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Atherosclerotic coronary artery disease: The accuracy of measures to diagnose preclinical atherosclerosis. Exp Ther Med 2016; 12:2899-2902. [PMID: 27882093 PMCID: PMC5103722 DOI: 10.3892/etm.2016.3710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/28/2016] [Indexed: 01/21/2023] Open
Abstract
Different methods can be used to diagnose early pre-clinical stage atherosclerosis. The present study was carried out to evaluate the efficiency of these methods. Measures including carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and coronary calcium score (CCS) were evalutated for the detection of coronary artery disease (CAD). We studied the clinical and biochemical profiles of individuals with non-CAD and CAD to assess measures of pre-clinical atherosclerosis. The association between CIMT, PWV and CCS on the one hand, and the coronary atherosclerosis on the other, was studied. In total, 150 cases of cardiovascular disease (CVD) participated in the present study and were subjected to computed tomographic (CT) coronary angiography to divide them into non-CAD (n=100) and CAD (n=50) groups. The patients were also subjected to pre-clinical atherosclerosis tests (CIMT, PWV and CCS). CAD patients had higher CIMT values on both sides (right side, 0.74±0.09 vs. 0.62±0.12 mm; left side, 0.78±0.16 vs. 0.64±0.19 mm; and average, 0.76±0.12 vs. 0.63±0.14 mm; all P-values <0.01). These patients also had significantly higher brachial-ankle PWV (baPWV) on left side (1638.8±372.9 vs. 1498.6±339.8 cm/sec, P<0.001). The overall CCS was significantly increased in CAD patients as compared to the patients without CAD (117.8±118.6 vs. 8.6±18.3, P<0.001). In conclusion, the present study showed that among different measures of preclinical atherosclerosis, CCS had the best diagnostic accuracy. However, the combination of CIMT and baPWV had an excellent negative predictive value for atherosclerotic coronary vascular disease.
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152
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Wielemborek-Musial K, Szmigielska K, Leszczynska J, Jegier A. Blood Pressure Response to Submaximal Exercise Test in Adults. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5607507. [PMID: 27703976 PMCID: PMC5040833 DOI: 10.1155/2016/5607507] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/07/2016] [Indexed: 11/21/2022]
Abstract
Background. The assessment of blood pressure (BP) response during exercise test is an important diagnostic instrument in cardiovascular system evaluation. The study aim was to determine normal values of BP response to submaximal, multistage exercise test in healthy adults with regard to their age, gender, and workload. Materials and Methods. The study was conducted in randomly selected normotensive subjects (n = 1015), 512 females and 498 males, aged 18-64 years (mean age 42.1 ± 12.7 years) divided into five age groups. All subjects were clinically healthy with no chronic diseases diagnosed. Exercise stress tests were performed using Monark bicycle ergometer until a minimum of 85% of physical capacity was reached. BP was measured at rest and at peak of each exercise test stage. Results. The relations between BP, age, and workload during exercise test were determined by linear regression analysis and can be illustrated by the equations: systolic BP (mmHg) = 0.346 × load (W) + 135.76 for males and systolic BP (mmHg) = 0.103 × load (W) + 155.72 for females. Conclusions. Systolic BP increases significantly and proportionally to workload increase during exercise test in healthy adults. The relation can be described by linear equation which can be useful in diagnostics of cardiovascular diseases.
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Affiliation(s)
| | - Katarzyna Szmigielska
- Department of Sports Medicine, Medical University of Lodz, Pomorska 251, 92-513 Lodz, Poland
| | - Joanna Leszczynska
- Department of Sports Medicine, Medical University of Lodz, Pomorska 251, 92-513 Lodz, Poland
| | - Anna Jegier
- Department of Sports Medicine, Medical University of Lodz, Pomorska 251, 92-513 Lodz, Poland
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Abstract
Diuretics have long been cherished as drugs of choice for uncomplicated primary hypertension. Robust mortality and morbidity data is available for diuretics to back this strategy. Off-late the interest for diuretics has waned off perhaps due to availability of more effective drugs but more likely due to perceived lack of tolerance and side-effect profile of high-dose of diuretics required for mortality benefit. Low-dose diuretics particularly thiazide diuretics are safer but lack the mortality benefit shown by high-dose. However, indapamide and low dose chlorthalidone have fewer side-effects but continue to provide mortality benefit.
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154
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Subrahmanyam G, Pathapati RM, Ramalingam K, Indira SA, Kantha K, Soren B. Arterial Stiffness and Trace Elements in Apparently Healthy Population- A Cross-sectional Study. J Clin Diagn Res 2016; 10:LC12-LC15. [PMID: 27790472 DOI: 10.7860/jcdr/2016/21648.8548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/04/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Stiffening of arteries is a natural ageing process. Any diseases/disorders or risk factors that escalate oxidative stress, microvascular inflammation and endothelial damage may promote to premature vascular stiffening. Any imbalance in these trace element levels may independently contribute to the changes in the components in the arterial wall and thus, arterial stiffness via one or more mechanisms. AIM To evaluate the severity of arterial stiffness in apparently healthy population and also to evaluate role of various risk factors and trace elements in the severity of arterial stiffness. MATERIALS AND METHODS Male and female subjects living in urban and rural areas of Nellore district, Andhra Pradesh, India, between 20-60 years, apparently normal as judged by the clinician basing on clinical and laboratory findings, were studied. Carotid-Femoral Pulse Wave Velocity (cf-PWV) a marker of arterial stiffness was assessed using non-invasive blood pressure curve monitoring (periscope). Furthermore, we also estimated serum levels of Copper (Cu), Zinc (Zn), Selenium (Se), chromium (Cr), Aluminium (Al), silicon (Si), Manganese (Mn), Molybdenum (Mb), Vanadium (Vn) and lead (Pb) using atomic absorption spectrophotometer. ANOVA and Chi-Square test were used to study the clinical correlations between severity of arterial stiffness, risk factors and trace elements. RESULTS A total of 737 apparently healthy subjects participated in this cross-sectional study. Of the total 542 (73.5%) were from rural and the remaining 195 (26.5%) were living in urban areas, 328 (44.5%) were males, and 409 (55.5%) were females. A 63.5% (468/737) had normal arterial stiffness followed by 14.5% (107/737) with mild stiffness, 7% (57/737) had moderate stiffness and 14.2% (105/737) had severe arterial stiffness. Smoking, alcohol, blood pressures, fasting blood sugar, and total cholesterol, Cu, Al and Vn correlated (p<0.05) with different grades of arterial stiffness. CONCLUSION A 36.5% had high arterial stiffness despite being apparently healthy. Smoking, alcohol, blood pressures, fasting blood sugars, and total cholesterol, Cu, Al and Vn could have contributed for such an abnormality. Caution has to be executed while understanding the study results since the pathophysiological process is complex.
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Affiliation(s)
- Gangapatnam Subrahmanyam
- Director Research, Department of Cardiology, Narayana Medical Institutions , Nellore, Andhra Pradesh, India
| | - Rama Mohan Pathapati
- Associate Professor, Department of Pharmacology, Narayana Medical College , Nellore, Andhra Pradesh, India
| | - Krishnan Ramalingam
- Associate Professor, Department of Biochemistry, Narayana Medical College , Nellore, Andhra Pradesh, India
| | - Selvam Armugam Indira
- Nursing Dean, Department of Medical & Surgical Nursing, Narayana Nursing Institutions , Nellore, Andhra Pradesh, India
| | - Katari Kantha
- Professor, Department of Community Nursing, Narayana Nursing College , Nellore, Andhra Pradesh, India
| | - Bhemasen Soren
- Professor, Department of Medicine, Narayana Medical College , Nellore, Andhra Pradesh, India
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155
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The role of compliance with PAP use on blood pressure in patients with obstructive sleep apnea: is longer use a key-factor? J Hum Hypertens 2016; 31:106-115. [PMID: 27465978 DOI: 10.1038/jhh.2016.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 01/26/2023]
Abstract
Scientific data about the effects of positive airway pressure (PAP) treatment on blood pressure (BP) control are continuously increasing; however, they are controversial. We aimed to determine the long-term effects of compliance with PAP therapy on BP in both hypertensive and normotensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). One thousand one hundred sixty eight consecutive patients with newly diagnosed OSAHS, who had been recommended PAP therapy, were followed up for a minimum of 2 years. Patients with previous cardiovascular disease were excluded. BP was measured at baseline and after 2 years of PAP treatment. In addition, the correlation between the changes in BP with different levels of PAP compliance was assessed. At the end of the follow-up period, in the hypertensive group of patients (n=586), a significant decrease was shown in systolic (-11.2 mm Hg, P<0.001) and diastolic BP (-4.2 mm Hg, P<0.001). Furthermore, in the patients without hypertension (n=528), a significant decrease was noted both in systolic and diastolic BP (-3.6, P<0.001 and -2.4, P<0.001, respectively). A correlation between the magnitude of change in systolic and diastolic BP and hours of use of PAP (r=0.14, P=0.002 and r=0.1, P=0.025, respectively) was observed in all patients. Long-term use of PAP treatment, as well as increased hours of PAP in patients with OSAHS use showed significant reductions in BP not only in patients with hypertension, but also in normotensive patients. Therefore a significant potential reduction in cardiovascular mortality and morbidity should be expected in these patients.
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156
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Betge S, Kretzschmar D, Figulla HR, Lichtenauer M, Jung C. Predictive value of the augmentation index derived vascular age in patients with newly diagnosed atherosclerosis. Heart Vessels 2016; 32:252-259. [PMID: 27401737 PMCID: PMC5334397 DOI: 10.1007/s00380-016-0868-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/01/2016] [Indexed: 11/23/2022]
Abstract
Early detection of atherosclerosis, i.e., in occupational health screening programs could reduce the rate of cardiovascular events in the working population. Changes of the augmentation index (AIX) correlate with changes of the arterial stiffness induced by aging, atherosclerosis, or arterial hypertension and have a prognostic value for cardiovascular events. Their diagnostic yield should be increased by normalizing the AIX to age, in terms of a calculating the vascular age (VA). In this pilot study, 30 patients (mean age 65.3 ± 8.8 years, 21 male) with suspected coronary heart disease underwent a duplex ultrasound of the carotid arteries and a measurement of the ankle brachial index in addition to the coronary angiography. The AIX was recorded with a portable device (Vascular Explorer), and the VA was calculated. Atherosclerosis was found in 24 patients. They were older than the patients without atherosclerosis, but there was no age dependency found for the distribution pattern or severity of atherosclerosis. In patients with findings of atherosclerosis, the calculated VA was higher than the chronological age, and these differences were significant in patients below 65 years of age. Comparing patients in higher blood pressure classes with patients in lower classes, significantly higher AIX, VA, and differences to the chronological age were found. The VA, deduced from the noninvasively obtained AIX, is a promising candidate for screening programs for atherosclerosis, i.e., in occupational health screening programs.
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Affiliation(s)
- Stefan Betge
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Hans-Reiner Figulla
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstraße 48, Salzburg, 5020, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, Duesseldorf, 40225, Germany
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157
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Clustering of cardiovascular behavioral risk factors and blood pressure among people diagnosed with hypertension: a nationally representative survey in China. Sci Rep 2016; 6:27627. [PMID: 27279273 PMCID: PMC4899782 DOI: 10.1038/srep27627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
This study aimed to examine association between the number of behavioral risk factors and blood pressure (BP) level among a nationally representative sample of Chinese people diagnosed with hypertension. A total of 31,694 respondents aged 18+ years with diagnosed hypertension were extracted from the 2013-2014 China Chronic Disease and Risk Factor Surveillance. BP of each respondent was classified into six levels according to criteria in 2007 Guidelines for the Management of Arterial Hypertension. Information for smoking, alcohol drinking, fruit and vegetables consumption, physical inactivity, and overweight and obesity were obtained. The average number of risk factors was determined by BP level to explore potential risk factor clustering. Ten generalized proportional odds models were used to examine association between clustering of behavioral risk factors and BP level. A clear gradient between the number of behavioral risk factors and BP level was observed for men and women (P < 0.05 for both genders). BP level for men and women was much likely to upgrade as number of risk factors accumulated (P < 0.01 for 10 models). Behavioral modifications may decrease BP, and combinations of two or more behavioral interventions could potentially result in even better BP management among people diagnosed with hypertension.
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158
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Cybulsky M, Cook S, Kontsevaya AV, Vasiljev M, Leon DA. Pharmacological treatment of hypertension and hyperlipidemia in Izhevsk, Russia. BMC Cardiovasc Disord 2016; 16:122. [PMID: 27255373 PMCID: PMC4891885 DOI: 10.1186/s12872-016-0300-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in Russia. Hypertension and hyperlipidemia are important risk factors for CVD that are modifiable by pharmacological treatment and life-style changes. We aimed to characterize the extent of the problem in a typical Russian city by examining the prevalence, treatment and control rates of hypertension and hyperlipidemia and investigating whether the specific pharmacological regimes used were comparable with guidelines from a country with much lower CVD rates. Methods The Izhevsk Family Study II included a cross-sectional survey of a population sample of 1068 men, aged 25–60 years conducted in Izhevsk, Russia (2008–2009). Blood pressure and total cholesterol were measured and self-reported medication use was recorded by a clinician. We compared drug treatments with the Russian and Canadian treatment guidelines for hypertension and hyperlipidemia. Results The prevalence of hypertension was 61 % (age-standardised prevalence 51 %), with 66 % of those with hypertension aware of their diagnosis and 50 % of those aware taking treatment. 17 % of those taking treatment achieved blood pressure control. The majority (59 %) of those taking treatment were not doing so regularly. Prevalence of hyperlipidemia was 45 % (age-standardised prevalence 40 %), however less than 2 % of those with hyperlipidemia were taking any treatment. Types of lipid-lowering and anti-hypertensive medications prescribed were broadly in line with Russian and Canadian guidelines. Conclusion The prevalence of hypertension and hyperlipidemia is high in Izhevsk while the proportion of those treated and attaining treatment targets is very low. Prescribed medications were concurrent with those in Canada, but adherence is a major issue.
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Affiliation(s)
| | - Sarah Cook
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | | | - David A Leon
- Department of Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Arctic University of Norway, UiT, Tromsø, Norway
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159
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Petrie JR, Marso SP, Bain SC, Franek E, Jacob S, Masmiquel L, Leiter LA, Haluzik M, Satman I, Omar M, Shestakova M, Van Gaal L, Mann JF, Baeres FM, Zinman B, Poulter NR. LEADER-4: blood pressure control in patients with type 2 diabetes and high cardiovascular risk: baseline data from the LEADER randomized trial. J Hypertens 2016; 34:1140-50. [PMID: 26855018 PMCID: PMC4856174 DOI: 10.1097/hjh.0000000000000890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/05/2016] [Accepted: 01/25/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE As glucagon-like peptide-1 receptor agonists lower blood pressure (BP) in type 2 diabetes mellitus (T2DM), we examined BP control in relation to targets set by international bodies prior to randomization in the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial. METHODS We analyzed baseline data from LEADER (NCT01179048), an ongoing phase 3B, randomized, double-blind, placebo-controlled cardiovascular outcomes trial examining the cardiovascular safety of the glucagon-like peptide-1 receptor agonist liraglutide in 9340 people with T2DM from 32 countries [age (all mean ± SD) 64 ± 7.2 years, BMI 32.5 ± 6.3 kg/m, duration of diabetes 12.7 ± 8.0 years], all of whom were at high risk for cardiovascular disease (CVD). RESULTS A total of 81% (n = 7592) of participants had prior CVD and 90% (n = 8408) had a prior history of hypertension. Despite prescription of multiple antihypertensive agents at baseline, only 51% were treated to a target BP of less than 140/85 mmHg and only 26% to the recommended baseline BP target of less than 130/80 mmHg. In univariate analyses, those with prior CVD were prescribed more agents (P < 0.001) and had lower BP than those without (137 ± 18.8/78 ± 10.6 mmHg versus 140 ± 17.7/80 ± 9.9 mmHg; P < 0.001). In logistic regression analyses, residency in North America (64% treated to <140/85 mmHg; 38% treated to <130/80 mmHg) was the strongest predictor of BP control. CONCLUSION These contemporary data confirm that BP remains insufficiently controlled in a large proportion of individuals with T2DM at high cardiovascular risk, particularly outside North America. Longitudinal data from the LEADER trial may provide further insights into BP control in relation to cardiovascular outcomes in this condition.
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Affiliation(s)
- John R. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Steven P. Marso
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephen C. Bain
- Institute of Life Science, College of Medicine, Swansea University Medical School, Swansea, UK
| | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital MSW, Warsaw, Poland
| | - Stephan Jacob
- Kardio Metabolischen Instituts, Villingen-Schwenningen, Germany
| | - Luis Masmiquel
- Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Science Research (IUNICS)-Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Lawrence A. Leiter
- Divisions of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Martin Haluzik
- 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Ilhan Satman
- Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mohamed Omar
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, South Africa
| | - Marina Shestakova
- Endocrinology Research Centre, Diabetes Institute
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Luc Van Gaal
- Faculty of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Johannes F. Mann
- Department of Nephrology, Hypertension & Rheumatology, Friedrich Alexander University of Erlangen, Munchen, Germany
| | | | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Neil R. Poulter
- International Centre for Circulatory Health, Imperial College London, London, UK
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160
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Song BM, Kim HC, Shim JS, Lee MH, Choi DP. Inter-Arm Difference in Brachial Blood Pressure in the General Population of Koreans. Korean Circ J 2016; 46:374-83. [PMID: 27275174 PMCID: PMC4891602 DOI: 10.4070/kcj.2016.46.3.374] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/17/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors. Subjects and Methods A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure. Results The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure. Conclusion Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.
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Affiliation(s)
- Bo Mi Song
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jee-Seon Shim
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Ha Lee
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Phil Choi
- Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.; National Academy of Agricultural Science, Rural Development Administration, Jeonju, Korea
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161
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Kasliwal RR, Bansal M, Desai N, Kotak B, Raza A, Vasnawala H, Kumar A. A Study to derive distribution of carotid intima media thickness and to determine its COrrelation with cardiovascular Risk factors in asymptomatic nationwidE Indian population (SCORE-India). Indian Heart J 2016; 68:821-827. [PMID: 27931554 PMCID: PMC5143805 DOI: 10.1016/j.ihj.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/16/2016] [Accepted: 04/07/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is presently no data to describe normal distribution of carotid intima-media thickness (CIMT), an established measure of subclinical atherosclerosis, in Indian subjects. METHODS In this multi-centric study, 1229 subjects with age ≥30 years and no previous cardiovascular disease (CVD) underwent CVD risk factor assessment and CIMT measurement. Mean far wall common carotid artery IMT was measured on both sides and averaged. RESULTS Mean age of the subjects was 48.0±12.0 years and 54.2% were men. CIMT measurement was feasible in 1157 subjects. Mean, median and 75th percentile values of CIMT for different age-groups were derived for men and women separately. There was a progressive increase in CIMT with increasing age (P<0.001) and men had higher CIMT values than women (0.608±0.12mm vs. 0.579±0.11mm, P<0.001). The CIMT values were also higher in diabetics (0.635±0.10mm) and hypertensives (0.624±0.10mm) as compared to non-diabetics (0.589±0.12mm, P<0.001) and non-hypertensives (0.592±0.12, P 0.02) respectively. Among continuous variables, age, systolic blood pressure and fasting blood glucose had strong to modest correlation with CIMT (Pearson's r 0.524, 0.282 and 0.192 respectively, all P values <0.001), whereas body mass index, diastolic blood pressure and serum triglycerides exhibited weak but still statistically significant relationship (Pearson's r 0.069, P 0.019; Pearson's r 0.065, P 0.026; and Pearson's r 0.094, P 0.001, respectively). CONCLUSIONS This is the first study to provide age- and gender-specific distribution of CIMT in Indian subjects free from CVD. This information should help facilitate further research and clinical work involving CIMT in India.
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Affiliation(s)
| | | | - Nagaraj Desai
- Department of Cardiology, JSS Hospital MG Road, Mysuru, India
| | - Bhavesh Kotak
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Ammar Raza
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Hardik Vasnawala
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Amit Kumar
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
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162
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Bagci B, Bagci G, Huzmeli C, Sezgin I, Ozdemir O. Associations of fractalkine receptor (CX3CR1) and CCR5 gene variants with hypertension, diabetes and atherosclerosis in chronic renal failure patients undergoing hemodialysis. Int Urol Nephrol 2016; 48:1163-70. [PMID: 27118566 DOI: 10.1007/s11255-016-1293-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE We aimed to investigate the associations of fractalkine receptor (CX3CR1) V249I, T280M and CCR5-59029 A/G gene polymorphisms in chronic renal failure (CRF) subjects undergoing hemodialysis and to evaluate possible associations of these polymorphisms with hypertension (HT), diabetes mellitus (DM) and atherosclerosis (AS). METHODS A total of 225 CRF subjects undergoing hemodialysis and 201 healthy controls were enrolled in the study. CRF subjects were divided into three major subgroups according to comorbidities including HT (n = 127), DM (n = 65) and AS (n = 33). Genotyping was done using polymerase chain reaction-restriction fragment length polymorphism method. RESULTS The II genotype and I allele frequencies of CX3CR1 V249I polymorphism were found significantly more frequent in CRF subjects, CRF subjects with DM and CRF subjects with AS compared with controls (p < 0.05 for all comparisons). G allele frequency of CCR5 polymorphism was found significantly more prevalent in CRF subjects with DM than that of controls. Further, GG genotype and G allele frequencies of CCR5 polymorphism were significantly more prevalent in CRF subjects with AS compared with controls (p < 0.05). We also explored these polymorphisms among CRF subjects with and without following comorbidities: HT, DM, AS. We found significant association between CRF subjects with HT and without HT in terms of genotype and allele frequencies of V249I polymorphism (p < 0.05). CX3CR1 T280M polymorphism was not found significantly different in none of the comparisons. CONCLUSION These data demonstrate possible associations between CX3CR1 V249I and CCR5-59029 A/G polymorphisms and/or HT, DM and AS in CRF subjects.
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Affiliation(s)
- Binnur Bagci
- Department of Nutrition and Dietetics, School of Health Sciences, Cumhuriyet University, 58140, Sivas, Turkey.
