301
|
Sabini E, Mazzi B, Profilo MA, Mautone T, Casini G, Rocchi R, Ionni I, Menconi F, Leo M, Nardi M, Vitti P, Marcocci C, Marinò M. High Serum Cholesterol Is a Novel Risk Factor for Graves' Orbitopathy: Results of a Cross-Sectional Study. Thyroid 2018; 28:386-394. [PMID: 29336220 DOI: 10.1089/thy.2017.0430] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Limited data suggest that treatment with statins is associated with a reduced risk of Graves' orbitopathy (GO) in patients with Graves' disease (GD), attributed to the anti-inflammatory rather than to the hypolipemic effects of these medications. The aim of the present study was to investigate whether there is an association between high cholesterol and GO. The primary outcome was the relation between GO and low-density lipoprotein (LDL)-cholesterol. The secondary outcomes were the relation between severity or activity (the clinical activity score [CAS]) of GO and LDL-cholesterol. METHODS A cross-sectional investigation was conducted in consecutive patients with GD who came under the authors' observation to undergo radioiodine treatment, a stratification aimed at forming two distinct groups of patients under the same conditions. A total of 250 patients were enrolled, 133 with and 117 without GO. Ophthalmological assessments and serum lipids measurements were performed. RESULTS In multivariate analyses with correction for the duration of hyperthyroidism, a variable that differed between patients with respect to the presence or absence of GO, a correlation between the presence of GO and both total (p = 0.01) and LDL-cholesterol (p = 0.02) was observed. In patients with hyperthyroidism lasting <44 months, total and LDL-cholesterol were higher (p = 0.01 and p = 0.008, respectively) among GO patients. In this subgroup, based on the presence/absence of GO, cutoff values were established for total (191 mg/dL) and LDL-cholesterol (118.4 mg/dL), above which an increased risk of GO was observed (total cholesterol relative risk: 1.47; p = 0.03; LDL-cholesterol relative risk: 1.28; p = 0.03). GO severity and CAS did not correlate with serum lipids. However, CAS was found to be higher (p = 0.02) in patients with high total cholesterol. When the analysis was restricted to untreated GO patients, a correlation was found between CAS and both total (p = 0.04) and LDL-cholesterol (p = 0.03), after adjustment for GO duration. CONCLUSIONS In patients with a short duration of hyperthyroidism, total and LDL-cholesterol correlate with the presence of GO, suggesting a role of cholesterol in the development of GO. Depending on GO duration, total and LDL-cholesterol correlate with GO activity, suggesting a role of cholesterol in the clinical expression of GO.
Collapse
Affiliation(s)
- Elena Sabini
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Barbara Mazzi
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Maria Antonietta Profilo
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Teresa Mautone
- 2 Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Giamberto Casini
- 2 Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Roberto Rocchi
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Ilaria Ionni
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Francesca Menconi
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Marenza Leo
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Marco Nardi
- 2 Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Claudio Marcocci
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| | - Michele Marinò
- 1 Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa , Pisa, Italy
| |
Collapse
|
302
|
Ko SY, Ro YS, Shin SD, Song KJ, Hong KJ, Kong SY. Effect of a first responder on survival outcomes after out-of-hospital cardiac arrest occurs during a period of exercise in a public place. PLoS One 2018; 13:e0193361. [PMID: 29489877 PMCID: PMC5831003 DOI: 10.1371/journal.pone.0193361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/11/2018] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The deployment of first responders in a public place is one of the interventions that is used for increasing bystander cardiopulmonary resuscitation (CPR) of out-of-hospital cardiac arrests (OHCA). We studied the association between the presence of a first responder and the survival of OHCA that occurred during a period of exercise in a public place. METHODS All of the adult OHCAs of a presumed cardiac etiology that occurred during a period of exercise in a public place and that were witnessed by a bystander between 2013 and 2015 were analyzed. The main exposure of interest was the characteristics of the bystander (first responder vs. layperson). The endpoints were the provision of bystander CPR and good neurological recovery. Multivariable logistic regression analysis, adjusting for patient-environment and prehospital factors, was performed. RESULTS A total of 870 patients had a cardiac arrest during a period of exercise in a public place, and 58 (6.7%) patients were witnessed by the first responder. The OHCAs witnessed by first responders were more likely to result in bystander CPR than those witnessed by laypersons (89.7% vs. 75.4%, p = 0.01, adjusted OR (95% CI): 3.51 (1.44-8.55)). In terms of good neurological recovery, the OHCAs witnessed by first responders had a higher likelihood than the patients witnessed by laypersons (37.9% vs, 24.0%, p = 0.02, adjusted OR (95% CI): 2.92 (1.33-6.40)). CONCLUSION The OHCAs occurred during a period of exercise in a public place and whom first responders witnessed were more likely to receive bystander CPR and to have a neurologically intact survival.
Collapse
Affiliation(s)
- Seo Young Ko
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - So Yeon Kong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| |
Collapse
|
303
|
The effect of exercise therapy on depressive and anxious symptoms in patients with ischemic heart disease: A systematic review. J Psychosom Res 2018; 105:80-91. [PMID: 29332638 DOI: 10.1016/j.jpsychores.2017.11.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/13/2017] [Accepted: 11/29/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Depressive and anxiety symptoms are associated with Ischemic Heart Disease (IHD). Exercise interventions might improve both depressive and anxiety symptoms, but an overview of the evidence is lacking. Therefore, we systematically reviewed the existing literature on the effectiveness of exercise therapy to reduce depression and anxiety symptoms specifically in patients with IHD. METHODS MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials were searched until January 2016. The effectiveness of exercise was assessed within two groups: a) patients selected for study with severe depression or anxiety; and b) studies that did not exclusively targeted patients with increased levels of depression or anxiety. Secondary outcomes were mortality, cardiac events, re-hospitalizations and cardiovascular risk factors. RESULTS We included fourteen studies. Clinical and methodological heterogeneity precluded meta-analysis. Three studies specifically included patients with high levels of depression or anxiety and eleven studies selected patients with unclear levels of depression or anxiety. Some RCTs showed that exercise was effective in lowering severe depressive symptoms (short and long term follow-up), but for the group with unclear depressive symptoms the results were non-conclusive. In the group with elevated anxiety symptoms, exercise had a positive effect on the short term follow-up. In the group with unclear anxiety symptoms the results were inconsistent (short and long term follow-up). No differences were found regarding the secondary outcomes. CONCLUSIONS There is a general paucity of data on the effect of exercise, precluding firm conclusions about the effectiveness of exercise for depressive and anxiety symptoms in IHD patients.
Collapse
|
304
|
Münzel T. Editorial commentary: The air that I breathe……………..makes me sick! Trends Cardiovasc Med 2018; 28:127-129. [DOI: 10.1016/j.tcm.2017.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/19/2017] [Indexed: 11/30/2022]
|
305
|
Forés R, Alzamora MT, Pera G, Baena-Díez JM, Mundet-Tuduri X, Torán P. Contribution of the ankle-brachial index to improve the prediction of coronary risk: The ARTPER cohort. PLoS One 2018; 13:e0191283. [PMID: 29338049 PMCID: PMC5770061 DOI: 10.1371/journal.pone.0191283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The different cardiovascular risk prediction scales currently available are not sufficiently sensitive. AIM The aim of the present study was to analyze the contribution of the ankle-brachial index (ABI) added to the Framingham and REGICOR risk scales for the reclassification of cardiovascular risk after a 9-year follow up of a Mediterranean population with low cardiovascular risk. DESIGN AND SETTING A population-based prospective cohort study was performed in the province of Barcelona, Spain. METHOD A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was performed and cardiovascular risk was calculated with the Framingham and REGICOR scales. The participants were followed until November 2016 by telephone and review of the clinical history every 6 months to confirm the possible appearance of cardiovascular events. RESULTS 2,716 individuals participated in the study. There were 126 incidental cases of first coronary events (5%) during follow up. The incidence of coronary events in patients with ABI <0.9 was 4-fold greater than that of subjects with a normal ABI (17.2/1,000 persons-year versus 4.8/1,000 persons-year). Improvement in the predictive capacity of REGICOR scale was observed on including ABI in the model, obtaining a net reclassification improvement of 7% (95% confidence interval 0%-13%) for REGICOR+ ABI. Framingham + ABI obtained a NRI of 4% (-2%-11%). CONCLUSION The results of the present study support the addition of the ABI as a tool to help in the reclassification of cardiovascular risk and to confirm the greater incidence of coronary events in patients with ABI < 0.9.
