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Jeffery RA, To MJ, Hayduk-Costa G, Cameron A, Taylor C, Van Zoost C, Hayden JA. Interventions to improve adherence to cardiovascular disease guidelines: a systematic review. BMC FAMILY PRACTICE 2015; 16:147. [PMID: 26494597 PMCID: PMC4619086 DOI: 10.1186/s12875-015-0341-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/11/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Successful management of cardiovascular disease (CVD) is impaired by poor adherence to clinical practice guidelines. The objective of our review was to synthesize evidence about the effectiveness of interventions that target healthcare providers to improve adherence to CVD guidelines and patient outcomes. METHODS We searched PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science and CINAHL databases from inception to June 2014, using search terms related to adherence and clinical practice guidelines. Studies were limited to randomized controlled trials testing an intervention to improve adherence to guidelines that measured both a patient and adherence outcome. Descriptive summary tables were created from data extractions. Meta-analyses were conducted on clinically homogeneous comparisons, and sensitivity analyses and subgroup analyses were carried out where possible. GRADE summary of findings tables were created for each comparison and outcome. RESULTS AND DISCUSSION We included 38 RCTs in our review. Interventions included guideline dissemination, education, audit and feedback, and academic detailing. Meta-analyses were conducted for several outcomes by intervention type. Many comparisons favoured the intervention, though only the adherence outcome for the education intervention showed statistically significant improvement compared to usual care (standardized mean difference = 0.58 [95 % confidence interval 0.35 to 0.8]). CONCLUSIONS Many interventions show promise to improve practitioner adherence to CVD guidelines. The quality of evidence and number of trials limited our ability to draw conclusions.
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Affiliation(s)
- Rebecca A Jeffery
- Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2.
| | - Matthew J To
- Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2.
| | - Gabrielle Hayduk-Costa
- Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2.
| | - Adam Cameron
- Department of Medicine, Dalhousie University, Halifax, Canada.
| | - Cameron Taylor
- Department of Science, St. Mary's University, Halifax, Canada.
| | - Colin Van Zoost
- Faculty of Medicine, Dalhousie University, Mailbox 354, 5849 University Avenue, Halifax, NS, Canada, B3H 4R2.
- Department of Medicine, Dalhousie University, Halifax, Canada.
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
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Abstract
Cardiovascular disease (CVD) is the most important cause of premature death and disability globally. Much is known of the main aetiological risk factors, including elevated blood pressure, dyslipidaemia and smoking, with a raft of additional risks of increasing prevalence, such as obesity and diabetes. Furthermore, some of the most secure evidence-based management strategies in healthcare relate to interventions that modify risk. Yet major gaps remain in the implementation of such evidence, summarized in international guideline recommendations. Some of this gap relates to knowledge deficits amongst clinicians, but also to continued uncertainties over interpretation of the evidence base and areas where data are less available. This article collection in BMC Medicine seeks to offer reflections in each of these areas of uncertainty, spanning issues of better diagnosis, areas of controversy and glimpses of potentially potent future interventions in the prevention of CVD.
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Affiliation(s)
- F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Walton Street, Oxford, OX2 6GG, UK. .,Harris Manchester College, University of Oxford, Mansfield Road, Oxford, OX1 3TD, UK.
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153
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Ikdahl E, Hisdal J, Rollefstad S, Olsen IC, Kvien TK, Pedersen TR, Semb AG. Rosuvastatin improves endothelial function in patients with inflammatory joint diseases, longitudinal associations with atherosclerosis and arteriosclerosis: results from the RORA-AS statin intervention study. Arthritis Res Ther 2015; 17:279. [PMID: 26445924 PMCID: PMC4597440 DOI: 10.1186/s13075-015-0795-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/22/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Endothelial dysfunction is an early step in the atherosclerotic process and can be quantified by flow-mediated vasodilation (FMD). Our aim was to investigate the effect of long-term rosuvastatin therapy on endothelial function in patients with inflammatory joint diseases (IJD) with established atherosclerosis. Furthermore, to evaluate correlations between change in FMD (ΔFMD) and change in carotid plaque (CP) height, arterial stiffness [aortic pulse wave velocity (aPWV) and augmentation index (AIx)], lipids, disease activity and inflammation. METHODS Eighty-five statin-naïve patients with IJD and ultrasound-verified CP (rheumatoid arthritis: n = 53, ankylosing spondylitis: n = 24, psoriatic arthritis: n = 8) received rosuvastatin treatment for 18 months. Paired-samples t tests were used to assess ΔFMD from baseline to study end. Linear regression models were applied to evaluate correlations between ∆FMD and cardiovascular risk factors, rheumatic disease variables and medication. RESULTS The mean ± SD FMD was significantly improved from 7.10 ± 3.14 % at baseline to 8.70 ± 2.98 % at study end (p < 0.001). Improvement in AIx (p < 0.05) and CP height reduction (p = 0.001) were significantly associated with ΔFMD (dependent variable). CONCLUSIONS Long-term lipid lowering with rosuvastatin improved endothelial function in IJD patients with established atherosclerotic disease. Reduced arterial stiffness and CP regression were longitudinally correlated with the improvement in endothelial function measured by FMD. TRIAL REGISTRATION ClinicalTrials.gov NCT01389388 . Registered 16 April 2010.
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Affiliation(s)
- Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway.
| | - Jonny Hisdal
- Section of Vascular Investigations, Oslo University Hospital Aker, P.O. Box 0424, Blindern, 0316, Oslo, Norway.
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway.
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway.
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway.
| | - Terje R Pedersen
- Centre of Preventive Medicine, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway. .,Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern, 0316, Oslo, Norway.
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23, Vinderen, 0319, Oslo, Norway.
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154
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Gyberg V, De Bacquer D, De Backer G, Jennings C, Kotseva K, Mellbin L, Schnell O, Tuomilehto J, Wood D, Rydén L, Amouyel P, Bruthans J, Conde AC, Cifkova R, Deckers JW, De Sutter J, Dilic M, Dolzhenko M, Erglis A, Fras Z, Gaita D, Gotcheva N, Goudevenos J, Heuschmann P, Laucevicius A, Lehto S, Lovic D, Miličić D, Moore D, Nicolaides E, Oganov R, Pająk A, Pogosova N, Reiner Z, Stagmo M, Störk S, Tokgözoğlu L, Vulic D. Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology. Cardiovasc Diabetol 2015; 14:133. [PMID: 26427624 PMCID: PMC4591740 DOI: 10.1186/s12933-015-0296-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods A total of 6187 patients (18–80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012–2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results A total of 2846 (46 %) patients had no diabetes, 1158 (19 %) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60 %, respectively. A blood pressure target of <140/90 mmHg was achieved in 68, 61, 54 % and a LDL-cholesterol target of <1.8 mmol/L in 16, 18 and 28 %. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0 % (53 mmol/mol) in 95 and 53 % and 11 % of those with previously known diabetes had an HbA1c >9.0 % (>75 mmol/mol). Of the patients with diabetes 69 % reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27 % of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease.
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Affiliation(s)
- Viveca Gyberg
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Dirk De Bacquer
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Public Health, Ghent University, Ghent, Belgium.
| | - Guy De Backer
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Public Health, Ghent University, Ghent, Belgium.
| | - Catriona Jennings
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Kornelia Kotseva
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Linda Mellbin
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France.
| | - Oliver Schnell
- Forschergruppe Diabetes e.V. at the Helmholtz Center, Munich, Germany.
| | - Jaakko Tuomilehto
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Centre for Vascular Prevention, Danube-University Krems, Krems, Austria. .,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland. .,Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain. .,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - David Wood
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden. .,European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France.
| | - Philippe Amouyel
- Institut Pasteur de Lille, Inserm U744, Université Lille Nord de France, 1 rue du Professeur Calmette B.P. 245, 59019, Lille, France.
| | - Jan Bruthans
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Center for Cardiovascular Prevention, 1st School of Medicine, Charles University and Thomayer Hospital, Vídeňská 800, 140 59, Prague, Czech Republic.
| | - Almudena Castro Conde
- Cardiac Rehabilitation Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Renata Cifkova
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Center for Cardiovascular Prevention, 1st School of Medicine, Charles University and Thomayer Hospital, Vídeňská 800, 140 59, Prague, Czech Republic.
| | - Jaap W Deckers
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Thoraxcenter's Department of Cardiology, Dr Molewaterplein 50, 3000 DR, Rotterdam, The Netherlands.
| | - Johan De Sutter
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Department of Internal Medicine, University of Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Mirza Dilic
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Clinical Center University of Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina.
| | - Maryna Dolzhenko
- Department of Cardiology of Shupyk's Medical Academy of Postgraduate Education, 9 Dorohozhyts'ka str, Kiev, 04112, Ukraine.
| | - Andrejs Erglis
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,University of Latvia, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia.
| | - Zlatko Fras
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Preventive Cardiology Unit, Division of Internal Medicine, University Medical Centre Ljubljana, Zaloška 7, 1525, Ljubljana, Slovenia. .,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Dan Gaita
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie "Victor Babes", Timisoara, Romania.
| | - Nina Gotcheva
- Department of Cardiology, National Heart Hospital, 65, Konyovitsa, 1309, Sofia, Bulgaria.
| | - John Goudevenos
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Cardiology Department of Medical School, University of Ioannina, Ioannina, Greece.
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Aleksandras Laucevicius
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Clinic of Cardiovascular Diseases of Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania. .,Heart and Vascular Medicine of Vilnius University Hospital Santariskiu Clinics, Santariskiu 2, 08661, Vilnius, Lithuania.
| | - Seppo Lehto
- Kuopio University Hospital, Rakennus 5/6. Kerros, Puijonlaaksontie 2, 70210, Kuopio, Finland.
| | - Dragan Lovic
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Clinic for Internal Medicine Intermedica, Jovana Ristica 20/2, 18000, Nis, Serbia.
| | - Davor Miličić
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,University of Zagreb School of Medicine and University Hospital Centre Zagreb, Kispaticeva 12, HR-10000, Zagreb, Croatia.
| | - David Moore
- The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
| | - Evagoras Nicolaides
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,University of Nicosia Medical School, Nicosia General Hospital, 2029 Strovolos, Nicosia, Cyprus.
| | - Raphael Oganov
- National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, 10 Petroverigsky per, 101990, Moscow, Russia.
