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Abulikemu A, Zhang X, Su X, Meng T, Su W, Shi Q, Yu T, Niu Y, Yu H, Yuan H, Zhou C, Yang H, Zhang Y, Wang Y, Dai Y, Duan H. Particulate matter, polycyclic aromatic hydrocarbons and metals, platelet parameters and blood pressure alteration: Multi-pollutants study among population. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 941:173657. [PMID: 38838997 DOI: 10.1016/j.scitotenv.2024.173657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
Epidemiological findings have determined the linkage of fine particulate matter (PM2.5) and the morbidity of hypertension. However, the mode of action and specific contribution of PM2.5 component in the blood pressure elevation remain unclear. Platelets are critical for vascular homeostasis and thrombosis, which may be involved in the increase of blood pressure. Among 240 high-PM2.5 exposed, 318 low-PM2.5 exposed workers in a coking plant and 210 workers in the oxygen plant and cold-rolling mill enrolled in present study, both internal and external exposure characteristics were obtained, and we performed linear regression, adaptive elastic net regression, quantile g-computation and mediation analyses to analyze the relationship between urine metabolites of polycyclic aromatic hydrocarbons (PAHs) and metals fractions with platelets indices and blood pressure indicators. We found that PM2.5 exposure leads to increased systolic blood pressure (SBP) and pulse pressure (PP). Specifically, for every 10 μg/m3 increase in PM2.5, there was a 0.09 mmHg rise in PP. Additionally, one IQR increase in urinary 1-hydroxypyrene (1.06 μmol/mol creatinine) was associated with a 3.43 % elevation in PP. Similarly, an IQR increment of urine cobalt (2.31 μmol/mol creatinine) was associated with a separate 1.77 % and 4.71 % elevation of SBP and PP. Notably, platelet-to-lymphocyte ratio (PLR) played a mediating role in the elevation of SBP and PP induced by cobalt. Our multi-pollutants results showed that PAHs and cobalt were deleterious contributors to the elevated blood pressure. These findings deepen our understanding of the cardiovascular effects associated with PM2.5 constituents, highlighting the importance of increased vigilance in monitoring and controlling the harmful components in PM2.5.
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Affiliation(s)
- Alimire Abulikemu
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuewei Zhang
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xizi Su
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Meng
- Institute of Brain Science, Shanxi Datong University, Datong, China
| | - Wenge Su
- Laigang Hospital Affiliated to Taishan Medical University, Jinan, China
| | - Qiwei Shi
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Tao Yu
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Niu
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haitao Yu
- Laigang Hospital Affiliated to Taishan Medical University, Jinan, China
| | - Huige Yuan
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Cailan Zhou
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haoying Yang
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanshu Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yanhua Wang
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Chemical Safety and Health, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yufei Dai
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huawei Duan
- State Key Laboratory of Trauma and Chemical Poisoning, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China; Key Laboratory of Chemical Safety and Health, National Institute for Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China.
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Shi H, Yu Y, Li D, Zhu K, Cheng X, Ma T, Tao Z, Hong Y, Liu Z, Zhou S, Zhang J, Chen Y, Zhang XJ, Zhang P, Li H. TNIP3 protects against pathological cardiac hypertrophy by stabilizing STAT1. Cell Death Dis 2024; 15:450. [PMID: 38926347 PMCID: PMC11208599 DOI: 10.1038/s41419-024-06805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Pathological cardiac hypertrophy is one of the major risk factors of heart failure and other cardiovascular diseases. However, the mechanisms underlying pathological cardiac hypertrophy remain largely unknown. Here, we identified the first evidence that TNFAIP3 interacting protein 3 (TNIP3) was a negative regulator of pathological cardiac hypertrophy. We observed a significant upregulation of TNIP3 in mouse hearts subjected to transverse aortic constriction (TAC) surgery and in primary neonatal rat cardiomyocytes stimulated by phenylephrine (PE). In Tnip3-deficient mice, cardiac hypertrophy was aggravated after TAC surgery. Conversely, cardiac-specific Tnip3 transgenic (TG) mice showed a notable reversal of the same phenotype. Accordingly, TNIP3 alleviated PE-induced cardiomyocyte enlargement in vitro. Mechanistically, RNA-sequencing and interactome analysis were combined to identify the signal transducer and activator of transcription 1 (STAT1) as a potential target to clarify the molecular mechanism of TNIP3 in pathological cardiac hypertrophy. Via immunoprecipitation and Glutathione S-transferase assay, we found that TNIP3 could interact with STAT1 directly and suppress its degradation by suppressing K48-type ubiquitination in response to hypertrophic stimulation. Remarkably, preservation effect of TNIP3 on cardiac hypertrophy was blocked by STAT1 inhibitor Fludaradbine or STAT1 knockdown. Our study found that TNIP3 serves as a novel suppressor of pathological cardiac hypertrophy by promoting STAT1 stability, which suggests that TNIP3 could be a promising therapeutic target of pathological cardiac hypertrophy and heart failure.
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Affiliation(s)
- Hongjie Shi
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Yongjie Yu
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Dajun Li
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Kun Zhu
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Xu Cheng
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, 341000, Ganzhou, China
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Innovation and Translational Medicine Research Institute, 341000, Ganzhou, China
| | - Tengfei Ma
- Department of Neurosurgery, Huanggang Central Hospital, 438000, Huanggang, China
- Huanggang Institute of Translational Medicine, 438000, Huanggang, China
| | - Zhangqian Tao
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Ying Hong
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Zhen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, 430000, Wuhan, China
| | - Siyi Zhou
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Jianqing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, 430000, Wuhan, China
| | - Yun Chen
- Clinical trial centers, Huanggang Central Hospital, 438000, Huanggang, China
| | - Xiao-Jing Zhang
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China
| | - Peng Zhang
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China.
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China.
| | - Hongliang Li
- Taikang Medical School (School of Basic Medical Sciences), Wuhan University, 430000, Wuhan, China.
- Institute of Model Animal, Wuhan University, 430000, Wuhan, China.
- Gannan Innovation and Translational Medicine Research Institute, Gannan Medical University, 341000, Ganzhou, China.
- State Key Laboratory of New Drug Discovery and Development for Major Diseases, Gannan Innovation and Translational Medicine Research Institute, 341000, Ganzhou, China.
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El Sherbini A, Rosenson RS, Al Rifai M, Virk HUH, Wang Z, Virani S, Glicksberg BS, Lavie CJ, Krittanawong C. Artificial intelligence in preventive cardiology. Prog Cardiovasc Dis 2024; 84:76-89. [PMID: 38460897 DOI: 10.1016/j.pcad.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
Artificial intelligence (AI) is a field of study that strives to replicate aspects of human intelligence into machines. Preventive cardiology, a subspeciality of cardiovascular (CV) medicine, aims to target and mitigate known risk factors for CV disease (CVD). AI's integration into preventive cardiology may introduce novel treatment interventions and AI-centered clinician assistive tools to reduce the risk of CVD. AI's role in nutrition, weight loss, physical activity, sleep hygiene, blood pressure, dyslipidemia, smoking, alcohol, recreational drugs, and mental health has been investigated. AI has immense potential to be used for the screening, detection, and monitoring of the mentioned risk factors. However, the current literature must be supplemented with future clinical trials to evaluate the capabilities of AI interventions for preventive cardiology. This review discusses present examples, potentials, and limitations of AI's role for the primary and secondary prevention of CVD.
