2016; 33:233-48. [PMID: 26941087 DOI: 10.1007/s40266-016-0359-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There are unique challenges in the treatment and prevention of acute coronary syndromes (ACS) with antithrombotics in elderly patients: elderly patients usually require multiple drugs due to comorbidities, are highly susceptible to adverse drug reactions and drug-drug interactions, may have cognitive problems affecting compliance and complications, are especially exposed to the risk of falls and, most importantly, ageing is an independent risk factor for bleeding. Antithrombotic drugs, alone or in association, further and variously amplify age-related bleeding risk. Moreover, age-related changes in primary haemostasis may potentially affect the pharmacodynamics of some antiplatelet drugs. Thus, elderly subjects might be more or less sensitive to standard antiplatelet regimens depending on individual characteristics affecting antiplatelet drug response. Importantly, elderly patients are a rapidly growing population worldwide, have the highest incidence of ACS, but are poorly represented in clinical trials. As a consequence, evidence on antithrombotic drug benefits and risks is limited. Thus, in the real-world setting, older people are often denied antithrombotic drugs because of unjustified concerns, or might be over-treated and exposed to excessive bleeding risk. Personalized antithrombotic therapy in elderly patients is particularly critical, to minimize risks without affecting efficacy.
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Affiliation(s)
- Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Largo F.Vito 1, 00168, Rome, Italy.
| | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro and Institute of Biomedicine, Aarhus University, Aarhus, Denmark
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Christle JW, Schlumberger A, Haller B, Gloeckl R, Halle M, Pressler A. Individualized vs. group exercise in improving quality of life and physical activity in patients with cardiac disease and low exercise capacity: results from the DOPPELHERZ trial. Disabil Rehabil 2016; 39:2566-2571. [DOI: 10.1080/09638288.2016.1242174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeffrey Wilcox Christle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Anna Schlumberger
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - Bernhard Haller
- Klinikum rechts der Isar, Technische Universitat Munchen, Institute of Medical Statistics and Epidemiology, Munich, Germany
| | - Rainer Gloeckl
- Department of Respiratory Medicine & Pulmonary Rehabilitation, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
- Partner Site Munich Heart Alliance, DZHK (German Center for Cardiovascular Research), Munich, Germany
- Klinkum rechts der Isar, Else-Kroener-Fresenius-Zentrum, Munich, Germany
| | - Axel Pressler
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
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Ji MS, Jeong MH, Ahn YK, Kim SH, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ. Clinical outcome of statin plus ezetimibe versus high-intensity statin therapy in patients with acute myocardial infarction propensity-score matching analysis. Int J Cardiol 2016; 225:50-59. [PMID: 27710803 DOI: 10.1016/j.ijcard.2016.09.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. METHODS A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. RESULTS In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. CONCLUSIONS In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients.
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Affiliation(s)
- Mi Seon Ji
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Young Keun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang Hyung Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | | | | | | | - In Whan Seong
- Chungnam National Univ. Hosp., Daejon, Republic of Korea
| | - Jei Keon Chae
- Chunbuk National Univ. Hosp., Jeonju, Republic of Korea
| | | | - Myeong Chan Cho
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seung-Woon Rha
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jang Ho Bae
- Konyang University, Daejon, Republic of Korea
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107
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Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:256. [PMID: 27500157 DOI: 10.21037/atm.2016.06.33] [Citation(s) in RCA: 635] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.
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Affiliation(s)
| | - Carme Perez-Quilis
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain
| | - Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Hagen, Germany
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre ('i+12'), Madrid, Spain;; European University of Madrid, Madrid, Spain
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108
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Huang Y, Chen J, Zhou Y, Yu X, Huang C, Li J, Feng Y. Circulating miR-30 is related to carotid artery atherosclerosis. Clin Exp Hypertens 2016; 38:489-94. [PMID: 27379414 DOI: 10.3109/10641963.2016.1163370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the relationship of miR-30 with office and ambulatory blood pressure parameters and carotid intima-media thickness (CIMT) in patients with hypertension and healthy controls. METHODS We assessed the expression level of miR-30 in 40 patients with essential hypertension and 40 healthy individuals. All patients underwent carotid artery ultrasonography, and office and ambulatory blood pressure monitoring. Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was used to evaluate the expression level of selected miR-30. The miR-30 expression level correlation between blood pressure parameters and CIMT was assessed using the Spearman correlation coefficient. Multiple logistic regression analysis was performed to assess independent association between miR-30 expression level and CIMT. RESULTS We observed lower expression level of miR-30 (26.01 ± 2.40 vs. 28.26 ± 1.28; p < 0.001) in hypertensive patients compared with healthy control individuals, as well as in increased CIMT group compared with normal CIMT group (25.09 ± 1.84 vs. 27.81 ± 2.37; p < 0.001). miR-30 expression level showed significant negative correlation with 24 h mean SBP (r = -0.51, p < 0.001), 24 h mean DBP(r = -0.316, p = 0.004), office SBP(r = -0.502, p < 0.001), office DBP (r = -0.205, p = 0.068), and CIMT (r = -0.578, p < 0.001), respectively. The odds ratio for CIMT was 0.519 (B = -0.748, CI 95% 0.278, 0.806; p = 0.006). CONCLUSION Our study suggests that circulating miR-30 might be used as a biomarker for atherosclerosis in essential hypertensive patients.