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jafiellonian University Medical College, Grzegórzecka 20, 31-531, Cracow, Poland.
| | - Nana Pogosova
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Federal Health Centre and Department of Chronic Noncommunicable Diseases Prevention, National Research Centre for Preventive Medicine, 10 Petroverigsky per, 101953, Moscow, Russia.
| | - Zeljko Reiner
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Martin Stagmo
- Department of Heart failure and Valve Disease, Skåne University Hospital, Lund, Sweden.
| | - Stefan Störk
- Comprehensive Heart Failure Centre and Department of Medicine I, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany.
| | - Lale Tokgözoğlu
- European Society of Cardiology, Les Templiers, 2035 route des Colles, CS 80179 BIOT, 06903, Sophia Antipolis Cedex, France. .,Hacettepe University, 06690, Ankara, Turkey.
| | - Dusko Vulic
- Centre for Medical Research, School of Medicine, University of Banja Luka, Vuka Karadzica 6, 78000, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
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Berg C, Strandhagen E, Mehlig K, Subramoney S, Lissner L, Björck L. Normal weight adiposity in a Swedish population: how well is cardiovascular risk associated with excess body fat captured by BMI? Obes Sci Pract 2015; 1:50-58. [PMID: 27721982 PMCID: PMC5049492 DOI: 10.1002/osp4.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of this study was to examine how well body mass index (BMI) reflects cardiovascular risk associated with excess adiposity in a Swedish population by examining the association between body fat, BMI and cardiovascular risk factors. METHODS A total of 3,010 adults participated. Normal weight adiposity was defined as the combination of BMI < 25 kg/m2 and percentage body fat ≥35% for women and ≥25% for men. Associations with blood pressure, blood lipids, apolipoproteins and C-reactive protein were analysed in age-adjusted regression models. RESULTS The majority of the individuals with overweight and obesity were correctly classified to adiposity, while a wide range of body fat was observed among the normal weight subjects. In total, 9% of the participants were categorised as normal weight with adiposity. Compared with the normal weight leanness group, participants with normal weight adiposity had higher levels of serum triglycerides, low-density lipoprotein cholesterol, C-reactive protein, apolipoptotein B and the apolipoprotein B/A-I ratio. In normal weight men, adiposity was also associated with higher blood pressure and lower high-density lipoprotein cholesterol. CONCLUSIONS Higher percentage of body fat was associated with less favourable risk factor profile even in subjects who were normal weight. Thus, it might be relevant to screen for metabolic risk factors in the upper end of the normal weight category.
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Affiliation(s)
- Christina Berg
- Department of Food and Nutrition, and Sport ScienceUniversity of GothenburgGothenburgSweden
| | - Elisabeth Strandhagen
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sreevidya Subramoney
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Nordic School of Public HealthGothenburgSweden
| | - Lauren Lissner
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine and Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
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156
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Haberka M, Gąsior Z. A carotid extra-media thickness, PATIMA combined index and coronary artery disease: Comparison with well-established indexes of carotid artery and fat depots. Atherosclerosis 2015; 243:307-13. [PMID: 26414210 DOI: 10.1016/j.atherosclerosis.2015.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/24/2015] [Accepted: 09/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The clinical utility of traditional cardiovascular (CV) risk factors to predict coronary artery disease (CAD) is insufficient and limited. Our aim was to evaluate the association between a novel ultrasound index of periarterial fat and adventitia (carotid extra-media thickness; EMT) and the severity of CAD and to compare this with well-known vascular indexes in patients with high and very high CV risk. METHODS AND RESULTS Four hundred twenty two patients scheduled for elective coronary angiography were included in the study (age: 61.3 ± 7.4 years; males 65%). Several clinical parameters of obesity were obtained as well as the following ultrasound indexes: carotid EMT and intima-media thickness (IMT), epicardial and pericardial fat thickness (EFT and PFT), and intra-abdominal fat thickness (IAT). These were then related to CAD severity in all individuals. Our study patients had a very high estimated CV risk (82%), and most (60%) fulfilled the MS criteria. Most individuals (71%) had CAD (≥50% stenosis) with equal rates of one, two, or three-vessel disease, and critical (≥70%) coronary stenosis was found in 40% of patients. Carotid EMT was significantly increased in patients with CAD (812 ± 116 vs 746 ± 131 μm) and patients with critical coronary stenosis (829 ± 119 vs 769 ± 122 μm) compared to the appropriate control groups. Moreover, carotid EMT was significantly associated with the severity of CAD. Carotid IMT and EFT (but not PFT and IAT) also revealed significant relations to the number of diseased vessels. Carotid EMT and the new proposed combined index (PATIMA = EMT/BMIx35 + IMT + EFTx60) were predictive for CAD (AUC: 686 ± 304 and 755 ± 260, sensitivity: 60 and 62%, specificity: 76 and 81% for 772 μm and 2015u). CONCLUSIONS We present the first study showing that the new vascular index (carotid EMT) and the proposed combined index PATIMA are associated with the presence and the severity of CAD.
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Affiliation(s)
- Maciej Haberka
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
| | - Zbigniew Gąsior
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland
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157
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Belikov AV, Belikov VV. A citation-based, author- and age-normalized, logarithmic index for evaluation of individual researchers independently of publication counts. F1000Res 2015; 4:884. [PMCID: PMC4654436 DOI: 10.12688/f1000research.7070.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 09/26/2023] Open
Abstract
The use of citation metrics for evaluation of individual researchers has dramatically increased over the last decade. However, currently existing indices either are based on misleading premises or are cumbersome to implement. This leads to poor assessment of researchers and creates dangerous trends in science, such as overproduction of low quality articles. Here we propose an index (namely, the L-index) that does not depend on the number of publications, accounts for different co-author contributions and age of publications, and scales from 0.0 to 9.9. Moreover, it can be calculated with the help of freely available software.
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Affiliation(s)
| | - Vitaly V. Belikov
- Water Problems Institute, Russian Academy of Sciences, Moscow, Russian Federation
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158
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Rollefstad S, Ikdahl E, Hisdal J, Olsen IC, Holme I, Hammer HB, Smerud KT, Kitas GD, Pedersen TR, Kvien TK, Semb AG. Rosuvastatin-Induced Carotid Plaque Regression in Patients With Inflammatory Joint Diseases: The Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis Rheumatol 2015; 67:1718-28. [PMID: 25778850 DOI: 10.1002/art.39114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/10/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) and carotid artery plaques have an increased risk of acute coronary syndromes. Statin treatment with the goal of achieving a low-density lipoprotein (LDL) cholesterol level of ≤1.8 mmoles/liter (≤70 mg/dl) is recommended for individuals in the general population who have carotid plaques. The aim of the ROsuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and other inflammatory joint diseases (RORA-AS) study was to evaluate the effect of 18 months of intensive lipid-lowering treatment with rosuvastatin with regard to change in carotid plaque height. METHODS Eighty-six patients (60.5% of whom were female) with carotid plaques and inflammatory joint disease (55 with RA, 21 with AS, and 10 with psoriatic arthritis) were treated with rosuvastatin to obtain the LDL cholesterol goal. Carotid plaque height was evaluated by B-mode ultrasonography. RESULTS The mean ± SD age of the patients was 60.8 ± 8.5 years, and the median compliance with rosuvastatin treatment was 97.9% (interquartile range [IQR] 96.0-99.4). At baseline, the median number and height of the carotid plaques were 1.0 (range 1-8) and 1.80 mm (IQR 1.60-2.10), respectively. The mean ± SD change in carotid plaque height after 18 months of treatment with rosuvastatin was -0.19 ± 0.35 mm (P < 0.0001). The mean ± SD baseline LDL cholesterol level was 4.0 ± 0.9 mmoles/liter (154.7 ± 34.8 mg/dl), and the mean reduction in the LDL cholesterol level was -2.3 mmoles/liter (95% confidence interval [95% CI] -2.48, -2.15) (-88.9 mg/dl [95% CI -95.9, -83.1]). The mean ± SD LDL cholesterol level during the 18 months of rosuvastatin treatment was 1.7 ± 0.4 mmoles/liter (area under the curve). After adjustment for age/sex/blood pressure, no linear relationship between a reduction in carotid plaque height and the level of LDL cholesterol exposure during the study period was observed. Attainment of the LDL cholesterol goal of ≤1.8 mmoles/liter (≤70 mg/dl) or the amount of change in the LDL cholesterol level during the study period did not influence the degree of carotid plaque height reduction. CONCLUSION Intensive lipid-lowering treatment with rosuvastatin induced atherosclerotic regression and reduced the LDL cholesterol level significantly in patients with inflammatory joint disease.
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Affiliation(s)
| | - E Ikdahl
- Diakonhjemmet Hospital, Oslo, Norway
| | - J Hisdal
- Oslo University Hospital, Aker, Oslo, Norway
| | - I C Olsen
- Diakonhjemmet Hospital, Oslo, Norway
| | - I Holme
- Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - K T Smerud
- Smerud Medical Research International AS, Oslo, Norway
| | - G D Kitas
- The Dudley Group NHS Foundation Trust, West Midlands, UK
| | - T R Pedersen
- Centre of Preventive Medicine, Oslo University Hospital, Ullevål, and University of Oslo, Oslo, Norway
| | - T K Kvien
- Diakonhjemmet Hospital, Oslo, Norway
| | - A G Semb
- Diakonhjemmet Hospital, Oslo, Norway
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The impact of changes in national prescribing conditions for statins on their public expenditure and utilization in the Czech Republic 1997–2013. Health Policy 2015; 119:1255-64. [DOI: 10.1016/j.healthpol.2015.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
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Melamed RJ, Tillmann A, Kufleitner HE, Thürmer U, Dürsch M. Evaluating the efficacy of an education and treatment program for patients with coronary heart disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:802-8. [PMID: 25487763 DOI: 10.3238/arztebl.2014.0802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Until now, there has not been any evaluated, disease-specific education and treatment program for patients with coronary heart disease (CHD) in Germany. It is thought that education can improve these patients' physical activity and quality of life and teach them how to lessen their risk factors, what to do in case of an emergency, and how to assess their own medical treatment. METHODS A randomized controlled open intervention trial was carried out from February 2010 to September 2011. 196 patients were assigned to receive the intervention (patient education), while 199 were assigned to a control group. In an intention-to-treat analysis, baseline and follow-up data were compared after a mean interval of 220 days. The evaluative instruments included the Freiburg Questionnaire of Physical Activity, the MacNew Heart Disease Quality of Life Questionnaire, questionnaires regarding knowledge about CHD, ergometric performance ability, and the body-mass index. RESULTS The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week (MET=metabolic equivalent of task), compared to 2.5 MET/week in the control group; the difference of 6.8 MET/week was statistically significant (p = 0.015). The patients in the intervention group also rated their quality of life higher than those in the control group (0.2 ± 0.56 vs. 0.09 ± 0.53 [mean ± standard deviation], p = 0.056). They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency. CONCLUSION Persistently unhealthy lifestyle is a common problem of CHD patients; the education and treatment program presented here may be a suitable means of improving patients' lifestyle for secondary prevention. Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well.
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Affiliation(s)
- Richard J Melamed
- Tillmann have equally contributed to the article, Department of Medicine, Goethe University Frankfurt/Main, Studiumdigitale-E-Learning Center, Goethe University Frankfurt/Main, Bürgerhospital, Frankfurt am Main, Praxis Thürmer/Endruleit, Frankfurt am Main, Cardiology Frankfurt-Sachsenhausen, Frankfurt am Main
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Abstract
Vitamin E (α-tocopherol) is recognised as a key essential lipophilic antioxidant in humans protecting lipoproteins, PUFA, cellular and intra-cellular membranes from damage. The aim of this review was to evaluate the relevant published data about vitamin E requirements in relation to dietary PUFA intake. Evidence in animals and humans indicates a minimal basal requirement of 4–5 mg/d of RRR-α-tocopherol when the diet is very low in PUFA. The vitamin E requirement will increase with an increase in PUFA consumption and with the degree of unsaturation of the PUFA in the diet. The vitamin E requirement related to dietary linoleic acid, which is globally the major dietary PUFA in humans, was calculated to be 0·4–0·6 mg of RRR-α-tocopherol/g of linoleic acid. Animal studies show that for fatty acids with a higher degree of unsaturation, the vitamin E requirement increases almost linearly with the degree of unsaturation of the PUFA in the relative ratios of 0·3, 2, 3, 4, 5 and 6 for mono-, di-, tri-, tetra-, penta- and hexaenoic fatty acids, respectively. Assuming a typical intake of dietary PUFA, a vitamin E requirement ranging from 12 to 20 mg of RRR-α-tocopherol/d can be calculated. A number of guidelines recommend to increase PUFA intake as they have well-established health benefits. It will be prudent to assure an adequate vitamin E intake to match the increased PUFA intake, especially as vitamin E intake is already below recommendations in many populations worldwide.