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Affiliation(s)
- Adham El Sherbini
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Hospital, Mount Sinai Heart, NY, United States of America
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Salim Virani
- Section of Cardiology, The Aga Khan University, Texas Heart Institute, Baylor College of Medicine, Houston, TX, United States of America
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, United States of America.
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Pedersen MW, Duch K, Lindgren FL, Lundgren NLO, Tayal B, Hagendorff A, Jensen GB, Biering-Sørensen T, Schnohr P, Møgelvang R, Høst N, Kragholm K, Andersen NH, Søgaard P. Aortic Root Dimension Using Transthoracic Echocardiography: Results from the Copenhagen City Heart Study. Am J Cardiol 2024; 218:86-93. [PMID: 38452843 DOI: 10.1016/j.amjcard.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.
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Affiliation(s)
- Maria W Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Filip L Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils L O Lundgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Non-invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Denmark; Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Nordsjællands Hospital, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Zelelew AN, Workie DL. Joint Modeling of Blood Pressure Measurements and Survival Time to Cardiovascular Disease Complication among Hypertension Patients Follow-up at DebreTabor Hospital, Ethiopia. Vasc Health Risk Manag 2023; 19:621-635. [PMID: 37753512 PMCID: PMC10518359 DOI: 10.2147/vhrm.s418568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypertension is also referred to as a silent killer and a leading factor for cardiovascular disease complication in the world today. This study aimed to identify the factors that affect longitudinal outcomes and survival time for cardiovascular disease complications among patients with hypertension. Methods A retrospective cohort study was conducted among a randomly selected sample of 178 outpatients with hypertension at the Debre Tabor Specialized Hospital between September 2017 and December 2019. Three different models were used to analyze the data: the bivariate mixed-effects model, Cox proportional hazard model, and bivariate joint model for longitudinal and survival sub-models linked by shared random effects. Results Bivariate mixed-effects and Cox proportional hazards survival sub-models were jointly preferred based on the minimum Akaike Information Criterion value. The estimated values of the association parameters were 0.0655 (p = 0.0270) and 0.963 (p = 0.0387), indicating that the association between systolic and diastolic blood pressure with time to event was guaranteed. The joint bivariate mixed-effects model analysis showed that patients with hypertension with a family history of hypertension and clinical stage II hypertension have a high chance of developing cardiovascular disease complications and have high average systolic and diastolic blood pressure compared to their counterparts. Patients with hypertension and diabetes have higher systolic and diastolic blood pressure than their counterparts. Conclusion Generally, systolic and diastolic blood pressure stabilized over the follow-up period of treatment, while sex and residence were statistically insignificant to the survival time of cardiovascular disease complication. Health professionals and concerned bodies should therefore focus on patients with comorbidities, older age, and poor adherence to hypertension control and cardiovascular disease complications using technology, such as text messaging, and mobile application to promote cardiovascular health at early stage. It is important to provide early interventions for these groups of people, especially for those with family history.
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Gu L, Liu X, Wu S, Chu K, Bao JJ. A cross-sectional study on the tea consumption effects of ankle-brachial index. Vascular 2023; 31:341-349. [PMID: 34957865 DOI: 10.1177/17085381211064745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This thesis aims to explore the relationship between tea consumption and ankle-brachial index (ABI) and further studies the relationship between tea consumption and lower extremity atherosclerosis. METHODS This is a cross-sectional, epidemiological survey of 17,373 subjects selected from the staff of Kailuan Group who had come to Kailuan General Hospital for a health examination from January 2016 to December 2017. Tea consumption was obtained by questionnaires. ABI was measured using an automated analyzer. The other data, such as age, gender, body mass index (BMI), and so on, was collected on the same day of the health examination results. The relationship between tea drinking habits and ABI was studied using logistic regression and multivariate linear regression analysis. RESULTS Among the 17,373 analyzed subjects, the difference in age, gender, BMI, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), C-reactive protein (CRP), fasting blood-glucose (Fbg), and ABI was statistically significant in the tea-drinking group and the nontea-drinking group (p < 0.05). Multiple logistic regression models revealed that tea consumption was a positive predictor for ABI (odds ratio (OR) = 0.782, confidence interval (CI), 0.615-0.994) (p < 0.05). Multivariate linear regression analysis of the ABI value showed that frequent tea-drinking has a positive correlation with the ABI value (p < 0.05). CONCLUSIONS The higher tea consumption is significantly associated with higher ABI which means less risk for lower extremity atherosclerosis.
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Affiliation(s)
- Lishuang Gu
- Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, 546663Capital Medical University, Beijing, China
| | - Xuemei Liu
- Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, 546663Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, 159361Kailuan General Hospital, Tangshan, China
| | - Kaiyun Chu
- Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, 546663Capital Medical University, Beijing, China
| | - Jing-Jing Bao
- Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, 546663Capital Medical University, Beijing, China
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Wang TD, Chiang CE, Chao TH, Cheng HM, Wu YW, Wu YJ, Lin YH, Chen MYC, Ueng KC, Chang WT, Lee YH, Wang YC, Chu PH, Chao TF, Kao HL, Hou CJY, Lin TH. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. ACTA CARDIOLOGICA SINICA 2022; 38:225-325. [PMID: 35673334 PMCID: PMC9121756 DOI: 10.6515/acs.202205_38(3).20220321a] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.