Collapse
Affiliation(s)
- Rosa Forés
- Centre d’Atenció Primària Riu Nord- Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Teresa Alzamora
- Centre d’Atenció Primària Riu Nord- Riu Sud Santa Coloma de Gramenet, Direcció d’Atenció Primària Barcelonés Nord i Maresme, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - José Miguel Baena-Díez
- Centre d’Atenció Primària La Marina, Direcció d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Xavier Mundet-Tuduri
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| |
Collapse
|
306
|
Rosenson RS, Gandra SR, McKendrick J, Dent R, Wieffer H, Cheng LI, Catapano AL, Oh P, Kees Hovingh G, Stroes ES. Identification and Management of Statin-Associated Symptoms in Clinical Practice: Extension of a Clinician Survey to 12 Further Countries. Cardiovasc Drugs Ther 2018; 31:187-195. [PMID: 28466399 PMCID: PMC5427112 DOI: 10.1007/s10557-017-6727-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Statins are the first-choice pharmacological treatment for patients with hypercholesterolemia and at risk for cardiovascular disease; however, a minority of patients experience statin-associated symptoms (SAS) and are considered to have reduced statin tolerance. The objective of this study was to establish how patients with SAS are identified and managed in clinical practice in Austria, Belgium, Colombia, Croatia, the Czech Republic, Denmark, Portugal, Switzerland, Russia, Saudi Arabia, Turkey, and the United Arab Emirates. METHODS A cross-sectional survey was conducted (2015-2016) among clinicians (n = 60 per country; Croatia: n = 30) who are specialized/experienced in the treatment of hypercholesterolemia. Participants were asked about their experience of patients presenting with potential SAS and how such patients were identified and treated. RESULTS Muscle-related symptoms were the most common presentation of potential SAS (average: 51%; range across countries [RAC] 17-74%); other signs/symptoms included persistent elevation in transaminases. To establish whether symptoms are due to statins, clinicians required rechallenge after discontinuation of statin treatment (average: 77%; RAC 40-90%); other requirements included trying at least one alternative statin. Clinicians reported that half of high-risk patients with confirmed SAS receive a lower-dose statin (average: 53%; RAC 43-72%), and that most receive another non-statin lipid-lowering therapy with or without a concomitant statin (average: 65%; RAC 52-83%). CONCLUSIONS The specialists and GPs surveyed use stringent criteria to establish causality between statin use and signs or symptoms, and persevere with statin treatment where possible.
Collapse
Affiliation(s)
- Robert S Rosenson
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, MC1 Level, New York, NY, 10029, USA.
| | | | | | | | | | | | | | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | | | |
Collapse
|
307
|
Sampogna G, Fiorillo A, Luciano M, Del Vecchio V, Steardo L, Pocai B, Barone M, Amore M, Pacitti F, Dell'Osso L, Di Lorenzo G, Maj M. A Randomized Controlled Trial on the Efficacy of a Psychosocial Behavioral Intervention to Improve the Lifestyle of Patients With Severe Mental Disorders: Study Protocol. Front Psychiatry 2018; 9:235. [PMID: 29930520 PMCID: PMC6001842 DOI: 10.3389/fpsyt.2018.00235] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/15/2018] [Indexed: 01/21/2023] Open
Abstract
UNLABELLED Patients with severe mental disorders die on average 20 years prior to the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and the adoption of unhealthy lifestyle behaviors.The LIFESTYLE trial aims to evaluate the efficacy of a new psychosocial group intervention (including psychoeducational, motivational, and problem-solving techniques) focused on healthy lifestyle behavior compared to a brief educational group intervention in a community sample of patients with severe mental disorders. The trial is a national-funded, multicentric, randomized controlled trial with blinded outcome assessments, which is carried out in six outpatient units of the Universities of Campania "Luigi Vanvitelli" in Naples, Bari, Genova, L'Aquila, Pisa, and Rome-Tor Vergata. All patients are assessed at the following time points: baseline (T0); 2 months post-randomization (T1); 4 months post-randomization (T2); 6 months post-randomization (T3); 12 months post-randomization (T4); and 24 months post-randomization (T5). T1 and T2 assessments include only anthropometric tests. The BMI, a reliable and feasible anthropometric parameter, has been selected as primary outcome. In particular, the mean value of BMI at 6 months from baseline (T3) will be evaluated through a Generalized Estimated Equation model. The work hypothesis is that the LIFESTYLE psychosocial group intervention will be more effective than the brief educational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point (and standard deviation of two points) at BMI. Secondary outcomes are: the improvement in dietary patterns, in smoking habits, in sleeping habits, physical activity, personal and social functioning, severity of physical comorbidities, and adherence to medications. The expected sample size consists of 420 patients (70 patients for each of the six participating centers), and they are allocated with a 1:1 ratio randomization, stratified according to center, age, gender, and educational level. Heavy smoking, sedentary behavior, and unhealthy diet pattern are very frequent and are associated with a reduced life expectancy and higher levels of physical comorbidities in people with severe mental disorders. New interventions are needed and we hope that the LIFESTYLE protocol will help to fill this gap. TRIAL REGISTRATION NUMBER 2015C7374S.
Collapse
Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Steardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Benedetta Pocai
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marina Barone
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Francesca Pacitti
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | |
Collapse
|
308
|
Ivanovs R, Kivite A, Ziedonis D, Mintale I, Vrublevska J, Rancans E. Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System. Front Psychiatry 2018; 9:276. [PMID: 29997533 PMCID: PMC6029265 DOI: 10.3389/fpsyt.2018.00276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022] Open
Abstract
Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.
Collapse
Affiliation(s)
- Rolands Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Anda Kivite
- Department of Public Health and Epidemiology, Riga Stradins University, Riga, Latvia
| | - Douglas Ziedonis
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Iveta Mintale
- Department of Cardiology, University Clinic of Paul Stradins, Riga, Latvia
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| |
Collapse
|
309
|
Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany. Atherosclerosis 2018; 268:99-107. [DOI: 10.1016/j.atherosclerosis.2017.11.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/05/2017] [Accepted: 11/16/2017] [Indexed: 01/15/2023]
|
310
|
Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, Aleksandrić S, Đorđević-Dikić A, Beleslin B. The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography. Clin Radiol 2017; 73:454-459. [PMID: 29292048 DOI: 10.1016/j.crad.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the hypothesis that breast arterial calcification (BAC) may predict coronary artery disease (CAD) severity. MATERIALS AND METHODS The study comprised 102 women >45 years (mean age 62±8 years) referred for digital mammography after coronary angiography. BAC was assessed using the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial) score. RESULTS In comparison to the low SYNTAX score group (≤22) patients with a intermediate-to-high SYNTAX score (>22) were older (p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes (p=0.021), and a history of smoking (p=0.048). They also had a statistically higher level of fasting blood glucose (p<0.001), glycated haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen (p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the group with a SYNTAX score ≤22 (p=0.005). BAC was significantly higher in patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC (odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7, p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001) and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent predictive factors for patients with intermediate-to-high SYNTAX score. CONCLUSIONS In women >45 years, there was a significant correlation between the severity of CAD as evaluated by the SYNTAX score and BAC as evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen may be used as an additional diagnostic tool to predict the presence and severity of CAD.
Collapse
Affiliation(s)
- D Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia.
| | - M Dobrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - M Vuković
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - D Hrnčić
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Street Višegradska 26, 11000, Belgrade, Serbia
| | - S Đorđević
- General Hospital Valjevo, Department of Radiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - M Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - S Aleksandrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - A Đorđević-Dikić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - B Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| |
Collapse
|
311
|
Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins. Clin Res Cardiol 2017; 107:380-388. [PMID: 29273856 PMCID: PMC5913378 DOI: 10.1007/s00392-017-1193-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/11/2017] [Indexed: 01/14/2023]
Abstract
Background European clinical guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL. Statin use varies and past studies suggest low rates of real-world goal attainment. This study describes LDL-C goal attainment among atherosclerotic CV disease (ASCVD) patients with various utilization patterns of moderate- or high-intensity statins in routine care. Methods This retrospective cohort study used electronic medical records data from the QuintilesIMS® Disease Analyzer (> 2 million individuals annually) to identify ASCVD (coronary atherosclerosis, stable/unstable angina, myocardial infarction, ischemic stroke, transient ischemic attack, aneurysm, peripheral artery disease) patients on moderate-/high-intensity statin in Germany. Proportion of patients with LDL-C < 70 mg/dL was determined using the lowest LDL-C value for each patient (index) in 2012, 2013, and 2014, while on statin. Treatment patterns were assessed for patients with at least 1 year of post-index follow-up. Results were stratified by year and treatment pattern [no change, switch, dose up-/down-titration, discontinuation (≥ 90 day gap)]. Results In > 14,000 patients assessed in each year (mean age 71 years, 35% female, 8–12% taking high-intensity statins), approximately 80% had LDL-C ≥ 70 mg/dL. Treatment patterns were assessed for most (88–93%) patients. Approximately 79–81% of patients made no change to statin regimens, 1% switched statins, 14–16% discontinued; 1% of moderate-intensity patients up-titrated, and 3% of all patients down-titrated. LDL-C goal attainment in these treatment pattern groups was 20, 16–24, 17, 11–14, and 17–19%, respectively. Conclusions Majority of ASCVD patients had LDL-C ≥ 70 mg/dL while on moderate-/high-intensity statins. Despite low LDL-C goal attainment, few patients changed their treatment regimens. Electronic supplementary material The online version of this article (10.1007/s00392-017-1193-z) contains supplementary material, which is available to authorized users.