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Affiliation(s)
- Yuqing Huang
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Jiyan Chen
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Yingling Zhou
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Xueju Yu
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Cheng Huang
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Jie Li
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
| | - Yingqing Feng
- a Department of Cardiology , Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology , Guangzhou , China
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Mattlage AE, Redlin SA, Rosterman LR, Harn N, Sisante JFV, Abraham MG, Billinger SA. Use of a Nonexercise Estimate for Prestroke Peak Vo 2 During the Acute Stroke Hospital Stay. Cardiopulm Phys Ther J 2016; 27:96-103. [PMID: 27478424 PMCID: PMC4963028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE For individuals with acute stroke, it is difficult to conduct an exercise test to assess peak oxygen consumption (peak Vo2). Therefore, the purpose of this study was to use a clinically feasible tool for assessing prestroke peak Vo2 using a nonexercise estimation equation to test whether estimated prestroke peak Vo2 was related to the functional outcome measures at discharge from the hospital in individuals after an acute stroke. We hypothesized that the estimated prestroke peak Vo2 would be significantly related to discharge Physical Performance Test (PPT), 6-minute walk test (6MWT), and lower extremity Fugl-Meyer (LEFM) assessment. METHODS Estimated prestroke peak Vo2 was calculated using a previously validated prediction equation using the following variables: body mass index, age, sex, resting heart rate, and a self-reported measure of physical activity. Outcome measures were assessed 4 days after enrollment or immediately before discharge (whichever occurred first). RESULTS Thirty-four participants (mean age = 56.0, SD = 12.6 years; 20 men) with acute stroke were enrolled within 48 hours of admission. For all individuals, mean estimated prestroke peak Vo2 was 27.3 (SD = 7.4) mL·kg-1·min-1 and had a weak, nonsignificant relationship with the PPT (r = 0.19; P = .28), 6MWT (r = 0.10; P = .56), and LEFM (r = 0.32; P = .06). However, when considering sex, women, but not men, had a significant relationship with LEFM (r = 0.73; P = .005) and moderate but nonsignificant relationship with PPT (r = 0.53; P = .06) and 6MWT (r = 0.47; P = .10). CONCLUSIONS Within 48 hours of stroke admission, we were able to administer a nonexercise equation to estimate prestroke peak Vo2. For the entire sample, functional measures conducted at discharge were not related to estimated prestroke peak Vo2. However, when considering sex, the relationship between prestroke Vo2 and the functional measures was strengthened.
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Affiliation(s)
- Anna E. Mattlage
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Sara A. Redlin
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Lee R. Rosterman
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Nick Harn
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS
| | - Jason-Flor V. Sisante
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
| | - Michael G. Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS
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Use of a Nonexercise Estimate for Prestroke Peak Vo 2 During the Acute Stroke Hospital Stay. Cardiopulm Phys Ther J 2016. [DOI: 10.1097/cpt.0000000000000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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111
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Gouda M, Moustafa A, Hussein L, Hamza M. Three week dietary intervention using apricots, pomegranate juice or/and fermented sour sobya and impact on biomarkers of antioxidative activity, oxidative stress and erythrocytic glutathione transferase activity among adults. Nutr J 2016; 15:52. [PMID: 27175476 PMCID: PMC4864915 DOI: 10.1186/s12937-016-0173-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/04/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The beneficial effects of the polyphenol (PP) rich fruits and Lactic acid bacteria fermented foods had been reported as cost-effective strategies for health promotion. Randomized controlled trial was designed to test the hypothesis that daily intake of polyphenol rich pomegranate juice (PGJ) or/ and lactic acid bacteria fermented sobya (FS) improved selected biomarkers of relevance to heath status. METHODS The design of the human trial consisted of 35 healthy adults, who were distributed to 5 equal groups; The first group served as control and received no supplements; the second group received fresh apricot fruits (200 g); the third (PGJ) (250 g), the fourth a mixture of PGJ (150 g) and FS (140 g) and the fifth group received (FS) (170 g). The supplements were served daily between 5 - 6 pm for 21 days. Blood and urine samples were collected at days zero and 22 of the dietary intervention. The supplements were analyzed chemically for (PP) contents and total antioxidative activities and microbiologically for selected bacteria and yeast counts. The blood samples were assayed for plasma antioxidative activities and for erythrocytic glutathione transferase activity (E-GST). Urine samples were analyzed for the excretions of total PP, antioxidative activity and thiobarbituric acid reactive substances (TBARS). STATISTICAL ANALYSIS Two way analysis of variance (ANOVA) was conducted and included the main effects of treatment, time and treatment x time interaction. RESULTS Daily intake of (PGJ) for 3 weeks significantly increased the plasma and urinary anti-oxidative activities and reduced the urinary excretion of (TBARS). Daily intake of (FS) for 3 weeks increased only (E-GST) activity. Daily intake of a mixture of PGJ and (FS) was also effective. CONCLUSIONS The daily intakes of PGJ and/ or (FS) affected positively selected biomarkers of relevance to health status. These functional foods have potential implication for use as bio-therapeutic foods. TRIAL REGISTRATION The study was approved by the research ethical committee of the Ministry of Health & population, Egypt. The trial registration - the unique identifying number. (REC) decision No 12-2013-9, which complied with the Declaration of Helsinki guidelines (2004). The protocol was fully explained to all subjects and written informed consent was obtained before their participation in the trial.
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Affiliation(s)
- Mostafa Gouda
- Department of Nutrition & Food Sc, National Research Center, Giza, Dokki, Egypt
| | - Amr Moustafa
- Department of Biochemistry, Faculty of Agriculture, Cairo University, Giza, Egypt
| | - Laila Hussein
- Department of Nutrition & Food Sc, National Research Center, Giza, Dokki, Egypt.