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Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Hao-Min Cheng
- School of Medicine, Institute of Public Health and Community Medicine Research Center, and Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yen-Hung Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Kwo-Chang Ueng
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yu-Chen Wang
- Division of Cardiology, Department of Medicine, Asia University Hospital
- Department of Medical Laboratory Science and Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Tzu-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Hsien-Li Kao
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine Kaohsiung Medical University Hospital
- Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hamo CE, Kwak L, Wang D, Florido R, Echouffo‐Tcheugui JB, Blumenthal RS, Loehr L, Matsushita K, Nambi V, Ballantyne CM, Selvin E, Folsom AR, Heiss G, Coresh J, Ndumele CE. Heart Failure Risk Associated With Severity of Modifiable Heart Failure Risk Factors: The ARIC Study. J Am Heart Assoc 2022; 11:e021583. [PMID: 35156388 PMCID: PMC9245814 DOI: 10.1161/jaha.121.021583] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Carine E. Hamo
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins UniversityBaltimoreMD
| | - Lucia Kwak
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Dan Wang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Roberta Florido
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins UniversityBaltimoreMD
| | - Justin B. Echouffo‐Tcheugui
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Division of Endocrinology, Diabetes & Metabolism, Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Roger S. Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins UniversityBaltimoreMD
| | - Laura Loehr
- Division of General Medicine and Clinical Epidemiology, UNC School of MedicineUniversity of North CarolinaChapel HillNC
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs HospitalHoustonTX
- Section of Cardiovascular Research, Center for Cardiometabolic Disease PreventionBaylor College of MedicineHoustonTX
| | - Christie M. Ballantyne
- Section of Cardiovascular Research, Center for Cardiometabolic Disease PreventionBaylor College of MedicineHoustonTX
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Aaron R. Folsom
- Division of Epidemiology & Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Gerardo Heiss
- Division of General Medicine and Clinical Epidemiology, UNC School of MedicineUniversity of North CarolinaChapel HillNC
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Chiadi E. Ndumele
- Ciccarone Center for the Prevention of Cardiovascular DiseaseDivision of CardiologyJohns Hopkins UniversityBaltimoreMD
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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9
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Ayele H, Banbeta A, Negash A. Cardiovascular Disease Risk Factors in Hypertensive Patients: A Case Study of Jimma University Medical Center. Health Serv Res Manag Epidemiol 2022; 9:23333928221078601. [PMID: 35187200 PMCID: PMC8848038 DOI: 10.1177/23333928221078601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases are a group of disorders of the heart and blood vessels. Globally an estimated 17.9 million people died from cardiovascular diseases, which covers 31% of all global deaths, and the three quarters taking place in developing countries. Hypertension is the major cause of cardiovascular diseases. Its influence is high with other risk factors. This study aimed to determine the major risk factors of cardiovascular disease among hypertensive patients at Jimma University Medical Center. Methods Using December to January 2017 hypertension-related report of Jimma University Medical Center (JUMC), a retrospective cohort study type was conducted on purposively selected 343 patients. Three nurses from JUMC participated in the data collection, and the data were fitted using the Cox-Proportional Hazard (Cox-PH) model. Results About 138 (40.23%) patients were experienced cardiovascular disease at 28 months median time. From the Cox-PH model, the hazard ratio and 95% CI of age (HR = 1.0495, 95% CI: 1.0250-1.0747), urban (HR = 2.1225, 95% CI: 1.3813-3.2613), diabetes mellitus (HR = 1.702, 95% CI: 1.0082-2.8731), proteinuria (HR = 1.8749, 95% CI: 1.2675-2.7734), two drug users (HR = 0.2533, 95% CI: 0.1376-0.4662), systolic blood pressure (HR = 1.0343, 95% CI: 1.0147-1.0542) and pulse rate (HR = 1.0111, 95% CI: 0.9933-1.0293). Conclusion The presence of proteinuria, diabetes mellitus, and being an urban resident had a great impact on the cardiovascular diseases of hypertensive patients.
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10
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Kim MS, Kim WJ, Khera AV, Kim JY, Yon DK, Lee SW, Shin JI, Won HH. Association between adiposity and cardiovascular outcomes: an umbrella review and meta-analysis of observational and Mendelian randomization studies. Eur Heart J 2021; 42:3388-3403. [PMID: 34333589 PMCID: PMC8423481 DOI: 10.1093/eurheartj/ehab454] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to investigate the causal relationship and evidence of an association between increased adiposity and the risk of incident cardiovascular disease (CVD) events or mortality. METHODS AND RESULTS Observational (informing association) and Mendelian randomization (MR) (informing causality) studies were assessed to gather mutually complementary insights and elucidate perplexing epidemiological relationships. Systematic reviews and meta-analyses of observational and MR studies that were published until January 2021 and evaluated the association between obesity-related indices and CVD risk were searched. Twelve systematic reviews with 53 meta-analyses results (including over 501 cohort studies) and 12 MR studies were included in the analysis. A body mass index (BMI) increase was associated with higher risks of coronary heart disease, heart failure, atrial fibrillation, all-cause stroke, haemorrhagic stroke, ischaemic stroke, hypertension, aortic valve stenosis, pulmonary embolism, and venous thrombo-embolism. The MR study results demonstrated a causal effect of obesity on all indices but stroke. The CVD risk increase for every 5 kg/m2 increase in BMI varied from 10% [relative risk (RR) 1.10; 95% confidence interval (CI) 1.01-1.21; certainty of evidence, low] for haemorrhagic stroke to 49% (RR 1.49; 95% CI 1.40-1.60; certainty of evidence, high) for hypertension. The all-cause and CVD-specific mortality risks increased with adiposity in cohorts, but the MR studies demonstrated no causal effect of adiposity on all-cause mortality. CONCLUSION High adiposity is associated with increased CVD risk despite divergent evidence gradients. Adiposity was a causal risk factor for CVD except all-cause mortality and stroke. Half (49%; 26/53) of the associations were supported by high-level evidence. The associations were consistent between sexes and across global regions. This study provides guidance on how to integrate evidence from observational (association) and genetics-driven (causation) studies accumulated to date, to enable a more reliable interpretation of epidemiological relationships.
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Affiliation(s)
- Min Seo Kim
- College of Medicine, Korea University, Seoul, Republic of Korea.,Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Irwon-ro 81, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Won Jun Kim
- College of Medicine, Korea University, Seoul, Republic of Korea.,Gangneung Prison Medical Department, Ministry of Justice, Republic of Korea
| | - Amit V Khera
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, College of Software Convergence, Sejong University, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong-Hee Won
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Irwon-ro 81, Gangnam-gu, Seoul 06351, Republic of Korea.,Samsung Genome Institute, Samsung Medical Center, Seoul, Republic of Korea
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11
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Kwak JH, Choi YH. Sex and body mass index dependent associations between serum 25-hydroxyvitamin D and pulse pressure in middle-aged and older US adults. Sci Rep 2021; 11:9989. [PMID: 33976245 PMCID: PMC8113426 DOI: 10.1038/s41598-021-88855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/12/2021] [Indexed: 02/03/2023] Open
Abstract
High pulse pressure (PP) is a valid indicator of arterial stiffness. Many studies have reported that vitamin D concentration is inversely associated with vascular stiffening. This association may differ depending on sex and body mass index (BMI). This study investigated the associations between vitamin D and PP and evaluated whether these associations differ according to sex and BMI, using data for individuals aged ≥ 50 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were used as biomarkers of vitamin D levels. High PP was defined as ≥ 60 mmHg. Total 25(OH)D concentrations were dose-dependently associated with lower odds ratios (ORs) for high PP (p-trend = 0.01), after controlling for sociodemographic, behavioral, and dietary factors. When stratified by sex, there was a dose-dependent association between total 25(OH)D concentrations and lower risk of high PP (p-trend < 0.001) in females, but not in males. When stratified by BMI, there was a dose-dependent association between total 25(OH)D concentrations and lower risk of high PP (p-trend < 0.001) in non-overweight subjects, but not in overweight subjects. Improving the vitamin D status could delay elevation of PP and vascular stiffening in female and non-overweight subjects.
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Affiliation(s)
- Jung Hyun Kwak
- grid.256155.00000 0004 0647 2973Department of Preventive Medicine, Gachon University College of Medicine, 155 Gaetbeol-ro, Yeonsu-gu, Incheon, 21999 Republic of Korea ,grid.255588.70000 0004 1798 4296Department of Food and Nutrition, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam, 13135 Republic of Korea
| | - Yoon-Hyeong Choi
- grid.256155.00000 0004 0647 2973Department of Preventive Medicine, Gachon University College of Medicine, 155 Gaetbeol-ro, Yeonsu-gu, Incheon, 21999 Republic of Korea ,Gachon Advanced Institute for Health Sciences and Technology, Incheon, Republic of Korea
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12
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Abstract
BACKGROUND Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings. OBJECTIVES To determine the effect of walking as a physical activity intervention on blood pressure and heart rate. SEARCH METHODS We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings. MAIN RESULTS A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times. AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.