- Advanced Technology Research Center, Cumhuriyet University, Sivas, Turkey.
| | - Gokhan Bagci
- Department of Medical Genetics, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Can Huzmeli
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ilhan Sezgin
- Department of Medical Genetics, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, School of Medicine, Canakkale On Sekiz Mart University, Canakkale, Turkey
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Rami AH, Lucian M, Dana P, Dumitru Z. Characteristics of syncope in patients with dilated cardiomyopathy. Indian Heart J 2016; 68 Suppl 1:S29-35. [PMID: 27056650 PMCID: PMC4824336 DOI: 10.1016/j.ihj.2015.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/27/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Syncope carries a poor prognosis among patients with dilated cardiomyopathy (DCM). OBJECTIVES To assess the prevalence, describe the underlying mechanisms and to identify risk factors for syncope in patients with DCM. METHODS One thousand six hundred and ten medical files of 897 patients with a diagnosis of DCM were reviewed. Patients with syncope were identified and their clinical and paraclinical profiles were compared to an equal number of age- and sex-matched patients with DCM without syncope. RESULTS Thirty patients (27 males) with an average age of 62.5 years were identified, corresponding to a prevalence of syncope of 3.3%. A cardiac origin of syncope was identified in 56% of patients (n=17): ventricular arrhythmias in 33% (n=10), and conduction disorders in 23% (n=7). Other mechanisms of syncope were neurally mediated in 7% (n=2) and orthostatic hypotension in 7% (n=2). In 30% of cases (n=9), the etiology was unidentified. There were no significant differences regarding the etiology of DCM, ejection fraction (35.3% vs 35.3%, p=1.0), NYHA class (mild or advanced, p=0.79) and associated conditions (hypertension, p=0.36; diabetes, p=0.75; atrial fibrillation, p=0.43; and dyslipidemia, p=0.33) between the two groups. However, among patients with syncope, patients with a noncardiac cause were more likely to have hypertension (61.53% vs 23.52%, p=0.08) and diabetes (46.15% vs 5.88%, p=0.03). CONCLUSION In patients with DCM, syncope is a relatively rare finding. Cardiac causes (arrhythmias and conduction disorders) are responsible for the majority of cases. Risk factors for syncope in these patients remain to be determined.
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Affiliation(s)
- Abdel-Hadi Rami
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Cluj, Romania
| | - Muresan Lucian
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Cluj, Romania; Rehabilitation Hospital, Cardiology Service, Cluj-Napoca, Cluj, Romania.
| | - Pop Dana
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Cluj, Romania; Rehabilitation Hospital, Cardiology Service, Cluj-Napoca, Cluj, Romania
| | - Zdrenghea Dumitru
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Cluj, Romania; Rehabilitation Hospital, Cardiology Service, Cluj-Napoca, Cluj, Romania
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164
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Tocci G, Barbato E, Coluccia R, Modestino A, Pagliaro B, Mastromarino V, Giovannelli F, Berni A, Volpe M. Blood Pressure Levels at the Time of Percutaneous Coronary Revascularization and Risk of Coronary In-Stent Restenosis. Am J Hypertens 2016; 29:509-18. [PMID: 26271109 PMCID: PMC4886488 DOI: 10.1093/ajh/hpv131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/10/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High blood pressure (BP) levels expose patients treated with percutaneous coronary interventions (PCI) to very high risk of 10-year cardiovascular morbidity and mortality. OBJECTIVE To investigate the role of BP levels at the time of PCI on the risk of in-stent restenosis (ISR). METHODS We retrospectively included 796 patients previously treated with PCI, who underwent repeated angiography for recurrent angina or reversible myocardial ischemia. Patients were stratified into either case (n = 354) and control (n = 442) groups in the presence or absence of ISR (defined as in-stent diameter stenosis ≥50%). BP levels were measured at the time of first and second procedures. Normal BP levels were defined for <140/90 mm Hg. RESULTS Patients with normal BP showed significantly higher ISR-free survival (Log-rank: 5.937; P = 0.015). Both systolic (HR (95% CI): 0.731 (0.590-0.906)) and systolic/diastolic BP (HR (95% CI): 0.757 (0.611-0.939)) were significantly and independently associated with lower risk of ISR at Cox-regression analysis, adjusted for potential confounding factors, including stent type and concomitant medications. Patients with ISR showed lower rates of normal systolic/diastolic BP values (166 (47%) vs. 254 (57%); P = 0.003) compared to controls. They also received higher stent number (1.40±0.74 vs. 1.24±0.51; P < 0.001) with higher stent length (24.3±15.6 vs. 21.7±13.9 mm; P = 0.012), and lower rate of drug-eluting stents (DESs) (210 (48%) vs. 139 (40%); P = 0.025) compared to controls. CONCLUSIONS Normal BP at the time of PCI is associated with nearly 24% risk reduction of ISR as evaluated in a new angiography in patients with coronary artery disease.
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Affiliation(s)
- Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Roberta Coluccia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Anna Modestino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Beniamino Pagliaro
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Vittoria Mastromarino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Francesca Giovannelli
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Berni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy;
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Kim JS, Lee SH, Oh YS, Park JW, An JY, Park SK, Han SR, Lee KS. Cardiovascular Autonomic Dysfunction in Mild and Advanced Parkinson's Disease. J Mov Disord 2016; 9:97-103. [PMID: 27020456 PMCID: PMC4886202 DOI: 10.14802/jmd.16001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of the present study was to investigate cardiovascular autonomic dysfunction in patients with Parkinson’s disease (PD) with mild to severe stages of motor symptoms and to compare cardiovascular autonomic dysfunction between drug-naïve and dopaminergic drug-treated groups. Methods This study included 188 PD patients and 25 age-matched healthy controls who underwent head-up tilt-testing, 24-h ambulatory blood pressure (BP) monitoring and 24-h Holter monitoring. Autonomic function test results were evaluated among groups categorized by motor symptom severities (mild vs. moderate vs. severe) and treatment (drug-naïve or dopaminergic drug treatment). Results Orthostatic hypotension and supine hypertension were more frequent in patients with PD than in healthy controls. The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different among groups. Additionally, no significant differences were detected in supine BP, orthostatic BP change, nighttime BP, nocturnal BP dipping, or heart rate variabilities among groups. Conclusions Cardiovascular autonomic dysfunction is not confined to moderate to severe PD patients, and starts early in the course of the disease in a high proportion of PD patients. In addition, dopaminergic drug treatments do not affect cardiovascular autonomic function.
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Affiliation(s)
- Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si-Hoon Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Wook Park
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Young An
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Kyung Park
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si-Ryung Han
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Additive Effect of Non-Alcoholic Fatty Liver Disease on Metabolic Syndrome-Related Endothelial Dysfunction in Hypertensive Patients. Int J Mol Sci 2016; 17:456. [PMID: 27023537 PMCID: PMC4848912 DOI: 10.3390/ijms17040456] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MS) is characterized by an increased risk of incident diabetes and cardiovascular (CV) events, identifying insulin resistance (IR) and endothelial dysfunction as key elements. Moreover, non-alcoholic fatty liver disease (NAFLD) is bidirectionally linked with MS as a consequence of metabolic and inflammatory abnormalities. We addressed the question if the evolution in NAFLD might worsen endothelium-dependent vasodilating response in MS hypertensives. We recruited 272 Caucasian newly-diagnosed never-treated hypertensive outpatients divided into three groups according to the presence/absence of MS alone or in combination with NAFLD. MS and NAFLD were defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) and non-invasive fatty liver index, respectively. We determined IR by using the homeostasis model assessment (HOMA) index. Vascular function, as forearm blood flow (FBF), was determined through strain-gauge plethysmography after intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside. MS+NAFLD+ group showed worse metabolic, inflammatory and vascular profiles compared with MS−NAFLD− and MS+NAFLD−. HOMA resulted in being the strongest predictor of FBF both in the MS+NAFLD− and in the MS+NAFLD+ groups, accounting for 20.5% and 33.2% of its variation, respectively. In conclusion, we demonstrated that MS+NAFLD+ hypertensives show a worse endothelium-dependent vasodilation compared with MS+NAFLD−, allowing for consideration of NAFLD as an early marker of endothelial dysfunction in hypertensives.
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Hütt P, Songisepp E, Rätsep M, Mahlapuu R, Kilk K, Mikelsaar M. Impact of probiotic Lactobacillus plantarum TENSIA in different dairy products on anthropometric and blood biochemical indices of healthy adults. Benef Microbes 2016; 6:233-43. [PMID: 25524863 DOI: 10.3920/bm2014.0035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The blood pressure-lowering effect of dairy products holds the potential to decrease the risk of cardiovascular disease (CVD). An open question is if the successful expression of functional properties of the probiotic strain depends on host biomarkers and/or food matrix properties. The probiotic Lactobacillus plantarum strain TENSIA® (DSM 21380) is a novel microorganism with antimicrobial and antihypertensive functional properties. The aim of this study was to characterise the functional properties of the probiotic L. plantarum TENSIA and compare its effects on host anthropometric, clinical, and blood biomarkers when consumed with cheese or yoghurt. This study involved two double-blinded randomised placebo-controlled exploratory trials (ISRCTN15061552 and ISRCTN79645828) of healthy adults over a three-week period. The three-week consumption of probiotic L. plantarum TENSIA in a daily dose of 1×1010 cfu in probiotic cheese or a daily dose of 6×109 cfu in yoghurt with different content of carbohydrates, proteins, and lipids did not significantly change the body mass index (BMI), plasma glucose and lipid levels, or inflammatory markers in the blood. Reduced lowered systolic and diastolic blood pressure values were detected, regardless of food matrix or baseline values for blood pressure and BMI. In conclusion, our study showed that three-week consumption of the probiotic L. plantarum TENSIA either in cheese or yoghurt lowered diastolic and systolic blood pressure regardless of food matrix and baseline values of blood pressure and BMI, confirming the impact of the functional properties of the probiotic strain in decreasing CVD risk.
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Affiliation(s)
- P Hütt
- Bio-Competence Centre of Healthy Dairy Products LLC, Kreutzwaldi 1, 51014, Tartu, Estonia Department of Microbiology, Faculty of Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - E Songisepp
- Bio-Competence Centre of Healthy Dairy Products LLC, Kreutzwaldi 1, 51014, Tartu, Estonia
| | - M Rätsep
- Bio-Competence Centre of Healthy Dairy Products LLC, Kreutzwaldi 1, 51014, Tartu, Estonia
| | - R Mahlapuu
- Department of Bio- and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - K Kilk
- Department of Bio- and Translational Medicine, Faculty of Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - M Mikelsaar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Ravila 19, Tartu 50411, Estonia
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Labonté LE, Bourbeau J, Daskalopoulou SS, Zhang M, Coulombe P, Garland K, Baglole CJ. Club Cell-16 and RelB as Novel Determinants of Arterial Stiffness in Exacerbating COPD Patients. PLoS One 2016; 11:e0149974. [PMID: 26914709 PMCID: PMC4767820 DOI: 10.1371/journal.pone.0149974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/08/2016] [Indexed: 01/15/2023] Open
Abstract
Background Exacerbations of chronic obstructive pulmonary disease (COPD) are acute events of worsened respiratory symptoms that may increase the risk of cardiovascular disease (CVD), a leading cause of mortality amongst COPD patients. The utility of lung-specific inflammatory mediators such as club cell protein-16 (CC-16) and surfactant protein D (SPD) and that of a novel marker of CV outcomes in COPD- RelB- in predicting adverse cardiovascular events during exacerbation is not known. Methods Thirty-eight subjects with COPD admitted to the hospital for severe exacerbation were included in this analysis. Clinical, physiological and arterial stiffness measurements were performed within 72 hours of admission; this was followed by measurements taken every 3 days until hospital discharge, then once a week until 30 days after discharge, and then again at 90 and 180 days. Plasma concentrations of inflammatory mediators were measured from peripheral venous blood taken at admission, and at days 15, 30, 90 and 180. Results CC-16 and RelB concentrations were increased at day 15 of exacerbations whereas SPD concentrations were decreased. The course of change in CC-16 and RelB levels over time was inversely associated with that of carotid-femoral pulse wave velocity, the gold-standard measure of arterial stiffness. Increases in CC-16 could predict a decreased number of subsequent exacerbations during follow-up. Conclusions Lung-specific (CC-16) and novel (RelB) biomarkers are associated with systemic cardiovascular changes over time. CC-16 can predict subsequent exacerbations in subjects with severe COPD and may be an important biomarker of pulmonary and systemic stress in COPD.