| | - Mohamed Hamza
- Department of Agronomy, Faculty of Agric, Cairo University, Giza, Egypt
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Stress during neurosurgery: no need to worry? Acta Neurochir (Wien) 2016; 158:623-624. [PMID: 26852035 DOI: 10.1007/s00701-016-2729-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
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113
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Kuller LH, Lopez OL, Mackey RH, Rosano C, Edmundowicz D, Becker JT, Newman AB. Subclinical Cardiovascular Disease and Death, Dementia, and Coronary Heart Disease in Patients 80+ Years. J Am Coll Cardiol 2016; 67:1013-1022. [PMID: 26940919 PMCID: PMC5502352 DOI: 10.1016/j.jacc.2015.12.034] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The successful prevention and treatment of coronary heart disease (CHD) and stroke has resulted in a substantial increase in longevity, with subsequent growth in the population of older people at risk for dementia. OBJECTIVES The authors evaluated the relationship of coronary and other peripheral atherosclerosis to risk of death, dementia, and CHD in the very elderly. Because the extent of vascular disease differs substantially between men and women, sex- and race-specific analyses were included, with a specific focus on women with low coronary artery calcium (CAC) Agatston scores. METHODS We evaluated the relationship between measures of subclinical cardiovascular disease (CAC, carotid intimal medial thickness, stenosis, and ankle brachial index) and risk of dementia, CHD, and total mortality in 532 participants of the Cardiovascular Health Study-Cognition Study from 1998/1999 (mean age, 80 years) to 2012/2013 (mean age, 93 years). RESULTS Thirty-six percent of participants had CAC scores >400. Women and African-Americans had lower CAC scores. Few men had low CAC scores. CAC score and number of coronary calcifications were directly related to age-adjusted total mortality and CHD. The age-specific incidence of dementia was higher than for CHD. Only about 25% of deaths were caused by CHD and 16% by dementia. Approximately 64% of those who died had a prior diagnosis of dementia. White women with low CAC scores had a significantly decreased incidence of dementia. CONCLUSIONS In subjects 80+ years of age, there is a greater incidence of dementia than of CHD. CAC, as a marker of atherosclerosis, is a determinant of mortality, and risk of CHD and myocardial infarction. White women with low CAC scores had a significantly decreased risk of dementia. A very important unanswered question, especially in the very elderly, is whether prevention of atherosclerosis and its complications is associated with less Alzheimer disease pathology and dementia. (Cardiovascular Health Study [CHS]; NCT00005133).
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Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rachel H Mackey
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel Edmundowicz
- Department of Medicine, Section of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - James T Becker
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Saraf AA, Bell SP. Risk Stratification for Older Adults with Myocardial Infarction. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0493-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bell SP, Orr NM, Dodson JA, Rich MW, Wenger NK, Blum K, Harold JG, Tinetti ME, Maurer MS, Forman DE. What to Expect From the Evolving Field of Geriatric Cardiology. J Am Coll Cardiol 2015; 66:1286-1299. [PMID: 26361161 DOI: 10.1016/j.jacc.2015.07.048] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/24/2015] [Accepted: 07/26/2015] [Indexed: 11/20/2022]
Abstract
The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients.
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Affiliation(s)
- Susan P Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Quality Aging, Division of Geriatric Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nicole M Orr
- Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Michael W Rich
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Nanette K Wenger
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Kay Blum
- Geriatric Cardiology Section, American College of Cardiology, Washington, DC
| | - John Gordon Harold
- Cedars-Sinai Heart Institute and David Geffen School of Medicine, University of California, Los Angeles, California
| | - Mary E Tinetti
- Departments of Internal Medicine and Public Health and Epidemiology, Yale School of Medicine, New Haven, Connecticut
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Daniel E Forman
- Geriatric Cardiology Section, Department of Medicine, University of Pittsburgh Medical Center, and Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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Folta SC, Seguin RA, Chui KKH, Clark V, Corbin MA, Goldberg JP, Heidkamp-Young E, Lichtenstein AH, Wiker N, Nelson ME. National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women. Am J Public Health 2015; 105:2578-85. [PMID: 26469644 PMCID: PMC4638239 DOI: 10.2105/ajph.2015.302866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. METHODS In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. RESULTS Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. CONCLUSIONS The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.
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Affiliation(s)
- Sara C Folta
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Rebecca A Seguin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Kenneth K H Chui
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Valerie Clark
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Marilyn A Corbin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Jeanne P Goldberg
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Eleanor Heidkamp-Young
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Alice H Lichtenstein
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Nancy Wiker
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Miriam E Nelson
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
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Doll JA, Hellkamp A, Thomas L, Ho PM, Kontos MC, Whooley MA, Boyden TF, Peterson ED, Wang TY. Effectiveness of cardiac rehabilitation among older patients after acute myocardial infarction. Am Heart J 2015; 170:855-64. [PMID: 26542492 DOI: 10.1016/j.ahj.2015.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines recommend cardiac rehabilitation after acute myocardial infarction, yet little is known about the impact of cardiac rehabilitation on medication adherence and clinical outcomes among contemporary older adults. The optimal number of cardiac rehabilitation sessions is not clear. METHODS We linked patients 65years or older enrolled in the Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG) from January 2007 to December 2010 to Medicare longitudinal claims data to obtain 1 year follow-up. RESULTS A total of 11,862 patients participated in cardiac rehabilitation after acute myocardial infarction, attending a median number of 26 sessions. Patients attending ≥26 sessions were more likely to be male, had lesser prevalence of comorbid conditions and prior revascularization, and were more likely to present with ST-segment elevation myocardial infarction, compared with patients attending 1 to 25 sessions. Among patients with Medicare Part D prescription coverage, increasing number of cardiac rehabilitation sessions was associated with improvement in adherence to secondary prevention medications such as P2Y12 inhibitors and β-blockers. Each 5-session increase in participation was associated with lower mortality (adjusted hazard ratio [HR] 0.87, 95% CI 0.83-0.92) and lower overall risk of major adverse cardiac event (adjusted HR 0.69, 95% CI 0.65-0.73) and death/readmission (adjusted HR 0.79, 95% CI 0.76-0.83). CONCLUSIONS In this older patient population, number of cardiac rehabilitation sessions attended was associated with improved medication adherence and lower downstream cardiovascular risk in a dose-response relationship. This provides support for the continued use of cardiac rehabilitation for older adults and encourages efforts to maximize attendance.
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Affiliation(s)
- Jacob A Doll
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University, Durham, NC.
| | | | | | - P Michael Ho
- VA Eastern Colorado Health Care System, Aurora, CO; University of Colorado School of Medicine, Aurora, CO
| | | | - Mary A Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of California, San Francisco, San Francisco, CA
| | | | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University, Durham, NC
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University, Durham, NC
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Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9:S1-122.e1. [DOI: 10.1016/j.jacl.2015.09.002] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Secondary cardiovascular prevention in older adults: an evidence based review. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:459-64. [PMID: 26512234 PMCID: PMC4605938 DOI: 10.11909/j.issn.1671-5411.2015.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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120
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Orringer CE, Bays HE, Brown WV. Clinical lipidology: A subspecialty whose time has come. J Clin Lipidol 2015; 9:634-9. [PMID: 26350808 DOI: 10.1016/j.jacl.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/05/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Carl E Orringer
- University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
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Role of physical activity in cardiovascular disease prevention in older adults. SPORT SCIENCES FOR HEALTH 2015. [DOI: 10.1007/s11332-015-0233-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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122
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Abstract
The 2013 American College of Cardiology/American Heart Association guidelines for management of low-density lipoprotein cholesterol (LDL-C) to reduce atherosclerotic cardiovascular disease (ASCVD) risk identified four groups of adults (40-75 years of age) with significant evidence for benefit from statin therapy: presence of clinical ASCVD or diabetes, age ≥21 years and LDL-C >190 mg/dl, and 10-year risk of hard ASCVD events ≥7.5 % as determined by the new Cardiovascular Risk Calculator. However, clinicians are faced daily with at-risk patients who do not clearly match one of these statin-benefit groups. Understanding the limitations of available evidence and awareness of additional published guidelines for statin non-benefit groups will help practitioners make personalized decisions with patients and inform the clinician-patient discussion regarding potential risks and benefits of statin therapy.
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Affiliation(s)
- Pamela B Morris
- Medical University of South Carolina, 25 Courtenay Drive, MSC 592, Charleston, SC, 29425, USA,
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Pedro-Botet J, Climent E, Chillarón JJ, Toro R, Benaiges D, Flores-Le Roux JA. Statins for primary cardiovascular prevention in the elderly. J Geriatr Cardiol 2015; 12:431-8. [PMID: 26345308 PMCID: PMC4554788 DOI: 10.11909/j.issn.1671-5411.2015.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/22/2015] [Accepted: 05/29/2015] [Indexed: 04/08/2023] Open
Abstract
The elderly population is increasing worldwide, with subjects > 65 years of age constituting the fastest-growing age group. Furthermore, the elderly face the greatest risk and burden of cardiovascular disease mortality and morbidity. Although elderly patients, particularly those older > 75, have not been well represented in randomized clinical trials evaluating lipid-lowering therapy, the available evidence supporting the use of statin therapy in primary prevention in older individuals is derived mainly from subgroup analyses and post-hoc data. On the other hand, elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of statin therapy. The aim of this review was to present the relevant literature regarding statin use in the elderly for their primary cardiovascular disease, with the associated risks and benefits of treatment.
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Affiliation(s)
- Juan Pedro-Botet
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Elisenda Climent
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Juan J Chillarón
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
| | - Rocio Toro
- Department of Medicine, School of Medicine. Cádiz University, Cádiz, Spain
| | - David Benaiges
- Lipid and Vascular Risk Unit, Endocrinology department, Hospital del Mar. Spain
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Seidl H, Hunger M, Leidl R, Meisinger C, Wende R, Kuch B, Holle R. Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: results from the KORINNA study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:671-681. [PMID: 25108626 DOI: 10.1007/s10198-014-0623-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES We assessed the cost-effectiveness of a case management intervention by trained nurses in elderly (≥65 years) patients with myocardial infarction from a societal perspective. METHODS The intervention and observation period spanned 1 year and 329 participants were enrolled. The intervention consisted of at least one home visit and quarterly telephone calls. Data on resource use and quality of life were collected quarterly. The primary measurements of effect were quality-adjusted life years (QALYs), based on the EuroQol five-dimensional questionnaire (EQ-5D-3L) health utilities from the German time trade-off. The secondary measurements were EQ-5D-3L utility values and patients' self-rated health states according to the visual analogue scale (VAS) among survivors. To estimate mean differences, a linear regression model was used for QALYs and a gamma model for costs. Health states among the survivors were analysed using linear mixed models. To assess the impact of different health state valuation methods, VAS-adjusted life years were constructed. RESULTS The mean difference in QALYs was small and not significant (-0.0163; CI -0.0681-0.0354, p value: 0.536, n = 297). Among survivors, EQ-5D-3L utilities showed significant improvements within 6 months in the intervention group (0.051; CI 0.0028-0.0989; p value: 0.0379, n = 280) but returned towards baseline levels by month 12. The mean improvement in self-rated health (VAS) within 1 year was significantly larger in the intervention group (+9.2, CI 4.665-13.766, p value: <0.0001, n = 266). The overall cost difference was -<euro>17.61 (CI - <euro>2,601-<euro>2,615; p value: 0.9856, n = 297). The difference in VAS-adjusted life years was 0.0378 (CI -0.0040-0.0796, p value: 0.0759, n = 297). CONCLUSIONS This study could not provide evidence to conclude that the case management intervention was an effective and cost-effective alternative to usual care within a time horizon of 1 year.