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Affiliation(s)
- Ling-Ling Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Hualien County, Taiwan
| | | | | | | | - Michael C Watson
- School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Hui-Hsin Lin
- Medical Affairs Division, Hualien Armed Forces General Hospital, Hualien, Taiwan
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13
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Risk of fatal and nonfatal coronary heart disease and stroke events among adult patients with hypertension: basic Markov model inputs for evaluating cost-effectiveness of hypertension treatment: systematic review of cohort studies. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Objectives
Hypertension is a risk factor for a number of vascular and cardiac complications. A Markov like simulation based on cardiovascular disease (CVD) policy model is being used for evaluating cost-effectiveness of hypertension treatment. Stroke, angina, myocardial infarction (MI), cardiac arrest and all-cause mortality were only included CVD outcome variables in the model. Therefore this systematic review was conducted to evaluate completeness of CVD policy model for evaluation of cost-effectiveness across different regions.
Key findings
Fourteen cohort studies involving a total of 1 674 773 hypertensive adult population and 499 226 adults with treatment resistant hypertension were included in this systematic review. Hypertension is clearly associated with coronary heart disease (CHD) and stroke mortality, unstable angina, stable angina, MI, heart failure (HF), sudden cardiac death, transient ischemic attack, ischemic stroke, sub-arachnoid hemorrhage, intracranial hemorrhage, peripheral arterial disease (PAD), and abdominal aortic aneurism (AAA). Lifetime risk of developing HF is higher among hypertensives across all ages, with slight variation among regions. Treatment resistant hypertension is associated with higher relative risk of developing major CVD events and mortality when compared with the non-resistant hypertension.
Summary
The CVD policy model can be used in most of the regions for evaluation of cost-effectiveness of hypertension treatment. However, hypertension is highly associated with HF in Latin America, Eastern Europe, and Sub-Saharan Africa. Therefore, it is important to consider HF in CVD policy model for evaluating cost-effectiveness of hypertension treatment in these regions. We do not suggest the inclusion of PAD and AAA in CVD policy model for evaluating cost-effectiveness of hypertension treatment due to lack of sufficient evidence. Researchers should consider the effect of treatment resistant hypertension either through including in the basic model or during setting the model assumptions.
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14
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Cannabis and tramadol addiction: Do they imply additive risk for acute myocardial infarction in adults younger than 45 years? Anatol J Cardiol 2020; 24:316-325. [PMID: 33122481 PMCID: PMC7724384 DOI: 10.14744/anatoljcardiol.2020.67206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Acute myocardial infarction (AMI) is the main cause of cardiovascular events worldwide. AMI commonly occurs in elderly patients because of atherosclerotic process related to common risk factors. Consequently, the rupture of atheromatous plaque with deleterious sequela is the common etiology of the disease. However, there are less studied etiological factors in youth compared with the usual population. Therefore, this study aimed to examine the risk profile of Egyptian youth presenting with AMI. METHODS A study was conducted in 106 patients aged ≤45 years admitted with AMI in our university hospital to explore their clinical profile risk factors. RESULTS In the study, 71 (67%) and 35 (33%) patients presented with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Anterior wall MI was predominant in 49 patients (46.2%). Moreover, 93 patients (88%) were smokers, 31 (29.2%) used tramadol, 43 (40.6%) smoked cannabis, 50 (47.2%) had poor sleeping habits, 29 (27.4%) had high stress levels, 37 (34.9%) had hypertension, and 22 (20.8%) had diabetes. Twenty (18.9%) patients had a family history of premature coronary artery disease. High and low high-density lipoprotein (HDL) levels were observed in 20 (18.9%) and 47 (44.3%) patients, respectively. The left anterior descending artery (LAD) was involved in 56% of the studied population associated with tramadol use. A significant association was found between both tramadol use and cannabis smoking and presence of heavy thrombus burden on coronary angiography. CONCLUSION AMI in Egyptian youth was predominantly observed in men, with anterior STEMI as the most common presentation. Cannabis and tramadol addiction were high risk factors for AMI in Egyptian youth.
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15
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Lai S, Mangiulli M, Perrotta AM, Gigante A, Napoleoni L, Cipolloni E, Mitterhofer AP, Gasperini ML, Muscaritoli M, Cianci R, Giovannetti A, Falco F, Mastroluca D, Mazzaferro S. Cardiovascular Risk and Quality of Life in Autosomal Dominant Polycystic Kidney Disease Patients on Therapy With Tolvaptan: A Pilot Study. Curr Vasc Pharmacol 2020; 19:556-564. [PMID: 32957887 DOI: 10.2174/1570161118999200918094809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cardiovascular (CV) complications are the most frequent cause of morbidity and mortality in autosomal dominant polycystic kidney disease (ADPKD) patients. In 2017, the Italian Medicines Agency authorised tolvaptan, a vasopressin V2 receptor antagonist, for the treatment of ADPKD, based on the Tolvaptan Phase 3 Efficacy and Safety Study in ADPKD (TEMPO 3: 4), TEMPO 4: 4 and Replicating Evidence of Preserved Renal Function: An Investigation of Tolvaptan Safety and Efficacy (REPRISE) studies. AIM OF THE STUDY The aim of the study was to assess the impact of tolvaptan on CV risk and quality of life, evaluated by nutritional, inflammatory, metabolic, instrumental parameters and psychocognitive tests on ADPKD patients. METHODS AND MATERIALS We evaluated 36 patients with ADPKD; 10 patients (7 males, mean age 42.5±7.0 years) treated with tolvaptan and 26 controls (11 males, mean age 36.7±9.1 years). They underwent, at T0, monthly, and at T1 (1 year) clinical, laboratory and instrumental evaluation, in addition to psychocognitive tests. RESULTS In ADPKD patients treated with tolvaptan, we found at T1, a decrease in carotid intima-- media thickness (p=0.048), epicardial adipose tissue thickness (p=0.002), C-reactive protein (p=0.026), sympathovagal balance during night (p=0.045) and increased flow-mediated dilation (p=0.023) with a reduction in depression (Hamilton and Beck tests, p=0.008 and p=0.002, respectively) compared with controls. CONCLUSION These preliminary results suggest that treatment with tolvaptan could improve early atherosclerosis and endothelial dysfunction markers and improve mood in ADPKD patients (probably by acting on endothelial cell and adipocyte V2 receptors).