Collapse
|
312
|
Body mass index as a biomarker for the evaluation of the "Obesity Paradox" among inpatients. Clin Nutr 2017; 38:412-421. [PMID: 29291899 DOI: 10.1016/j.clnu.2017.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/19/2017] [Accepted: 12/03/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Overweight and obesity are, on the one hand, recognized as risk factors for many health-related disorders, and, on the other, as favorable prognostic factors in various patients treated for several different conditions; what is called the "obesity paradox". Until now, the existence of this phenomenon among a general population of consecutive inpatients has not been evaluated. We decided, therefore, to perform an evaluation. PATIENTS AND METHODS Historical prospective analysis of the medical documentation of 23 603 hospitalizations during two consecutive years in one center was performed. The outcomes measured were as follows: length of stay, in-hospital all-cause mortality, and non-scheduled readmission in the 14-day, 30-day and one-year periods following discharge. RESULTS Overweight and obese patients had a lower or similar prevalence of the measured outcomes than malnourished patients and those of normal weight. Adjustment of the standard WHO BMI ranges for patients aged ≥65 y (normal weight BMI range 23-33 kg/m2) made these differences more apparent. In logistic regression, the ratio of fat to fat-free body mass was a stronger and unfavorable risk factor compared with BMI for the measured outcomes. CONCLUSIONS The greatest risk of all-cause in-hospital death and readmission concerned malnourished inpatients. Compared to patients with a normal BMI range, overweight and obesity had a lower or similar (but not greater) risk of the outcomes measured. However, due to several BMI limitations, our observations should be interpreted as suggesting a "BMI paradox", rather than an "obesity paradox".
Collapse
|
313
|
Abstract
PURPOSE OF REVIEW Recent studies indicate that the risk of thrombosis in hematologic patients may be similar or even higher than that found in patients with solid tumors. However, available information about pathogenesis and incidence of thrombosis in acute leukemia is limited. This review focuses on mechanisms underlying thrombosis in acute leukemia and discusses recent literature data. RECENT FINDINGS In the last few years, proofs have been provided that leukemic cells release free prothrombotic products, such as micro-vesicles, tissue factors, circulating free DNA and RNA. Furthermore, leukemic blasts can activate the procoagulant population of platelets, which initiate and amplify coagulation, causing thrombosis. In addition to factors produced by acute leukemia itself, others concur to trigger thrombosis. Some drugs, infections and insertion of central venous catheter have been described to increase risk of thrombosis in patients with acute leukemia. SUMMARY Thrombosis represents a serious complication in patients affected by myeloid and lymphoid acute leukemia. A proper knowledge of its pathophysiology and of the predisposing risk factors may allow to implement strategies of prevention. Improving prevention of thrombosis appears a major goal in patients whose frequent conditions of thrombocytopenia impede an adequate delivery of anticoagulant therapy.
Collapse
|
314
|
Ratziu V. Back to Byzance: Querelles byzantines over NASH and fibrosis. J Hepatol 2017; 67:1134-1136. [PMID: 28966125 DOI: 10.1016/j.jhep.2017.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Vlad Ratziu
- Hospital Pitié-Salpêtrière, Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France.
| |
Collapse
|
315
|
Assessment of novel cardiovascular biomarkers in women with a history of recurrent miscarriage. Pregnancy Hypertens 2017; 11:129-135. [PMID: 29102596 DOI: 10.1016/j.preghy.2017.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES A history of recurrent miscarriage is associated with future cardiovascular disease. The aim of this study was to determine novel cardiovascular biomarkers in women with a history of recurrent miscarriage as this might lead to a better understanding of the association. STUDY DESIGN Women who visited the recurrent miscarriage clinic at Leiden University Medical Centre (between 2000 and 2010), and had three consecutive miscarriages ≤30 years were invited to participate in this follow-up study (between 2012 and 2014). The reference group consisted of women with at least one uncomplicated pregnancy and a history of no miscarriage, matched on zip code, age, and date of pregnancy. MAIN OUTCOME MEASURES Cardiovascular biomarkers were determined, classified into; inflammation (HsCRP, lipoprotein-associated phospholipase A2), thrombosis (homocysteine, folate, anti-cardiolipin antibodies and anti-ß-2-glycoprotein antibodies), lipid metabolism (lipoprotein(a)), renal function (creatinine, microalbuminuria), myocardial damage (N-terminal pro-brain natriuretic peptide, high sensitive TroponineT) and multiple mechanisms (albumin, vitamin D). RESULTS In both groups, 36 women were included. Women with recurrent miscarriage had a significantly higher median HsCRP (1.49 mg/L) compared to women with no miscarriage (1.01 mg/L, p = 0.03) and a significantly lower mean albumin (46.0 vs 47.6g/L, p = 0.004) and vitamin D (55.6 vs 75.4nmol/L, p = 0.007), respectively. Differences remained after adjustments for classic cardiovascular risk factors (BMI, smoking, diabetes mellitus, and hypertension). CONCLUSIONS Our findings suggest a proinflammatory state in women with a history of recurrent miscarriage, which suggests a less optimal health, compared to women with no miscarriage. More research (observational and intervention) is warranted to investigate the association with vitamin D.
Collapse
|
316
|
Ceponiene I, Nakanishi R, Osawa K, Kanisawa M, Nezarat N, Rahmani S, Kissel K, Kim M, Jayawardena E, Broersen A, Kitslaar P, Budoff MJ. Coronary Artery Calcium Progression Is Associated With Coronary Plaque Volume Progression: Results From a Quantitative Semiautomated Coronary Artery Plaque Analysis. JACC Cardiovasc Imaging 2017; 11:1785-1794. [PMID: 29055625 DOI: 10.1016/j.jcmg.2017.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/05/2017] [Accepted: 07/21/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether coronary artery calcium (CAC) progression was associated with coronary plaque progression on coronary computed tomographic angiography. BACKGROUND CAC progression and coronary plaque characteristics are associated with incident coronary heart disease. However, natural history of coronary atherosclerosis has not been well described to date, and the understanding of the association between CAC progression and coronary plaque subtypes such as noncalcified plaque progression remains unclear. METHODS Consecutive patients who were referred to our clinic for evaluation and had serial coronary computed tomography angiography scans performed were included in the study. Coronary artery plaque (total, fibrous, fibrous-fatty, low-attenuation, densely calcified) volumes were calculated using semiautomated plaque analysis software. RESULTS A total of 211 patients (61.3 ± 12.7 years of age, 75.4% men) were included in the analysis. The mean interval between baseline and follow-up scans was 3.3 ± 1.7 years. CAC progression was associated with a significant linear increase in all types of coronary plaque and no plaque progression was observed in subjects without CAC progression. In multivariate analysis, annualized and normalized total plaque (β = 0.38; p < 0.001), noncalcified plaque (β = 0.35; p = 0.001), fibrous plaque (β = 0.56; p < 0.001), and calcified plaque (β = 0.63; p = 0.001) volume progression, but not fibrous-fatty (β = 0.03; p = 0.28) or low-attenuation plaque (β = 0.11; p = 0.1) progression, were independently associated with CAC progression. Plaque progression did not differ between the sexes. A significantly increased total and calcified plaque progression was observed in statin users. CONCLUSIONS In a clinical practice setting, progression of CAC was significantly associated with an increase in both calcified and noncalcified plaque volume, except fibrous-fatty and low-attenuation plaque. Serial CAC measurements may be helpful in determining the need for intensification of preventive treatment.
Collapse
Affiliation(s)
- Indre Ceponiene
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California; Departments of Cardiology and Radiology, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California.
| | - Kazuhiro Osawa
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Mitsuru Kanisawa
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Negin Nezarat
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Sina Rahmani
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Kendall Kissel
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Michael Kim
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Eranthi Jayawardena
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| | - Alexander Broersen
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter Kitslaar
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Medis Medical Imaging Systems, Leiden, the Netherlands
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, California
| |
Collapse
|
317
|
Raggi P, Pontone G, Andreini D. Role of new imaging modalities in pursuit of the vulnerable plaque and the vulnerable patient. Int J Cardiol 2017; 250:278-283. [PMID: 29102056 DOI: 10.1016/j.ijcard.2017.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/08/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Numerous biomarkers and imaging modalities were investigated during the past few decades to identify patients harboring plaques at high risk of rupturing and causing catastrophic events. The classical description of a vulnerable plaque included a large lipid core, covered by a thin fibrous cap and evidence of inflammation especially around the hinge points of the plaque. Unfortunately, the search has resulted to a large extent in a failure to accurately identify the site of a future event. In time the search focus switched to the vulnerable patient rather than the individual vulnerable plaques, but the debate continues as to the more appropriate approach to risk assessment. This review discusses the most recent developments in molecular, anatomical and functional imaging directed at identifying a patient at high-risk of coronary artery disease events.
Collapse
Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada; University of Alberta, Edmonton, AB, Canada.
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy; Yonsei University Health System, Seoul, South Korea
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| |
Collapse
|
318
|
Meinshausen M, Rieckert A, Renom-Guiteras A, Kröger M, Sommerauer C, Kunnamo I, Martinez YV, Esmail A, Sönnichsen A. Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults - a systematic review. BMC Geriatr 2017; 17:225. [PMID: 29047342 PMCID: PMC5647552 DOI: 10.1186/s12877-017-0572-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Platelet aggregation inhibitors (PAI) are among the most frequently prescribed drugs in older people, though evidence about risks and benefits of their use in older adults is scarce. The objectives of this systematic review are firstly to identify the risks and benefits of their use in the prevention and treatment of vascular events in older adults, and secondly to develop recommendations on discontinuing PAI in this population if risks outweigh benefits. METHODS Staged systematic review consisting of three searches. Searches 1 and 2 identified systematic reviews and meta-analyses. Search 3 included controlled intervention and observational studies from review-articles not included in searches 1 and 2. All articles were assessed by two independent reviewers regarding the type of study, age of participants, type of intervention, and clinically relevant outcomes. After data extraction and quality appraisal we developed recommendations to stop the prescribing of specific drugs in older adults following the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. RESULTS Overall, 2385 records were screened leading to an inclusion of 35 articles reporting on 22 systematic reviews and meta-analyses, 11 randomised controlled trials, and two observational studies. Mean ages ranged from 57.0 to 84.6 years. Ten studies included a subgroup analysis by age. Overall, based on the evaluated evidence, three recommendations were formulated. First, the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) in older people cannot be recommended due to an uncertainty in the risk-benefit ratio (weak recommendation; low quality of evidence). Secondly, the combination of ASA and clopidogrel in patients without specific indications should be avoided (strong recommendation; moderate quality of evidence). Lastly, to improve the effectiveness and reduce the risks of stroke prevention therapy in older people with atrial fibrillation (AF) and a CHA2DS2-VASc score of ≥ 2, the use of ASA for the primary prevention of stroke should be discontinued in preference for the use of oral anticoagulants (weak recommendation; low quality of evidence). CONCLUSIONS The use of ASA for the primary prevention of CVD and the combination therapy of ASA and clopidogrel for the secondary prevention of vascular events in older people may not be justified. The use of oral anticoagulants instead of ASA in older people with atrial fibrillation may be recommended. Further high quality studies with older adults are needed.
Collapse
Affiliation(s)
- Maren Meinshausen
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.
| | - Anja Rieckert
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany
| | - Anna Renom-Guiteras
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany.,Department of Geriatrics, In the University Hospital Parc de Salut Mar, Passeig Marítim, Barcelona, Spain
| | - Moritz Kröger
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany
| | - Christina Sommerauer
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany
| | - Ilkka Kunnamo
- Duodecim Medical Publications Ltd, Kalevankatu, Helsinki, Finland
| | - Yolanda V Martinez
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Oxford Rd, Manchester, UK
| | - Aneez Esmail
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße, Witten, Germany
| |
Collapse
|
319
|
Bove M, Fogacci F, Cicero AFG. Pharmacokinetic drug evaluation of ezetimibe + simvastatin for the treatment of hypercholesterolemia. Expert Opin Drug Metab Toxicol 2017; 13:1099-1104. [DOI: 10.1080/17425255.2017.1381085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marilisa Bove
- Internal and Surgical Medicine Sciences Department, University of Bologna, Bologna, Italy
| | - Federica Fogacci
- Internal and Surgical Medicine Sciences Department, University of Bologna, Bologna, Italy
| | - Arrigo F. G. Cicero
- Internal and Surgical Medicine Sciences Department, University of Bologna, Bologna, Italy
| |
Collapse
|
320
|
Christensen JJ, Ulven SM, Retterstøl K, Narverud I, Bogsrud MP, Henriksen T, Bollerslev J, Halvorsen B, Aukrust P, Holven KB. Comprehensive lipid and metabolite profiling of children with and without familial hypercholesterolemia: A cross-sectional study. Atherosclerosis 2017; 266:48-57. [PMID: 28963918 DOI: 10.1016/j.atherosclerosis.2017.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/01/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Individuals with familial hypercholesterolemia (FH) have elevated low-density lipoprotein cholesterol (LDL-C), accelerated atherosclerosis, and premature cardiovascular disease. Whereas children with lifestyle-induced dyslipidemias often present with complex lipid abnormalities, children with FH have isolated hypercholesterolemia. However, to the best of our knowledge, a comprehensive profiling of FH children is lacking. Therefore, we aimed to characterize the lipid-related and metabolic alterations associated with elevated LDL-C in children with FH and healthy children. METHODS We measured plasma metabolites in children with FH (n = 47) and in healthy children (n = 57) using a high-throughput nuclear magnetic resonance (NMR) spectroscopy platform, and compared the differences between FH and healthy children. RESULTS Both statin treated (n = 17) and non-statin treated FH children (n = 30) had higher levels of atherogenic ApoB-containing lipoproteins and lipids, and lipid fractions in lipoprotein subclasses, compared to healthy children (n = 57). FH children displayed alterations in HDL particle concentration and lipid content, compared with healthy children. Interestingly, the small HDL particles were characterized by higher content of cholesteryl esters, and lower levels of free cholesterol and phospholipids. Furthermore, plasma fatty acids were higher in non-statin treated FH children, particularly linoleic acid. Finally, acetoacetate and acetate were lower in FH children compared with healthy children. CONCLUSIONS Hypercholesterolemia in children associates with diverse metabolic repercussions and is more complex than previously believed. In particular, we found that hypercholesterolemia in FH children was paralleled not only by increased atherogenic ApoB-containing lipoproteins and lipid fractions, but also alterations in HDL subfractions that suggest impaired reverse cholesterol transport.
Collapse
Affiliation(s)
- Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway; The Lipid Clinic, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway; The Lipid Clinic, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Ingunn Narverud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University, Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Martin P Bogsrud
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University, Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Tore Henriksen
- Department of Obstetrics, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway; Faculty of Medicine, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway
| | - Jens Bollerslev
- Faculty of Medicine, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway; Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O box 1171 Blindern 0318 Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, P.O box 1171 Blindern 0318 Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O box 1171 Blindern 0318 Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, P.O box 1171 Blindern 0318 Oslo, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O box 1046 Blindern, 0317 Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University, Hospital Rikshospitalet, P.O box 4950 Nydalen, 0424 Oslo, Oslo, Norway.
| |
Collapse
|
321
|
Zhao M, Vaartjes I, Graham I, Grobbee D, Spiering W, Klipstein-Grobusch K, Woodward M, Peters SA. Sex differences in risk factor management of coronary heart disease across three regions. Heart 2017; 103:1587-1594. [PMID: 28931567 PMCID: PMC5739833 DOI: 10.1136/heartjnl-2017-311429] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate whether there are sex differences in risk factor management of patients with established coronary heart disease (CHD), and to assess demographic variations of any potential sex differences. Methods Patients with CHD were recruited from Europe, Asia, and the Middle East between 2012-2013. Adherence to guideline-recommended treatment and lifestyle targets was assessed and summarised as a Cardiovascular Health Index Score (CHIS). Age-adjusted regression models were used to estimate odds ratios for women versus men in risk factor management. Results 10 112 patients (29% women) were included. Compared with men, women were less likely to achieve targets for total cholesterol (OR 0.50, 95% CI 0.43 to 0.59), low-density lipoprotein cholesterol (OR 0.57, 95% CI 0.51 to 0.64), and glucose (OR 0.78, 95% CI 0.70 to 0.87), or to be physically active (OR 0.74, 95% CI 0.68 to 0.81) or non-obese (OR 0.82, 95% CI 0.74 to 0.90). In contrast, women had better control of blood pressure (OR 1.31, 95% CI 1.20 to 1.44) and were more likely to be a non-smoker (OR 1.93, 95% CI 1.67 to 2.22) than men. Overall, women were less likely than men to achieve all treatment targets (OR 0.75, 95% CI 0.60 to 0.93) or obtain an adequate CHIS (OR 0.81, 95% CI 0.73 to 0.91), but no significant differences were found for all lifestyle targets (OR 0.93, 95% CI 0.84 to 1.02). Sex disparities in reaching treatment targets were smaller in Europe than in Asia and the Middle East. Women in Asia were more likely than men to reach lifestyle targets, with opposing results in Europe and the Middle East. Conclusions Risk factor management for the secondary prevention of CHD was generally worse in women than in men. The magnitude and direction of the sex differences varied by region.
Collapse
Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Global Geo and Health Data Center, Utrecht University, Utrecht, The Netherlands
| | | | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Global Geo and Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
322
|
Mostaza JM, Lahoz C, Salinero-Fort MA, Laguna F, Estirado E, García-Iglesias F, González Alegre T, Sabín C, López S, Cornejo V. Risk factors associated with the carotid intima-media thickness and plaques: ESPREDIA Study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 30:49-55. [PMID: 28939054 DOI: 10.1016/j.arteri.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/29/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether there were any differences in the risk factor profile associated with either the intima-media thickness (IMT) or the presence of carotid plaques. METHODS Cross-sectional study in 1475 subjects between 45 and 75years, randomly selected from the population of the Northwest area of Madrid (Spain). They had a physical exam, blood analysis, and ultrasound measurement of the IMT and of the presence of plaques. RESULTS Mean IMT was 0.725±0.132mm. Forty seven percent of the participants had carotid plaques. In multivariate analysis, factors directly associated with the IMT were, age (β0.227, P<.0001), sex (β0.104, P<.0001), presence of hypertension (β0.082, P=.002), diabetes (β0.130, P<.0001) and current smoking (β0.107, P<.0001), systolic blood pressure (SBP) (β0.219, P<.0001) and LDL-cholesterol levels (β0.074, P=.003), and inversely, diastolic blood pressure (DBP) (β-0.124, P=.001), HDL-cholesterol (β-0.111, P<.0001) and triglyceride levels (β-0.060, P=.028). The presence of plaques was directly associated with age (OR1.08; 95%CI: 1.05-1.10), sex (OR1.95; 95%CI: 1.52-2.51), current smoking (OR2.75; 95%CI: 1.92-3.95), history of hypertension (OR1.58; 95%CI: 1.22-2.04) or diabetes (OR1.84; 95%CI: 1.31-2.58), statin treatment (OR1.56; 95%CI: 1.19-2.04) and SBP (OR1.03; 95%CI: 1.02-1.05), and inversely with DBP (OR0.98; 95%CI: 0.96-0.99). CONCLUSION Factors associated with the IMT and the presence of plaques are similar, a finding that support a continuum between muscular layer hypertrophy and arteriosclerosis development.
Collapse
Affiliation(s)
- Jose M Mostaza
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Lahoz
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - Miguel A Salinero-Fort
- Gerencia Adjunta de Planificación y Calidad, Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - Fernando Laguna
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - Eva Estirado
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - Francisca García-Iglesias
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - Teresa González Alegre
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | | | - Silvia López
- Unidad de día, Hospital Carlos III, Madrid, España
| | | | | |
Collapse
|
323
|
Svanteson M, Rollefstad S, Kløw NE, Hisdal J, Ikdahl E, Semb AG, Haig Y. Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases. RMD Open 2017; 3:e000544. [PMID: 28955501 PMCID: PMC5604717 DOI: 10.1136/rmdopen-2017-000544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/11/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques. METHODS Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables. RESULTS Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05. CONCLUSION Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD. TRIAL REGISTRATION NUMBER NCT01389388, Results.
Collapse
Affiliation(s)
- Mona Svanteson
- Department of Radiology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Nils Einar Kløw
- Department of Radiology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Department of Vascular Investigations, Oslo University Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - Ylva Haig
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
324
|
The role of dietary sodium intake on the modulation of T helper 17 cells and regulatory T cells in patients with rheumatoid arthritis and systemic lupus erythematosus. PLoS One 2017; 12:e0184449. [PMID: 28877244 PMCID: PMC5587319 DOI: 10.1371/journal.pone.0184449] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/24/2017] [Indexed: 12/30/2022] Open
Abstract
We aimed at investigating whether the frequency and function of T helper 17 (Th17) and regulatory T cells (Treg) are affected by a restriction of dietary sodium intake in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We enrolled RA and SLE patients not receiving drugs known to increase urinary sodium excretion. Patients underwent a dietary regimen starting with a restricted daily sodium intake followed by a normal-sodium daily intake. The timepoints were identified at baseline (T0), after 3 weeks of low-sodium dietary regimen (T3), after 2 weeks of normal-sodium dietary regimen (T5). On these visits, we measured the 24-hour urinary sodium excretion, the frequency and function of Th17 and Treg cells in the peripheral blood, the serum levels of cytokines. Analysis of urinary sodium excretion confirmed adherence to the dietary regimen. In RA patients, a trend toward a reduction in the frequencies of Th17 cells over the low-sodium dietary regimen followed by an increase at T5 was observed, while Treg cells exhibited the opposite trend. SLE patients showed a progressive reduction in the percentage of Th17 cells that reached a significance at T5 compared to T0 (p = 0.01) and an increase in the percentage of Treg cells following the low-sodium dietary regimen at both T1 and T3 compared to T0 (p = 0.04 and p = 0.02, respectively). No significant apoptosis or proliferation modulation was found. In RA patients, we found a reduction at T5 compared to T0 in serum levels of both TGFβ (p = 0.0016) and IL-9 (p = 0.0007); serum IL-9 levels were also reduced in SLE patients at T5 with respect to T0 (p = 0.03). This is the first study investigating the effects of dietary sodium intake on adaptive immunity. Based on the results, we hypothesize that a restricted sodium dietary intake may dampen the inflammatory response in RA and SLE patients.
Collapse
|
325
|
Hultberg J, Rudebeck CE. Patient participation in decision-making about cardiovascular preventive drugs - resistance as agency. Scand J Prim Health Care 2017; 35:231-239. [PMID: 28277056 PMCID: PMC5592349 DOI: 10.1080/02813432.2017.1288814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care. DESIGN Six general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis. RESULTS The study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation. CONCLUSIONS The recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient-doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients' disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care. KEY POINTS Guidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals. •The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care. •Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication.
Collapse
Affiliation(s)
- Josabeth Hultberg
- Primary Care and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden;
- CONTACT Josabeth Hultberg Åby Health Care Centre, Box 75, 616 21 Åby, Sweden
| | - Carl Edvard Rudebeck
- Research Unit, Kalmar County Council, Sweden, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| |
Collapse
|
326
|
Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca CT, Atanasov AG. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol 2017; 8:1058. [PMID: 28912780 PMCID: PMC5583158 DOI: 10.3389/fimmu.2017.01058] [Citation(s) in RCA: 213] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 01/13/2023] Open
Abstract
Arterial stiffness predicts an increased risk of cardiovascular events. Inflammation plays a major role in large arteries stiffening, related to atherosclerosis, arteriosclerosis, endothelial dysfunction, smooth muscle cell migration, vascular calcification, increased activity of metalloproteinases, extracellular matrix degradation, oxidative stress, elastolysis, and degradation of collagen. The present paper reviews main mechanisms explaining the crosstalk between inflammation and arterial stiffness and the most common inflammatory markers associated with increased arterial stiffness, considering the most recent clinical and experimental studies. Diverse studies revealed significant correlations between the severity of arterial stiffness and inflammatory markers, such as white blood cell count, neutrophil/lymphocyte ratio, adhesion molecules, fibrinogen, C-reactive protein, cytokines, microRNAs, and cyclooxygenase-2, in patients with a broad variety of diseases, such as metabolic syndrome, diabetes, coronary heart disease, peripheral arterial disease, malignant and rheumatic disorders, polycystic kidney disease, renal transplant, familial Mediterranean fever, and oral infections, and in women with preeclampsia or after menopause. There is strong evidence that inflammation plays an important and, at least, partly reversible role in the development of arterial stiffness, and inflammatory markers may be useful additional tools in the assessment of the cardiovascular risk in clinical practice. Combined assessment of arterial stiffness and inflammatory markers may improve non-invasive assessment of cardiovascular risk, enabling selection of high-risk patients for prophylactic treatment or more regular medical examination. Development of future destiffening therapies may target pro-inflammatory mechanisms.
Collapse
Affiliation(s)
- Ioana Mozos
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.,Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Jarosław Horbańczuk
- The Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Jastrzębiec, Poland
| | - Cristina Gug
- Department of Microscopic Morphology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- 2nd Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Constantin Tudor Luca
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Atanas G Atanasov
- The Institute of Genetics and Animal Breeding, Polish Academy of Sciences, Jastrzębiec, Poland.,Department of Pharmacognosy, Faculty of Life Sciences, University of Vienna, Vienna, Austria.,Department of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
327
|
von Eckardstein A. [Not Available]. PRAXIS 2017; 106:941-948. [PMID: 28830319 DOI: 10.1024/1661-8157/a002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Mit steigenden Plasma-Konzentrationen der Triglyzeride nehmen die Risiken für atherosklerotische Herz-Kreislauf-Erkrankungen (ASKVK) und akute Pankreatitis zu. Ein niedriger HDL-Cholesterin-Spiegel erhöht das ASKVK-Risiko. Bei hohen Konzentrationen von HDL-Cholesterin ist das Risiko für ASKVK nicht vermindert, aber das für Mortalität erhöht. Hypertriglyzeridämie und niedriges HDL-Cholesterin treten häufig gemeinsam und zusammen mit anderen Risikofaktoren auf. Genetische Studien und gescheiterte Interventionsstudien machen eine kausale Beziehung zwischen HDL-Cholesterin und ASKVK unwahrscheinlich, sodass die Erhöhung des HDL-Cholesterin-Spiegels kein Behandlungsziel ist. Genetische Analysen sprechen zwar für eine kausale Beziehung der triglyzeridreichen Lipoproteine zum kardiovaskulären Risiko, aber es gibt keine Erfolgsnachweise aus Interventionsstudien. Deswegen ist die Senkung der Triglyzeride nur bei Chylomikronämie primäres Behandlungsziel. Bei moderater Hypertriglyzeridämie (<10 mmol/l) und niedrigem HDL-Cholesterin ist die Kontrolle anderer ASKVK-Risikofaktoren, insbesondere die Erreichung des LDL-Cholesterin-Zielwertes, primäres Behandlungsziel. Hohe Triglyzerid-Konzentrationen lassen sich besonders gut durch Lebensstil (körperliche Aktivität), Ernährungsweise (Vermeidung von Alkohol, gesättigten Fettsäuren und leicht resorbierbaren Kohlenhydraten) und Behandlung der Grundkrankheit (vor allem Diabetes) senken. Fibrate und Omega-3-Fettsäuren kommen in Betracht, wenn diese Massnahmen versagen.
Collapse
|
328
|
Liu R, Heiss EH, Schachner D, Jiang B, Liu W, Breuss JM, Dirsch VM, Atanasov AG. Xanthohumol Blocks Proliferation and Migration of Vascular Smooth Muscle Cells in Vitro and Reduces Neointima Formation in Vivo. JOURNAL OF NATURAL PRODUCTS 2017; 80. [PMID: 28627872 PMCID: PMC5537697 DOI: 10.1021/acs.jnatprod.7b00268] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Xanthohumol (1) is a principal prenylated chalcone found in hops. The aim of this study was to examine its influence on platelet-derived growth factor (PDGF)-BB-triggered vascular smooth muscle cell (VSMC) proliferation and migration in vitro and on experimentally induced neointima formation in vivo. Quantification of resazurin conversion indicated that 1 can inhibit PDGF-BB-induced VSMC proliferation concentration-dependently (IC50 = 3.49 μM). Furthermore, in a wound-healing assay 1 potently suppresses PDGF-BB-induced VSMC migration at 15 μM. Tested in a mouse femoral artery cuff model, 1 significantly reduces neointima formation. Taken together, we show that 1 represses PDGF-BB-induced VSMC proliferation and migration in vitro as well as neointima formation in vivo. This novel activity suggests 1 as an interesting candidate for further studies addressing a possible therapeutic application to counteract vascular proliferative disease.
Collapse
Affiliation(s)
- Rongxia Liu
- School of Pharmacy,
Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai
University), Ministry of Education, Collaborative Innovation Center
of Advanced Drug Delivery System and Biotech Drugs in Universities
of Shandong, Yantai University, Yantai, 264005, People’s Republic of China
| | - Elke H. Heiss
- Department
of Pharmacognosy, University of Vienna, Vienna, 1090, Austria
- Tel: +43-1-4277-55993. Fax: +43-1-4277-855270. E-mail: (E. H. Heiss)
| | - Daniel Schachner
- Department
of Pharmacognosy, University of Vienna, Vienna, 1090, Austria
| | - Baohong Jiang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy
of Sciences, Shanghai, 201203, People’s Republic
of China
| | - Wanhui Liu
- School of Pharmacy,
Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai
University), Ministry of Education, Collaborative Innovation Center
of Advanced Drug Delivery System and Biotech Drugs in Universities
of Shandong, Yantai University, Yantai, 264005, People’s Republic of China
| | - Johannes M. Breuss
- Center for Physiology and Pharmacology, Institute for
Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, 1090, Austria
| | - Verena M. Dirsch
- Department
of Pharmacognosy, University of Vienna, Vienna, 1090, Austria
| | - Atanas G. Atanasov
- Department
of Pharmacognosy, University of Vienna, Vienna, 1090, Austria
- Institute of Genetics and Animal Breeding of the Polish Academy of
Sciences, 05-552 Jastrzebiec, Poland
- Tel: +43-1-4277-55231. Fax: +43-1-4277-55969. E-mail: (A. G. Atanasov)
| |
Collapse
|
329
|
Hernández M, López C, Real J, Valls J, Ortega-Martinez de Victoria E, Vázquez F, Rubinat E, Granado-Casas M, Alonso N, Molí T, Betriu A, Lecube A, Fernández E, Leslie RD, Mauricio D. Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes. Cardiovasc Diabetol 2017; 16:94. [PMID: 28750634 PMCID: PMC5532780 DOI: 10.1186/s12933-017-0576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/21/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND LADA is probably the most prevalent form of autoimmune diabetes. Nevertheless, there are few data about cardiovascular disease in this group of patients. The aim of this study was to investigate the frequency of carotid atherosclerotic plaques in patients with LADA as compared with patients with classic type 1 diabetes and type 2 diabetes. METHODS Patients with LADA were matched for age and gender in different proportions to patients with type 2 diabetes, and classic type 1 diabetes. None of the patients had clinical cardiovascular disease. All subjects underwent B-mode carotid ultrasound to detect atheroma plaques. Demographics were obtained from all subjects. RESULTS We included 71 patients with LADA, 191 patients with type 2 diabetes and 116 patients with type 1 diabetes. Carotid atherosclerosis was more frequent in patients with LADA compared with type 2 diabetes (73.2% vs. 56.9%, P = 0.0018) and classic type 1 diabetes (57.1%, P = 0.026); these changes occurred despite healthier macrovascular risk profiles in the former. Age (P < 0.001), smoking (P = 0.003) and hypertension (P = 0.019) were independently associated with carotid atherosclerosis. Multiple plaques were also more frequent in patients with LADA as compared with classic type 1 diabetes and type 2 diabetes (45.1% and 33.6% vs. 27.2%, respectively, P = 0.022). The frequency of carotid plaques increased with increasing diabetes duration in LADA patients compared with type 2 diabetes (85.7% vs. 58.8%, inverse OR 5.72 [1.5-21.8]; P = 0.009). CONCLUSIONS LADA patients do not present with less carotid atherosclerosis than patients with type 1 and type 2 diabetes. Their macrovascular risk occurs despite a healthier macrovascular risk profile than those patients with type 2 diabetes.
Collapse
Affiliation(s)
- Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Carolina López
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Jordi Real
- Unitat de Suport a la Recerca Lleida, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Epidemiologia i Salut Pública, Universitat International de Catalunya, Sant Cugat del Vallés, Spain
| | - Joan Valls
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | - Emilio Ortega-Martinez de Victoria
- Department of Endocrinology and Nutrition, CIBEROBN-Spanish Biomedical Research Centre in Physiopathology of Obesity, Hospital Clínic, Barcelona, Spain
| | - Federico Vázquez
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | | | - Minerva Granado-Casas
- Nursing School, Universitat de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Nuria Alonso
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| | - Teresa Molí
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Angels Betriu
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Albert Lecube
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
- Nursing School, Universitat de Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Elvira Fernández
- UDETMA, Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Richard David Leslie
- The Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Dídac Mauricio
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, Badalona, 08916 Spain
| |
Collapse
|
330
|
Unmet Needs in the Pathogenesis and Treatment of Cardiovascular Comorbidities in Chronic Inflammatory Diseases. Clin Rev Allergy Immunol 2017; 55:254-270. [PMID: 28741263 DOI: 10.1007/s12016-017-8624-5] [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] [Indexed: 12/27/2022]
Abstract
The developments that have taken place in recent decades in the diagnosis and therapy of a number of diseases have led to improvements in prognosis and life expectancy. As a consequence, there has been an increase in the number of patients affected by chronic diseases and who can face new pathologies during their lifetime. The prevalence of chronic heart failure, for example, is approximately 1-2% of the adult population in developed countries, rising to ≥10% among people >70 years of age; in 2015, more than 85 million people in Europe were living with some sort of cardiovascular disease (CVD) (Lubrano and Balzan World J Exp Med 5:21-32, 5; Takahashi et al. Circ J 72:867-72, 8; Kaptoge et al. Lancet 375:132-40, 9). Chronic disease can become, in turn, a major risk factor for other diseases. Furthermore, several new drugs have entered clinical practice whose adverse effects on multiple organs are still to be evaluated. All this necessarily involves a multidisciplinary vision of medicine, where the physician must view the patient as a whole and where collaboration between the various specialists plays a key role. An example of what has been said so far is the relationship between CVD and chronic inflammatory diseases (CIDs). Patients with chronic CVD may develop a CID within their lifetime, and, vice versa, a CID can be a risk factor for the development of CVD. Moreover, drugs used for the treatment of CIDs may have side effects involving the cardiovascular system and thus may be contraindicated. The purpose of this paper is to investigate the close relationship between these two groups of diseases and to provide recommendations on the diagnostic approach and treatments in light of the most recent scientific data available.
Collapse
|
331
|
Wibetoe G, Ikdahl E, Rollefstad S, Olsen IC, Bergsmark K, Kvien TK, Salberg A, Soldal DM, Bakland G, Lexberg Å, Fevang BT, Gulseth HC, Haugeberg G, Semb AG. Cardiovascular disease risk profiles in inflammatory joint disease entities. Arthritis Res Ther 2017; 19:153. [PMID: 28673314 PMCID: PMC5496163 DOI: 10.1186/s13075-017-1358-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/01/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patients with inflammatory joint diseases (IJD) have increased risk of cardiovascular disease (CVD). Our aim was to compare CVD risk profiles in patients with IJD, including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and evaluate the future risk of CVD. Methods The prevalence and numbers of major CVD risk factors (CVD-RFs) (hypertension, elevated cholesterol, obesity, smoking, and diabetes mellitus) were estimated in patients with RA, axSpA and PsA. Relative and absolute risk of CVD according to Systematic Coronary Risk Evaluation (SCORE) was calculated. Results In total, 3791 patients were included. CVD was present in 274 patients (7.2%). Of those without established CVD; hypertension and elevated cholesterol were the most frequent CVD-RFs, occurring in 49.8% and 32.8% of patients. Patients with PsA were more often hypertensive and obese. Overall, 73.6% of patients had a minimum of one CVD-RF, which increased from 53.2% among patients aged 30 to <45 years, to 86.2% of patients aged 60 to ≤80 years. Most patients (93.5%) had low/moderate estimated risk of CVD according to SCORE. According to relative risk estimations, 35.2% and 24.7% of patients had two or three times risk or higher, respectively, compared to individuals with no CVD-RFs. Conclusions In this nationwide Norwegian project, we have shown for the first time that prevalence and numbers of CVD-RFs were relatively comparable across the three major IJD entities. Furthermore, estimated absolute CVD risk was low, but the relative risk of CVD was markedly high in patients with IJD. Our findings indicate the need for CVD risk assessment in all patients with IJD. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1358-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Salberg
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Vestre Viken Hospital, Drammen, Norway
| | - Bjørg-Tilde Fevang
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| |
Collapse
|
332
|
Minneboo M, Lachman S, Snaterse M, Jørstad HT, ter Riet G, Boekholdt SM, Scholte op Reimer WJ, Peters RJ, Riezebos R, van Liebergen R, van der Spank A, van Dantzig J, de Milliano P, van Hessen M, Kragten J, Jaarsma W, den Hartog F, Bartels G, Aengevaeren W, van Rossum P, Anneveldt A, de Vries C. Community-Based Lifestyle Intervention in Patients With Coronary Artery Disease. J Am Coll Cardiol 2017; 70:318-327. [DOI: 10.1016/j.jacc.2017.05.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
|
333
|
Castellano Vázquez JM. From Risk Scales to Subclinical Atherosclerosis Quantification Through Non-invasive Imaging: Toward a New Paradigm in Cardiovascular Risk Prediction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:532-534. [PMID: 28366498 DOI: 10.1016/j.rec.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/23/2016] [Indexed: 06/07/2023]
Affiliation(s)
- José M Castellano Vázquez
- Centro Nacional de Investigaciones Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain; Centro Integral de Enfermedades Cardiovasculares (CIEC), Hospital Universitario Montepríncipe, HM Hospitales, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Madrid, Spain.
| |
Collapse
|
334
|
Spanos K, Kouvelos G, Matsagkas M, Giannoukas A. Antiplatelet Resistance in Ischaemic Stroke Patients. Eur J Vasc Endovasc Surg 2017; 54:3-4. [DOI: 10.1016/j.ejvs.2017.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/30/2017] [Indexed: 11/29/2022]
|
335
|
De las escalas de riesgo poblacional a la cuantificación de la ateroesclerosis subclínica: hacia un nuevo paradigma en la predicción cardiovascular. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
336
|
Cortés-Beringola A, Fitzsimons D, Pelliccia A, Moreno G, Martín-Asenjo R, Bueno H. Planning secondary prevention: Room for improvement. Eur J Prev Cardiol 2017; 24:22-28. [DOI: 10.1177/2047487317704954] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | - Guillermo Moreno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Héctor Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
337
|
Lipid testing in infectious diseases: possible role in diagnosis and prognosis. Infection 2017; 45:575-588. [PMID: 28484991 DOI: 10.1007/s15010-017-1022-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/04/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Acute infections lead to significant alterations in metabolic regulation including lipids and lipoproteins, which play a central role in the host immune response. In this regard, several studies have investigated the role of lipid levels as a marker of infection severity and prognosis. SCOPE OF REVIEW We review here the role of lipids in immune response and the potential mechanisms underneath. Moreover, we summarize studies on lipid and lipoprotein alterations in acute bacterial, viral and parasitic infections as well as their diagnostic and prognostic significance. Chronic infections (HIV, HBV, HCV) are also considered. RESULTS All lipid parameters have been found to be significantly dearranged during acute infection. Common lipid alterations in this setting include a decrease of total cholesterol levels and an increase in the concentration of triglyceride-rich lipoproteins, mainly very low-density lipoproteins. Also, low-density lipoprotein cholesterol, apolipoprotein A1, low-density lipoprotein cholesterol and apolipoprotein-B levels decrease. These lipid alterations may have prognostic and diagnostic role in certain infections. CONCLUSION Lipid testing may be of help to assess response to treatment in septic patients and those with various acute infections (such as pneumonia, leptospirosis and others). Diagnostically, new onset of altered lipid levels should prompt the clinician to test for underlying infection (such as leishmaniasis).
Collapse
|
338
|
Daïen CI, Tubery A, Cailar GD, Mura T, Roubille F, Morel J, Bousquet J, Fesler P, Combe B. Application of the 2015/2016 EULAR recommendations for cardiovascular risk in daily practice: data from an observational study. Ann Rheum Dis 2017; 77:625-626. [DOI: 10.1136/annrheumdis-2017-211074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 12/31/2022]
|
339
|
|
340
|
Abstract
INTRODUCTION Cardiovascular morbidity and mortality are of increasing concern, not only to patients but also to the health care profession and service providers. The preventative benefit of treatment of dyslipidaemia is unquestioned but there is a large, so far unmet need to improve clinical outcome. There are exciting new discoveries of targets that may translate into improved clinical outcome. Areas covered: This review highlights some new pathways in cholesterol and triglyceride metabolism and examines new targets, new drugs and new molecules. The review includes the results of recent trials of relatively new drugs that have shown benefit in cardiovascular endpoint outcomes, drugs that have been licenced without endpoint trials yet available and new drugs that have not yet been licenced but have produced exciting results in animal studies and some in early phase 2 human studies. Expert opinion: The new areas that have been discovered as the cause of dyslipidaemia have opened up a host of new targets for new drugs including antisense RNA's, microRNA's and human monoclonal antibodies. The plethora of new targets and new drugs has made it an extraordinarily exciting time in the development of therapeutics to combat atherosclerosis.
Collapse
Affiliation(s)
- Gerald H Tomkin
- a Diabetes Institute of Ireland , Beacon Clinic and Trinity College , Dublin 2 , Ireland
| | - Daphne Owens
- a Diabetes Institute of Ireland , Beacon Clinic and Trinity College , Dublin 2 , Ireland
| |
Collapse
|
341
|
Ro YS, Shin SD, Song KJ, Hong KJ, Ahn KO. Association of Exercise and Metabolic Equivalent of Task (MET) Score with Survival Outcomes after Out-of-Hospital Cardiac Arrest of Young and Middle Age. Resuscitation 2017; 115:44-51. [PMID: 28389240 DOI: 10.1016/j.resuscitation.2017.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/18/2017] [Accepted: 03/31/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Regular physical activity is recommended to prevent cardiovascular disease including out-of-hospital cardiac arrest (OHCA). However, it is uncertain whether the intensity during physical activity is associated with better outcomes. We studied the effect of exercise at the time of arrest and the association between metabolic equivalent of task (MET) score and survival of OHCA patients of young and middle age. METHODS All OHCAs of presumed cardiac etiology who were 18-65 years of age and were witnessed by a layperson between 2013 and 2015 were analyzed. The main exposure of interest was physical activity at the time of, or immediately prior to, the arrest and the MET score groups (0-3 for light, 3-6 for moderate, and ≥6 for vigorous). The endpoint was survival with good neurological recovery. For the sensitivity analysis, we created a matched dataset by matching for age, gender, residential area, and comorbidities (diabetes, hypertension, heart disease, and stroke). Multivariable logistic regression analysis was performed, adjusting for patient and arrest-environmental factors. RESULTS A total of 6,273 patients in the original dataset were included, and 762 (12.1%) patients had a cardiac arrest during exercise. The exercise-related OHCAs were more likely to have a good neurological recovery rate (25.9%) than the non-exercise-related OHCA (12.9%) in the original dataset (AOR (95% CI): 1.36 (1.08-1.70)) but not in the matched dataset (1.37 (0.92-1.97)). Using MET score groups, the moderate-intensity group compared with the non-exercise group was associated with better neurological outcome (1.70 (1.11-2.63)), but neither light-intensity (0.77 (0.40-1.49)) nor vigorous-intensity (1.44 (0.91-2.28)) groups were associated with better outcomes. CONCLUSIONS Patients who had an OHCA during exercise were more likely to have neurologically intact survival compared to patients who had an OHCA during periods of non-exercise; however, only the moderate-intensity group was associated with a better neurological outcome.
Collapse
Affiliation(s)
- Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea.
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
| | - Ki Jeong Hong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea.
| | - Ki Ok Ahn
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea.
| |
Collapse
|
342
|
Crowson CS, Rollefstad S, Kitas GD, van Riel PLCM, Gabriel SE, Semb AG. Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis. PLoS One 2017; 12:e0174656. [PMID: 28334012 PMCID: PMC5363942 DOI: 10.1371/journal.pone.0174656] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/13/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Cardiovascular disease (CVD) risk calculators designed for use in the general population do not accurately predict the risk of CVD among patients with rheumatoid arthritis (RA), who are at increased risk of CVD. The process of developing risk prediction models involves numerous issues. Our goal was to develop a CVD risk calculator for patients with RA. METHODS Thirteen cohorts of patients with RA originating from 10 different countries (UK, Norway, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico) were combined. CVD risk factors and RA characteristics at baseline, in addition to information on CVD outcomes were collected. Cox models were used to develop a CVD risk calculator, considering traditional CVD risk factors and RA characteristics. Model performance was assessed using measures of discrimination and calibration with 10-fold cross-validation. RESULTS A total of 5638 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female). During a mean follow-up of 5.8 years (30139 person years), 389 patients developed a CVD event. Event rates varied between cohorts, necessitating inclusion of high and low risk strata in the models. The multivariable analyses revealed 2 risk prediction models including either a disease activity score including a 28 joint count and erythrocyte sedimentation rate (DAS28ESR) or a health assessment questionnaire (HAQ) along with age, sex, presence of hypertension, current smoking and ratio of total cholesterol to high-density lipoprotein cholesterol. Unfortunately, performance of these models was similar to general population CVD risk calculators. CONCLUSION Efforts to develop a specific CVD risk calculator for patients with RA yielded 2 potential models including RA disease characteristics, but neither demonstrated improved performance compared to risk calculators designed for use in the general population. Challenges encountered and lessons learned are discussed in detail.
Collapse
Affiliation(s)
- Cynthia S. Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research and Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - George D. Kitas
- Dudley Group NHS Foundation Trust, West Midlands, United Kingdom
| | - Piet L. C. M. van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Sherine E. Gabriel
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research and Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | |
Collapse
|
343
|
Pérez-Calahorra S, Sánchez-Hernández RM, Plana N, Marco-Benedi V, Pedro-Botet J, Almagro F, Brea A, Ascaso JF, Lahoz C, Civeira F. Value of the Definition of Severe Familial Hypercholesterolemia for Stratification of Heterozygous Patients. Am J Cardiol 2017; 119:742-748. [PMID: 28081939 DOI: 10.1016/j.amjcard.2016.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
Abstract
Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol with co-dominant transmission and high risk of cardiovascular disease (CVD), although with high variability among subjects. Currently, CVD stratification tools for heterozygous FH (HeFH) are not available. A definition of severe HeFH has been recently proposed by the International Atherosclerosis Society (IAS), but it has not been validated. Our study aims to see clinical characteristics and prevalence of CVD in subjects defined as severe HeFH by IAS criteria. Probable or definite HeFH introduced in the Dyslipidemia Registry of Spanish Arteriosclerosis Society were analyzed by the IAS criteria. Univariate and multivariate analysis was used to assess the association of CVD with the IAS criteria. About 1,732 HeFH cases were analyzed. Severe HeFH had higher prevalence of familial history of CVD, personal history of tendon xanthomas, LDL cholesterol, and CVD than nonsevere HeFH. A total of 656 (77.1%) and 441 (50.1%) of men and women, respectively, fulfilled the IAS criteria of severe HeFH. In the univariate analysis, subjects defined as severe HeFH showed odds ratio 3.016 (95% CI 3.136 to 4.257, p <0.001) for CVD. However, when traditional risk factors were included in the multivariate analysis, only the presence of cholesterol >400 mg/dl had a statistically significant association with CVD odds ratio 8.76 (95% CI 3.90 to 19.69, p <0.001). In conclusion, the IAS definition of severe HeFH is not significantly associated with CVD when adjusted for classic risk factors. Risk stratification in HeFH is an important issue, but the proposed criteria do not seem to solve this problem.
Collapse
|
344
|
Affiliation(s)
- Erling Falk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| |
Collapse
|
345
|
Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification. ANNALES D'ENDOCRINOLOGIE 2017; 78:14-19. [DOI: 10.1016/j.ando.2016.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/07/2016] [Accepted: 12/02/2016] [Indexed: 11/18/2022]
|
346
|
Ritti-Dias RM, Cucato GG, do Prado WL, Conceição RDO, Santos RD, Bittencourt MS. Self-initiated changes in physical activity levels improve cardiometabolic profiles: A longitudinal follow-up study. Nutr Metab Cardiovasc Dis 2017; 27:48-53. [PMID: 27956022 DOI: 10.1016/j.numecd.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS While studies have described the importance of higher physical activity levels (PAL) in weight loss, the impact of self-initiated PAL on health status warrants further study. We aimed to prospectively examine the effects of self-initiated longitudinal PAL changes on body mass index (BMI) and cardiometabolic parameters in normal weight, overweight and obese adults. METHODS AND RESULTS We included 4840 adults (mean age 41.6 ± 7.9 years, 79% male) undergoing routine health screening examinations. Self-reported PAL, height, weight, blood pressure and blood samples were collected at baseline and after a mean (95% confidence interval) follow up of 536 (531-541) days. Subjects were stratified according to BMI [39.8% normal weight (<25 kg/m2), 45.1% overweight (25.0-29.9 kg/m2), and 19.1% obese (≥30 kg/m2)]. In normal weight individuals, BMI increased from baseline to follow-up, irrespective of PAL changes. On the other hand, overweight and obese individuals that increased PAL experienced a decrease in BMI by -0.9% and -3.1%, respectively (p < 0.05). Overweight and obese individuals that increased PAL also experienced a decrease in -5.8% -4.6% in non-HDL concentrations from baseline to follow-up (p < 0.05). Finally, in overweight individuals, LDL cholesterol concentrations decreased from baseline to follow-up, irrespective of PAL changes whereas in obese individuals, a maintenance or increased PAL were associated with a decrease in -4.7% and -6.1% (p < 0.05), respectively. CONCLUSIONS In a large cohort of screening patients, longitudinal self-initiated PAL is associated with improved BMI and cardiometabolic profile in overweight and obese individuals.
Collapse
Affiliation(s)
- R M Ritti-Dias
- Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
| | - G G Cucato
- Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - W L do Prado
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - R D O Conceição
- Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - R D Santos
- Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of Sao Paulo, Medical School Hospital, Sao Paulo, Brazil
| | - M S Bittencourt
- Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| |
Collapse
|
347
|
Pedro-Botet J, Climent E. [A glow in the secondary prevention of cardiovascular disease]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2017; 29:20-21. [PMID: 28173922 DOI: 10.1016/j.arteri.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
348
|
Mehta R, Zubirán R, Martagón AJ, Vazquez-Cárdenas A, Segura-Kato Y, Tusié-Luna MT, Aguilar-Salinas CA. The panorama of familial hypercholesterolemia in Latin America: a systematic review. J Lipid Res 2016; 57:2115-2129. [PMID: 27777316 PMCID: PMC5321217 DOI: 10.1194/jlr.r072231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 10/23/2016] [Indexed: 11/20/2022] Open
Abstract
The burden caused by familial hypercholesterolemia (FH) varies among countries and ethnic groups. The prevalence and characteristics of FH in Latin American (LA) countries is largely unknown. We present a systematic review (following the PRISMA statement) of FH in LA countries. The epidemiology, genetics, screening, management, and unique challenges encountered in these countries are discussed. Published reports discussing FH in Hispanic or LA groups was considered for analysis. Thirty studies were included representing 10 countries. The bulk of the data was generated in Brazil and Mexico. Few countries have registries and there was little commonality in FH mutations between LA countries. LDL receptor mutations predominate; APOB and PCSK9 mutations are rare. No mutation was found in an FH gene in nearly 50% of cases. In addition, some country-specific mutations have been reported. Scant information exists regarding models of care, cascade screening, cost, treatment effectiveness, morbidity, and mortality. In conclusion, FH is largely underdiagnosed and undertreated in the LA region. The genetic admixture with indigenous populations, producing mestizo's groups, may influence the mutational findings in Latin America. Potential opportunities to close gaps in knowledge and health care are identified.
Collapse
Affiliation(s)
- Roopa Mehta
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Rafael Zubirán
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | - Yayoi Segura-Kato
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico; Unidad de Biología Molecular y Medicina Genómica Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Teresa Tusié-Luna
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico; Unidad de Biología Molecular y Medicina Genómica Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
| |
Collapse
|
349
|
Ruscica M, Baldessin L, Boccia D, Racagni G, Mitro N. Non-insulin anti-diabetic drugs: An update on pharmacological interactions. Pharmacol Res 2016; 115:14-24. [PMID: 27838511 DOI: 10.1016/j.phrs.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 12/17/2022]
Abstract
Nowadays, the goal in the management of type 2 diabetes mellitus (T2DM) remains personalized control of glucose. Since less than 50% of patients with T2DM achieve glycemic treatment goal and most of them take medications for comorbidities associated to T2DM, drug interactions, namely pharmacokinetic and pharmacodynamic interactions, may enhance or reduce the effect of compounds involved in hyperglycemia. Hence, clinicians should be aware of the severe complications in T2DM patients in case of a concomitant use of these medications. It is within this context that this review aims to evaluate the effect of a second drug on the pharmacokinetic of these compounds which may lead, along with several pharmacodynamic interactions, to severe clinical complications, i.e., hypoglycemia. Available drugs already approved in Europe, USA and Japan have been included.
Collapse
Affiliation(s)
- M Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
| | | | | | - G Racagni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - N Mitro
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
| |
Collapse
|
350
|
Oikonomou E, Tousoulis D. Novel risk factors’ hunting. Lessons from the study of older olds. Hellenic J Cardiol 2016; 57:415-416. [DOI: 10.1016/j.hjc.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/14/2016] [Indexed: 10/19/2022] Open
|