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Haberka M, Sosnowski M, Zuziak-Pruska J, Gąsior Z. Extra-media thickness and epicardial fat: Comparison of a novel carotid artery ultrasound index and a well-established cardiac magnetic resonance fat quantification method. Nutr Metab Cardiovasc Dis 2015; 25:763-770. [PMID: 26033393 DOI: 10.1016/j.numecd.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/18/2015] [Accepted: 04/30/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIM Epicardial and pericardial fat are well-established surrogate markers of cardiovascular diseases and complications. Extra-media thickness (EMT) is a novel ultrasound index corresponding to arterial adventitia and adipose tissue. We aimed to evaluate the association between carotid EMT and epicardial fat (EF) and pericardial fat (PF) and their relation to cardiovascular risk and metabolic syndrome (MS). METHODS AND RESULTS One hundred consecutive patients (age: 51.7 ± 15.4 years; males 70%) scheduled for cardiac magnetic resonance (CMR) were prospectively included in the study. Anthropometric parameters, CMR indices of EF and PF, both common carotid arteries EMT, and ultrasound indices of visceral and subcutaneous fat were measured in patients. In our study group, 53% of patients represented a very high cardiovascular risk, overweight or obesity was found in 68%, high body fat in 45%, and MS in 59% of individuals. Mean EMT (662 ± 129 μm) was significantly associated with EF area (r = 0.46; p < 0.001) and PF area (r = 0.3; p < 0.001). Among all fat indices, only EMT (MS+ 736 ± 140 μm vs. MS-658 ± 97 μm; p = 0.002) and EF area (MS+ 870 ± 451 mm(2) vs. MS 668 ± 333 mm(2); p = 0.02) were significantly increased in patients with MS compared with individuals without MS. Multivariable regression analysis also showed that mean EMT is independently associated with number of cardiovascular risk factors (b = 0.005; p < 0.001). Moreover, very high cardiovascular risk subjects showed significantly increased EMT/BMI (p < 0.001) and EF area/BMI (p = 0.03) ratios. However, there was no significant association between EMT/BMI and EF area/BMI values (p = ns). CONCLUSIONS Our study showed the first findings on the relations between a novel ultrasound index EMT and EF assessed in a reference method of CMR. Carotid EMT may be a new surrogate marker, including both periarterial fat as a major component and arterial adventitia, which may provide additional data on cardiometabolic risk beyond that derived form a well-established EF alone.
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Affiliation(s)
- M Haberka
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
| | - M Sosnowski
- School of Medicine, Medical University of Silesia, 3rd Department of Cardiology, Katowice, Poland
| | - J Zuziak-Pruska
- Upper Silesian Medical Centre, Medical University of Silesia, Department of Diagnostic Imaging, Katowice, Poland
| | - Z Gąsior
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland
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Lachman S, Minneboo M, Snaterse M, Jorstad HT, Ter Riet G, Scholte Op Reimer WJ, Boekholdt SM, Peters RJG. Community-based comprehensive lifestyle programs in patients with coronary artery disease: Objectives, design and expected results of Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 trial (RESPONSE 2). Am Heart J 2015; 170:216-22. [PMID: 26299217 DOI: 10.1016/j.ahj.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/10/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Patients with coronary artery disease (CAD) are at high risk of recurrent events. A healthy lifestyle can significantly reduce this risk. A previous trial, Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists (RESPONSE), demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors. However, lifestyle-related risk factors, including smoking, overweight, and physical inactivity, were common and remained largely unchanged at follow-up in most patients (66%). The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD. We are conducting a multicenter (n = 15), randomized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs, aimed at patients and their partners, on top of usual care. These programs are aimed at smoking cessation (Luchtsignaal(®)), weight loss (Weight Watchers(®)), and improving physical activity (Philips DirectLife(®)). OUTCOMES The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2, and a relative increase of at least 30% in this proportion is considered clinically relevant.
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Affiliation(s)
- Sangeeta Lachman
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Madelon Minneboo
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marjolein Snaterse
- Amsterdam University of Applied Sciences, School of Health Professions, Amsterdam, the Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Ron J G Peters
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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Effects of lifestyle intervention improve cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China. Menopause 2015; 21:1263-8. [PMID: 24781851 DOI: 10.1097/gme.0000000000000248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of a 12-month lifestyle intervention in improving cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China. METHODS One hundred healthy menopausal transition and early postmenopausal women aged 40 to 60 years were randomly assigned to receive either lifestyle change intervention (n = 53) or usual care (n = 47). Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop + 10 based on prospective menstrual calendars. Women in the intervention group were provided with a colorful booklet that included dietary and physical activity recommendations, were individually interviewed, and completed biophysical cardiovascular risk assessments at the Women's Health Center (Beijing, China). Women were encouraged to follow a healthy eating pattern and to increase their aerobic activity (moderate level, 3 d/wk, 40 min/d). Women in the control group continued their usual eating patterns and activities. Weight, body mass index (BMI), waist circumference-to-hip circumference ratio (WHR), waist circumference (WC), body composition, blood pressure (BP), blood glucose, and serum lipids were assessed at baseline, 3 months, 6 months, and 12 months in both groups. RESULTS Women in the intervention group were observed to have significant decreases in weight, BMI, WC, WHR, systolic BP, total cholesterol, and low-density lipoprotein cholesterol compared with women in the control group. At 3 months, there were significant decreases in weight (-0.28 vs 0.68 kg, P = 0.002), BMI (-0.06 vs 0.44 kg/m2, P = 0.003), WC (-0.28 vs 1.43 cm, P = 0.001), and WHR (-0.01 vs 0.01, P = 0.045) in the intervention group compared with the control group. At 6 months, there were significant decreases in WC (-0.73 vs 1.02 cm, P = 0.012), WHR (-0.02 vs -0.003, P = 0.020), and systolic BP (-7.52 vs -0.63 mm Hg, P = 0.012) favoring the intervention group over the control group. At 12 months, there were significant decreases in total cholesterol (-0.07 vs 0.03 mmol/L, P = 0.045) and low-density lipoprotein cholesterol (-0.13 vs 0.01 mmol/L, P = 0.022) in the intervention group versus the control group. CONCLUSIONS Lifestyle intervention may be an effective means for reducing cardiovascular disease risk factors in menopausal transition and early postmenopausal women in China.
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Kopčeková J, Lorková M, Habánová M, Chlebo P, Ferenčíková Z, Chlebová Z. The occurence of risk factors of cardiovascular diseases and the effect of selected dietary habits on the lipid profile and body mass index. POTRAVINARSTVO 2015. [DOI: 10.5219/491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In a group of 204 randomly selected patients hospitalized in the Cardiocentre Nitra, of which 63 were women (30.88%) and 141 men (69.12%), we evaluated the prevalence of modifiable risk factors for cardiovascular diseases and the impact of dietary habits on the lipid profile and body mass index (BMI). We have recorded a high prevalence of risk factors, especially overweight and obesity, where 87.3% of women and 92.91% of men had BMI ≥25. Normal weight was observed only in 12.70% of women and in 7.09% of men. In the study group up to 60.32% of women and 57.45% of men had blood pressure higher than ≥130/85 mmHg. More than half of the respondents were simultaneously overweighted or obese together with high blood pressure occurence. The total cholesterol level higher than 5.2 mmol/Ll was recorded in 41.24% of women and 34.75% of men. There was statistically significant difference between men and women (P <0.05) in the prevalence of low HDL cholesterol to the detriment of men while the value below 1.3 mmol/L was recorded in 31.75% of women and the value lower than 1.1 mmol/L in 52.48 % of men. Values of triglycerides (TG) ≥1.7 mmol/L were recorded in 28.57% of women and in 35.42% of men. Fasting blood glucose levels ≥5.6 mmol/L were recorded in up to 68.25% of women and 71.63% of men. There was not statistically significant difference (P >0.05) in the occurrence of increased levels of cholesterol, triglycerides, blood pressure and glycemia according to gender. We found out that most of the respondents consumed food 3-4 times per day, i.e. 53.97% of women and 60.99% of men. Food intake for five to six times a day was reported only by 28.57% of women and 19.15% of men. The number of daily meals was significantly reflected in the BMI values in men who consumed food 1-2 times a day compared to the men who ate 3-4 meals daily (P <0.001). We detected lower BMI values in women with more frequent food consumption, however the difference was not statistically significant. While assessing the nutritional history, we have recorded frequent consumption of meat and meat products which are consumed by 49.21% of women and 60.28% of men (P <0.001) more than four times a week, while more than 30% of women and men consume them daily. On the contrary, women consume fish more often, while 53.97% of women and 48.23% of men consume it 1 to 2 times a week. Although fruit and vegetable are part of daily diet of almost all patients, it is insufficient in portions of one or two pieces a day compared with dietary recommendations. We noticed significantly higher BMI (P <0.05) in men who consume sweetened beverages, than men who consume mostly non-sweetened beverages.
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Sovová E, Čajka V, Pastucha D, Malinčíková J, Radová L, Sovová M. Positive effect of yoga on cardiorespiratory fitness: A pilot study. Int J Yoga 2015; 8:134-8. [PMID: 26170593 PMCID: PMC4479891 DOI: 10.4103/0973-6131.158482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death in developed countries. An integral part of primary prevention is physical activity. One form of physical activity to be potentially used is yoga, but this activity is associated with lower energy expenditure than that recommended for prevention. The study aimed at assessing the effect of regular yoga sessions on the aerobic capacity of the practitioners and comparing it with the normal population performing physical activity recommended by guidelines. MATERIALS AND METHODS Fifty-eight persons (16 males) with a mean age of 50.0 ± 11.06 years comprising the yoga group practiced yoga for at least 1 h a day for over 2 years. They underwent spiroergometry under maximal exercise testing to assess basic performance parameters. Their results were compared with those in 54 age-matched controls (16 males mean age of 48 ± 11.86 years performing a regular aerobic physical activity for at least 7 h a week. RESULTS The yoga group had statistically significantly higher maximum performance per kilogram (P = 0.007) and maximum oxygen consumption per kilogram per minute (P = 0.028). CONCLUSIONS Despite low energy expenditure, yoga practices are better in some cardiorespiratory fitness parameters than other aerobic activities recommended by current guidelines for CVD prevention.