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Affiliation(s)
- Silvia Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Marco Mangiulli
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Adolfo M Perrotta
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ludovica Napoleoni
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Elena Cipolloni
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Anna P Mitterhofer
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Maria L Gasperini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Antonello Giovannetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabiana Falco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniela Mastroluca
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy
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Beaney T, Ster AC, Poulter NR, Xia X, Fageh H, Msalam O, Derbi HA, Osman AM, Aghilla M, Bettamer ZA, Fhail Alboum MO, Elsari OT, Elhemali EM, Zidan RA, Musbah A, Eltawell H, Ben Masaud HA. May Measurement Month 2018: an analysis of blood pressure screening in Libya. Eur Heart J Suppl 2020; 22:H77-H79. [PMID: 32884477 PMCID: PMC7456182 DOI: 10.1093/eurheartj/suaa011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Elevated blood pressure (BP) is an important public health concern and leads to several adverse cardiovascular outcomes. In the stepwise survey done in Libya by the Libyan Cardiac Society and National Centre for Disease Control in 2009, the percentage of hypertension was 40.6%. To raise awareness of high BP and to highlight the size of the problem and the need for screening. A cross-sectional opportunistic study included men and women aged ≥18 years. Blood pressure was measured three times and a questionnaire was completed. Hypertension was defined as BP ≥140/90 mmHg based on the mean of the 2nd and 3rd readings, or on antihypertensive treatment. Among 7279 participants, the mean age was 44.3 ± 14.8 years, 57.8% male, 2567 (35.3%) of the participants had hypertension of whom 63.4% were aware of having hypertension, 55.8% on medication, and of those on medication 50.9% had controlled BP. This survey identified a high proportion of individuals with high BP, which highlights the need for a more strategic approach to fighting hypertension.
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Affiliation(s)
- Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
- Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Hatem Fageh
- Cardiovascular Medicine Department, Tripoli University Hospital, Faculty of Medicine, Hypertension Working Group, Libyan Cardiac Society, Aeen Zarra, Alfornaj, Tripoli, Libya
| | - Omar Msalam
- Cardiovascular Medicine Department, Almostakbal Almoshrek Clinic, Prevention Working Group, Libyan Cardiac Society (LCS), Aeen Zarra, Alfornaj, Tripoli, Libya
| | - Hawa A Derbi
- Cardiology Department, Tripoli University Hospital, LCS, Aeen Zarra, Alfornaj, Tripoli, Libya
| | - Afaf M Osman
- Noncommunicable Disease Department, National Center for Disease Control (NCDC), Aeen Zarra, Tripoli, Libya
| | - Mohamed Aghilla
- Noncommunicable Disease Department, National Center for Disease Control (NCDC), Aeen Zarra, Tripoli, Libya
| | - Zaki A Bettamer
- Cardiology Department Libyan, International University, Aljamhouria Hospital, LCS, Benghazi, Libya
| | | | - Osama T Elsari
- Radiology Department, Zliten Teaching Hospital, Zliten, Libya
| | | | | | | | - Hazem Eltawell
- Noncommunicable Disease Department, National Center for Disease Control (NCDC), Aeen Zarra, Tripoli, Libya
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Sex-Specific Epidemiology of Heart Failure Risk and Mortality in Europe: Results From the BiomarCaRE Consortium. JACC-HEART FAILURE 2020; 7:204-213. [PMID: 30819375 DOI: 10.1016/j.jchf.2018.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study investigates differences between women and men in heart failure (HF) risk and mortality. BACKGROUND Sex differences in HF epidemiology are insufficiently understood. METHODS In 78,657 individuals (median 49.5 years of age; age range 24.1 to 98.7 years; 51.7% women) from community-based European studies (FINRISK, DanMONICA, Moli-sani, Northern Sweden) of the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium, the association between incident HF and mortality, the relationship of cardiovascular risk factors, prevalent cardiovascular diseases, biomarkers (C-reactive protein [CRP]; N-terminal pro-B-type natriuretic peptide [NT-proBNP]) with incident HF, and their attributable risks were tested in women vs. men. RESULTS Over a median follow-up of 12.7 years, fewer HF cases were observed in women (n = 2,399 [5.9%]) than in men (n = 2,771 [7.3%]). HF incidence increased markedly after 60 years of age, initially with a more rapid increase in men, whereas incidence in women exceeded that of men after 85 years of age. HF onset substantially increased mortality risk in both sexes. Multivariable-adjusted Cox models showed the following sex differences for the association with incident HF: systolic blood pressure hazard ratio (HR) according to SD in women of 1.09 (95% confidence interval [CI]: 1.05 to 1.14) versus HR of 1.19 (95% CI: 1.14 to 1.24) in men; heart rate HR of 0.98 (95% CI: 0.93 to 1.03) in women versus HR of 1.09 (95% CI: 1.04 to 1.13) in men; CRP HR of 1.10 (95% CI: 1.00 to 1.20) in women versus HR of 1.32 (95% CI: 1.24 to 1.41) in men; and NT-proBNP HR of 1.54 (95% CI: 1.37 to 1.74) in women versus HR of 1.89 (95% CI: 1.75 to 2.05) in men. Population-attributable risk of all risk factors combined was 59.0% in women and 62.9% in men. CONCLUSIONS Women had a lower risk for HF than men. Sex differences were seen for systolic blood pressure, heart rate, CRP, and NT-proBNP, with a lower HF risk in women.
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18
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Lai S, Mazzaferro S, Muscaritoli M, Mastroluca D, Testorio M, Perrotta A, Esposito Y, Carta M, Campagna L, Di Grado M, Ramaccini C, De Leo S, Galani A, Amabile MI, Molfino A. Prebiotic Therapy with Inulin Associated with Low Protein Diet in Chronic Kidney Disease Patients: Evaluation of Nutritional, Cardiovascular and Psychocognitive Parameters. Toxins (Basel) 2020; 12:toxins12060381. [PMID: 32526852 PMCID: PMC7354587 DOI: 10.3390/toxins12060381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
A relationship between dysbiotic gut microbiome and chronic kidney disease (CKD) has been recently documented; it contributes to CKD-related complications, including cardiovascular disease. Aim: We tested how a low-protein diet (LPD)-with or without oral inulin supplementation as a prebiotic-modulates some inflammatory, atherosclerosis and endothelial dysfunction indices and nutritional markers, as well as psychocognitive functions in CKD patients. We conducted a prospective, case-control study on CKD patients on conservative therapy, divided in two groups: the intervention group treated with LPD (0.6 g/kg/day) plus inulin (19 g/day) and a control group treated with LPD without inulin, for six consecutive months. Clinical and hematochemical parameters as well as instrumental, and psychocognitive assessments (by SF-36 survey and MMSE, HAM-D, BDI-II) were recorded in all the participants at baseline (T0), at three months (T1) and at six months (T2). A total of 41 patients were enrolled: 18 in the intervention group and 23 in the control group. At T2, in both groups, we observed a significant reduction of serum nitrogen and phosphorus (p ≤ 0.01) and serum uric acid (p ≤ 0.03), and an improvement in metabolic acidosis (bicarbonates, p ≤ 0.01; base excess, p ≤ 0.02). Moreover, at T2 the intervention group showed a reduction in serum insulin (p = 0.008) and fasting glucose levels (p = 0.022), HOMA-IR (p = 0.004), as well as lower total serum cholesterol (p = 0.012), triglycerides (p = 0.016), C-reactive protein (p = 0.044) and homocysteine (p = 0.044) and higher HDL (p < 0.001) with respect to baseline. We also observed a significant amelioration of some quality of life and functional status indices (SF-36 survey) among the intervention group compared to controls, without a significant improvement in the cognitive state (MMSE). On the other hand, an amelioration in mood (by HAM-D and BDI-II) was found in the intervention group and in controls (only by BID-II). In conclusion, LPD in association with oral inulin supplementation improved glycemic and lipid metabolism and ameliorated the systemic inflammatory state, likely reducing cardiovascular risk in CKD patients and this may represent a promising therapeutic option, also improving quality of life and mood.
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Affiliation(s)
- Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
- Correspondence: ; Tel.: +39-393-384094031; Fax: +390649972068
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Daniela Mastroluca
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Massimo Testorio
- Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Unit of Nephrology, Sapienza University of Rome, 00161 Rome, Italy;
| | - Adolfo Perrotta
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Ylenia Esposito
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Maria Carta
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Linda Campagna
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Marta Di Grado
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Cesarina Ramaccini
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Sabrina De Leo
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Maria Ida Amabile
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (M.M.); (D.M.); (A.P.); (Y.E.); (M.C.); (L.C.); (M.D.G.); (C.R.); (S.D.L.); (M.I.A.); (A.M.)
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Yeh CB, Tsai MC, Teng YH, Ku MS, Huang JY, Wang BY, Tai CL, Kornelius E, Ho SW. Association of alprazolam with major cardiovascular events in patients with hypertension. J Eval Clin Pract 2020; 26:983-991. [PMID: 31387138 DOI: 10.1111/jep.13254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE Anxiety is a mediator for emotional reactivity and acute blood pressure elevations, which are associated with an increased risk of cardiovascular death. Alprazolam is a common medication for anxiolysis. We hypothesized that alprazolam usage can reduce the risk of major adverse cardiovascular events (MACEs) in patients with hypertension. METHODS A retrospective cohort study was performed using datasets from Taiwanese Health and Welfare Data. Patients with hypertension were divided into exposed (Alprazolam-exposed) and control groups (non-Alprazolam-exposed) with 1:1 propensity score matching. The study endpoint was the occurrence of MACE. Adjusted hazard ratio (aHR) of MACE risk was estimated using the multiple Cox proportional hazard model. Age-stratified analysis was performed to evaluate the interaction of age and alprazolam use with MACEs. RESULTS The study cohort consisted of 335 517 alprazolam-exposed patients and 1:1 PSM controls. The mean age was 63.62 ± 12.71 years in the Alprazolam-exposed population. Alprazolam exposure was significantly associated with reduced risk of MACEs (aHR = 0.965, 95% CI = 0.954-0.977), including ischemic stroke (aHR = 0.958, 95% CI = 0.940-0.976), hemorrhagic stroke (aHR = 0.856, 95% CI = 0.821-0.892), myocardial infarction (aHR = 0.933, 95% CI = 0.900-0.968), sudden cardiac death (aHR = 0.955, 95% CI = 0.916-0.996), and all-cause mortality (aHR = 0.921, 95% CI = 0.909-0.932). In the age-subgroup analysis, alprazolam showed the greatest risk reduction effect in hemorrhagic stroke for patients aged <65 years (aHR = 0.779, 95% CI = 0.727-0.835). CONCLUSION Alprazolam usage in patients with hypertension was associated with a slightly reduced risk of MACEs and all-cause mortality, and up to 22% reduced risk of hemorrhagic stroke was observed in alprazolam users aged <65 years.
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Affiliation(s)
- Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Che Tsai
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ying-Hock Teng
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Min-Sho Ku
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bo-Yuan Wang
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Ling Tai
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Edy Kornelius
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sai-Wai Ho
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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Mefford MT, Goyal P, Howard G, Durant RW, Dunlap NE, Safford MM, Muntner P, Levitan EB. The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults. J Clin Hypertens (Greenwich) 2020; 22:857-866. [PMID: 32282123 PMCID: PMC7359908 DOI: 10.1111/jch.13856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 12/25/2022]
Abstract
Associations between hypertension and some cardiovascular diseases are stronger in black vs white adults. We examined associations of hypertension, hypertension duration, and control with incident heart failure (HF) in black and white REasons for Geographic And Racial Differences in Stroke study participants (n = 25 770) who were followed for incident HF hospitalization (n = 947) from enrollment in 2003-2007 through 2015. Hypertension was defined, using updated US guidelines, as systolic or diastolic blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use. Duration was assessed at baseline, and control was defined as treated BP < 130/80 mm Hg. Compared with no hypertension, hypertension was associated with higher risk of incident HF (HRwhites 1.90 [95% CI 1.49, 2.41], HRblacks 2.36 [95% CI 1.53, 3.65]), HF with preserved ejection fraction (HRwhites 2.01 [95% CI 1.34, 3.01], HRblacks 2.70 [95% CI 1.25, 2.53]), and HF with reduced/mid-range ejection fraction (HRwhites 1.69 [95% CI 1.23, 2.33], HRblacks 2.29 [95% CI 1.26, 4.15]). Hypertension duration <10 years and ≥10 years were associated with higher risk for incident HF compared with no hypertension. Although risk of incident HF was highest among participants with uncontrolled BP, even controlled BP vs no hypertension was associated with increased risk of HF (HRwhites 1.93 [95% CI 1.44, 2.58], HRblacks 2.01 [95% CI 1.22, 3.29]). Interactions with race were not statistically significant. The risk of HF associated with hypertension, even with shorter duration or controlled BP, suggests that both prevention and therapeutic management of hypertension are important in reducing HF risk.
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Affiliation(s)
| | | | | | | | | | | | - Paul Muntner
- University of Alabama at BirminghamBirminghamALUSA
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21
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Loehr LR, Soliman EZ, Poon AK, Couper D, Chen LY, Mosley TH, Wagenknecht LE, Whitsel EA, Alonso A, Wruck L, Heiss G. The prevalence of atrial fibrillation on 48-hour ambulatory electrocardiography in African Americans compared to Whites: The Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2019; 216:1-8. [PMID: 31352135 PMCID: PMC6842681 DOI: 10.1016/j.ahj.2019.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND A lower prevalence of atrial fibrillation (AF), but paradoxically higher burden of cardiovascular disease risk factors, has been observed among African Americans compared to Whites in studies of AF identified by mostly 12-lead electrocardiograms (ECGs) and clinically. METHODS We performed 48-hour ambulatory electrocardiography (aECG) in a biracial sample of 1,193 participants in the Atherosclerosis Risk in Communities (ARIC) (mean age = 78 years, 62% African Americans, 64% female). Atrial fibrillation was identified from aECG, study visit ECGs, and discharge codes from cohort hospitalizations. We used covariate-adjusted logistic regression to estimate prevalence odds ratios (ORs) for AF in African Americans versus Whites, with adjustment for sampling and nonresponse. RESULTS African Americans were more likely than Whites to have hypertension and diabetes but less likely to have coronary heart disease. The prevalence of AF detected by aECG or ARIC study ECG (adjusted for age and coronary heart disease) was lower in African Americans than Whites (2.7% vs 5.0%). White men had a higher (although not significant) AF prevalence of 7.8% compared to the other race and gender groups at 2.3%-2.8%. The adjusted OR for AF was 0.49 (0.24-0.99) comparing African Americans to Whites. Findings were similar when AF was defined to include prior AF hospitalizations (OR = 0.42, 0.25-0.72). There were no significant differences by race for asymptomatic or paroxysmal AF. CONCLUSIONS Atrial fibrillation was less prevalent in African American than white older adults, regardless of detection method. Although overall detection of new AF cases with aECG was low, future studies should consider longer-term monitoring to characterize AF by race.
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Affiliation(s)
- Laura R Loehr
- University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Anna K Poon
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Eric A Whitsel
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Lisa Wruck
- Duke Clinical Research Institute, Durham, NC
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Lai S, Petramala L, Muscaritoli M, Cianci R, Mazzaferro S, Mitterhofer AP, Pasquali M, D'Ambrosio V, Carta M, Ansuini M, Ramaccini C, Galani A, Amabile MI, Molfino A, Letizia C. α-lipoic acid in patients with autosomal dominant polycystic kidney disease. Nutrition 2019; 71:110594. [PMID: 31790890 DOI: 10.1016/j.nut.2019.110594] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease characterized by multiple and bilateral cystic dilation of renal tubules. Hypertension, endothelial dysfunction, systemic inflammation, and accelerated atherosclerosis are alterations found at a very early stage of the disease and are responsible for increasing both cardiovascular risks and progression toward end-stage renal disease. The aim of the study was to evaluate the effects of the use of 1.6 g α-lipoic acid (ALA) daily for 3 and 6 on the main markers of systemic inflammation, endothelial dysfunction, and atherosclerosis, as well as on nutritional, cardiovascular, and psychocognitive parameters, in ADPKD patients with CKD stage G2/G3 Kidney Disease Improving Global Outcomes chronic kidney disease (KDIGO) compared to controls. METHODS This was a controlled, longitudinal, prospective, interventional study with 59 patients with ADPKD. Of the patients, 33 were treated with ALA (1.6 g/d) for 6 mo and 26 were controls. Clinical, laboratory (inflammation and metabolic indexes), instrumental parameters (intima media thickness (IMT), renal resistive index (RRI), flow-mediated dilation (FMD), ankle-brachial index (ABI), and psycho-cognitive tests (Mini-Mental State Examination [MMSE], Hamilton Depression Rating Scale [HAM-D], Beck Depression Inventory-II [BDI-II]) were evaluated at baseline (T0), 3 mo (T1), and 6 mo (T2). RESULTS Patients treated with ALA at T1 and T2 showed a significant reduction in serum glucose, insulin, homeostatic model assessment-insulin resistance, and serum uric acid (P = 0.013, P = 0.002, P = 0.002, P <0.001; respectively) and significantly higher values of base excess (P < 0.001), compared with the control group. Moreover, the results showed a significant increase in bicarbonates (P = 0.009) and FMD (P < 0.001), and a significant reduction of C-reactive protein (P <0.001) and RRI (P = 0.013). On the other hand, we did not assess a significant difference in IMT and ABI at T1 and T2. Psychocognitive tests (BDI-II, HAM-D, and MMSE) were significantly improved (P = 0.007, P < 0.001, P < 0.001; respectively) in patients treated with ALA for 6 mo compared with the control group. A significant difference in nicotinamide adenine dinucleotide phosphate oxidase 2 concentrations was observed between T0 and T2 only in ADPKD patients treated with ALA (P = 0.039, P = 0.039; respectively), although we did not find a significant difference in interleukin-6, interleukin -1β, and tumor necrosis factor-α concentrations in either group. CONCLUSIONS We suggest an early and careful monitoring of traditional and non-traditional cardiovascular risk factors in patients with ADPKD. Moreover, we suggest the use of ALA, an anti-inflammatory and antioxidant nutraceutical with few side effects. Additionally, it is important to evaluate the cognitive abilities, psychological health, and quality of life of patients with ADPKD, especially at the early stage of disease.
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Affiliation(s)
- Silvia Lai
- Department of Translational and Precision Medicine, Unit of Nephrology and Dialysis, Sapienza University of Rome, Italy.
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Secondary Hypertension Unit, Sapienza University of Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Unit of Nephrology and Dialysis, Sapienza University of Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Unit of Nephrology and Dialysis, Sapienza University of Rome, Italy
| | - Anna Paola Mitterhofer
- Department of Translational and Precision Medicine, Unit of Nephrology and Dialysis, Sapienza University of Rome, Italy
| | - Marzia Pasquali
- Unit of Nephrology and Dialysis, University Hospital, Policlinico Umberto I, Rome, Italy
| | - Viola D'Ambrosio
- Department of Translational and Precision Medicine, Unit of Nephrology and Dialysis, Sapienza University of Rome, Italy
| | - Maria Carta
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Matteo Ansuini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Cesarina Ramaccini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Ida Amabile
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Claudio Letizia
- Department of Translational and Precision Medicine, Secondary Hypertension Unit, Sapienza University of Rome, Italy
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Linalyl acetate prevents three related factors of vascular damage in COPD-like and hypertensive rats. Life Sci 2019; 232:116608. [DOI: 10.1016/j.lfs.2019.116608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
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24
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Ozoemena EL, Iweama CN, Agbaje OS, Umoke PCI, Ene OC, Ofili PC, Agu BN, Orisa CU, Agu M, Anthony E. Effects of a health education intervention on hypertension-related knowledge, prevention and self-care practices in Nigerian retirees: a quasi-experimental study. Arch Public Health 2019; 77:23. [PMID: 31143446 PMCID: PMC6532220 DOI: 10.1186/s13690-019-0349-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Education is vital to increasing knowledge, improving prevention and self-care practices for hypertension in older adults. This study aimed to determine the effectiveness of a health education intervention in improving hypertension (HT) knowledge, prevention and self-care practices among retirees in Enugu State, South-east, Nigeria. METHODS In this quasi-experimental study, we enrolled 400 participants in Enugu and Nsukka cities in Enugu State, south-east Nigeria. Participants were assigned to the treatment and control groups. Participants in the intervention/treatment group (T-group) received the intervention provided by public health experts and nurses and participants in the control group (C-group) received health talk without the intervention. Data collected at baseline (before intervention), 16 weeks (4th month) and follow-up (5th month) included demographic variables, knowledge about hypertension, prevention and self-care practices. We used paired samples t-test, Chi-square test and one-way ANOVA repeated measures for data analyses. RESULTS The mean age of the participants was 65.9 (± 8.9) years, the mean SBP and DBP were 136.5 (± 13.3) and 87.9 (± 9.1) respectively. More than half of the participants were (50.3%) were males, and the mean BMI was 23.9 (± 5.1) kg/m2. The paired comparison analysis showed that the mean HT knowledge score significantly increased in the T-group between baseline and 1 month (4th month) post-intervention compared to those in the C-group (P < 0.0001). Also, PA (P = 0.007), sleep pattern and quality (P = 0.003), substance use abstinence (P = 0.000), healthy diet (P = 0.000), and medication adherence (P = 0.000) improved significantly in the T-group compared to the control between baseline and 1 month after intervention. The repeated measures analyses showed statistically significant effects (between-groups analysis) for all outcomes with small to large effect sizes. Similarly, the repeated measures ANOVA analyses showed significant time-by-group interaction effects (within-groups) for all the outcomes with small to large effect sizes. CONCLUSION Community-based health education intervention targeted at older adults can increase HT knowledge, improve prevention and self-care practices of hypertension at the population level.
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Affiliation(s)
- Eyuche L. Ozoemena
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Cylia N. Iweama
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Olaoluwa S. Agbaje
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Prince C. I. Umoke
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Osmond C. Ene
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Perpetua C. Ofili
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Benedicta N. Agu
- Department of Public Health, Faculty of Health Sciences, Madonna University Elele, Port Harcourt, Rivers State Nigeria
| | - Charity U. Orisa
- Department of Human Kinetics, Health and Safety Education, Ignatius Ajuru University of Education, Port Harcourt, Rivers State Nigeria
| | - Michael Agu
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Enejoh Anthony
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Enugu State, Nigeria
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Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019; 16:410-417. [PMID: 30846114 DOI: 10.1016/j.jsxm.2019.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Tighter blood pressure control is widely thought to be associated with better erectile function, although the preponderance of data is limited to dichotomous representations of hypertension without an attempt to look at degree of blood pressure control. AIM To determine the association between optimal blood pressure control over time and the development of erectile dysfunction (ED) in a cohort of potent men. METHODS We performed a retrospective cohort study of newly diagnosed hypertensive men without major medical comorbidities in an integrated healthcare system. Patients were stratified by exposure to hypertension, with varying levels of blood pressure control, as measured by ordinal categories of systolic blood pressure and deviation from the mean systolic pressure. MAIN OUTCOME MEASURES Incidence of ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health records within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnosis of ED and 2 filled prescriptions for ED medications. RESULTS We identified 39,320 newly diagnosed hypertensive men. The overall incidence for ED was 13.9%, with a mean follow-up of 55.1 ± 28.7 months. Higher average systolic blood pressure was associated with a higher risk of ED in a dose-dependent manner (trend test, P < .001). Wide variation in blood pressure control was associated with a higher incidence of ED (OR [95% CI]; 1.359 [1.258-1.469]) and a shorter time to the development of ED (log rank, P < .0001). CLINICAL IMPLICATIONS We believe these data may serve as a motivator for hypertensive men to better adhere to their hypertension treatment regimen. STRENGTH & LIMITATIONS The retrospective nature of our study precludes us from drawing more than an association between tighter blood pressure control and ED. Strengths of our study include the large sample size, community cohort, and completeness of follow-up. CONCLUSION Among adults diagnosed with hypertension, tighter blood pressure control, as measured by average systolic blood pressure and deviation from the average, is associated with a lower incidence and a longer time to the development of ED. Hsiao W, Bertsch RA, Hung Y-Y, et al. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med 2019;16:410-417.
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Hashimoto Y, Kaji A, Sakai R, Hamaguchi M, Okada H, Ushigome E, Asano M, Yamazaki M, Fukui M. Sarcopenia is associated with blood pressure variability in older patients with type 2 diabetes: A cross-sectional study of the KAMOGAWA-DM cohort study. Geriatr Gerontol Int 2018; 18:1345-1349. [DOI: 10.1111/ggi.13487] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/30/2018] [Accepted: 06/15/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Ayumi Kaji
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Ryosuke Sakai
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
- Department of Diabetology; Kameoka Municipal Hospital; Kameoka Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
- Department of Diabetology and Endocrinology; Matsushita Memorial Hospital; Kadoma Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism; Kyoto Prefectural University of Medicine, Graduate School of Medical Science; Kyoto Japan
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Escobedo J, Paz-Aragón E, Vega-Rodríguez LH, Benítez Sanfeliz MA, Estrada-Rodríguez H, González-Figueroa E, Liceaga-Craviotto MG, Gutiérrez-Cuevas J, Valladares-Salgado A, Cruz M. The Methylenetetrahydrofolate Reductase C677T (rs1801133) and Apolipoprotein A5-1131T>C (rs662799) Polymorphisms, and Anemia Are Independent Risk Factors for Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:1357-1362. [PMID: PMID: 29398535 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although there is adequate knowledge as to the role of traditional cardiovascular risk factors on stroke incidence, knowledge of other risk factors, particularly genetic ones, is still incomplete. METHODS To assess the participation of some polymorphisms, along with other modifiable risk factors, a case-control study was conducted. A total of 253 cases were identified in the emergency room of a general regional hospital, with a clinical trait of stroke confirmed by a skull computerized axial tomography scan. In the surgery ward, 253 controls were identified, gender and age (±5 years) matched. Biochemical parameters were measured, and 4 polymorphisms were genotyped by polymerase chain reaction, rs1801133 (methylenetetrahydrofolate reductase [MTHFR]), rs1498373 (dimethylarginine dimethylaminohydrolase type 1 [DDAH1]), rs662799 (apolipoprotein A5 [APOA5]), and rs1799983 (endothelial nitric oxide). Odds ratios were estimated to assess the strength of association, with 95% confidence intervals, both in a matched case-control analysis and in a conditional regression analysis. RESULTS Cases had higher mean blood pressure and triglycerides and lower hemoglobin levels. Heterozygous and homozygous subjects to the rs1801133 variant of the MTHFR gene had a 3-fold higher risk of stroke. In the dominant model, those with the polymorphism rs662799 of the promoter region for APOA5 had twice the risk of stroke. Anemia increased the risk of stroke 4-fold. CONCLUSIONS Polymorphisms of the genes MTHFR (rs1801133) and APOA5 (rs662799), as well as anemia, are independent risk factors for stroke in Mexicans, together with traditional cardiovascular risk factors such as high triglycerides and high blood pressure.
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Affiliation(s)
- Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; Internal Medicine Department, Hospital General Regional No. 1. IMSS, Mexico City, Mexico.
| | - Emmanuel Paz-Aragón
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; Internal Medicine Department, Hospital General Regional No. 1. IMSS, Mexico City, Mexico
| | - Luz Helena Vega-Rodríguez
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; Internal Medicine Department, Hospital General Regional No. 1. IMSS, Mexico City, Mexico
| | - Miguel Alejandro Benítez Sanfeliz
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; Internal Medicine Department, Hospital General Regional No. 1. IMSS, Mexico City, Mexico
| | - Humberto Estrada-Rodríguez
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico; Internal Medicine Department, Hospital General Regional No. 1. IMSS, Mexico City, Mexico
| | - Evangelina González-Figueroa
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Jorge Gutiérrez-Cuevas
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Adán Valladares-Salgado
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Mahajan H, Choo J, Masaki K, Fujiyoshi A, Guo J, Hisamatsu T, Evans R, Shangguan S, Willcox B, Okamura T, Vishnu A, Barinas-Mitchell E, Ahuja V, Miura K, