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Zhang MJ, Spite M. Resolvins: Anti-Inflammatory and Proresolving Mediators Derived from Omega-3 Polyunsaturated Fatty Acids. Annu Rev Nutr 2012; 32:203-27. [DOI: 10.1146/annurev-nutr-071811-150726] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Michael J. Zhang
- Diabetes and Obesity Center,
- Division of Cardiovascular Medicine,
| | - Matthew Spite
- Diabetes and Obesity Center,
- Division of Cardiovascular Medicine,
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, Kentucky 40202;
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Abstract
Disruption of intracoronary plaque with thrombus formation provides the pathophysiologic foundation for acute coronary syndromes, which comprise ST-segment myocardial infarction, non-ST-segment myocardial infarction, and unstable angina. Management differs depending on whether ST-segment elevation is present, but the general principles of timely restoration of coronary blood flow and initiation of secondary prevention strategies are applicable to all patients. The purpose of this review is to discuss first the epidemiology, pathophysiology, and diagnosis of acute myocardial infarction. Risk stratification and therapy for patients with ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes are then reviewed along with diagnosis and management of the complications of myocardial infarction.
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253
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Pradeepa R, Prabhakaran D, Mohan V. Emerging economies and diabetes and cardiovascular disease. Diabetes Technol Ther 2012; 14 Suppl 1:S59-67. [PMID: 22650226 DOI: 10.1089/dia.2012.0065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetes and cardiovascular diseases (CVDs) are increasing in epidemic proportions globally, with the most marked increase in emerging economies. Among emerging economies, China and India have the highest numbers of people with diabetes and CVD. Over the last two decades, 80% of CVD and diabetes mortality occurred in low- and middle-income countries, suggesting that these disorders have become a leading threat to public health in most of the developing countries. The burden of CVD and diabetes in the developing countries affects the productive younger age group, and this has serious economic implications. Diabetes shares many characteristics and risk factors with CVD, and thus the risk for CVD also escalates with the increase in prevalence of diabetes. Both genetic and environmental factors play a major role in causation of diabetes and CVD. However, the major drivers of this dual epidemic are demographic changes with increased life expectancy, lifestyle changes due to rapid urbanization, and industrialization. To reduce the burden of diabetes and CVD in the coming decades, emerging economies need to set national goals for early diagnosis, effective management, and primary prevention of these disorders. In order to curb the epidemic of diabetes and CVD, population-based, multisectoral, multidisciplinary, and culturally relevant approaches including various departments of the government as well as non-governmental agencies are required.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, International Diabetes Federation Centre for Education, Gopalapuram, Chennai, India
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254
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Dutra ES, de Carvalho KM, Miyazaki É, Hamann EM, Ito MK. Metabolic syndrome in central Brazil: prevalence and correlates in the adult population. Diabetol Metab Syndr 2012; 4:20. [PMID: 22583910 PMCID: PMC3457864 DOI: 10.1186/1758-5996-4-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 03/13/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country. METHODS A cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates. RESULTS The overall prevalence of MetS was 32.0% (95%CI: 28.9-35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17-8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77-6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49-0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied. CONCLUSIONS This study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil's FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.
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Affiliation(s)
- Eliane Said Dutra
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Kênia MaraBaiocchi de Carvalho
- Programa de Pós-graduação em Nutrição Humana, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Édina Miyazaki
- Departamento de Estatística, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Edgar Merchán- Hamann
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Marina Kiyomi Ito
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
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255
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Nikishin AG, Kurbanov RD, Pirnazarov MM. Hospital admission time and acute myocardial infarction outcomes in elderly patients from Central Asia. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2012. [DOI: 10.15829/1728-8800-2012-2-53-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To identify the specifics of acute myocardial infarction (AMI) clinical course and to study the association between clinical outcomes and hospital admission time among elderly patients from Central Asia. Material and methods. In total, 508 AMI patients were divided into the main group (MG), which included 298 men and women aged over 65 years, and the control group (CG; n=210). The analysed parameters included mean time between AMI onset and hospital admission; percentage of patients hospitalised within first 6 hours; percentage of patients administered streptokinase; streptokinase effectiveness; clinical course of AMI; and in-hospital outcomes. Results. Mean hospital admission time was significantly higher in the MG, compared to the CG: 1220±165 vs. 977±88 minutes (p<0,05). Out of 188 MG patients with ST segment elevation, thrombolytic therapy (TLT) was administered to 14,3 %; in the CG (149 patients with ST segment elevation), the respective percentage was 25,5 %. Clinical course of AMI was similar in both groups. However, the MG was characterised by a significantly higher risk of death (9,4 % vs. 2,86 %; F=0,001; OR 3,53, 95 % CI 1,43—8,67), acute heart failure (33,89 % vs. 21,9 %; F=0,001; OR 1,83, 95 % CI 1,22—2,74), or chronic heart failure (41,31 % vs. 24,76 %; F=0,000; OR 2,62, 95 % CI 1,78—3,86). Conclusion. Elderly patients faced a lower chance of myocardial reperfusion, due to later hospital admission and lower TLT effectiveness, and, as a result, had a higher risk of heart failure.
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256
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Urbina EM, Gao Z, Khoury PR, Martin LJ, Dolan LM. Insulin resistance and arterial stiffness in healthy adolescents and young adults. Diabetologia 2012; 55:625-31. [PMID: 22193511 PMCID: PMC3269756 DOI: 10.1007/s00125-011-2412-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/21/2011] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS Increased arterial stiffness is a risk factor for adverse cardiovascular events in adults with obesity-related insulin resistance (IR) or type 2 diabetes mellitus. Adolescents with type 2 diabetes have stiffer vessels. Whether stiffness is increased in obesity/IR in youth is not known. We sought to determine if IR was a determinant of arterial stiffness in youth, independent of obesity and cardiovascular risk factors. METHODS We measured cardiovascular risk factors, IR, adipocytokines and arterial stiffness (brachial artery distensibility [BrachD], pulse wave velocity [PWV]) and wave reflection (augmentation index [AIx]) in 343 adolescents and young adults without type 2 diabetes (15-28 years old, 47% male, 48% non-white). Individuals <85th percentile of BMI were classified as lean (n = 232). Obese individuals were grouped by HOMA index as not insulin resistant (n = 46) or insulin resistant (n = 65) by the 90th percentile for HOMA for lean. Mean differences were evaluated by ANOVA. Multivariate models evaluated whether HOMA was an independent determinant of arterial stiffness. RESULTS Risk factors deteriorated from lean to obese to obese/insulin resistant (all p ≤ 0.017). Higher AIx, lower BrachD and higher PWV indicated increased arterial stiffness in obese and obese/insulin-resistant participants. HOMA was not an independent determinant. Age, sex, BMI and BP were the most consistent determinants, with HDL-cholesterol playing a role for BrachD and leptin for PWV (AIx R²= 0.34; BrachD R² = 0.37; PWV R² = 0.40; all p ≤ 0.02). CONCLUSIONS/INTERPRETATION Although IR is associated with increased arterial stiffness, traditional cardiovascular risk factors, especially obesity and BP, are the major determinants of arterial stiffness in healthy young people.
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Affiliation(s)
- E M Urbina
- Department of Pediatrics, Preventive Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, 3333 Burnet Avenue, MLC-7002, Cincinnati, OH 45229, USA.
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257
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Fong AYY, Yan BP. Better late or never too late? Management of ST-elevation myocardial infarction initially treated with fibrinolysis in Asia. Eur Heart J Suppl 2012. [DOI: 10.1093/eurheartj/sur034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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258
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Wurie HR, Cappuccio FP. Cardiovascular disease in low- and middle-income countries: an urgent priority. ETHNICITY & HEALTH 2012; 17:543-550. [PMID: 23534502 PMCID: PMC7613448 DOI: 10.1080/13557858.2012.778642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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259
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Carpentier Y, Komsa-Penkova R. Clinical Nutrition University. The place of nutrition in the prevention of cardiovascular diseases (CVDs). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eclnm.2011.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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260
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Davis MB, Duvernoy CS. How to stay heart healthy in 2011: considerations for the primary prevention of cardiovascular disease in women. ACTA ACUST UNITED AC 2011; 7:433-51. [PMID: 21790337 DOI: 10.2217/whe.11.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
More women die of cardiovascular disease than any other cause. Effective primary prevention depends on accurate assessment of risk status. While most risk factors are similar for men and women, risk factors may differ in magnitude between the sexes, and recognition of gender-specific risk factors such as gestational diabetes, hypertensive syndromes of pregnancy and polycystic ovarian syndrome provides opportunities for early intervention and prevention. Obesity, hypertension and hyperlipidemia affect both genders; however, women often postpone addressing these risk factors until later in life. The American Heart Association emphasizes that all women are at cardiovascular risk and should maintain a healthy lifestyle and avoid smoking. Blood pressure, hyperlipidemia and diabetes should be aggressively treated. Current available data regarding proposed preventive drug therapies including daily aspirin, HRT, vitamin D and omega-3 fatty acid supplements will be reviewed.
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Affiliation(s)
- Melinda B Davis
- Cardiology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
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261
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Odegaard AO, Koh WP, Gross MD, Yuan JM, Pereira MA. Combined lifestyle factors and cardiovascular disease mortality in Chinese men and women: the Singapore Chinese health study. Circulation 2011; 124:2847-54. [PMID: 22104554 DOI: 10.1161/circulationaha.111.048843] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lifestyle factors directly influence cardiovascular disease (CVD) risk, yet little research has examined the association of combined lifestyle factors with CVD mortality, especially in Asian populations. METHODS AND RESULTS We examined the association of 6 combined lifestyle factors (dietary pattern, physical activity, alcohol intake, usual sleep, smoking status, and body mass index) with CVD mortality in 50 466 (44 056 without a history of diabetes mellitus, CVD, or cancer and 6410 with diabetes mellitus or history of clinical CVD) Chinese men and women in Singapore who were 45 to 74 years of age during enrollment in the Singapore Chinese Health Study in 1993 to 1998 and followed up through 2009. Each lifestyle factor was independently associated with CVD mortality. When combined, there was a strong, monotonic decrease in age- and sex-standardized CVD mortality rates with an increasing number of protective lifestyle factors. Relative to participants with no protective lifestyle factors, the hazard ratios of CVD mortality for 1, 2, 3, 4, and 5 to 6 protective lifestyle factors were 0.60 (95% confidence interval, 0.45-0.84), 0.50 (95% confidence interval, 0.38-0.67), 0.40 (95% confidence interval, 0.30-0.53), 0.32 (95% confidence interval, 0.24-0.43), and 0.24 (95% confidence interval, 0.17-0.34), respectively, among those without a history of diabetes mellitus, CVD, or cancer (P for trend <0.0001). A parallel graded inverse association was observed in participants with a history of CVD or diabetes mellitus at baseline. Results were consistent for coronary heart disease and cerebrovascular disease mortality. CONCLUSION An increasing number of protective lifestyle factors is associated with a marked decreased risk of coronary heart disease, cerebrovascular disease, and overall CVD mortality in Chinese men and women.
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Affiliation(s)
- Andrew O Odegaard
- MPH, University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, 1300 S 2nd St, Ste 300, Minneapolis MN, 55454, USA.
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262
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Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2011; 58:2342-54. [DOI: 10.1016/j.jacc.2011.08.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 07/25/2011] [Accepted: 08/02/2011] [Indexed: 12/22/2022]
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263
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Maulik N, Sanchez JA. Risk factors in heart disease: therapeutic interventions. Antioxid Redox Signal 2011; 15:1765-7. [PMID: 21395498 PMCID: PMC3159102 DOI: 10.1089/ars.2011.3981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nilanjana Maulik
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Juan A. Sanchez
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
- Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
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264
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ORTEGA FRANCISCOB, LABAYEN IDOIA, RUIZ JONATANR, KURVINEN ELVIRA, LOIT HELLEMAI, HARRO JAANUS, VEIDEBAUM TOOMAS, SJÖSTRÖM MICHAEL. Improvements in Fitness Reduce the Risk of Becoming Overweight across Puberty. Med Sci Sports Exerc 2011; 43:1891-7. [PMID: 21407124 DOI: 10.1249/mss.0b013e3182190d71] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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265
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Vashitz G, Meyer J, Parmet Y, Henkin Y, Peleg R, Gilutz H. Physician adherence to the dyslipidemia guidelines is as challenging an issue as patient adherence. Fam Pract 2011; 28:524-31. [PMID: 21566005 DOI: 10.1093/fampra/cmr025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A wide therapeutic gap exists between evidence-based guidelines and their practice in the primary care, which is primarily attributed to physician and patient adherence. OBJECTIVE This study aims to differentiate physician and patient adherence to dyslipidemia secondary prevention guidelines and various factors affecting it. METHODS A post hoc analysis of data collected by a prospective cluster randomized trial with 7041 patients diagnosed with clinical atherosclerosis requiring secondary prevention of dyslipidemia and 127 primary care physicians over an 18-month period. Adherence was measured by physicians' and patients' actions taken according to the guidelines and correlated using multivariate logistic regressions. RESULTS Physician adherence was 36.9% for lipid profile screening, 27.6% for pharmacotherapy up-titration and 21.0% for pharmacotherapy initiation. Physician adherence was positively correlated with frequent patient visits [odds ratios (OR = 1.304)], having more dyslipidemic patients (OR = 1.304) and treating immigrants (OR = 1.268). Patient adherence was 83.8%, 71.9% and 62.6% for medication up-titration, lipid profile screening and pharmacotherapy initiation, respectively. Patient adherence was affected by attending clinics with many dyslipidemic patients (OR = 1.542), being older (OR = 1.271) and being treated by a male physician (OR = 0.870). CONCLUSIONS We learn from this study that (i) physician non-adherence was a major cause for the failure to follow guidelines, (ii) pharmacotherapy initiation was the most challenging issue to tackle and (iii) greater adherence occurred mainly in high volume conditions (patients and visits). Practical implications are designated focus on metabolic condition prevention in primary care by cardiologists or primary care clinics specializing in metabolic conditions and the need to facilitate more frequent follow-up visits.
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266
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Cape Heart Centre, University of Cape Town, Private Bag X3, Observatory, 7935 Cape Town, South Africa.
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267
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Baliga MS, Bhat HP, Pai RJ, Boloor R, Palatty PL. The chemistry and medicinal uses of the underutilized Indian fruit tree Garcinia indica Choisy (kokum): A review. Food Res Int 2011. [DOI: 10.1016/j.foodres.2011.01.064] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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268
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Rubinstein AL, Irazola VE, Poggio R, Bazzano L, Calandrelli M, Lanas Zanetti FT, Manfredi JA, Olivera H, Seron P, Ponzo J, He J. Detection and follow-up of cardiovascular disease and risk factors in the Southern Cone of Latin America: the CESCAS I study. BMJ Open 2011; 1:e000126. [PMID: 22021769 PMCID: PMC3191438 DOI: 10.1136/bmjopen-2011-000126] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/04/2011] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are increasing throughout the world and cause 16.7 million deaths each year, 80% of which occur in low and middle income countries. In Argentina, Chile and Uruguay, the available data on cardiovascular risk factors come predominantly from cross-sectional studies that are principally based on self-report or studies conducted with small convenience samples. The CESCAS I study will generate reliable estimates of the prevalence and distribution of and secular trends in CVD and its risk factors in this region. METHODS AND ANALYSIS CESCAS I is an observational prospective cohort study with a multistage probabilistic sample of 8000 participants aged 35-74 years from four mid-sized cities representing the Southern Cone of Latin America: Bariloche and Marcos Paz in Argentina, Temuco in Chile and Pando-Barros Blancos in Uruguay. In the first phase, baseline data regarding exposure to risk factors and prevalence of CVD will be collected in two stages: (1) in homes and (2) in health centres. Information will be gathered on medical history, risk factors, lifestyles and health utilisation through specific questionnaires, physical measurements, an ECG and an overnight, fasting blood sample to measure levels of serum lipids, glucose and creatinine. In the second phase, annual follow-up data will be obtained on the incidence rate of CVD events and the association between exposure and events. ETHICS AND DISSEMINATION The protocol has obtained formal ethics approval from institutional review boards in Argentina, Chile, Uruguay and the USA. The lack of follow-up studies has prevented Argentina, Chile and Uruguay from implementing risk factor stratification and management strategies at a population level. However, the CESCAS I study data will help the development of public health strategies based on primary care intervention, thus helping to improve cardiovascular health in this region.
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Affiliation(s)
- Adolfo Luis Rubinstein
- Southern Cone American Center for Cardiovascular Health (CESCAS/SACECH), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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269
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Rubinstein AL, Irazola VE, Poggio R, Bazzano L, Calandrelli M, Lanas Zanetti FT, Manfredi JA, Olivera H, Seron P, Ponzo J, He J. Detection and follow-up of cardiovascular disease and risk factors in the Southern Cone of Latin America: the CESCAS I study. BMJ Open 2011. [PMID: 22021769 DOI: 10.1136/bmjopen-2011-00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are increasing throughout the world and cause 16.7 million deaths each year, 80% of which occur in low and middle income countries. In Argentina, Chile and Uruguay, the available data on cardiovascular risk factors come predominantly from cross-sectional studies that are principally based on self-report or studies conducted with small convenience samples. The CESCAS I study will generate reliable estimates of the prevalence and distribution of and secular trends in CVD and its risk factors in this region. METHODS AND ANALYSIS CESCAS I is an observational prospective cohort study with a multistage probabilistic sample of 8000 participants aged 35-74 years from four mid-sized cities representing the Southern Cone of Latin America: Bariloche and Marcos Paz in Argentina, Temuco in Chile and Pando-Barros Blancos in Uruguay. In the first phase, baseline data regarding exposure to risk factors and prevalence of CVD will be collected in two stages: (1) in homes and (2) in health centres. Information will be gathered on medical history, risk factors, lifestyles and health utilisation through specific questionnaires, physical measurements, an ECG and an overnight, fasting blood sample to measure levels of serum lipids, glucose and creatinine. In the second phase, annual follow-up data will be obtained on the incidence rate of CVD events and the association between exposure and events. ETHICS AND DISSEMINATION The protocol has obtained formal ethics approval from institutional review boards in Argentina, Chile, Uruguay and the USA. The lack of follow-up studies has prevented Argentina, Chile and Uruguay from implementing risk factor stratification and management strategies at a population level. However, the CESCAS I study data will help the development of public health strategies based on primary care intervention, thus helping to improve cardiovascular health in this region.
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Affiliation(s)
- Adolfo Luis Rubinstein
- Southern Cone American Center for Cardiovascular Health (CESCAS/SACECH), Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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Abstract
Cardiovascular disease prevention is a continuum that encompasses the life-course. This article discusses preventive strategies focusing on policy and clinical initiatives including primordial prevention (lifestyle changes involving smoking, diet and exercise), primary prevention (risk factor control), and secondary prevention (acute and chronic disease management). Combined use of all the three strategies can have an immediate and large impact on reducing CVD morbidity and mortality.
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271
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Du L, Dronadula N, Tanaka S, Dichek DA. Helper-dependent adenoviral vector achieves prolonged, stable expression of interleukin-10 in rabbit carotid arteries but does not limit early atherogenesis. Hum Gene Ther 2011; 22:959-68. [PMID: 21198399 DOI: 10.1089/hum.2010.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Vascular gene therapy could potentially complement or replace current therapies for human atherosclerosis, while avoiding their side effects. However, development of vascular gene therapy is limited by lack of a useful vector. Helper-dependent adenovirus (HDAd) shows promise to overcome this barrier because, unlike first-generation adenovirus, HDAd achieves durable transgene expression in the artery wall with minimal inflammation. To begin to test whether HDAd, delivered to the artery wall, can limit atherosclerosis we constructed HDAd that expresses rabbit interleukin (IL)-10, a potent atheroprotective cytokine, and tested its activity in a rabbit model of early carotid atherogenesis. HDAd expressed immunoreactive, active IL-10 in vitro. In contrast to other HDAd-expressed transgenes, IL-10 expression from HDAd increased significantly between 3 days and 2 weeks after infusion and remained stable for at least 8 weeks. Rising, persistent IL-10 expression was associated with relative persistence of HDAdIL-10 genomes 4 weeks after infusion, compared with HDAdNull genomes. Surprisingly, IL-10 expression had no significant effects on atherosclerotic lesion size, macrophage content, or expression of either adhesion molecules or atherogenic cytokines. These results might be due to inadequate protein expression in vivo or lack of suitability of this rabbit model to reveal IL-10 therapeutic effects. IL-10 remains a promising agent for vascular gene therapy and HDAd remains a promising vector; however, proof of efficacy of HDAdIL-10 is elusive. Future preclinical studies will be aimed at increasing IL-10 expression levels and improving the sensitivity of this animal model to detect atheroprotective effects.