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Affiliation(s)
- Eliška Sovová
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Faculty of Medicine and Dentistry Palacky University Olomouc, University Hospital Olomouc, Czech Republic
| | - Vít Čajka
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Faculty of Medicine and Dentistry Palacky University Olomouc, University Hospital Olomouc, Czech Republic
| | - Dalibor Pastucha
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Faculty of Medicine and Dentistry Palacky University Olomouc, University Hospital Olomouc, Czech Republic
| | - Jana Malinčíková
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Faculty of Medicine and Dentistry Palacky University Olomouc, University Hospital Olomouc, Czech Republic
| | - Lenka Radová
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Markéta Sovová
- Department of Internal Medicine II – Gastroenterology and Hepatology, Faculty of Medicine and Dentistry Palacky University Olomouc, University Hospital Olomouc, Czech Republic
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Guijarro C, Ruilope LM. Colesterol ligado a lipoproteínas de baja densidad (LDL) y reducción del riesgo vascular. Proproteína convertasa subtilisina / kexina tipo 9 (PCSK9): una nueva diana terapéutica. Med Clin (Barc) 2015; 145:67-9. [DOI: 10.1016/j.medcli.2015.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/10/2015] [Accepted: 04/14/2015] [Indexed: 01/08/2023]
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Bem D, Dretzke J, Stevens S, Lordkipanidzé M, Hodgkinson J, Bayliss S, Moore D, Fitzmaurice D. Investigating the effectiveness of different aspirin dosing regimens and the timing of aspirin intake in primary and secondary prevention of cardiovascular disease: protocol for a systematic review. Syst Rev 2015; 4:88. [PMID: 26088608 PMCID: PMC4475616 DOI: 10.1186/s13643-015-0078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Once-daily low-dose aspirin is routinely used for the prevention of secondary events in cardiovascular disease (CVD). The routine use of aspirin in primary prevention of CVD is less clear due to a finer balance between benefits and harms. In addition, the variability in benefit achievable from the prescription of aspirin has led to a growing interest in considering whether there are more effective aspirin regimens than once-daily dosing or whether effectiveness is influenced by the time of day aspirin is taken (chronotherapy). The proposed systematic review will evaluate the evidence on the effects of different aspirin regimens used in terms of number of doses (e.g. split or alternate dosing) or dosing time of aspirin (e.g. morning versus evening) in primary and secondary prevention of CVD. METHODS/DESIGN Standard systematic review methodology will be employed for study identification, selection and data extraction. Electronic databases will be searched incorporating terms relating to population and the intervention. No date or language limitations will apply. Systematic reviews and controlled studies comparing different aspirin regimens-in terms of frequency or timing-for primary and/or secondary prevention of CVD will be included. No restrictions on outcome will apply. Quality assessment will be appropriate for each study design. The data will be tabulated and narratively synthesised. Meta-analysis may be undertaken where clinical and methodological homogeneity exists. DISCUSSION There are a number of published and ongoing primary studies that investigate the cardiovascular protective effect of different aspirin regimens. However, no systematic review to date has attempted to review the evidence pertaining to aspirin dosing regimens differing in frequency and/or in timing. The proposed systematic review will cover both the above questions and could potentially be beneficial for reconsidering the current practice of managing patients with aspirin in primary care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014010596.
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Affiliation(s)
- Danai Bem
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH, UK.
| | - Simon Stevens
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Marie Lordkipanidzé
- Montreal Heart Institute, Research Centre, 5000 rue Bélanger, Montréal, QC, H1T 1C8, Canada. .,Faculté de pharmacie, Université de Montreal, C.P. 6128, Succ. Centre-ville, Montreal, QC, H3C 3J7, Canada.
| | - James Hodgkinson
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sue Bayliss
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - David Moore
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - David Fitzmaurice
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Formentín P, Catalán Ú, Fernández-Castillejo S, Alba M, Baranowska M, Solà R, Pallarès J, Marsal LF. Human aortic endothelial cell morphology influenced by topography of porous silicon substrates. J Biomater Appl 2015; 30:398-408. [PMID: 26017716 DOI: 10.1177/0885328215588414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Porous silicon has received much attention because of its optical properties and for its usefulness in cell-based biosensing, drug delivery, and tissue engineering applications. Surface properties of the biomaterial are associated with cell adhesion and with proliferation, migration, and differentiation. The present article analyzes the behavior of human aortic endothelial cells in macro- and nanoporous collagen-modified porous silicon samples. On both substrates, cells are well adhered and numerous. Confocal microscopy and scanning electron microscopy were employed to study the effects of porosity on the morphology of the cells. On macroporous silicon, filopodia is not observed but the cell spreads on the surface, increasing the lamellipodia surface which penetrates the macropore. On nanoporous silicon, multiple filopodia were found to branch out from the cell body. These results demonstrate that the pore size plays a key role in controlling the morphology and growth rate of human aortic endothelial cells, and that these forms of silicon can be used to control cell development in tissue engineering as well as in basic cell biology research.
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Affiliation(s)
- Pilar Formentín
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Úrsula Catalán
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Sara Fernández-Castillejo
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Maria Alba
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Malgorzata Baranowska
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Rosa Solà
- Unit of Lipids and Atherosclerosis Research, Department of Medicine and Surgery, Universitat Rovira i Virgili, Tarragona, Spain
| | - Josep Pallarès
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
| | - Lluís F Marsal
- Nano-electronic and Photonic Systems, Departament d'Enginyeria Electrònica, Elèctrica i Automàtica, Universitat Rovira i Virgili, Tarragona, Spain
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Go C, Avgerinos ED, Chaer RA, Ling J, Wazen J, Marone L, Fish L, Makaroun MS. Long-term clinical outcomes and cardiovascular events after carotid endarterectomy. Ann Vasc Surg 2015; 29:1265-71. [PMID: 26004951 DOI: 10.1016/j.avsg.2015.03.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-term atherosclerotic adverse events are anticipated in patients undergoing carotid endarterectomy (CEA); however, their incidence and risk predictors remain unknown. METHODS A consecutive cohort of CEAs between 1/1/2000-12/31/2007 was analyzed. End points were any stroke, coronary event (myocardial infarction, coronary bypass, or stenting), vascular interventions for critical limb ischemia, aortic aneurysm or carotid disease, and death. Survival analysis and Cox regression models were used to identify clinical predictors. RESULTS A total of 1,136 CEAs (bilateral, 89; mean age, 71.2 ± 9.2 years; 56.5% male; 36.3% symptomatic, and 3.9% combined with coronary bypass) were performed during the study period with a mean clinical follow-up of 60 months (0-155 months). The postoperative combined stroke and/or death rate was 2.7% and 1.9% for asymptomatic and 4.1% for symptomatic patients. Five and 10-year risks of the end points were 7.2% and 16.1% for stroke, 18.4% and 31.5% for coronary interventions, 20.6% and 28.5% for major vascular interventions, and 25.8% and 50.1% for death. Statins conferred a significant protective effect for stroke (hazard ratio [HR], 0.53; P = 0.016) and death (HR, 0.66; P < 0.0001). Baseline vascular disease predicted future vascular interventions: aortic aneurysm (HR, 1.90; P = 0.003), peripheral arterial disease (HR, 2.03; P < 0.0001), and contralateral internal carotid artery (ICA) stenosis ≥50% (HR, 4.61; P < 0.0001). Renal insufficiency predicted worse outcomes for all other end points (HR, 2.21; P = 0.023 for stroke; HR, 1.62; P = 0.008 for coronary events; HR, 2.38; P < 0.0001 for death). CONCLUSIONS Patients undergoing CEA continue to derive long-term low stroke rate benefit but still sustain major coronary events and require vascular interventions, indicating a need for more intensive medical treatment and rigorous follow-up.
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Affiliation(s)
- Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer Ling
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joe Wazen
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Luke Marone
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Larry Fish
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Michel S Makaroun
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Robinson JG, Stone NJ. The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk: a new paradigm supported by more evidence. Eur Heart J 2015; 36:2110-2118. [DOI: 10.1093/eurheartj/ehv182] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/27/2015] [Indexed: 12/15/2022] Open
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Krempf M, Simpson RJ, Ramey DR, Brudi P, Giezek H, Tomassini JE, Lee R, Farnier M. Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey. Lipids Health Dis 2015; 14:45. [PMID: 25985907 PMCID: PMC4457981 DOI: 10.1186/s12944-015-0037-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/17/2015] [Indexed: 01/14/2023] Open
Abstract
Background Goal attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) is suboptimal. Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We examined physicians’ treatment recommendations in high-risk patients whose LDL-C remained uncontrolled despite statin monotherapy. Methods Physicians completed a questionnaire prior to randomization into period I of a two-period randomized controlled trial evaluating LDL-C goal attainment in patients whose LDL-C remained ≥100 mg/dL after 5 weeks’ treatment with atorvastatin 10 mg/day (NCT01154036). Physicians’ treatment recommendations were surveyed for two hypothetical and one real scenario: (1) LDL-C presumed near goal (between 100–105 mg/dL), (2) LDL-C presumed far from goal (~120 mg/dL), and (3) observed baseline LDL-C of enrolled patients. Prognostic factors considered during decision-making were identified by regression analysis. Observed lipid outcomes at the end of period I (following 6 weeks’ treatment with ezetimibe 10 mg plus atorvastatin 10 mg, atorvastatin 20 mg, or rosuvastatin 10 mg) were compared with estimated LDL-C outcomes for physicians’ treatment recommendations after 6 weeks (based on individual patients’ pre-randomization LDL-C and expected incremental change). Results Questionnaires were completed for 1,534 patients. No change in therapy, or double atorvastatin dose, were frequently recommended, even when LDL-C was far from goal (6.5% and 52.2% of patients, respectively). Double atorvastatin dose was commonly recommended in all scenarios (43–52% of patients). More intensive LDL-C-lowering regimens were recommended infrequently e.g. double atorvastatin dose and add ezetimibe only <12% in all scenarios. Overall, cardiovascular risk factors and desire to achieve a more aggressive LDL-C goal were prominent factors in decision-making for treatment. Comparison of observed and estimated LDL-C levels showed that physicians tended to overestimate the effectiveness of their recommendations. Conclusions This study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. The need for lower LDL-C and cardiovascular risk were key drivers in clinical decision-making, but physicians’ treatment choices were more conservative than guideline recommendations, potentially resulting in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose. Trial registration Clinicaltrials.gov: NCT01154036 Electronic supplementary material The online version of this article (doi:10.1186/s12944-015-0037-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Krempf
- Endocrinology and Nutrition, Hôpital Laënnec, Nantes, 44035, France.
| | - Ross J Simpson
- Center for Heart and Vascular Care, University of North Carolina, Chapel Hill, NC, USA.