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Affiliation(s)
- Laura E. Labonté
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | | | - Michele Zhang
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Patrick Coulombe
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Katie Garland
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Center, Montreal, Québec, Canada
| | - Carolyn J. Baglole
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Pathology, McGill University, Montreal, Quebec, Canada
- Department of Pharmacology & Therapeutics, McGill University, Montreal, Québec, Canada
- Meakins Christie Laboratories, McGill University, Montreal, Québec, Canada
- * E-mail:
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169
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Abstract
Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries. The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in low- and middle-income countries. Barriers at the patient, healthcare provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD, will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including (1) effective measures for tobacco control, (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of healthcare through task-sharing (nonphysician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above will lead to substantial reductions in CVD and related mortality.
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Affiliation(s)
- J D Schwalm
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.).
| | - Martin McKee
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Mark D Huffman
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Salim Yusuf
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
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170
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Orun O. Roles of catecholamine related polymorphisms in hypertension. World J Hypertens 2016; 6:41-52. [DOI: 10.5494/wjh.v6.i1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/19/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023] Open
Abstract
The objective of this review is to summarize current data obtained so far in catecholamine-essential hypertension (EH) relationships on a genetic basis. As the major elements driving the sympathetic system’s actions, catecholamines modulate a variety of physiological processes and mutations related to the system. This could generate serious disorders, such as severe mental illnesses, stress-induced disorders, or impaired control of blood pressure or motor pathways. EH is idiopathic, and the genetic basis of its causes and substantial interindividual discrepancies in response to different types of treatments are the focus of interest. Susceptibility to disease or efficacy of treatments are thought to reflect genomic variabilities among individuals. Therefore, outlining the available knowledge in functional genetic polymorphisms linked to EH will make the picture clearer and will help to establish future prospects in the field.
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171
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Wu D, Mansoor G, Kempf C. Clinical attributes, treatment, and control in hypertension (CATCH)-a French and Italian longitudinal patient database study. Clin Hypertens 2016; 21:18. [PMID: 26893928 PMCID: PMC4750805 DOI: 10.1186/s40885-015-0029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/10/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Hypertension, a risk factor for cardiovascular disease (CVD), is frequently associated with other CVD risk factors. Despite recent improvement in blood pressure (BP) control in Europe, a substantial proportion of patients fail to achieve BP targets. Methods This retrospective cohort study used longitudinal patient databases (LPDs) in France and Italy to examine CVD risk profiles, treatment patterns, and BP goal attainment in hypertensive patients treated in real-world clinical practice between 2007 and 2008. Overall, 147,964 and 140,189 eligible patients from LPDs in France and Italy, respectively, were prescribed an antihypertensive medication in 2007. Results Among patients with hypertension with other risk factors (France 88 %, Italy 83 %), the most prevalent risk factors were being elderly (France 66.9 %, Italy 70. 9 %), followed by hypertension combined with dyslipidemia (France 36.7 %, Italy 23.9 %) and isolated systolic hypertension (France 32.5 %, Italy 24.2 %). The odds ratios for target BP attainment were significantly (p < 0.001) higher in patients with hypertension without other risk factors vs patients with hypertension with other risk factors (1.41 [95 % confidence interval 1.35, 1.48] in France; 1.38 [1.31, 1.46] in Italy). The odds of BP control were significantly lower for patients with vs patients without an associated CVD risk factor (range 0.54 to 1.10 France; 0.59 to 1.17 Italy). Discussion This study demonstrates that the majority of treated hypertensive patients in France and Italy have at least one additional CVD risk factor. Despite treatment with antihypertensive medications, blood pressure attainment was substantially less optimal in patients with an associated CVD risk factor compared to patients without an associated CVD risk factor. Electronic supplementary material The online version of this article (doi:10.1186/s40885-015-0029-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Wu
- Merck &Co., Inc., Kenilworth, NJ USA ; Global Health Outcomes, Merck & Co., Inc., 600 Corporate Drive, CRB-205, Cokesbury, NJ 08833 USA
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172
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Chen X, Zou S, Wu X, Sun H, Ma B, Yang B, Zhang W, Shi J. Dietary Features and Blood Pressure among 18-88-Year-Old Residents in an Island Population in China. J Nutr Health Aging 2016; 20:107-13. [PMID: 26812505 DOI: 10.1007/s12603-015-0563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Dietary recommendations to reduce blood pressure (BP) have been widely disseminated and residents who live on islands have unique dietary characteristics. Here, we identified associations between dietary intake and BP levels among island residents in China. DESIGN Cross-sectional study. SETTING The Changhai islands, which is an important island county in China. PARTICIPANTS A total of 876 residents, 18-88 years old, of Changhai county. MEASUREMENTS Dietary intake and BP measurements were assessed using standardized questionnaires and protocols, respectively. Dietary intake was compared across BP categories and linear regression analyses were performed between dietary intake and systolic blood pressure (SBP) and diastolic blood pressure (DBP). RESULTS Participants previously diagnosed with hypertension consumed less salt than those with undiagnosed high BP (p < 0.01). After exclusion of participants previously diagnosed with hypertension, salt and meat consumption were positively and linearly associated with both SBP (p < 0.01 and < 0.001, respectively) and DBP (p = 0.03 and < 0.01, respectively), whereas consumption of marine products was inversely associated with SBP (p = 0.047). Mixed edible oil and edible oil consumption were associated with SBP (p < 0.01) and DBP (p = 0.021), respectively. In the multiple linear regression model, meat intake was positively associated with both SBP and DBP (β = 0.139, p < 0.001; β = 0.066, p = 0.047, respectively), whereas consumption of marine products was inversely associated with SBP (β = -0.102, p <0.001), while mixed edible oil was associated with SBP (β = 0.062, p = 0.03). CONCLUSION Adherence to nutritional recommendations can be improved among hypertensive patients, even those aware of their conditions. In the general island population, eating habits regarding salt, meat, edible oil consumption, and use of mixed edible oil increased the risk of hypertension onset, whereas marine products were found to decrease this risk.
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Affiliation(s)
- X Chen
- Jingpu Shi, Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, No. 155 Nanjing Bei Street, Heping District, Shenyang, Liaoning Province 110001, China, Tel.: +86 24 8328 2840; fax: +86 24 8328 2840, E-mail address:
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Ohyama Y, Teixido-Tura G, Ambale-Venkatesh B, Noda C, Chugh AR, Liu CY, Redheuil A, Stacey RB, Dietz H, Gomes AS, Prince MR, Evangelista A, Wu CO, Hundley WG, Bluemke DA, Lima JAC. Ten-year longitudinal change in aortic stiffness assessed by cardiac MRI in the second half of the human lifespan: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imaging 2016; 17:1044-53. [PMID: 26758407 DOI: 10.1093/ehjci/jev332] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/22/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Longitudinal determinants of aortic stiffness (AS) measured by magnetic resonance imaging (MRI) have not been assessed in a large community-based population. Our aim was to examine the determinants of change in thoracic AS over 10 years of follow-up in a multi-ethnic population of individuals 45 years of age and older measured by MRI. METHODS AND RESULTS We studied 1160 participants (mean age = 60 ± 9 years at baseline, 45% male) with aortic MRI at both the MESA Year 0 and Year 10 examinations. Ascending and descending aorta distensibility (AAD/DAD) and aortic arch pulse-wave velocity (PWV) were measured using MRI. Determinants of the change in AS parameters over 10 years were assessed using linear regression adjusted for baseline values, demographic variables, baseline risk factors and change in risk factors, and chronic risk exposure. AAD and DAD decreased slightly (5% decrease in median for AAD: 1.33-1.26 mmHg(-1) · 10(-3), P = 0.008; 5% decrease in median for DAD: 1.73-1.64 mmHg(-1) · 10(-3), P < 0.001), and PWV increased over 10 years (18% increase in median: 6.8-8.0 m/s P < 0.001). Baseline age was related to a reduction in AAD and DAD and an increase in PWV throughout the follow-up period. Baseline and change in mean blood pressure and continued smoking were associated with a reduction in AAD and an increase in PWV. Furthermore, baseline heart rate was also related to a reduction in AAD and DAD. Blood pressure normalization was related to less aortic stiffening throughout the follow-up period. CONCLUSIONS In our longitudinal, community-based cohort study of adult individuals aged 45 years or greater, greater mean blood pressure and a history of smoking history were associated with increased aortic stiffening over 10 years as assessed by MRI.
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Affiliation(s)
- Yoshiaki Ohyama
- Department of cardiology, Johns Hopkins University, 600 N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA
| | - Gisela Teixido-Tura
- Department of cardiology, Johns Hopkins University, 600 N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA Department of Radiology, Weil Medical College of Cornell University, New York, NY, USA
| | | | - Chikara Noda
- Department of cardiology, Johns Hopkins University, 600 N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA
| | - Atul R Chugh
- Department of cardiology, Johns Hopkins University, 600 N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA
| | - Chia-Ying Liu
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Alban Redheuil
- LIB INSERM UMRS-1146 and Cardiovascular Imaging Department DICVRI, Cardiology Institute, La Pitié Salpêtrière, Sorbonne Universités, UPMC, ICAN, Paris, France
| | - R Brandon Stacey
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Harry Dietz
- Department of Pediatric Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Martin R Prince
- Department of Radiology, Weil Medical College of Cornell University, New York, NY, USA
| | - Arturo Evangelista
- Department of Cardiology, Hospital General Universitari Vall d'Herbron, Barcelona, Spain
| | - Colin O Wu
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - W Gregory Hundley
- Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David A Bluemke
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Joao A C Lima
- Department of cardiology, Johns Hopkins University, 600 N. Wolf Street/Blalock 524, Baltimore, MD 21287, USA
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Li W, Katzmarzyk PT, Horswell R, Wang Y, Johnson J, Hu G. Blood pressure and all-cause mortality among patients with type 2 diabetes. Int J Cardiol 2016; 206:116-21. [PMID: 26788685 DOI: 10.1016/j.ijcard.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/14/2015] [Accepted: 01/01/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND The recommended goal for blood pressure (BP) control has recently been adjusted for people with diabetes, but the optimal BP control range for the diabetic population is still uncertain. METHODS We performed a prospective cohort study of 35,261 patients with type 2 diabetes. Cox proportional hazard regression models were used to estimate the association of BP with all-cause mortality. RESULTS During a mean follow-up period of 8.7 years, 4199 deaths were identified. The multivariable-adjusted hazard ratios of all-cause mortality associated with different levels of systolic/diastolic BP (<110/65, 110-119/65-69, 120-129/70-80, 130-139/80-90 [reference group], 140-159/90-100, and ≥160/100 mmHg) were 1.70 (95% confidence interval [CI] 1.42-2.04), 1.26 (95% CI 1.07-1.50), 0.99 (95% CI 0.86-1.12), 1.00, 0.92 (95% CI 0.82-1.03), and 1.10 (95% CI 0.98-1.23) using baseline BP measurements, and 2.62 (95% CI 2.00-3.44), 1.77 (95% CI 1.51-2.09), 1.22 (95% CI 1.09-1.36), 1.00, 0.90 (95% CI 0.82-1.00), and 0.98 (95% CI 0.86-1.12) using an updated mean value of BP during follow-up, respectively. The U-shaped associations were confirmed in both African American and white patients, in both men and women, in those who were or were not taking antihypertensive drugs, and in patients aged 30-49 years and 50-59 years. CONCLUSIONS The current study found a U-shaped association between BP at baseline and during follow-up and the risk of all-cause mortality among patients with type 2 diabetes.
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Affiliation(s)
- Weiqin Li
- Pennington Biomedical Research Center, Baton Rouge, LA, USA; Tianjin Women's and Children's Health Center, Tianjin, China
| | | | | | - Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jolene Johnson
- Louisiana State University Health Center, Baton Rouge, LA, USA
| | - Gang Hu
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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175
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Kim JS, Oh YS, Park HE, Lee SH, Park JW, Song IU, An JY, Park HJ, Son BC, Lee KS. Cardiovascular autonomic dysfunctions in elderly patients with essential tremor: comparison with healthy controls. Neurol Sci 2016; 37:711-6. [PMID: 26728270 DOI: 10.1007/s10072-015-2465-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/22/2015] [Indexed: 11/24/2022]
Abstract
Questionnaire-based analyses show that patients with essential tremor (ET) may have several autonomic dysfunctions, especially in the cardiovascular and genitourinary domains; yet the laboratory correlates of autonomic dysfunction in ET are unknown and have not been studied. Herein, we explored whether sympathetic and parasympathetic functions differed between control subjects and patients with ET. Seventy-five elderly patients with ET were enrolled in this study, along with 25 age-matched controls. Orthostatic vital signs, ambulatory 24-h blood pressure monitoring and 24-h Holter monitoring values were recorded and metaiodobenzylguanidine (MIBG) uptake was assessed using the heart-to-mediastinum ratio (H/M ratio). The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different between the ET patients and the controls, although ET patients had more episodes of orthostatic intolerance. The ET group also had similar heart rate variations as the control group for all the time-domains. The mean H/M ratios for the ET group were not statistically different from that of the control group. This result proves that the autonomic control of the cardiovascular system is normal in ET.
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Affiliation(s)
- Joong-Seok Kim
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea.
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Hyung-Eun Park
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Si-Hoon Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Jeong-Wook Park
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - In-Uk Song
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Jae-Young An
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
| | - Hun-Jun Park
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Chul Son
- Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Republic of Korea
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Kong Q, Xia M, Liang R, Li L, Cu X, Sun Z, Hu J. Increased serum visfatin as a risk factor for atherosclerosis in patients with ischaemic cerebrovascular disease. Singapore Med J 2015; 55:383-7. [PMID: 25091888 DOI: 10.11622/smedj.2014091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The present study aimed to investigate the possible associations between serum levels of visfatin, an adipokine, and atherosclerosis in patients with ischaemic cerebrovascular disease. METHODS A total of 95 participants were recruited for this study. Group A comprised 35 individuals with no history of cerebrovascular disease (control group) and Group B comprised 60 patients with ischaemic cerebrovascular disease. Group B was further categorised into two subgroups based on the ultrasonographic findings of the common carotid artery intima‑media thickness (CCA‑IMT) - Group B1 consisted of 21 patients with no atherosclerosis (i.e. CCA‑IMT ≤ 0.9 mm) and Group B2 consisted of 39 patients with atherosclerosis (i.e. CCA‑IMT > 0.9 mm). The body mass index, fasting blood total cholesterol, triglycerides, high‑density lipoprotein cholesterol, low‑density lipoprotein cholesterol and glucose levels of each patient were measured. Serum visfatin levels were determined using enzyme‑linked immunosorbent assays. Visfatin levels were compared between groups, and stepwise logistic regression analysis was used to identify risk factors for atherosclerosis, including visfatin levels. RESULTS The mean serum visfatin level of the patients in Group B was higher than that in Group A (75.5 ± 77.80 ng/mL vs. 8.6 ± 4.69 ng/mL; p < 0.05) and the level was higher in patients from Group B2 than those from Group B1 (89.0 ± 80.68 ng/mL vs. 50.4 ± 72.44 ng/mL; p < 0.05). Multivariate regression analysis showed that CCA‑IMT values were not significantly associated with visfatin levels. However, logistic regression analysis showed that serum visfatin was an independent risk factor for atherosclerosis (odds ratio 37.80; p = 0.004). CONCLUSION Serum visfatin may be an independent risk factor for cerebral infarction, as high serum visfatin levels are positively associated with the underlying pathogenic mechanisms of ischaemic cerebrovascular disease.
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Affiliation(s)
- Qingxia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical College, Jining, Shandong Province, China.
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Lasek-Bal A, Jędrzejowska-Szypułka H, Różycka J, Bal W, Holecki M, Duława J, Lewin-Kowalik J. Low Concentration of BDNF in the Acute Phase of Ischemic Stroke as a Factor in Poor Prognosis in Terms of Functional Status of Patients. Med Sci Monit 2015; 21:3900-5. [PMID: 26656843 PMCID: PMC4684138 DOI: 10.12659/msm.895358] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND According to recent studies, brain-derived neurotrophic factor (BDNF) probably plays a role in development of cerebral ischemia and can be significant for the prognosis of improved mobility after stroke. The aim of this prospective study was to evaluate the blood concentration of BDNF during the 1st day of first-ever ischemic stroke and find a potential association between BDNF concentration and the neurological status in the acute period, as well as between BDNF and the functional status in the sub-acute phase of stroke. MATERIAL AND METHODS The prospective study involved 87 patients aged 39-99 years (42 women, 45 men) with first-in-life complete ischemic stroke. All study subjects underwent analysis as follows: BDNF blood concentration and neurological status according to NIHSS on the 1st day of stroke, comorbidities, etiological type of ischemic stroke by ASCOD, and functional status on the 14th and 90th day after the onset according to mRankin scale. RESULTS Mean concentration of BDNF in the study group was 9.96 ng/mL±5.21, median 10.39 ng/mL. Patients aged ≤65 years (25 individuals) had a significantly higher mean concentration of BDNF (11.94 ng/mL±4.46; median 12.34 ng/mL) than the older subjects (62 individuals) with a mean concentration of 9.17 ng/mL±5.32 (median 8.66 ng/mL). The mean score by mRankin scale on the 90th day was significantly higher among patients with lower concentrations of BDNF on the 1st day of stroke, which reflects their poorer functional status. The functional status on the 90th day was significantly worse (3-6 points by Rankin scale) in patients who had BDNF below the mean value in the acute phase of stroke. The independent factors for poor functional status of patients on the 90th day after stroke were a score >4 points by NIHSS (RR 1.14; 95% CI: 1.00-1.31; p=0.027) and the concentration of BDNF below the mean value (assessed on the 1st day of stroke) (RR 14.49; CI 4.60-45.45; p=0.000). CONCLUSIONS The neurological status and concentration of BDNF on the 1st day of ischemic stroke are independent prognostic factors in medium-term observation. Reduction in the concentration of BDNF in the acute phase of stroke is a factor for poor prognosis in terms of the functional status of patients on the 90th day after onset.
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Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
- School of Health Sciences, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Jagoda Różycka
- Department of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Wiesław Bal
- Department of Radiation Oncology and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Michał Holecki
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland
| | - Joanna Lewin-Kowalik
- Department of Physiology, School of Medicine, Medical University of Silesia in Katowice, Katowice, Poland
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178
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Endothelial Gata5 transcription factor regulates blood pressure. Nat Commun 2015; 6:8835. [PMID: 26617239 PMCID: PMC4696516 DOI: 10.1038/ncomms9835] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022] Open
Abstract
Despite its high prevalence and economic burden, the aetiology of human hypertension remains incompletely understood. Here we identify the transcription factor GATA5, as a new regulator of blood pressure (BP). GATA5 is expressed in microvascular endothelial cells and its genetic inactivation in mice (Gata5-null) leads to vascular endothelial dysfunction and hypertension. Endothelial-specific inactivation of Gata5 mimics the hypertensive phenotype of the Gata5-null mice, suggestive of an important role for GATA5 in endothelial homeostasis. Transcriptomic analysis of human microvascular endothelial cells with GATA5 knockdown reveals that GATA5 affects several genes and pathways critical for proper endothelial function, such as PKA and nitric oxide pathways. Consistent with a role in human hypertension, we report genetic association of variants at the GATA5 locus with hypertension traits in two large independent cohorts. Our results unveil an unsuspected link between GATA5 and a prominent human condition, and provide a new animal model for hypertension. Unravelling the molecular basis of hypertension remains a major challenge. Here, the authors identify the transcription factor GATA5 as a novel regulator of blood pressure and potential genetic determinant of human hypertension and describe a unique mouse model for research of salt-sensitive hypertension.
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179
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Benziger CP, Bernabé-Ortiz A, Gilman RH, Checkley W, Smeeth L, Málaga G, Miranda JJ. Metabolic Abnormalities Are Common among South American Hispanics Subjects with Normal Weight or Excess Body Weight: The CRONICAS Cohort Study. PLoS One 2015; 10:e0138968. [PMID: 26599322 PMCID: PMC4658165 DOI: 10.1371/journal.pone.0138968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to characterize metabolic status by body mass index (BMI) status. Methods The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru’s capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0–1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. Results A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p<0.001). Among normal weight individuals, 43.1% were metabolically unhealthy, and age ≥65 years, female, and highest socioeconomic groups were more likely to have this pattern. In contrast, only 16.4% of overweight and 3.9% of obese individuals were metabolically healthy and, compared to Lima, the rural and urban sites in Puno were more likely to have a metabolically healthier profile. Conclusions Most Peruvians with overweight and obesity have additional risk factors for cardiovascular disease, as well as a majority of those with a healthy weight. Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose.
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Affiliation(s)
- Catherine P. Benziger
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, United States of America
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
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180
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High Risk versus Proportional Benefit: Modelling Equitable Strategies in Cardiovascular Prevention. PLoS One 2015; 10:e0140793. [PMID: 26529507 PMCID: PMC4631497 DOI: 10.1371/journal.pone.0140793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 09/30/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the performances of an alternative strategy to decide initiating BP-lowering drugs called Proportional Benefit (PB). It selects candidates addressing the inequity induced by the high-risk approach since it distributes the gains proportionally to the burden of disease by genders and ages. STUDY DESIGN AND SETTING Mild hypertensives from a Realistic Virtual Population by genders and 10-year age classes (range 35-64 years) received simulated treatment over 10 years according to the PB strategy or the 2007 ESH/ESC guidelines (ESH/ESC). Primary outcomes were the relative life-year gain (life-years gained-to-years of potential life lost ratio) and the number needed to treat to gain a life-year. A sensitivity analysis was performed to assess the impact of changes introduced by the ESH/ESC guidelines appeared in 2013 on these outcomes. RESULTS The 2007 ESH/ESC relative life-year gains by ages were 2%; 10%; 14% in men, and 0%; 2%; 11% in women, this gradient being abolished by the PB (relative gain in all categories = 10%), while preserving the same overall gain in life-years. The redistribution of benefits improved the profile of residual events in younger individuals compared to the 2007 ESH/ESC guidelines. The PB strategy was more efficient (NNT = 131) than the 2013 ESH/ESC guidelines, whatever the level of evidence of the scenario adopted (NNT = 139 and NNT = 179 with the evidence-based scenario and the opinion-based scenario, respectively), although the 2007 ESH/ESC guidelines remained the most efficient strategy (NNT = 114). CONCLUSION The Proportional Benefit strategy provides the first response ever proposed against the inequity of resource use when treating highest risk people. It occupies an intermediate position with regards to the efficiency expected from the application of historical and current ESH/ESC hypertension guidelines. Our approach allows adapting recommendations to the risk and resources of a particular country.
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181
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Sun N, Xi Y, Zhu Z, Yin H, Tao Q, Wang H, Wang L, Ma Z, Chen Y, Yao D. Effects of Anxiety and Depression on Arterial Elasticity of Subjects With Suboptimal Physical Health. Clin Cardiol 2015; 38:614-20. [PMID: 26509854 DOI: 10.1002/clc.22455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 08/13/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The authors investigated the effects of suboptimal health status (SHS; high-normal blood pressure, blood glucose, and blood lipids) on arterial elasticity in subjects with or without anxiety or depression. HYPOTHESIS Suboptimal physical health status and anxiety or depression increase the risk of cardiovascular diseases. METHODS This was a cross-sectional, observational, multicenter study. Among 1520 subjects who underwent physical examination between May 2009 and December 2012 in Beijing and Chongqing, China, 955 were included. All subjects completed anxiety and depression questionnaires. Systemic vascular compliance (SVC), systemic vascular resistance, and brachial artery distensibility (BAD) were measured during arterial elasticity evaluation. RESULTS Of 955 participants, 633 were classified as having SHS and 322 were classified as healthy. Systemic vascular compliance and BAD were worse in SHS subjects than in healthy subjects (SVC: 1.23 ± 0.22 vs 1.29 ± 0.25 mL/mm Hg; BAD: 6.26 ± 1.32 vs 6.61 ± 1.24%/mm Hg, respectively; both P < 0.05). Of 955 subjects, 37.7% and 43.9% had anxiety and depression, respectively. Systemic vascular compliance and BAD in SHS subjects with concomitant anxiety or depression were significantly lower than in SHS subjects without anxiety or depression (SVC: 1.22 ± 0.23 vs 1.23 ± 0.20 mL/mm Hg; BAD: 6.10 ± 1.36 vs 6.33 ± 1.20 %/mm Hg, respectively; both P < 0.05) and even lower than in healthy subjects. CONCLUSIONS Though anxiety and depression had less impact on arterial elasticity in a healthy population, they may be involved in pathogenesis of vascular damage in the population with SHS.
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Affiliation(s)
- Ningling Sun
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Yang Xi
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Zhiming Zhu
- Hypertension and Metabolic Disease Center, The Third Affiliated Hospital of Third Military Medical University, Chongqing, China
| | - Huijun Yin
- Department of Cardiology, Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Qiushan Tao
- Department of Heart Center, Hypertensive Laboratory, Peking University School of Public Health, Beijing, China
| | - Hongyi Wang
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Luyan Wang
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Zhiyi Ma
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Chen
- Heart Center, Peking University People's Hospital, Beijing, China
| | - Dan Yao
- Heart Center, Peking University People's Hospital, Beijing, China
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182
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Zhang W, Wang L, Chen Y, Tang F, Xue F, Zhang C. Identification of Hypertension Predictors and Application to Hypertension Prediction in an Urban Han Chinese Population: A Longitudinal Study, 2005-2010. Prev Chronic Dis 2015; 12:E184. [PMID: 26513440 PMCID: PMC4663898 DOI: 10.5888/pcd12.150192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Research suggests that targeting high-risk, nonhypertensive patients for preventive intervention may delay the onset of hypertension. We aimed to develop a biomarker-based risk prediction model for assessing hypertension risk in an urban Han Chinese population. Methods We analyzed data from 26,496 people with hypertension to extract factors from 11 check-up biomarkers. Then, depending on a 5-year follow-up cohort, a Cox model for predicting hypertension development was built by using extracted factors as predictors. Finally, we created a hypertension synthetic predictor (HSP) by weighting each factor with its risk for hypertension to develop a risk assessment matrix. Results After factor analysis, 5 risk factors were extracted from data for both men and women. After a 5-year follow-up, the cohort of participants had an area under receiver operating characteristic curve (area under the curve [AUC]) with an odds ratio (OR) of 0.755 (95% confidence interval [CI], 0.746–0.763) for men and an OR of 0.801 (95% CI, 0.792–0.810) for women. After tenfold cross validation, the AUC was still high, with 0.755 (95% CI, 0.746–0.763) for men and 0.800 (95% CI, 0.791–0.810) for women. An HSP-based 5-year risk matrix provided a convenient tool for risk appraisal. Conclusion Hypertension could be explained by 5 factors in a population sample of Chinese urban Han. The HSP may be useful in predicting hypertension.
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Affiliation(s)
- Wenchao Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Linping Wang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, China
| | - Yafei Chen
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Fang Tang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China>
| | - Chengqi Zhang
- Health Management Center, Shandong Provincial QianFoShan Hospital, Jinan 250014, China.
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De Nunzio C, Truscelli G, Trucchi A, Petta S, Tubaro M, Gacci M, Gaudio C, Presicce F, Tubaro A. Metabolic abnormalities linked to an increased cardiovascular risk are associated with high-grade prostate cancer: a single biopsy cohort analysis. Prostate Cancer Prostatic Dis 2015; 19:35-9. [PMID: 26439746 DOI: 10.1038/pcan.2015.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Accepted: 08/17/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Smoking, hypertension, abdominal obesity and metabolic abnormalities have been considered individual factors involved in prostate cancer (PCa) pathogenesis. All of these factors are used to define the individual cardiovascular risk (CVR). The aim of our study was to evaluate the association between CVR and PCa diagnosis and grade among a consecutive series of men undergoing prostate biopsy. METHODS From 2010 onwards, consecutive patients undergoing 12-core prostate biopsy were enrolled. Body mass index was measured before the biopsy. Blood samples were collected and tested for: PSA, fasting glucose, triglycerides and high-density lipoproteins. Blood pressure was also recorded. Metabolic syndrome was defined according to the Adult Treatment Panel III and CVR according to the European Association of Cardiologist Guidelines. We evaluated the association between CVR and PCa biopsy Gleason score using logistic regression analyses. RESULTS Five hundred and eighty-four patients were enrolled. Four hundred and six patients (70%) presented a moderate/high CVR. Two hundred and thirty-seven (40.6%) patients had cancer on biopsy; 157 with moderate/high CVR and 80 with low/no CVR (P=0.11). Out of the 237 patients with PCa, 113 had a Gleason score 6 and 124 a Gleason score ⩾7. Out of them, 92/124 (75%) presented a moderate/high CVR (P=0.004). Moderate/high CVR was not associated with an increased risk of PCa (odds ratio (OR): 0.741, confidence interval (CI): 0.474-1.156; P=0.186) but with an increased risk of Gleason score ⩾7 (OR: 2.154, CI: 1.076-4.314; P=0.030). CONCLUSIONS In our study, a moderate/high CVR is associated with an increased risk of a high-grade Gleason score when PCa is diagnosed on biopsy. Although these results should be confirmed in multicentre studies, patients with moderate/high CVR should be carefully evaluated for PCa diagnosis.
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Affiliation(s)
- C De Nunzio
- Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - G Truscelli
- Department of Heart and Great Vessels 'A. Reale', Policlinico Umberto I, ' Sapienza' University of Rome, Rome, Italy
| | - A Trucchi
- Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - S Petta
- Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - M Tubaro
- ICCU, Cardiovascular Department, Ospedale San Filippo Neri, Rome, Italy
| | - M Gacci
- Department of Urology, Ospedale Careggi, University of Florence, Florence, Italy
| | - C Gaudio
- Department of Heart and Great Vessels 'A. Reale', Policlinico Umberto I, ' Sapienza' University of Rome, Rome, Italy
| | - F Presicce
- Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
| | - A Tubaro
- Department of Urology, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy
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Ciccone MM, Scicchitano P, Zito A, Cortese F, Rotondo C, Coladonato L, Gesualdo M, Notarnicola A, Iannone F. Evaluation of differences in carotid intima-media thickness in patients affected by systemic rheumatic diseases. Intern Emerg Med 2015; 10:823-30. [PMID: 26037393 DOI: 10.1007/s11739-015-1250-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/17/2015] [Indexed: 01/08/2023]
Abstract
The objective of this study is to investigate whether rheumatic autoimmune diseases, systemic sclerosis (SSc) in particular, are associated with increased carotid intima-media thickness (C-IMT). A total of 108 clinical outpatients (93 females), mean age 51 ± 14 years suffering from CTD were consecutively enrolled. Patients were subdivided into the following two groups: (1) Systemic Sclerosis (SSc, 60 patients); (2) non-Systemic Sclerosis (NoSSc, 48 patients). No randomization was managed. All patients underwent structured clinical interview, physical examination, laboratory evaluation and two-dimensional echo-color Doppler of the carotid arteries to measure C-IMT and atherosclerotic plaques. Framingham risk score was also calculated. We also enrolled 108 healthy controls (HC), matched by sex and age. The primary outcome was to stratify cardiovascular risk of CTD patients. There were no significant differences between SSc and NoSSc patients regarding any of the demographics and traditional cardiovascular risk factors. Mean C-IMT was not significantly different between the whole CTD patients (0.86 ± 0.13 mm) and HC (0.83 ± 0.13 mm). C-IMT was significantly higher in SSc than in NoSSc group (0.91 ± 0.1 mm vs 0.80 ± 0.14 mm, p < 0.001). Furthermore, C-IMT in SSc group was significantly higher than C-IMT in controls (0.91 ± 0.1 mm vs 0.83 ± 0.13 mm, p < 0.001). C-IMT did correlate neither with disease activity nor with drug intake. SSc patients had a significant increase in C-IMT as compared to NoSSc patients and healthy controls.
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Affiliation(s)
- Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Pietro Scicchitano
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Annapaola Zito
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesca Cortese
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Cinzia Rotondo
- Interdisciplinary Department of Medicine, Rheumatology Unit, School of Medicine, University of Bari, 70124, Bari, Italy
| | - Laura Coladonato
- Interdisciplinary Department of Medicine, Rheumatology Unit, School of Medicine, University of Bari, 70124, Bari, Italy
| | - Michele Gesualdo
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Antonella Notarnicola
- Interdisciplinary Department of Medicine, Rheumatology Unit, School of Medicine, University of Bari, 70124, Bari, Italy
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine, Rheumatology Unit, School of Medicine, University of Bari, 70124, Bari, Italy
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185
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Dörr O, Liebetrau C, Möllmann H, Gaede L, Troidl C, Morczeck K, Wiebe J, Hoffmann J, Voss S, Bauer T, Hamm C, Nef H. Influence of Renal Sympathetic Denervation on Cardiac Extracellular Matrix Turnover and Cardiac Fibrosis. Am J Hypertens 2015; 28:1285-92. [PMID: 25767136 DOI: 10.1093/ajh/hpv020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Renal sympathetic denervation (RSD) represents an effective treatment option for patients with resistant arterial hypertension (HT). Extracellular matrix (ECM) turnover and deposition are essential processes in HT-related cardiovascular remodeling, fibrosis, and cardiac hypertrophy and contribute to hypertensive heart disease. OBJECTIVES The primary aim of the present study was to examine the effect of RSD on increased collagen turnover as reflected by serum levels of amino-terminal pro-peptides (PINP, PIIINP) and a carboxyl-terminal pro-peptide (PICP), specific biomarkers for cardiac ECM turnover and cardiovascular fibrosis. METHODS A total of 100 consecutive patients (mean age: 65.9±10.1 years) undergoing RSD were included in this study. A therapeutic response was defined as an office systolic blood pressure (SBP) reduction of >10mm Hg 6 months after RSD. Venous serum samples for measurement of PICP, PINP, and PIIINP were collected prior to and 6 months after RSD. RESULTS A significant reduction in the office SBP of 24.3 mm Hg (SBP baseline: 166.9±14.3 mm Hg (P < 0.001) was documented 6 months after RSD. At this time point, the serum levels of PICP, PINP, and PIIINP (P < 0.01) were significantly decreased compared to baseline values in patients with an increased collagen turnover, showing significant differences comparing BP responders and nonresponders. CONCLUSION In addition to the effective blood pressure reduction in response to RSD, this study demonstrates a positive effect of RSD on biomarkers reflecting cardiovascular ECM turnover and deposition. These results suggest a beneficial effect of RSD on cardiovascular fibrosis, hypertensive heart disease, and end-organ damage in high-risk patients.
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Affiliation(s)
- Oliver Dörr
- Department of Cardiology, University of Giessen, Giessen, Germany;
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian Troidl
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Kareen Morczeck
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Jens Wiebe
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Jedrzej Hoffmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Sandra Voss
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Timm Bauer
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Christian Hamm
- Department of Cardiology, University of Giessen, Giessen, Germany; Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Holger Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
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186
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Sun N, Xi Y, Han W, Zhao L, Wang H, Chen Y. Relationship of 24-h urinary sodium excretion with blood pressure, arterial distensibility, and urine albumin in Chinese hypertensive patients. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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187
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Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery. World J Surg 2015; 39:417-23. [PMID: 25331726 DOI: 10.1007/s00268-014-2826-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of surgically induced weight loss on the abdominal adipose tissue depots and the metabolic profile in morbidly obese (MO) patients. METHODS The study was performed with a semi-automated quantification of adipose tissue compartments on single-slice abdominal CT series before surgery, 6 and 12 months after bariatric surgery. Thirty-eight MO patients with mean age of 35.7 ± 10.1 years and mean body mass index (BMI) of 43.6 ± 6.5 kg/m(2) were studied (20 patients underwent gastric banding and 18 patients underwent sleeve gastrectomy). Anthropometric measurements, metabolic and inflammatory parameters were analyzed in each patient. RESULTS Markedly decreased levels of total abdominal adipose tissue, abdominal subcutaneous adipose tissue (AbSAT) and visceral adipose tissue (VAT) at 6 and 12 months were noted in comparison to the preoperative values. The total % reduction of VAT was significant higher in comparison to the total % reduction of AbSAT at 12 months after bariatric surgery (P < 0.01) with the mean ratio of AbSAT/VAT to increase from 4.1 ± 1.7 preoperatively to 6.2 ± 3.1 at 12 months postoperatively (P < 0.001). In addition, high-sensitivity C-reactive protein (hsCRP) decreased significantly with weight loss after bariatric surgery and the total abdominal lipid loss was related to the decrease in hsCRP. CONCLUSIONS Significant changes in abdominal lipid deposition occurred in MO patients 6 and 12 months after bariatric surgery. The changes were significantly, correlated with the magnitude of BMI loss. The fat redistribution may contribute to the improvements in metabolic abnormalities.
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188
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Figueiredo EL, Magalhães CA, Belli KC, Mandil A, Garcia JCF, Araújo RA, Figueiredo AFDS, Pellanda LC. Human Tissue Kallikrein Activity in Angiographically Documented Chronic Stable Coronary Artery Disease. Arq Bras Cardiol 2015; 105:457-565. [PMID: 26351984 PMCID: PMC4651403 DOI: 10.5935/abc.20150109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/15/2015] [Indexed: 01/22/2023] Open
Abstract
Background Human tissue kallikrein (hK1) is a key enzyme in the kallikrein–kinin system
(KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive
and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary
artery disease (CAD) remains unclear. Objective To evaluate hK1-specific amidase activity in the urine of CAD patients Methods Sixty-five individuals (18–75 years) who underwent cardiac catheterism (CATH) were
included. Random midstream urine samples were collected immediately before CATH.
Patients were classified in two groups according to the presence of coronary
lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was
estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was
determined using Jaffé’s method. Urinary hK1-specific amidase activity was
expressed as µM/(min · mg creatinine) to correct for differences
in urine flow rates. Results Urinary hK1-specific amidase activity levels were similar between CAD [0.146
µM/(min ·mg creatinine)] and non-CAD [0.189
µM/(min . mg creatinine)] patients (p = 0.803) and remained
similar to values previously reported for hypertensive patients [0.210
µM/(min . mg creatinine)] and HF patients [0.104
µM/(min . mg creatinine)]. CAD severity and hypertension were
not observed to significantly affect urinary hK1-specific amidase activity. Conclusion CAD patients had low levels of urinary hK1-specific amidase activity, suggesting
that renal KKS activity may be reduced in patients with this disease.
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Affiliation(s)
| | - Carolina Antunes Magalhães
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Karlyse Claudino Belli
- Divisão de Cardiologia, Laboratório de Pesquisa de Patofisiologia do Exercício, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ari Mandil
- Departamento de Hemodinâmica, Hospital Lifecenter, Belo Horizonte, MG, Brazil
| | | | | | | | - Lucia Campos Pellanda
- Programa de Pós-Graduação em Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
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189
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Evaluation of patients diagnosed with essential arterial hypertension through network analysis. Ir J Med Sci 2015; 185:443-51. [PMID: 26318328 DOI: 10.1007/s11845-015-1342-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/19/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Essential hypertension is a chronic pathology that causes long-term complications due to late diagnosis of patients, the inability to control the disease through medication, or due to the complexity of associated risk factors. AIMS Our study sets out to identify specific patterns of response to arterial hypertension treatment, by taking into consideration the multiple connections between risk factors in a relevant population of hypertensive patients. METHODS Network science is an emerging paradigm, branching over multiple aspects of physical, biological and social phenomena. One such branch, which has brought significant contributions to medical science, is the field of network medicine. To apply this methodology, we create a complex network of hypertensive patients based on their common medical conditions. Consequently, we obtain a community-based representation which pinpoints specific-and previously uncharted-patterns of hypertension development. This approach creates incentives for evaluating patient's treatment efficacy, by considering its network topological position. RESULTS Distinct clusters of patients with common properties have emerged for each study group (group A-treated with nebivolol, group B-treated with perindopril and group C-treated with candesartan cilexetil). Therefore, our network-based clustering allows for a better treatment assessment.
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190
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Abstract
Despite the availability of effective pharmacological treatments to aid the control of blood pressure, the global rate of uncontrolled blood pressure remains high. As such, further measures are required to improve blood pressure control. Recently, several national and international guidelines for the management of hypertension have been published. These aim to provide easily accessible information for healthcare professionals and patients to aid the diagnosis and treatment of hypertension. In this review, we have compared new and current guidelines from the American and International Societies of Hypertension; the American Heart Association, American College of Cardiology and the US Center for Disease Control and Prevention; the panel appointed to the Eighth Joint National Committee; the European Societies of Hypertension and Cardiology; the French Society of Hypertension; the Canadian Hypertension Education Program; the National Institute for Health and Clinical Excellence (UK); the Taiwan Society of Cardiology and the Chinese Hypertension League. We have identified consensus opinion regarding best practises for the management of hypertension and have highlighted any discrepancies between the recommendations. In general there is good agreement between the guidelines, however, in some areas, such as target blood pressure ranges for the elderly, further trials are required to provide sufficient high-quality evidence to form the basis of recommendations.
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191
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Streel S, Donneau AF, Hoge A, Majerus S, Kolh P, Chapelle JP, Albert A, Guillaume M. Socioeconomic Impact on the Prevalence of Cardiovascular Risk Factors in Wallonia, Belgium: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:580849. [PMID: 26380280 PMCID: PMC4561934 DOI: 10.1155/2015/580849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/21/2015] [Indexed: 01/14/2023]
Abstract
Background. Monitoring the epidemiology of cardiovascular risk factors (CRFs) and their determinants is important to develop appropriate recommendations to prevent cardiovascular diseases in specific risk groups. The NESCaV study was designed to collect standardized data to estimate the prevalence of CRFs in relation to socioeconomic parameters among the general adult population in the province of Liège, Wallonia, Belgium. Methods. A representative stratified random sample of 1017 subjects, aged 20-69 years, participated in the NESCaV study (2010-2012). A self-administered questionnaire, a clinical examination, and laboratory tests were performed on participants. CRFs included hypertension, dyslipidemia, global obesity, abdominal obesity, diabetes, current smoking, and physical inactivity. Covariates were education and subjective and objective socioeconomic levels. Data were analyzed by weighted logistic regression. Results. The prevalence of hypertension, abdominal obesity, global obesity, current smoking, and physical inactivity was higher in subjects with low education and who considered themselves "financially in need." Living below poverty threshold also increased the risk of global and abdominal obesity, current smoking, and physical inactivity. Conclusion. The study shows that socioeconomic factors impact the prevalence of CRFs in the adult population of Wallonia. Current public health policies should be adjusted to reduce health inequalities in specific risk groups.
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Affiliation(s)
- Sylvie Streel
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | | | - Axelle Hoge
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Sven Majerus
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Philippe Kolh
- Department of Health Economics Information, University Hospital of Liège, 4000 Liège, Belgium
| | - Jean-Paul Chapelle
- Department of Laboratory Medicine, University Hospital of Liège, 4000 Liège, Belgium
| | - Adelin Albert
- Department of Public Health, University of Liège, 4000 Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health, University of Liège, 4000 Liège, Belgium
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192
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Eguchi K, Hoshide S, Komori T, Nagasaka S, Kario K. A New Proposal for the Target Value for Home BP in Type 2 Diabetes Patients: The J-HOP Study. Am J Hypertens 2015; 28:971-9. [PMID: 25528450 DOI: 10.1093/ajh/hpu249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/07/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The target levels of home-monitored blood pressure (BP) in patients with type 2 diabetes mellitus (T2DM) have not yet been established. We sought to examine the appropriate target home BP level in T2DM. METHODS This is a subanalysis of the Japan Morning Surge-Home Blood Pressure (J-HOP) study. We enrolled 4,310 patients who had at least 1 cardiovascular risk factor, and clinic and home BP monitoring was performed. The urinary albumin-to-creatinine ratio (UACR) was measured as a marker of microvascular disease. Quadratic equations of the relationship between clinic/home systolic BP (SBP) and log-transformed UACR were used to determine the home BP value. Home BP levels corresponding to clinic SBP/diastolic BP (DBP) level using the UACR values were calculated separately by the presence/absence of diabetes. RESULTS The mean age of the patients was 64.9±10.9 years; 47.0% were males. Of the 4,310 subjects enrolled, 1,057 (24.5%) had T2DM (the DM group) and 3,253 (75.5%) did not (non-DM group). The home BP levels equivalent to clinic BP 140/90 mm Hg were 135/84 and 135/83 mm Hg in the DM and non-DM groups, respectively. The home SBP levels equivalent to clinic SBP 130/80 mm Hg were 122/79 mm Hg in the non-DM group and 129/78 mm Hg in the DM group. CONCLUSIONS Regardless of diabetic status, the home BP level that corresponds to the clinic SBP 140/90 mm Hg was 135/85 mm Hg. In patients with T2DM, the home SBP level equivalent to clinic SBP 130/80 mm Hg was 129/78 mm Hg with regard to the extent of microvascular disease.