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Affiliation(s)
- Liang Du
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
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Stewart S, Carrington MJ, Pretorius S, Ogah OS, Blauwet L, Antras-Ferry J, Sliwa K. Elevated risk factors but low burden of heart disease in urban African primary care patients: a fundamental role for primary prevention. Int J Cardiol 2011; 158:205-10. [PMID: 21353319 DOI: 10.1016/j.ijcard.2011.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 01/08/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few data describe the case burden of heart disease and cardiovascular risk factors relative to other conditions in urban Africans seeking primary health care. METHODS A clinical registry captured data on 1311 consecutive primary care patients (99% African) from two primary care clinics in Soweto, South Africa. Those with suspected sub-clinical heart disease had more advanced cardiologic assessment. RESULTS Overall, 862 women (66%, 41 ± 16 years) and 449 men (38 ± 14 years) were studied. Whilst more men were smokers (47% vs. 14%; OR 5.23, 95% CI 4.01-6.82), more women were obese (42% vs. 14%; OR 4.54, 95% CI 3.33-5.88); blood glucose levels doubling with age in obese women. Although 33% were hypertensive, only 4.9% had type 2 diabetes (n=45), heart disease (n=10) and/or cerebrovascular disease (n=12). Overall, 16% (n=205) had an abnormal 12-lead ECG with more men than women showing a major abnormality (24% vs. 11%; OR 2.63, 95% CI 1.89-3.46). Of 99 cases (7.6%) subject to advanced cardiologic assessment, 29 (2.2%) had newly diagnosed heart disease: including hypertensive heart failure (13 women vs. 2 men, OR 4.51 95% CI 1.00-21.2), coronary artery disease (n=3), valve disease (n=3), dilated cardiomyopathy (n=3) and 2 cases of acute myocarditis. CONCLUSIONS These data demonstrate a relatively low burden of heart disease in urban African patients seeking primary health care. Alternatively, high antecedent risk, particularly among obese women, highlights a key role for enhanced primary prevention.
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Affiliation(s)
- Simon Stewart
- Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
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273
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Ramírez JH, Arce RM, Contreras A. Periodontal treatment effects on endothelial function and cardiovascular disease biomarkers in subjects with chronic periodontitis: protocol for a randomized clinical trial. Trials 2011; 12:46. [PMID: 21324167 PMCID: PMC3049125 DOI: 10.1186/1745-6215-12-46] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/16/2011] [Indexed: 01/22/2023] Open
Abstract
Background Periodontal disease (PD) is an infectious clinical entity characterized by the destruction of supporting tissues of the teeth as the result of a chronic inflammatory response in a susceptible host. It has been proposed that PD as subclinical infection may contribute to the etiology and to the pathogenesis of several systemic diseases including Atherosclerosis. A number of epidemiological studies link periodontal disease/edentulism as independent risk factor for acute myocardial infarction, peripheral vascular disease, and cerebrovascular disease. Moreover, new randomized controlled clinical trials have shown an improvement on cardiovascular surrogate markers (endothelial function, sICAM, hsPCR level, fibrinogen) after periodontal treatment. Nonetheless, such trials are still limited in terms of external validity, periodontal treatment strategies, CONSORT-based design and results consistency/extrapolation. The current study is designed to evaluate if periodontal treatment with scaling and root planning plus local delivered chlorhexidine improves endothelial function and other biomarkers of cardiovascular disease in subjects with moderate to severe periodontitis. Methods/Design This randomized, single-blind clinical trial will be performed at two health centers and will include two periodontal treatment strategies. After medical/periodontal screening, a baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) and other systemic surrogate markers will be obtained from all recruited subjects. Patients then will be randomized to receive either supragingival/subgingival plaque cleaning and calculus removal plus chlorhexidine (treatment group) or supragingival plaque removal only (control group). A second and third FMD will be obtained after 24 hours and 12 weeks in both treatment arms. Each group will consist of 49 patients (n = 98) and all patients will be followed-up for secondary outcomes and will be monitored through a coordinating center. The primary outcomes are FMD differences baseline, 24 hours and 3 months after treatment. The secondary outcomes are differences in C-reactive protein (hs-CRP), glucose serum levels, blood lipid profile, and HOMA index. Discussion This RCT is expected to provide more evidence on the effects of different periodontal treatment modalities on FMD values, as well as to correlate such findings with different surrogate markers of systemic inflammation with cardiovascular effects. Trial registration number ClinicalTrials.gov Identifier: NCT00681564.
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Affiliation(s)
- Jorge H Ramírez
- Periodontal Medicine Research Group, Department of Periodontology, School of Dentistry, Universidad del Valle, Calle 4B 36-00, Cali, Colombia.
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274
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Gupta R, Guptha S, Joshi R, Xavier D. Translating evidence into policy for cardiovascular disease control in India. Health Res Policy Syst 2011; 9:8. [PMID: 21306620 PMCID: PMC3045991 DOI: 10.1186/1478-4505-9-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/09/2011] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care.
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Affiliation(s)
| | | | - Rajnish Joshi
- Mahatma Gandhi Institute of Medical Sciences, Wardha 442102, India
| | - Denis Xavier
- St John's Medical College, Bangalore 560038, India
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275
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Correll CU, Lencz T, Malhotra AK. Antipsychotic drugs and obesity. Trends Mol Med 2010; 17:97-107. [PMID: 21185230 DOI: 10.1016/j.molmed.2010.10.010] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/26/2010] [Accepted: 10/26/2010] [Indexed: 12/15/2022]
Abstract
Mechanisms underlying antipsychotic cardiometabolic adverse effects are incompletely understood. This hampers the identification of high-risk patients, low-risk antipsychotics and preventive/ameliorative treatments. Recent clinical, molecular and genetic data suggest that: (i) antipsychotic-naïve samples provide the greatest power for mechanistic studies; (ii) weight and metabolic effects can be discordant, pointing to overlapping and distinct mechanisms; (iii) antipsychotics affect satiety and energy homeostasis signaling; (iv) the specific peptides mediating these effects are unknown but probably overlap with those involved in idiopathic obesity; and (v) single nucleotide polymorphisms in genes encoding known neurotransmitter receptors and metabolic proteins are promising pharmacogenomic targets for countering adverse affects. However, sophisticated molecular studies and genome-wide association studies, ideally in antipsychotic-naïve/first episode samples, are needed to further advance the field.
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276
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Abstract
The clinical entities that comprise acute coronary syndromes (ACS)-ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina-have been recognized as widespread causes of death and disability for more than a century. Seminal research in the past 50 years has led to important scientific and medical advances in our understanding of ACS. Rapid modernization of the developing world has led to a pandemic of coronary artery disease and its manifestation as ACS, with profound implications for personal, societal, and global health. Epidemiological studies have provided insight into the changing demographics of ACS, and highlighted the importance of modifiable risk factors and adherence to guideline-recommended therapy.
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Affiliation(s)
- Christian T Ruff
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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277
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Faulin TDES, Cavalcante MF, Abdalla DSP. Role of electronegative LDL and its associated antibodies in the pathogenesis of atherosclerosis. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.10.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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278
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Abstract
Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only explain a small part of the variability in CVD risk, which is a major obstacle for its prevention and treatment. A more thorough understanding of the factors that contribute to CVD is, therefore, needed to develop more efficacious and cost-effective therapy. Application of the 'omics' technologies will hopefully make these advances a reality. Epigenomics has emerged as one of the most promising areas that will address some of the gaps in our current knowledge of the interaction between nature and nurture in the development of CVD. Epigenetic mechanisms include DNA methylation, histone modification, and microRNA alterations, which collectively enable the cell to respond quickly to environmental changes. A number of CVD risk factors, such as nutrition, smoking, pollution, stress, and the circadian rhythm, have been associated with modification of epigenetic marks. Further examination of these mechanisms may lead to earlier prevention and novel therapy for CVD.
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Affiliation(s)
- José M Ordovás
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA.
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