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Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR. Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 2015; 44:20150094. [PMID: 25945511 DOI: 10.1259/dmfr.20150094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Outcome studies among post-menopausal females with calcified carotid artery plaque (CCAP) on their panoramic images have not been previously undertaken. We sought to compare the extent of abdominal aortic calcification (AAC) on lateral lumbar spine radiographs (LLSRs), among groups of females with (CCAP+) and without (CCAP-) carotid lesions on their panoramic images. "Severe" levels of AAC have previously been validated as a risk indicator of future adverse cardiovascular events. METHODS This cross-sectional case-control study included a "CCAP+ group" consisting of females more than 50 years of age having the carotid lesion diagnosed by their dentists and an atherogenic risk factor (age, body mass index, hypertension, diabetes and dyslipidaemia)-matched "CCAP- group". A physician radiologist, using the Framingham index, evaluated the LLSRs for the magnitude of AAC. Summary statistics for key variables were computed and conditional logistic regression techniques were considered. RESULTS Members of the CCAP+ group were significantly (p=0.038) more likely to demonstrate "severe" levels of AAC on their LLSRs than members of the CCAP group. CONCLUSIONS This is the first published study demonstrating that CCAP on panoramic images of post-menopausal females is significantly associated with "severe" levels of AACs on LLSRs independent of traditional risk factors. Given that these levels of AAC are a validated risk indicator of future myocardial infarction and stroke, dentists must evaluate the panoramic images of post-menopausal females for the presence of CCAP. Patients with carotid atheromas should be referred to their physicians for further evaluation given the systemic implications.
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Affiliation(s)
- A H Friedlander
- 1 Department of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - S M El Saden
- 3 Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,4 Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R C Hazboun
- 5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - T I Chang
- 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - W K Wong
- 6 Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - N R Garrett
- 7 Dean's Office, School of Dentistry, University of California Los Angeles, CA, USA
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Machado-Alba JE, García S, Calvo-Torres LF, Bañol-Giraldo AM. Patrones de prescripción del ácido acetilsalicílico. REVISTA COLOMBIANA DE CARDIOLOGÍA 2015. [DOI: 10.1016/j.rccar.2015.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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175
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Lonardo A, Ballestri S, Targher G, Loria P. Diagnosis and management of cardiovascular risk in nonalcoholic fatty liver disease. Expert Rev Gastroenterol Hepatol 2015; 9:629-50. [PMID: 25327387 DOI: 10.1586/17474124.2015.965143] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as an important cardiovascular risk (CVR) factor. This is a narrative clinical review aimed at answering how diagnosis and management of CVR should be conducted in the individual patient with NAFLD. To this end, the authors performed an extensive search of the existing literature on PubMed (1993-2014) using pertinent keywords. To date, CVR among patients with NAFLD might be assessed with the Framingham risk score equation or other risk calculators, to be adapted to the true CVR in the specific population being assessed; however, the use of these CVR calculators needs to be validated by future studies in larger cohorts of NAFLD patients of various ethnic backgrounds in order to substantiate their clinical relevance as a foundation for the primary prevention of cardiovascular diseases in this group of patients. Early and aggressive drug treatment of CVR should be started in NAFLD patients with a history of cardiovascular events, established diabetes or who are at high (calculated) CVR. Whether such an aggressive pharmacological approach is also justified in patients with NAFLD, who are at intermediate or low CVR, remains debatable. Currently, there are no clinical trials showing that the treatment of NAFLD per se (either associated or unassociated with traditional CVR factors) will result in decreased risk of cardiovascular events. Accordingly, drug treatment should be better individualized, aiming at correcting all the coexisting cardio-metabolic risk factors of the individual patient with NAFLD. To this end, an overview of the lifestyle interventions and the available drugs is offered, emphasis being conveyed to statins and metformin, which promise to cover worrying complications of NAFLD such as the risk of developing hepatocellular carcinoma.
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Affiliation(s)
- Amedeo Lonardo
- Department of Medicine, Division of Internal Medicine, Pavullo Hospital, Pavullo 41026, Italy
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Ageing modifies the effects of beetroot juice supplementation on 24-hour blood pressure variability: An individual participant meta-analysis. Nitric Oxide 2015; 47:97-105. [PMID: 25937622 DOI: 10.1016/j.niox.2015.04.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/21/2015] [Accepted: 04/25/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Abnormal circadian oscillations of blood pressure (BP) and nocturnal-diurnal BP differences (i.e., dipping) increase cardiovascular risk. Whether inorganic nitrate supplementation influences 24-hr BP variability is currently unknown. We studied the effects of high-nitrate beetroot juice supplementation on BP variability measured by 24-hr ambulatory BP monitoring (24-hr ABPM) in older subjects. METHODS Data from four independent randomised clinical trials were collated. Eighty-five older participants (age range: 55-76 years) were included in the final database. Two trials had an open-label, parallel design and two trials had a cross-over, double-blind design. Participants were randomised to either beetroot juice or placebo. Changes in 24-hr ABPM (daily, diurnal, nocturnal), variability (weighted-SDs), night-dipping, morning surge for systolic and diastolic BP were measured. Meta-analysis was conducted to obtain pooled estimates of the effect size for each BP outcome. Sub-group analyses were conducted to evaluate the influence of age, BMI, gender, BP status and changes in nitrite concentrations on the effect size. RESULTS The pooled effect of beetroot juice on all BP outcomes was not significant. Beetroot juice ingestion determined a significant decrease in nocturnal systolic BP variability in subjects aged less than 65 y (2.8 mmHg, -4.5 -1.0, p = 0.002) compared to the older group (≥ 65 y; 1.0 mmHg, -2.2 4.2, p = 0.54). A greater change in NO2(-) concentrations after beetroot supplementation was associated with significant differences for nocturnal mean (-3.4 mmHg, -0.6 -2.4, p = 0.02) and variability (-0.8 mmHg, -1.5 -0.06, p = 0.03) of systolic BP. CONCLUSIONS The vascular responsiveness to inorganic nitrate may be modified by mechanisms of vascular ageing influencing the reducing capacity to convert inorganic nitrate into nitrite and tissue-specific responses to dietary nitrate supplementation.
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Olofindayo J, Peng H, Liu Y, Li H, Zhang M, Wang A, Zhang Y. The interactive effect of diabetes and central obesity on stroke: a prospective cohort study of inner Mongolians. BMC Neurol 2015; 15:65. [PMID: 25927864 PMCID: PMC4424496 DOI: 10.1186/s12883-015-0328-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/21/2015] [Indexed: 01/19/2023] Open
Abstract
Background The relationship between central obesity and stroke is inconsistent in diabetic and non-diabetic populations. This indicates an interaction between diabetes and central obesity on stroke risk. The present study aimed to examine the interaction in a cohort of Inner Mongolians. Methods In this prospective cohort study, we assessed the interaction between diabetes and central obesity on stroke incidence between June 2003 and July 2012. At baseline, 2,589 adults were recruited and examined from Inner Mongolia, China. Participants were categorized into four subgroups according to presence of diabetes and/or central obesity. Both additive and multiplicative interactions were evaluated using Cox proportional-hazard models. Results 121 stroke events were recorded during the follow-up period. The cumulative incidence of stroke was highest for participants with both diabetes and central obesity (log-rank test, P = 0.042). The multivariable-adjusted risk for stroke was significantly higher in participants with both conditions (HR = 3.02, 95% CI 1.24-7.33, P = 0.015) compared to those with neither diabetes nor central obesity. Attributable proportion due to the interaction between diabetes and central obesity was 0.571 (95% CI 0.017-1.125). The multiplicative interactive effect between diabetes and central obesity on stroke was also statistically significant (HR = 2.67, 95% CI 1.14-6.26, P = 0.024). Conclusions The participants who were both diabetic and centrally obese had significantly higher risk for incident stroke than the combination of individuals who individually had either condition among Mongolian population. This study suggests that central obesity and diabetes act synergistically to increase the risk of stroke.
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Affiliation(s)
- Jennifer Olofindayo
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. .,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China.
| | - Yan Liu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China.
| | - Hongmei Li
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China.
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China.
| | - Aili Wang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China.
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Ren-ai Road Industrial Park District, Suzhou, China. .,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China.
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Ghorban K, Shanaki M, Mobarra N, Azad M, Asadi J, Pakzad R, Ehteram H. Apolipoproteins A1, B, and other prognostic biochemical cardiovascular risk factors in patients with beta-thalassemia major. ACTA ACUST UNITED AC 2015; 21:113-20. [PMID: 25913481 DOI: 10.1179/1607845415y.0000000016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The occurrence of cardiac iron deposition is one of the late effect of iron over load which causes cardiovascular disease (CVD) in patients who are affected by beta-thalassemia major. Evaluation of some cardiovascular risk factors plays a crucial role in prediction and prevention of CVD. SUBJECTS AND METHODS This study consisted of 70 young adult subjects with beta-thalassemia major (beta-TM) (aged <30 years) and 71 age- and sex-matched healthy subjects as control group in the range of 20-30 years. Hematological and biochemical laboratory parameters including apolipoprotein (Apo)A1 and ApoB, oxidative stress biomarker pro-oxidant-antioxidant balance (PAB), homocysteine, serum high-sensitivity C-reactive protein (hs-CRP), and lipid profile were evaluated. RESULTS ApoA1, ApoB, lipid profiles, and homocysteine were significantly decreased in patients group (P < 0.001); however, very low-density lipoprotein and also mean corpuscular hemoglobin concentration (P > 0.05) were different. Some elements included ferritin (P < 0.001), PAB (P < 0.001), and ApoB/apoA1 ratio (P < 0.05) statistically increased in patients, whereas hs-CRP (P > 0.05) was not significantly different in study groups. Exception of high-density lipoprotein (P > 0.05), other lipid profiles, and apoB had a negative meaningful correlation with PAB (P < 0.05). Likewise, apoA1, apoB, apoB/A1 ratio with apoB and homocysteine showed a strong correlation (P < 0.05). We did not find a slight correlation between apoB/A1 ratio in the company of oxidative stress marker PAB (r = -0.366; P = 0.086). We found a statistical correlation between apoB/A1 and homocysteine (P < 0.05). DISCUSSION Higher level of some risk factors like PAB values, apoB/A1 ratio concentration, and lipid profiles is able to involve in the prognostic pathological consequences in patients with beta-thalassemia major. Even so, they contribute toward the gradual development of CVD.
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Affiliation(s)
- Khodayar Ghorban
- a Department of Immunology, School of Medicine , AJA University of Medical Sciences , Tehran , Iran
| | - Mehrnoosh Shanaki
- b Department of Laboratory Medicine, School of Allied Medical Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Naser Mobarra
- a Department of Immunology, School of Medicine , AJA University of Medical Sciences , Tehran , Iran.,c Department of Biochemistry, Metabolic Disorders Research Center , School of Medicine, Golestan University of Medical Sciences , Gorgan , Iran.,g Students' Scientific Research Center, Tehran University of Medical Sciences , Iran
| | - Mehdi Azad
- d Department of Medical Laboratory Sciences, Faculty of Allied Medicine , Qazvin University of Medical Sciences , Iran
| | - Jahanbakhsh Asadi
- c Department of Biochemistry, Metabolic Disorders Research Center , School of Medicine, Golestan University of Medical Sciences , Gorgan , Iran
| | - Reza Pakzad
- e Departments of Epidemiology and Biostatistics , School of Public Health, Tehran University of Medical Sciences , Iran
| | - Hassan Ehteram
- f Department of Pathology, School of Medicine , Kashan University of Medical Sciences , Iran
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Dessein PH, Hsu HC, Tsang L, Millen AME, Woodiwiss AJ, Norton GR, Solomon A, Gonzalez-Gay MA. Kidney function, endothelial activation and atherosclerosis in black and white Africans with rheumatoid arthritis. PLoS One 2015; 10:e0121693. [PMID: 25806966 PMCID: PMC4373952 DOI: 10.1371/journal.pone.0121693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/14/2015] [Indexed: 12/19/2022] Open
Abstract
Objective To determine whether kidney function independently relates to endothelial activation and ultrasound determined carotid atherosclerosis in black and white Africans with rheumatoid arthritis (RA). Methods We calculated the Jelliffe, 5 Cockcroft-Gault equations, Salazar-Corcoran, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (EGFR) equations in 233 (112 black) RA patients. Results The CKD-EPI eGFR was <90 ml/min/1.73m2 in 49.1% and 30.6% of black and white patients, respectively (odds ratio (95% confidence interval) = 2.19 (1.28–3.75), p = 0.004). EGFRs were overall consistently associated with monocyte chemoattractant protein-1 and angiopoietin 2 concentrations in white patients, and with carotid intima-media thickness and plaque in black participants. Amongst black patients, plaque prevalence was 36.7% and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was not associated with plaque presence for the MDRD equation (p = 0.3), whereas the respective relationship was significant or borderline significant (p = 0.003 to 0.08) and of similar extent (p>0.1 for comparisons of AUC (SE)) for the other 8 equations. Based on optimal eGFR cutoff values with sensitivities and specificities ranging from 42 to 60% and 70 to 91% respectively, as determined in ROC curve analysis, a low eGFR increased the odds ratio for plaque 2.2 to 4.0 fold. Conclusion Reduced kidney function is independently associated with atherosclerosis and endothelial activation in black and white Africans with RA, respectively. CKD is highly prevalent in black Africans with RA. Apart from the MDRD, eGFR equations are useful in predicting carotid plaque presence, a coronary heart disease equivalent, amongst black African RA patients.
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Affiliation(s)
- Patrick H. Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Hon-Chun Hsu
- Department of Nephrology, Milpark Hospital, Johannesburg, South Africa
| | - Linda Tsang
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aletta M. E. Millen
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J. Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R. Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Solomon
- Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Miguel A. Gonzalez-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
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Yerly P, Marquès-Vidal P, Owlya R, Eeckhout E, Kappenberger L, Darioli R, Depairon M. The Atherosclerosis Burden Score (ABS): a Convenient Ultrasound-Based Score of Peripheral Atherosclerosis for Coronary Artery Disease Prediction. J Cardiovasc Transl Res 2015; 8:138-47. [DOI: 10.1007/s12265-015-9617-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/23/2015] [Indexed: 12/30/2022]
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182
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Corrales A, Dessein PH, Tsang L, Pina T, Blanco R, Gonzalez-Juanatey C, Llorca J, Gonzalez-Gay MA. Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study. Arthritis Res Ther 2015; 17:55. [PMID: 25888724 PMCID: PMC4376096 DOI: 10.1186/s13075-015-0576-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/20/2015] [Indexed: 11/13/2022] Open
Abstract
Introduction We previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and a concurrent low CVD risk according to the SCORE. Methods A cohort of 144 women with an evaluated low risk of CVD (SCORE value of zero) was assembled amongst 550 consecutive patients with RA that underwent CVD risk factor recording and carotid artery ultrasound. Participants had no established CVD, moderate or severe chronic kidney disease, or diabetes. We assessed carotid plaque(s) presence and its associated patient characteristics. Results Carotid artery plaque was present in 35 (24.3%) of women with RA. Age, the number of synthetic disease-modifying agents (DMARDs) and total cholesterol concentrations were independently associated with plaque in multivariable stepwise backward regression analysis (odds ratio (95% confidence interval) = 1.15 (1.07 to 1.24), P <0.0001, 1.51 (1.05 to 2.17), P = 0.03 and 1.66 (1.00 to 2.73) P = 0.04), respectively). The area under the curve (AUC) of the receiver operating curve (ROC) for the association with plaque was 0.807 (P <0.0001), 0.679 (P = 0.001) and 0.599 (P = 0.08) for age, total cholesterol concentrations and number of synthetic DMARDs used, respectively. The optimal cutoff value in predicting plaque presence for age was 49.5 years with a sensitivity and specificity of 74% and 75%, respectively, and for total cholesterol concentration, it was 5.4 mmol/l with a sensitivity and specificity of 63% and 70%, respectively. The plaque prevalence was 37.5% in patients (n = 80; 55.6%) with age >49.5 years or/and total cholesterol concentration of >5.4 mmol/l, respectively, compared to only 7.8% in those (n = 64; 44.4%) with age ≤49.5 years or/and total cholesterol concentration of ≤5.4 mmol/l, respectively. Conclusions Approximately one-third of women with RA who experience a low SCORE value and are aged >49.5 years or/and have a total cholesterol concentration of >5.4 mmol/l, experience high-risk atherosclerosis, which requires intensive CVD risk management. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0576-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | - Patrick H Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. .,School of Physiology, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
| | - Linda Tsang
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
| | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain.
| | | | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain.
| | - Miguel A Gonzalez-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. .,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
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183
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Association of perceived job insecurity with ischemic heart disease and antihypertensive medication in the Danish Work Environment Cohort Study 1990-2010. Int Arch Occup Environ Health 2015; 88:1087-97. [PMID: 25731852 PMCID: PMC4608994 DOI: 10.1007/s00420-015-1030-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 02/04/2015] [Indexed: 11/08/2022]
Abstract
Purpose To determine the effect of job insecurity based on repeated measurements on ischemic heart disease (IHD) and on antihypertensive medication. Methods The study population consists of 12,559 employees aged 18–59 years of the Danish Work Environment Cohort Study. With an open cohort design, data from up to four representative waves were linked to four registers. Poisson regression with time-dependent covariates was used to estimate the rate ratio (RR) with confidence interval (CI) of perceived job insecurity associated with first-time IHD hospitalization or mortality 1991–2010 (n = 561 cases) and incident dispensing of prescribed antihypertensive medications 1996–2010 (n = 2,402 cases). Results Participants with perceived job insecurity filled more antihypertensive prescriptions (age-, gender-, and calendar year-adjusted RR 1.23, 95 % CI 1.12–1.33) and had a borderline significant higher IHD incidence (RR 1.23, 95 % CI 0.98–1.55). In a subanalysis, the risk of antihypertensive medication dispensed was only significant among employees with worries about both unemployment and poor reemployment opportunities. After explorative stratifications by age, gender, and occupational status, perceived job insecurity was associated with more dispensing of antihypertensive medications to participants less than 50 years of age. Conclusions In a country with high social security and active labor market policy, employees with the feeling of an insecure job have a modestly increased risk to fill an antihypertensive prescription. Further studies on health risks of job insecurity should consider improved exposure assessment, earlier outcomes such as medication in order to increase statistical power, and identification of vulnerable population groups.
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184
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Comparison of arteriosclerotic indicators in patients with ischemic stroke: ankle-brachial index, brachial-ankle pulse wave velocity and cardio-ankle vascular index. Hypertens Res 2015; 38:323-8. [PMID: 25716647 DOI: 10.1038/hr.2015.8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 12/11/2014] [Indexed: 01/19/2023]
Abstract
The ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are surrogate markers of arteriosclerosis. However, their roles in patients with acute ischemic stroke remain unclear. From October 2003 to September 2011, we enrolled patients with arteriosclerotic ischemic stroke (AIS) exhibiting large infarcts attributed to large-artery atherosclerosis (LAA) or deep subcortical infarcts (mainly lacunar infarcts) attributed to small-artery disease (SAD). Outpatients without a history of stroke served as controls (CTL). We divided the study period into two terms and assessed patients using two different oscillometric devices (Form PWV/ABI, Omron Colin; and VaSera VS-1500, Fukuda Denshi) in each term. One-way analysis of variance and age- and sex-adjusted analysis of covariance were used to compare the three groups. We analyzed 842 patients. The ABI was significantly lower in the LAA (n = 102) group than in the SAD (n = 280) and CTL (n = 460) groups. The baPWV was significantly higher in the LAA and SAD groups than in the CTL group. The CAVI gradually increased in the order of CTL, SAD and LAA. The cutoff values of baPWV and CAVI for detection of AIS were 18.3 m s(-1) (odds ratio (OR): 6.09, 95% confidence interval (CI): 3.97-9.62, P < 0.01) and 9.5 (OR: 1.44, 95% CI: 1.24-1.70, P < 0.001), respectively. Among the three indicators, a lower ABI indicated advanced atherosclerosis associated with LAA, and an increased baPWV more closely indicated AIS. An increased CAVI may indicate the degree of vessel stiffness due to arteriosclerosis.
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185
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Pumprla J, Howorka K, Kolackova Z, Sovova E. Non-contact radiofrequency-induced reduction of subcutaneous abdominal fat correlates with initial cardiovascular autonomic balance and fat tissue hormones: safety analysis. F1000Res 2015; 4:49. [PMID: 26069728 PMCID: PMC4431383 DOI: 10.12688/f1000research.5708.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 12/14/2022] Open
Abstract
Background and objective: The non-invasive reduction of subcutaneous abdominal fat became popular in the last decade. Radiofrequency (RF), non-contact, selective-field device Vanquish® has been developed to selectively induce deep fat tissue heating to reduce waist circumference. Our analysis evaluates immediate and sustained effects of this treatment on cardiovascular autonomic function and on selected metabolic parameters. Study design/patients and methods: A retrospective proof-of-concept analysis of RF treatment effects was conducted in 20 individuals with metabolic syndrome, to reduce the subcutaneous abdominal fat. Four 30-minutes treatment sessions (manufacturer´s standard protocol) were performed in 1-week intervals. Vital signs, ECG, lab screening, body composition, subcutaneous fat thickness and spectral analysis of heart rate variability (HRV) have been examined before, after the 1
st and 4
th treatment, and at follow-up visits 1 month and 3 months after the treatment. Results: The RF treatment led to a significant reduction of abdominal circumference after the 4
th session (p<0.001), and during follow-up after 1 and 3 months (p<0.001 and p<0.02, resp.). There was a significant correlation (r=-0.58, p=0.007) between reduction of abdominal circumference and initial very-low frequency (VLF) spectral power at 1 month follow-up. A significant increase of cumulative spectral power in low frequency (p=0.02) and reduction in high frequency (p=0.05) band have been observed immediately (20
+14 minutes) after the treatment. On the contrary, no sustained impact on autonomic balance has been recorded 39
+18 days after the treatment. A significant correlation between the initial adiponectin values and immediate autonomic response to one treatment was observed in VLF and total spectral bands (r>0.59, p<0.04). Conclusions: Our analysis shows that the selective-field RF treatment is safe and efficient for reduction of subcutaneous abdominal fat. While the treatment increases the immediate sympathetic response of the body to deep tissue heating, no sustained change in autonomic function could be recorded at 1 month follow-up. The observed correlation between initial VLF spectral power and waist circumference reduction at follow-up, as well as the association of initial adiponectin values and immediate autonomic response to the treatment might be instrumental for decisions on body contouring strategies.