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Affiliation(s)
- Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany,
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Utility and efficacy of a smartphone application to enhance the learning and behavior goals of traditional cardiac rehabilitation: a feasibility study. J Cardiopulm Rehabil Prev 2015; 34:327-34. [PMID: 24866355 DOI: 10.1097/hcr.0000000000000058] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Most eligible patients do not participate in traditional clinic-based cardiac rehabilitation (CR) despite well-established benefits. Novel approaches to overcome logistic obstacles and increase efficiencies of learning, behavior modification, and exercise surveillance may increase CR participation. In an observational study, the feasibility and utility of a mobile smartphone application for CR, Heart Coach (HC), were assessed as part of standard care. Ultimately, innovative CR models incorporating HC may facilitate better CR usage and value. METHODS Twenty-six patients enrolled in CR installed HC. Over the next 30 days, they were prompted by HC to complete a daily "task list" that included medications, walking, education (text and videos), and surveys. Cardiac rehabilitation providers monitored each patient's progress through a HC-based Web dashboard and also sent them personalized feedback and support. Completion of the tasks and feedback (qualitative and quantitative) from patients and clinicians were tracked. RESULTS Patients engaged with HC 90% of days during the study period, with uniformly favorable impact on compliance and adherence. Eighty-three percent of patients reported a positive/very positive HC experience. Providers reported that HC enhanced their provision of therapy by improving communication, clinical insight, patient participation, and program efficiency. CONCLUSIONS Integrating a mobile care delivery platform into CR was feasible, safe, and agreeable to patients and clinicians. It enhanced patient perceptions of CR care and physician perceptions of the CR caregiving process. Mobile-enabled technologies hold promise to extend the quality and reach of CR, and to better achieve contemporary accountable care goals.
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Stamatelopoulos K, Sibbing D, Rallidis LS, Georgiopoulos G, Stakos D, Braun S, Gatsiou A, Sopova K, Kotakos C, Varounis C, Tellis CC, Kastritis E, Alevizaki M, Tselepis AD, Alexopoulos P, Laske C, Keller T, Kastrati A, Dimmeler S, Zeiher AM, Stellos K. Amyloid-beta (1-40) and the risk of death from cardiovascular causes in patients with coronary heart disease. J Am Coll Cardiol 2015; 65:904-16. [PMID: 25744007 DOI: 10.1016/j.jacc.2014.12.035] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 12/09/2014] [Accepted: 12/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The amyloid beta peptide is the major protein constituent of neuritic plaques in Alzheimer disease and appears to play a central role in vascular inflammation pathophysiology. OBJECTIVES This study sought to determine the clinical value of amyloid-beta 1-40 (Abeta40) measurement in predicting cardiovascular (CV) mortality in patients with coronary heart disease (CHD) and arterial stiffness progression in young healthy subjects. METHODS Abeta40 was retrospectively measured in blood samples collected from 3 independent prospective cohorts and 2 case-control cohorts (total N = 1,464). Major adverse cardiac events (MACE) were assessed in the 2 prospective cohorts (n = 877) followed for a median of 4.4 years. To look at effects on subclinical disease, arterial stiffness was evaluated at baseline and after 5-year follow-up (n = 107) in young healthy subjects. The primary endpoint was the predictive value of Abeta40 for CV mortality and outcomes in patients with CHD. RESULTS In Cox proportional hazards models adjusted for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, high-sensitivity C-reactive protein, and high-sensitivity troponin T, Abeta40 independently predicted CV death and MACE in patients with CHD (p < 0.05 for all). After multivariate adjustment, Abeta40 levels conferred a substantial enhancement of net reclassification index and integrated discrimination improvement of individuals at risk in the total combined CHD cohort over the best predictive model. Further cohort-based analysis revealed that Abeta40 levels were significantly and independently associated with arterial stiffness progression, incident subclinical atherosclerosis, and incident CHD. CONCLUSIONS Measuring blood levels of Abeta40 identified patients at high risk for CV death.
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Affiliation(s)
- Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Dirk Sibbing
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Loukianos S Rallidis
- Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Dimitrios Stakos
- Cardiology Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Siegmund Braun
- Deutsches Herzzentrum, Technische Universität, Munich, Germany
| | - Aikaterini Gatsiou
- Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kateryna Sopova
- Department of Cardiology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christos Kotakos
- Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Christos Varounis
- Second Department of Cardiology, Attikon Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Constantinos C Tellis
- Atherothrombosis Research Center/Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Maria Alevizaki
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Alexandros D Tselepis
- Atherothrombosis Research Center/Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Panagiotis Alexopoulos
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Christoph Laske
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany; Section for Dementia Research, Hertie-Institute of Clinical Brain Research, Tübingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Till Keller
- Department of Cardiology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany; German Center of Cardiovascular Research, Frankfurt, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum, Technische Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Stefanie Dimmeler
- Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany; German Center of Cardiovascular Research, Frankfurt, Germany
| | - Andreas M Zeiher
- Department of Cardiology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany; German Center of Cardiovascular Research, Frankfurt, Germany
| | - Konstantinos Stellos
- Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiology, J.W. Goethe University Frankfurt, Frankfurt am Main, Germany; German Center of Cardiovascular Research, Frankfurt, Germany.
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Wang W, Zhang H, Lopez V, Wu VX, Poo DCC, Kowitlawakul Y. Improving awareness, knowledge and heart-related lifestyle of coronary heart disease among working population through a mHealth programme: study protocol. J Adv Nurs 2015; 71:2200-7. [PMID: 25879395 DOI: 10.1111/jan.12668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/30/2022]
Abstract
AIM To develop a mHealth programme, entitled 'Care4Heart' for the working population in Singapore and thereafter examine its feasibility and effectiveness in increasing the awareness and knowledge of coronary heart disease and improving their heart-related lifestyle. BACKGROUND Teaching and encouraging the working population to adopt a healthier lifestyle could result in preventing and/or decreasing the incidence of coronary heart disease among this population. The use of mobile application (app) is the next logical wave of healthcare support tools to prevent and manage chronic diseases like coronary heart disease. DESIGN A quasi-experimental longitudinal study design. METHODS The study will be conducted in a tertiary university in Singapore. A non-probability, quota sampling of 200 participants will be recruited including 100 academic and research staff, 50 administrative staff and 50 support staff and business owners. Once consent is obtained, the newly developed mobile app will be installed onto the participants' smartphones and a well-trained research assistant will brief the participant on the use of the app. The main outcomes will be measured using the survey questionnaires: Awareness of coronary heart disease, Heart Disease Fact Questionnaire-2, Behavioural Risk Factor Surveillance System and Perceived Stress Scale. Data will be collected at baseline and at the 4th week and 6th month thereafter. DISCUSSION If this project is successful, Care4Heart - a mHealth and novel prevention educational programme for the working population in Singapore - can be used to promote knowledge and positive heart-related lifestyle changes to prevent coronary heart disease.
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Affiliation(s)
- Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Danny Chiang Choon Poo
- Department of Information Systems, Computing School, National University of Singapore, Singapore
| | - Yanika Kowitlawakul
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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128
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Canavan M, Smyth A, Bosch J, Jensen M, McGrath ER, Mulkerrin EC, O'Donnell MJ. Does lowering blood pressure with antihypertensive therapy preserve independence in activities of daily living? A systematic review. Am J Hypertens 2015; 28:273-9. [PMID: 25156624 DOI: 10.1093/ajh/hpu131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor for functional impairment. Dependence is an important related outcome for older adults, but outcomes in hypertension trials appear to focus primarily on major vascular events. This systematic review had 2 objectives: (i) to determine the proportion of randomized controlled trials (RCTs) evaluating antihypertensive therapies that reported a measure of a person's ability to carry out activities of daily living (ADL) and (ii) to evaluate the effect of blood pressure (BP)-lowering therapies on ability to carry out ADL compared with control therapy. METHODS We searched electronic databases, reference lists of relevant meta-analyses, and hypertension guidelines for clinical trials of adults with hypertension/prehypertension that were randomized to antihypertensive therapy or control for ≥1 year. RESULTS Of 2,924 citations screened, there were 93 eligible RCTs. One (1%) reported ADL as a primary outcome measure. Nine (10%) reported ADL as a secondary outcome. Of these, 6 used validated ADL scales, whereas 4 measured ADL within quality-of-life scales. Six trials with duration of ≥1 year (n = 12,663) were amenable to meta-analysis, despite use of different ADL scales. The odds of having difficulty with ADL was reduced by BP-lowering therapy compared with control therapy (odds ratio = 0.84; 95% confidence interval = 0.77-0.92; I (2) = 0%). CONCLUSIONS We identified few trials of antihypertensive therapy that reported ADL as an outcome measure, with heterogeneity in scales used. Antihypertensive therapy was associated with a lower risk of ADL impairment compared with control therapy. RCTs evaluating the effect of antihypertensive drugs on ADL in older adults with mild hypertension are required.
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Affiliation(s)
- Michelle Canavan
- Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland, Galway, Ireland;
| | - Andrew Smyth
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Emer R McGrath
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Massachusetts General Hospital, Boston, Massachusetts
| | - Eamon C Mulkerrin
- Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland
| | - Martin J O'Donnell
- Department of Medicine for Elderly, University Hospital Galway, Galway, Ireland; HRB Clinical Research Facility, National University of Ireland, Galway, Ireland; Population Health Research Institute, Hamilton, Ontario, Canada
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129
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Kramer CD, Weinberg EO, Gower AC, He X, Mekasha S, Slocum C, Beaulieu LM, Wetzler L, Alekseyev Y, Gibson FC, Freedman JE, Ingalls RR, Genco CA. Distinct gene signatures in aortic tissue from ApoE-/- mice exposed to pathogens or Western diet. BMC Genomics 2014; 15:1176. [PMID: 25540039 PMCID: PMC4367889 DOI: 10.1186/1471-2164-15-1176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/11/2014] [Indexed: 01/15/2023] Open
Abstract
Background Atherosclerosis is a progressive disease characterized by inflammation and accumulation of lipids in vascular tissue. Porphyromonas gingivalis (Pg) and Chlamydia pneumoniae (Cp) are associated with inflammatory atherosclerosis in humans. Similar to endogenous mediators arising from excessive dietary lipids, these Gram-negative pathogens are pro-atherogenic in animal models, although the specific inflammatory/atherogenic pathways induced by these stimuli are not well defined. In this study, we identified gene expression profiles that characterize P. gingivalis, C. pneumoniae, and Western diet (WD) at acute and chronic time points in aortas of Apolipoprotein E (ApoE-/-) mice. Results At the chronic time point, we observed that P. gingivalis was associated with a high number of unique differentially expressed genes compared to C. pneumoniae or WD. For the top 500 differentially expressed genes unique to each group, we observed a high percentage (76%) that exhibited decreased expression in P. gingivalis-treated mice in contrast to a high percentage (96%) that exhibited increased expression in WD mice. C. pneumoniae treatment resulted in approximately equal numbers of genes that exhibited increased and decreased expression. Gene Set Enrichment Analysis (GSEA) revealed distinct stimuli-associated phenotypes, including decreased expression of mitochondrion, glucose metabolism, and PPAR pathways in response to P. gingivalis but increased expression of mitochondrion, lipid metabolism, carbohydrate and amino acid metabolism, and PPAR pathways in response to C. pneumoniae; WD was associated with increased expression of immune and inflammatory pathways. DAVID analysis of gene clusters identified by two-way ANOVA at acute and chronic time points revealed a set of core genes that exhibited altered expression during the natural progression of atherosclerosis in ApoE-/- mice; these changes were enhanced in P. gingivalis-treated mice but attenuated in C. pneumoniae-treated mice. Notable differences in the expression of genes associated with unstable plaques were also observed among the three pro-atherogenic stimuli. Conclusions Despite the common outcome of P. gingivalis, C. pneumoniae, and WD on the induction of vascular inflammation and atherosclerosis, distinct gene signatures and pathways unique to each pro-atherogenic stimulus were identified. Our results suggest that pathogen exposure results in dysregulated cellular responses that may impact plaque progression and regression pathways. Electronic supplementary material The online version of this article (doi:10.1186/1471-2164-15-1176) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Caroline A Genco
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA.
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130
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Gómez-Huelgas R, Giner-Galvañ V, Mostaza JM, Cuende JI, de Miguel-Yanes JM, Rovira E, Sánchez-Fuentes D, Fernández CS, Sánchez PR. Unanswered clinical questions in the management of cardiometabolic risk in the elderly: a statement of the Spanish Society of Internal Medicine. BMC Cardiovasc Disord 2014; 14:193. [PMID: 25519433 PMCID: PMC4289584 DOI: 10.1186/1471-2261-14-193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/11/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite the progressive increase in life expectancy and the relationship between aging with multi-morbidities and the increased use of healthcare resources, current clinical practice guidelines (CPG) on cardiometabolic risk cannot be adequately applied to elderly subjects with multiple chronic conditions. Its management frequently becomes complicated by both, an excessive use of medications that may lead to overtreatment, drug interactions and increased toxicity, and errors in dosage and non-compliance. Concerned by this gap, the Spanish Society of Internal Medicine created a group of independent experts on cardiometabolic risk who discussed what they considered to be unanswered questions in the management of elderly patients. DISCUSSION Current guidelines do not specifically address the problem of elderly with multiple chronic conditions. For this reason, the combined use of the limited available evidence, clinical experience and common sense, could all help us to address this unmet need. In very old people, life expectancy and functionality are the most important factors for guiding potential treatments. Their higher propensity to develop serious adverse events and their shorter lifespan could prevent them from obtaining the potential benefits of the interventions administered. SUMMARY In this document, experts on cardiometabolic risk factors have established a number of consensual recommendations that have taken into account international guidelines and clinical experience, and have also considered the more effective use of healthcare resources. This document is intended to provide general recommendations for clinicians and to promote the effective use of procedures and medications.
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Affiliation(s)
| | - Vicente Giner-Galvañ
- />Cardiometabolic Risk Unit, Internal Medicine Department, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - José M Mostaza
- />Internal Medicine Department, Hospital Carlos III, Madrid, Spain
| | - José I Cuende
- />Cardiovascular Risk Unit, Internal Medicine Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | | | - Eduardo Rovira
- />Internal Medicine Department, Hospital Universitario La Ribera, Alzira, Valencia, Spain
| | | | | | - Pilar Román Sánchez
- />Internal Medicine Department, Hospital General de Requena, Valencia, Spain
| | - the SEMI Working Group
- />Hospital Regional Universitario, IBIMA, Málaga, Spain
- />Cardiometabolic Risk Unit, Internal Medicine Department, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
- />Internal Medicine Department, Hospital Carlos III, Madrid, Spain
- />Cardiovascular Risk Unit, Internal Medicine Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
- />Internal Medicine Department, Hospital Universitario del Sureste, Madrid, Spain
- />Internal Medicine Department, Hospital Universitario La Ribera, Alzira, Valencia, Spain
- />Internal Medicine Department, Hospital Nuestra Señora de Sonsoles, Ávila, Spain
- />Internal Medicine Department, Hospital Universitario de La Princesa, Madrid, Spain
- />Internal Medicine Department, Hospital General de Requena, Valencia, Spain
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131
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Willey JZ, Moon YP, Kahn E, Rodriguez CJ, Rundek T, Cheung K, Sacco RL, Elkind MSV. Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study. J Am Heart Assoc 2014; 3:e001106. [PMID: 25227406 PMCID: PMC4323833 DOI: 10.1161/jaha.114.001106] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/07/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. METHODS AND RESULTS The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non-Hispanic whites (2.6%; 95% CI, -33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (-0.3%; 95% CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/race-ethnicity. CONCLUSIONS HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.
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Affiliation(s)
- Joshua Z. Willey
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Yeseon Park Moon
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Emily Kahn
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Carlos J. Rodriguez
- Department of Medicine, Wake Forest University, Winston‐Salem, NC, USA (C.J.R.)
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miami, FL, USA (T.R., R.L.S.)
| | - Ken Cheung
- Department of Biostatistics, Columbia University, New York, USA (K.C.)
| | - Ralph L. Sacco
- Department of Neurology, University of Miami, Miami, FL, USA (T.R., R.L.S.)
| | - Mitchell S. V. Elkind
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
- Department of Epidemiology, Columbia University, New York, USA (M.V.E.)
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132
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Morris PB, Ballantyne CM, Birtcher KK, Dunn SP, Urbina EM. Review of clinical practice guidelines for the management of LDL-related risk. J Am Coll Cardiol 2014; 64:196-206. [PMID: 25011724 DOI: 10.1016/j.jacc.2014.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/01/2014] [Indexed: 11/24/2022]
Abstract
Managing risk related to low-density lipoprotein (LDL) is vital in therapy for patients at risk for atherosclerotic cardiovascular disease (ASCVD) events given its important etiologic role in atherogenesis. Despite decades of research showing reduction of ASCVD risk with multiple approaches to lowering of LDL cholesterol, there continue to be significant gaps in care with inadequate numbers of patients receiving standard of care lipid-lowering therapy. Confusion regarding implementation of the multiple published clinical practice guidelines has been identified as one contributor to suboptimal management of LDL-related risk. This review summarizes the current guidelines for reduction of LDL-related cardiovascular risk provided by a number of major professional societies, which have broad applicability to diverse populations worldwide. Statements have varied in the process and methodology of development of recommendations, the grading system for level and strength of evidence, the inclusion or exclusion of expert opinion, the suggested ASCVD risk assessment tool, the lipoproteins recommended for risk assessment, and the lipoprotein targets of therapy. The similarities and differences among important guidelines in the United States and internationally are discussed, with recommendations for future strategies to improve consistency in approaches to LDL-related ASCVD risk and to reduce gaps in implementation of evidence-based therapies.
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Affiliation(s)
- Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina.
| | | | - Kim K Birtcher
- University of Houston College of Pharmacy, Houston, Texas
| | - Steven P Dunn
- University of Virginia Health System, Charlottesville, Virginia
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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133
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Wang M, Monticone RE, Lakatta EG. Proinflammation of aging central arteries: a mini-review. Gerontology 2014; 60:519-29. [PMID: 25171100 DOI: 10.1159/000362548] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/31/2014] [Indexed: 12/16/2022] Open
Abstract
Arterial aging is a cornerstone of organismal aging. The central arterial wall structurally and functionally remodels under chronic proinflammatory stress over a lifetime. The low-grade proinflammation that accompanies advancing age causes arterial wall thickening and stiffening. These structural and functional alterations are consequences of adverse molecular and cellular events, e.g. an increase in local angiotensin II signaling that induces an inflammatory phenotypic shift of endothelial and smooth muscle cells. Thus, interventions to restrict proinflammatory signaling are a rational approach to delay or prevent age-associated adverse arterial remodeling.
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Affiliation(s)
- Mingyi Wang
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Biomedical Research Center (BRC), Baltimore, Md., USA
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134
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Kuller LH, Lopez OL. Preventing Dementia in Older Cardiovascular Patients. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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135
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Abstract
BACKGROUND Fatigue is prevalent after myocardial infarction (MI) and is a barrier to physical activity (PA). Because PA is an important health behavior in preventing or delaying recurrent MIs, examining the influence of biophysical markers and fatigue on PA is important as a prerequisite to developing effective interventions. OBJECTIVE This study compared PA in 34 men and 38 women, aged 65 and older, 6-8 months post MI, and examined the influence of biophysiological measures and fatigue on PA in this sample. METHODS Using a cross-sectional descriptive correlational design, adults completed a demographic form that included documentation of blood pressure, heart rate, height and weight; the Revised Piper Fatigue Scale (RPFS), and the Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire for Older Adults, and blood collection for measurement of hemoglobin (Hgb), interleukin-6, and B-natriuretic peptide. RESULTS There were no differences in frequency of PA between older men and older women; however, men reported a higher intensity of PA (p = .011). When controlling for sex, age, and biophysiological measures, the RPFS significantly explained 16% of the variance in the frequency of PA (p = .03), with no individual subscale serving as a significant predictor. The RPFS behavior/severity subscale explained 31% of the variance in energy expended on all PA (p < .001) and 40% of the variance in energy expended on moderate-intensity PA (p < .001). CONCLUSION The older adults participating in this study did not participate in the recommended levels of PA, and fatigue significantly influenced PA post MI.
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Affiliation(s)
- Patricia B Crane
- Adult Health Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Willie M Abel
- School of Nursing, The University of North Carolina at Charlotte, Greensboro, NC, USA
| | - Thomas P McCoy
- Community Practice Department, The University of North Carolina at Greensboro, Greensboro, NC, USA
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136
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Saunderson CED, Brogan RA, Simms AD, Sutton G, Batin PD, Gale CP. Acute coronary syndrome management in older adults: guidelines, temporal changes and challenges. Age Ageing 2014; 43:450-5. [PMID: 24742588 DOI: 10.1093/ageing/afu034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Advancing age is a risk factor for the development of coronary artery disease and is an important indicator of outcome after acute coronary syndrome. As the number of older adults increases, the burden of cardiovascular disease is set to grow particularly as older adults remain disadvantaged in the delivery of acute cardiac care. This article reviews the temporal changes in the provision of guideline recommended therapies for the management of acute coronary syndrome, discusses reasons for age-dependent inequalities in care and the challenges facing clinicians.
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Affiliation(s)
| | - Richard A Brogan
- Department of Cardiology, Mid Yorkshire NHS Trust, Wakefield, West Yorkshire, UK Department of Cardiology, York and Hull Medical School, University of York, York, UK
| | - Alexander D Simms
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, West Yorkshire, UK
| | - Graham Sutton
- Department of Elderly Medicine, St James's University Hospital, Leeds, West Yorkshire, UK
| | - Phillip D Batin
- Department of Cardiology, Mid Yorkshire NHS Trust, Wakefield, West Yorkshire, UK
| | - Christopher P Gale
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, West Yorkshire, UK
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137
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Phan BAP, Bittner V. Lipid-lowering therapy in patients 75 years and older: clinical priority or superfluous therapy? Prog Cardiovasc Dis 2014; 57:187-96. [PMID: 25216618 DOI: 10.1016/j.pcad.2014.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The incidence and prevalence of cardiovascular (CV)-related morbidity and mortality significantly increase with age. In the elderly, hypercholesterolemia with elevated total and low-density-lipoprotein cholesterol is a significant predictor of incident and recurrent CV disease. Multiple lines of evidence have established the benefit of statin therapy to lower cholesterol levels and reduce the risk of CV events as well as prevent progression of subclinical atherosclerotic disease. Elderly patients, particularly those older than 75 years, have not been well represented in randomized clinical trials evaluating lipid lowering therapy. The limited available data from clinical trials do support the benefit of statin therapy in the elderly population. Based upon these data, cholesterol treatment guidelines endorse statin therapy as the primary treatment of hypercholesterolemia in elderly patients, though caution is recommended given the greater number of co-morbid conditions and concern for poly-pharmacy common in the elderly. Additional research is needed to better establish the benefit of statin therapy in the elderly within the context of reducing CV risk, minimizing side effects, and improving overall quality of life.
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Affiliation(s)
- Binh An P Phan
- Division of Cardiology, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois 60153.
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama 35294.
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