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Affiliation(s)
- Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan;
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shoichiro Nagasaka
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 938] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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194
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Yu JM, Kong QY, Shen T, He YS, Wang JW, Zhao YP. Benefit of initial dual-therapy on stroke prevention in Chinese hypertensive patients: a real world cohort study. J Thorac Dis 2015; 7:881-9. [PMID: 26101644 DOI: 10.3978/j.issn.2072-1439.2015.04.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/03/2015] [Indexed: 02/03/2023]
Abstract
AIMS Studies have shown that combination anti-hypertensive therapy is superior to mono-therapy in blood pressure control and prevention of cardiovascular events. However, whether such advantage exists in the prevention of stroke in Chinese hypertensive patients remains unclear. This study aimed to compare the impact of initial combination versus mono-therapy on stroke events in a large cohort of Chinese hypertensive patients. METHODS AND RESULTS Hypertensive patients with uncontrolled blood pressure and without a history of stroke were screened from the Shanghai Community-dwelling Hypertensive Population Follow-up Database. Based on the initial treatment, individuals were divided into an initial mono-therapy group and initial dual combination group. Patients were followed for 42 months. 32,682 and 4,926 patients were included in the initial mono- and dual-therapy group. The achieved target blood pressure control rates of mono vs. combination groups at 6, 12, 24, and 42 months of follow-up, were 59.47% vs. 60.05%, 78.23% vs. 77.06%, 85.51% vs. 84.02%, and 86.90% vs. 85.44%, respectively. Their corresponding incidence densities of stroke were 0.792 vs. 0.489, 1.49 vs. 1.15, 2.79 vs. 2.38, and 4.25 vs. 4.32 (cases per 100 person-year), respectively. The 6-month incidence of stroke in dual-therapy group was significantly lower than mono-therapy group (adjusted HR 0.64; 95% CI: 0.30-0.93). However, no significant group differences in the incidence density were observed at 12, 24, and 42 months. CONCLUSIONS Our study demonstrates that, for patients with uncontrolled hypertension, initial dual therapy is more effective in the prevention of stroke during the first 6 months of treatment, but not thereafter. Combination antihypertensive therapy may be a beneficial initial strategy for early stroke prevention.
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Affiliation(s)
- Jin-Ming Yu
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Qun-Yu Kong
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Tian Shen
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Yu-Song He
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Ji-Wei Wang
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
| | - Yan-Ping Zhao
- 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China
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195
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GDF15(MIC1) H6D Polymorphism Does Not Influence Cardiovascular Disease in a Latin American Population with Rheumatoid Arthritis. J Immunol Res 2015; 2015:270763. [PMID: 26090487 PMCID: PMC4451155 DOI: 10.1155/2015/270763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 02/03/2015] [Indexed: 12/31/2022] Open
Abstract
Objective. Rheumatoid arthritis (RA) is the most common autoimmune arthropathy worldwide. The increased prevalence of cardiovascular disease (CVD) in RA is not fully explained by classic risk factors. The aim of this study was to determine the influence of rs1058587 SNP within GDF15(MIC1) gene on the risk of CVD in a Colombian RA population. Methods. This was a cross-sectional analytical study in which 310 consecutive Colombian patients with RA and 228 age- and sex-matched controls were included and assessed for variables associated with CVD. The mixed cluster methodology based on multivariate descriptive methods such as principal components analysis and multiple correspondence analyses and regression tree (CART) predictive model were performed. Results. Of the 310 patients, 87.4% were women and CVD was reported in 69.5%. Significant differences concerning GDF15 polymorphism were not observed between patients and controls. Mean arterial pressure, current smoking, and some clusters were significantly associated with CVD. Conclusion. GDF15 (rs1058587) does not influence the development of CVD in the population studied.
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Afsar B, Elsurer R, Soypacaci Z, Kanbay M. The relationship between weight, height and body mass index with hemodynamic parameters is not same in patients with and without chronic kidney disease. Clin Exp Nephrol 2015; 20:77-86. [PMID: 26087722 DOI: 10.1007/s10157-015-1136-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/08/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although anthropometric measurements are related with clinical outcomes; these relationships are not universal and differ in some disease states such as in chronic kidney disease (CKD). The current study was aimed to analyze the relationship between height, weight and BMI with hemodynamic and arterial stiffness parameters both in normal and CKD patients separately. METHODS This cross-sectional study included 381 patients with (N 226) and without CKD (N 155) with hypertension. Routine laboratory and 24-h urine collection were performed. Augmentation index (Aix) which is the ratio of augmentation pressure to pulse pressure was calculated from the blood pressure waveform after adjusted heart rate at 75 [Aix@75 (%)]. Pulse wave velocity (PWV) is a simple measure of the time taken by the pressure wave to travel over a specific distance. Both [Aix@75 (%)] and PWV which are measures of arterial stiffness were measured by validated oscillometric methods using mobil-O-Graph device. RESULTS In patients without CKD, height is inversely correlated with [Aix@75 (%)]. Additionally, weight and BMI were positively associated with PWV in multivariate analysis. However, in patients with CKD, weight and BMI were inversely and independently related with PWV. In CKD patients, as weight and BMI increased stiffness parameters such as Aix@75 (%) and PWV decreased. While BMI and weight are positively associated with arterial stiffness in normal patients, this association is negative in patients with CKD. CONCLUSION In conclusion, height, weight and BMI relationship with hemodynamic and arterial stiffness parameters differs in patients with and without CKD.
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Affiliation(s)
- Baris Afsar
- Department of Nephrology, Ferhuniye Mah. Hastane Cad. Konya Numune State Hospital, 42690, Konya, Turkey.
| | - Rengin Elsurer
- Department of Nephrology, Selcuklu Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Zeki Soypacaci
- Department of Nephrology, Ataturk Training and Educational Hospital, Izmir Katip Celebi University, Çiğli, Turkey.
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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197
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Garcia BH, Giverhaug T, Høgli JU, Skjold F, Småbrekke L. A pharmacist-led follow-up program for patients with established coronary heart disease in North Norway - a randomized controlled trial. Pharm Pract (Granada) 2015; 13:575. [PMID: 26131047 PMCID: PMC4482847 DOI: 10.18549/pharmpract.2015.02.575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/07/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives: The aim of the study was twofold; 1) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease (CHD) discharged from the University Hospital of North Norway, and 2) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors. Methods: A total of 102 patients aged 18-82 years were enrolled in a non-blinded randomized controlled trial with an intervention group and a control group. The intervention comprised medication reconciliation, medication review and patient education during three meetings; at discharge, after three months and after twelve months. The control group received standard care from their general practitioner. Primary outcomes were adherence to clinical guideline recommendations concerning prescription, therapy goal achievement and lifestyle education defined in the medication assessment tool for secondary prevention of CHD (MAT-CHDSP). Secondary outcomes included changes in the biomedical risk factors cholesterol, blood pressure and blood glucose. Results: Ninety-four patients completed the trial, 48 intervention group patients and 46 controls. Appropriate prescribing was high, but therapy goal achievement was low in both groups. Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end, 78.4% vs. 62.0%, p<0.001. The difference was statistically significant for the documented lifestyle advices in intervention group patients. No significant improvements in biomedical risk factors were observed in favor of the intervention group. Conclusions: The study showed an increased guideline adherence in both study groups. This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task. A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention. Amendments to the follow-up program are suggested before implementation in standard patient care can be recommended.
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Affiliation(s)
- Beate H Garcia
- Hospital Pharmacy of North Norway; & Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Trude Giverhaug
- Regional Drug Information Center of North Norway & University Hospital of North-Norway. Tromsø ( Norway ).
| | - June U Høgli
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
| | - Frode Skjold
- Department of Pharmacy, University of Tromsø , Tromsø ( Norway ).
| | - Lars Småbrekke
- Department of Pharmacy, University of Tromsø . Tromsø ( Norway ).
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198
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Rehkopf DH, Eisen EA, Modrek S, Mokyr Horner E, Goldstein B, Costello S, Cantley LF, Slade MD, Cullen MR. Early-Life State-of-Residence Characteristics and Later Life Hypertension, Diabetes, and Ischemic Heart Disease. Am J Public Health 2015; 105:1689-95. [PMID: 26066927 DOI: 10.2105/ajph.2014.302547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We examined how state characteristics in early life are associated with individual chronic disease later in life. METHODS We assessed early-life state of residence using the first 3 digits of social security numbers from blue- and white-collar workers from a US manufacturing company. Longitudinal data were available from 1997 to 2012, with 305 936 person-years of observation. Disease was assessed using medical claims. We modeled associations using pooled logistic regression with inverse probability of censoring weights. RESULTS We found small but statistically significant associations between early-state-of-residence characteristics and later life hypertension, diabetes, and ischemic heart disease. The most consistent associations were with income inequality, percentage non-White, and education. These associations were similar after statistically controlling for individual socioeconomic and demographic characteristics and current state characteristics. CONCLUSIONS Characteristics of the state in which an individual lives early in life are associated with prevalence of chronic disease later in life, with a strength of association equivalent to genetic associations found for these same health outcomes.
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Affiliation(s)
- David H Rehkopf
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Ellen A Eisen
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Sepideh Modrek
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Elizabeth Mokyr Horner
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Benjamin Goldstein
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Sadie Costello
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Linda F Cantley
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Martin D Slade
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
| | - Mark R Cullen
- At the time of the study, David H. Rehkopf, Sepideh Modrek, Elizabeth Mokyr Horner, Benjamin Goldstein, and Mark R. Cullen were with the Division of General Medical Disciplines, School of Medicine, Stanford University, Stanford, CA. Ellen A. Eisen and Sadie Costello are with the Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley. Linda F. Cantley and Martin D. Slade are with the Occupational and Environmental Medicine Program, School of Medicine, Yale University, New Haven, CT
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Sugawara J, Tanaka H. Brachial-Ankle Pulse Wave Velocity: Myths, Misconceptions, and Realities. Pulse (Basel) 2015; 3:106-13. [PMID: 26587459 DOI: 10.1159/000430771] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A variety of techniques to evaluate central arterial stiffness have been developed and introduced. None of these techniques, however, have been implemented widely in regular clinical settings, except for brachial-ankle pulse wave velocity (baPWV). The most prominent procedural advantage of baPWV is its ease of use, since it only requires the wrapping of blood pressure cuffs on the 4 extremities. There is mounting evidence indicating the ability of baPWV to predict the risk of future cardiovascular events and total mortality. Additionally, the guidelines for the management of hypertension in Japan recommended the measurement of baPWV be included in the assessment of subclinical target organ damage. However, baPWV has not been fully accepted worldwide due to perceived theoretical and methodological issues. In this review, we address the most frequently mentioned questions and concerns regarding baPWV to shed some light on this simple and easy arterial stiffness measurement.
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Affiliation(s)
- Jun Sugawara
- Human Informatics Research Institute, The National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Hirofumi Tanaka
- Cardiovascular Aging Research Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Tex., USA
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Neuropeptide Y as an indicator of successful alterations in sympathetic nervous activity after renal sympathetic denervation. Clin Res Cardiol 2015; 104:1064-71. [PMID: 26008896 DOI: 10.1007/s00392-015-0874-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/20/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Renal sympathetic denervation (RSD) represents a safe and effective treatment option for certain patients with resistant hypertension and has been shown to decrease sympathetic activity. Neuropeptide Y (NPY) is a neurotransmitter that is co-released with norepinephrine and is up-regulated during increased sympathetic activity. The aim of the present study was to examine the effect of RSD on NPY and to analyze the association between changes in NPY levels and blood pressure reduction after RSD. METHODS A total of 150 consecutive patients (age 64.9 ± 10.2 years) from three clinical centers undergoing RSD were included in this study. Response to RSD was defined as an office systolic blood pressure (SBP) reduction of >10 mmHg 6 months after RSD. Venous blood samples for measurement of NPY were collected prior to and 6 months after RSD. RESULTS BP and NPY levels were significantly reduced by 23/9 mmHg (p = 0.001/0.001) and 0.24 mg/dL (p < 0.01) 6 months after RSD. There was a significant correlation between baseline SBP- and RSD-related systolic BP reduction (r = -0.43; p < 0.001) and between serum NPY baseline values and NPY level changes (r = -0.52; p < 0.001) at the 6-month follow-up. The BP response to RSD (>10 mmHg) was associated with a significantly greater reduction in NPY level when compared with BP non-responders (p = 0.001). CONCLUSION This study demonstrates an effect of RSD on serum NPY levels, a specific marker for sympathetic activity. The association between RSD-related changes in SBP and NPY levels provides further evidence of the effect of RSD on the sympathetic nervous system.
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