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Affiliation(s)
- Jiri Pumprla
- International Research Group Functional Rehabilitation & Group Education, Vienna, 1090, Austria ; Vila Krasy Aesthetic Centre, Internal Medicine Outpatient Clinic, Olomouc, 779 00, Czech Republic ; Department of Internal Medicine I and Department of Sports Medicine and Cardiovascular Rehabilitation, University Palacky Medical School, Olomouc, 771 47, Czech Republic
| | - Kinga Howorka
- International Research Group Functional Rehabilitation & Group Education, Vienna, 1090, Austria ; Center of Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, 1090, Austria ; Internal Medicine/Diabetology Clinic, Prevention and Aesthetics Centre, Vienna, 1170, Austria
| | - Zuzana Kolackova
- Vila Krasy Aesthetic Centre, Internal Medicine Outpatient Clinic, Olomouc, 779 00, Czech Republic
| | - Eliska Sovova
- Department of Internal Medicine I and Department of Sports Medicine and Cardiovascular Rehabilitation, University Palacky Medical School, Olomouc, 771 47, Czech Republic
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186
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Robles NR. [Atherosclerotic ischemic renal disease: clinical challenges]. Med Clin (Barc) 2015; 144:163-5. [PMID: 25433792 DOI: 10.1016/j.medcli.2014.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/21/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Nicolás Roberto Robles
- Cátedra de Riesgo Cardiovascular, Facultad de Medicina, Universidad de Salamanca, Salamanca, España.
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187
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Mlakar P, Salobir B, Čobo N, Strašek J, Prezelj M, Debevc A, Jug B, Terčelj M, Šabovič M. The effect of cardioprotective diet rich with natural antioxidants on chronic inflammation and oxidized LDL during cardiac rehabilitation in patients after acute myocardial infarction. IJC HEART & VASCULATURE 2015; 7:40-48. [PMID: 28785643 PMCID: PMC5497189 DOI: 10.1016/j.ijcha.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/20/2014] [Accepted: 02/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention after acute myocardial infarction (AMI). The aim of our study was to determine the effect of diet, rich with natural antioxidants, added to physical activity (as a part of cardiac rehabilitation (CR) program) on inflammatory markers and ox-LDL, a marker of oxidative stress, closely involved in the process of chronic inflammation. METHODS 41 male patients after AMI undergoing CR were divided into a diet group (supervised cardioprotective diet throughout the CR), and control group (CR without diet). We measured hsCRP, leucocytes, neutrophils, IL-6, oxLDL, exercise capacity and classic risk factors before and after CR program. RESULTS Patients from the diet group presented with a significant decline in classic risk factors (BMI, waist circumference, waist to hip ratio, systolic blood pressure, heart rate, blood glucose, total cholesterol, LDL, TAG) and inflammatory markers (hsCRP, leucocytes, neutrophils) compared to control group. Furthermore, when studying nonsmokers, we observed significant decline of oxLDL in the diet group. CONCLUSIONS The addition of cardioprotective diet, rich with natural antioxidants, to physical activity as a part of a CR program, positively modifies not just classic risk factors and exercise capacity, but also diminishes chronic inflammation markers. These effects, and oxLDL decline were most prominent in nonsmoking patients.
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Key Words
- AMI, acute myocardial infarction
- Acute myocardial infarction
- BMI, body mass index
- BP, blood pressure
- CAD, coronary artery disease
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardioprotective diet
- HDL, high density lipoprotein
- IL-6, interleukin 6
- Inflammation
- LDL, low density lipoprotein
- Oxidized LDL
- Smoking
- TAG, triglycerides
- hsCRP, high sensitivity CRP
- oxLDL, oxidized LDL
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Affiliation(s)
- Polona Mlakar
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia.,Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Barbara Salobir
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | | | - Janja Strašek
- Health Resort Šmarješke Toplice, Šmarješke Toplice, Slovenia
| | - Marija Prezelj
- Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Center, Ljubljana, Slovenia
| | - Ana Debevc
- Cardial Medical Centre, Zaloška 69, 1000 Ljubljana, Slovenia
| | - Borut Jug
- Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Marjeta Terčelj
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
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188
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Teixeira PC, Ferber P, Vuilleumier N, Cutler P. Biomarkers for cardiovascular risk assessment in autoimmune diseases. Proteomics Clin Appl 2015; 9:48-57. [DOI: 10.1002/prca.201400125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/30/2014] [Accepted: 12/15/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Priscila Camillo Teixeira
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
- Division of Laboratory Medicine; Department of Genetics and Laboratory Medicine; Geneva University Hospitals; Geneva; Switzerland
| | - Philippe Ferber
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine; Department of Genetics and Laboratory Medicine; Geneva University Hospitals; Geneva; Switzerland
| | - Paul Cutler
- Pharma Research and Early Development; Roche Innovation Center Basel; Basel; Switzerland
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189
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Martín-Martínez MA, Castañeda S, González-Juanatey C, Llorca J, Díaz-Gonzalez F, González-Gay MA. Cardiovascular risk assessment in rheumatoid arthritis: What goals should be achieved? Semin Arthritis Rheum 2015; 44:e20-1. [PMID: 25648677 DOI: 10.1016/j.semarthrit.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Santos Castañeda
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | | | - Javier Llorca
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Federico Díaz-Gonzalez
- Research Unit of Spanish Society of Rheumatology, Madrid, Spain; School of Medicine, Universidad de La Laguna, La Laguna, Tenerife, Spain; Division of Rheumatology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain.
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190
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Barber CEH, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D. Best Practices for Cardiovascular Disease Prevention in Rheumatoid Arthritis: A Systematic Review of Guideline Recommendations and Quality Indicators. Arthritis Care Res (Hoboken) 2015; 67:169-79. [DOI: 10.1002/acr.22419] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Claire E. H. Barber
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | - Alexa Smith
- Dalhousie University, Halifax; Nova Scotia Canada
| | - John M. Esdaile
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Cheryl Barnabe
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Peter Faris
- University of Calgary and Alberta Health Services, Calgary; Alberta Canada
| | - Glen Hazlewood
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Nanette Alvarez
- University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary; Alberta Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | | | - J. Antonio Aviña-Zubieta
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Deborah Marshall
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
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191
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Haberka M, Gąsior Z. Carotid extra-media thickness in obesity and metabolic syndrome: a novel index of perivascular adipose tissue: extra-media thickness in obesity and metabolic syndrome. Atherosclerosis 2015; 239:169-77. [PMID: 25617857 DOI: 10.1016/j.atherosclerosis.2014.12.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/27/2014] [Accepted: 12/29/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to evaluate the association between a novel ultrasound index extra-media thickness (EMT), obesity, and metabolic syndrome (MS) using several measures of adiposity. METHODS Four hundred patients were included in the study (age: 60.95 ± 7.3 years, F/M: 35/65%). Both common carotid arteries (CCA) indexes (EMT and intima-media thickness), anthropometric parameters, body fat percentage and ultrasound measures of different fat depots were obtained in all patients. MS was identified using three alternative definitions: International Diabetes Federation 2005 (IDF), National Cholesterol Education Program Adult Treatment Panel III 2001 (NCEP ATP III) and World Health Organization 1998 (WHO). RESULTS The study group included patients with very high (80.2%) or high (19.8%) CV risk (IDF MS: 59.5%). Carotid EMT measures averaged from both sides (±SD) were as follows: mean EMT: 791 ± 126 μm, mean minimum EMT: 731 ± 115 μm and mean maximum EMT: 885 ± 210 μm. Patients with MS, irrespective of its definition and measures of obesity, displayed significantly thicker mean EMT compared to non-MS individuals: 819 ± 129 μm vs 747 ± 113 μm (p < 0.001; IDF), 824 ± 131 μm vs 751 ± 112 μm (p < 0.001; NCEP ATP III) and 825 ± 137 μm vs 773 ± 120 μm (p < 0.001; WHO). Moreover, EMT was related to all major parameters of general obesity, abdominal fat distribution, regional neck subcutaneous fat with weaker association between EMT and epicardial fat thickness. Finally, EMT is associated with an increasing number of CV risk factors. CONCLUSIONS This is the first study providing novel findings on the relationship between EMT, MS, and adiposity indexes. Our results suggest that EMT may be a new non-invasive index of perivascular adipose tissue corresponding to cardiometabolic risk.
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Affiliation(s)
- Maciej Haberka
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
| | - Zbigniew Gąsior
- School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland
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192
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Pallarés-Carratalá V, Pascual-Fuster V, Godoy-Rocatí D. [Dyslipidaemia and vascular risk. A new evidence based review]. Semergen 2015; 41:435-45. [PMID: 25559484 DOI: 10.1016/j.semerg.2014.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/11/2014] [Accepted: 10/20/2014] [Indexed: 01/06/2023]
Abstract
Dyslipidaemia is one of the major risk factors for ischaemic heart disease, the leading cause of death worldwide. Early detection and therapeutic intervention are key elements in the adequate prevention of cardiovascular disease. It is essential to have knowledge of the therapeutic arsenal available for their appropriate use in each of the clinical situations that might be presented in our patients. In the past 3 years, there has been a proliferation of multiple guidelines for the clinical management of patients with dyslipidaemia, with apparent contradictory messages regarding the achievement of the control objectives, which are confusing clinicians. This review aims to provide an updated overview of the situation as regards dyslipidaemia, based on the positioning of both European and American guidelines, through different risk situations and ending with the concept of atherogenic dyslipidaemia as a recognized cardiovascular risk factor.
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Affiliation(s)
- V Pallarés-Carratalá
- Medicina Familiar y Comunitaria, Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España.
| | - V Pascual-Fuster
- Medicina Familiar y Comunitaria, Centro de Salud Palleter, Castellón, España
| | - D Godoy-Rocatí
- Unidad de Lípidos, Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, España
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193
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Ripa RS, Kjaer A, Hesse B. Non-invasive imaging for subclinical coronary atherosclerosis in patients with peripheral artery disease. Curr Atheroscler Rep 2014; 16:415. [PMID: 24691587 PMCID: PMC4010714 DOI: 10.1007/s11883-014-0415-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patients with peripheral artery disease are at high risk of coronary artery disease. An increasing number of studies show that a large proportion of patients with peripheral artery disease have significant coronary atherosclerosis, even in the absence of symptoms. Although the reported prevalence of subclinical coronary artery disease varies widely in patients with peripheral artery disease, it could include more than half of patients. No consensus exists to date on either the rationale for screening patients with peripheral artery disease for coronary atherosclerosis or the optimal algorithm and method for screening. An increasing number of imaging modalities are emerging that allow improved in vivo non-invasive characterization of atherosclerotic plaques. These novel imaging methods may lead to early detection of high-risk vulnerable plaques, enabling clinicians to improve risk stratification of patients with peripheral artery disease, and thus paving the way for individualized therapy.
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Affiliation(s)
- Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine and PET, KF-4012 Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET, KF-4012 Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birger Hesse
- Department of Clinical Physiology, Nuclear Medicine and PET, KF-4012 Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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194
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Modesti PA, Perruolo E, Parati G. Need for better blood pressure measurement in developing countries to improve prevention of cardiovascular disease. J Epidemiol 2014; 25:91-8. [PMID: 25420484 PMCID: PMC4310869 DOI: 10.2188/jea.je20140146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hypertension is now the foremost cause of disability and is responsible for the highest percentage of attributable death among risk factors. These global changes are mainly due to the increase in the prevalence of hypertension in most low- and middle-income countries (LMICs) as a consequence of relevant socioeconomic changes occurring during the last decades. Implementation of global prevention efforts urgently needs to be accelerated because of the increasing incidence of haemorrhagic stroke, renal failure, and hypertensive heart disease in developing countries. Blood pressure (BP) measurement has different implications in epidemiological studies performed in low-resource settings. First, the frequency of blood pressure measurement is a simple but reliable indicator of access to healthcare in epidemiological studies, which may disclose the favourable effects of urbanization; the opportunity to have BP measured increases hypertension awareness, facilitates drug treatment, and leads to better achievement of BP control. Second, BP measurement is a key element in cardiovascular risk stratification, focusing solely on the preferred strategy in low-resource settings where costs of biochemical tests might be less sustainable. Third, the issue of obtaining reliable estimation of BP values is crucial to achieve sound data on the burden of hypertension in LMICs, and some aspects of BP measurement, such as the use of reliable automated devices, the number of measurements/visits to achieve a consistent diagnosis of hypertension, and the possible confounding effect of environmental factors, must be closely considered.
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195
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Effect of omega-3 fatty acid ethyl esters on the oxylipin composition of lipoproteins in hypertriglyceridemic, statin-treated subjects. PLoS One 2014; 9:e111471. [PMID: 25393536 PMCID: PMC4230929 DOI: 10.1371/journal.pone.0111471] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022] Open
Abstract
Background Oxylipins mediate inflammation, vascular tension, and more. Their presence in lipoproteins could explain why lipoproteins mediate nearly identical activities. Methods To determine how oxylipins are distributed in the lipoproteins of hypertriglyceridemic subjects, and whether omega-3 fatty acids alter them in a manner consistent with improved cardiovascular health, we recruited 15 dyslipidemic subjects whose levels of low density lipoprotein cholesterol (LDL-C) were at goal but who remained hypertriglyceridemic (200–499 mg/dL). They were treated them with the indicated dose of 4 g/d omega-3 acid ethyl esters (P-OM3) for 8 weeks. Measured oxylipins included mid-chain alcohols (HETEs, HEPEs and HDoHEs), ketones (KETEs), epoxides (as EpETrEs, EpETEs, and EpDPEs). Results At baseline, arachidonate-oxylipins (HETEs, KETEs, and EpETrEs) were most abundant in plasma with the greatest fraction of total abundance (mean |95% CI|) being carried in high density lipoproteins (HDL); 42% |31, 57| followed by very low density lipoproteins (VLDL); 27% |20, 36|; and LDL 21% |16, 28|. EPA- and DHA-derived oxylipins constituted less than 11% of total. HDL carried alcohols and epoxides but VLDL was also rich in ketones. Treatment decreased AA-derived oxylipins across lipoprotein classes (−23% |−33, −12|, p = 0.0003), and expanded EPA−(322% |241, 422|, p<0.0001) and DHA-derived oxylipins (123% |80, 176|, p<0.0001). Conclusions Each lipoprotein class carries a unique oxylipin complement. P-OM3 treatment alters the oxylipin content of all classes, reducing pro-inflammatory and increasing anti-inflammatory species, consistent with the improved inflammatory and vascular status associated with the treatment. Trial Registration ClinicalTrials.gov NCT00959842
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196
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Awad A, Al-Nafisi H. Public knowledge of cardiovascular disease and its risk factors in Kuwait: a cross-sectional survey. BMC Public Health 2014; 14:1131. [PMID: 25367768 PMCID: PMC4237772 DOI: 10.1186/1471-2458-14-1131] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/21/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is estimated to cause 46% of all mortalities in Kuwait. To design effective primary and secondary prevention programs, an assessment of a population's prior CVD knowledge is of paramount importance. There is scarcity of data on the existing CVD knowledge among the general Kuwaiti population. Hence, this study was performed to assess the level of knowledge towards CVD types, warning symptoms of heart attack or stroke, and CVD risk factors. It also explored public views on the community pharmacists' role in CVD prevention and management. METHODS A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 900 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis. RESULTS The response rate was 90.7%. Respondents' knowledge about types of CVD, heart attack or stroke symptoms was low. Almost 60% of respondents did not know any type of CVD, and coronary heart disease was the commonest identified type (29.0%). Two-fifths of participants were not aware of any heart attack symptoms, and the most commonly known were chest pain (50.4%) and shortness of breath (48.0%). Approximately half of respondents did not recognize any stroke symptoms, and the most commonly recognized were 'confusion or trouble speaking' (36.4%) and 'numbness or weakness' (34.7%). Respondents' knowledge regarding CVD risk factors was moderate. The commonest factors identified by over four-fifths of participants were smoking, obesity, unhealthy diet and physical inactivity. In the multivariate logistic regression analysis, independent predictors of better level of CVD knowledge were females, age 50-59 years, high level of education, regular eating of healthy diet, and had a family history of CVD. Most of respondents only identified the role that pharmacists had to play is to help patients manage their medications, with a minimal role in other aspects of CVD prevention and management. CONCLUSIONS There are deficiencies in CVD knowledge among Kuwaiti population, which could turn into insufficient preventative behaviours and suboptimal patient outcomes. There is an apparent need to establish more wide-spread and effective educational interventions, which should be sensitive to the perceptions, attitudes, and abilities of targeted individuals.
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Affiliation(s)
- Abdelmoneim Awad
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait
| | - Hala Al-Nafisi
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat, 13110 Kuwait
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Catapano AL, Farnier M, Foody JM, Toth PP, Tomassini JE, Brudi P, Tershakovec AM. Combination therapy in dyslipidemia: Where are we now? Atherosclerosis 2014; 237:319-35. [DOI: 10.1016/j.atherosclerosis.2014.09.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 01/06/2023]
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198
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Moriarty PM, Jacobson TA, Bruckert E, Thompson PD, Guyton JR, Baccara-Dinet MT, Gipe D. Efficacy and safety of alirocumab, a monoclonal antibody to PCSK9, in statin-intolerant patients: Design and rationale of ODYSSEY ALTERNATIVE, a randomized phase 3 trial. J Clin Lipidol 2014; 8:554-561. [DOI: 10.1016/j.jacl.2014.09.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 11/24/2022]
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199
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Tiffin-Richards FE, Costa AS, Holschbach B, Frank RD, Vassiliadou A, Krüger T, Kuckuck K, Gross T, Eitner F, Floege J, Schulz JB, Reetz K. The Montreal Cognitive Assessment (MoCA) - a sensitive screening instrument for detecting cognitive impairment in chronic hemodialysis patients. PLoS One 2014; 9:e106700. [PMID: 25347578 PMCID: PMC4209968 DOI: 10.1371/journal.pone.0106700] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) therapy have an increased risk of developing cognitive impairment and dementia, which are known relevant factors in disease prognosis and therapeutic success, but still lack adequate screening in clinical routine. We evaluated the Montreal Cognitive Assessment (MoCA) for suitability in assessing cognitive performance in HD patients in comparison to the commonly used Mini-Mental State Examination (MMSE) and a detailed neuropsychological test battery, used as gold standard. METHODS 43 HD patients and 42 healthy controls with an average age of 58 years, were assessed with the MoCA, the MMSE and a detailed neuropsychological test battery, covering the domains of memory, attention, language, visuospatial and executive functions. Composite scores were created for comparison of cognitive domains and test results were analyzed using Spearman's correlation and linear regression. Cognitive dysfunction was defined using z-score values and predictive values were calculated. Sensitivity and specificity of the MoCA were determined using receiver operating characteristic (ROC) analysis. RESULTS HD patients performed worse in all cognitive domains, especially in memory recall and executive functions. The MoCA correlated well with the detailed test battery and identified patients with cognitive impairment with a sensitivity of 76.7% and specificity of 78.6% for a cut-off value of ≤24 out of 30 points. In the detailed assessment executive functions accounted significantly for performance in the MoCA. The MMSE only discriminated weakly between groups. CONCLUSIONS The MoCA represents a suitable cognitive screening tool for hemodialysis patients, demonstrating good sensitivity and specificity levels, and covering executive functions, which appear to play an important role in cognitive performance of HD patients.
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Affiliation(s)
- Frances E. Tiffin-Richards
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen and Jülich, Germany
| | - Ana S. Costa
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen and Jülich, Germany
| | - Bernhard Holschbach
- KfH Curatorship for Dialysis and Kidney Transplant e.V., KfH-Nephrology Center, Stolberg, Germany
| | - Rolf D. Frank
- Department of Internal Medicine, St.-Antonius-Hospital Eschweiler, Eschweiler, Germany
| | | | - Thilo Krüger
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Karl Kuckuck
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen and Jülich, Germany
| | - Theresa Gross
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
- Department of Internal Medicine, Dresden-Friedreichstadt Hospital, Dresden, Germany
| | - Frank Eitner
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
- Bayer Pharma AG, Global Drug Development, Kidney Diseases Research, Wuppertal, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Jörg B. Schulz
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen and Jülich, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
- Jülich Aachen Research Alliance (JARA) – Translational Brain Medicine, Aachen and Jülich, Germany
- Institute of Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, Jülich, Germany
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200
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Saraiva FK, Sposito AC. Cardiovascular effects of glucagon-like peptide 1 (GLP-1) receptor agonists. Cardiovasc Diabetol 2014; 13:142. [PMID: 25338737 PMCID: PMC4216654 DOI: 10.1186/s12933-014-0142-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/06/2014] [Indexed: 02/08/2023] Open
Abstract
Patients with type 2 diabetes have a several-fold increased risk of developing cardiovascular disease when compared with nondiabetic controls. Myocardial infarction and stroke are responsible for 75% of all death in patients with diabetes, who present a 2-4× increased incidence of death from coronary artery disease. Patients with diabetes are considered for cardiovascular disease secondary prevention because their risk level is similar to that reported in patients without diabetes who have already suffered a myocardial infarction. More recently, with a better risk factors control, mainly in intensive LDL cholesterol targets with statins, a significant decrease in acute cardiovascular events was observed in population with diabetes. Together with other major risk factors, type 2 diabetes must be considered as an important cause of cardiovascular disease.Glucagon like peptide-1 receptor agonists represent a novel class of anti-hyperglycemic agents that have a cardiac-friendly profile, preserve neuronal cells and inhibit neuronal degeneration, an anti-inflammatory effect in liver protecting it against steatosis, increase insulin sensitivity, promote weight loss, and increase satiety or anorexia.This review is intended to rationally compile the multifactorial cardiovascular effects of glucagon-like peptide-1 receptor agonists available for the treatment of patients with type 2 diabetes.
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Affiliation(s)
| | - Andrei C Sposito
- Laboratory of Atherosclerosis and Vascular Biology (AteroLab), Cardiology Division, State University of Campinas Medicine School (Unicamp), Campinas, Sao Paulo, 13084-971, Brazil.
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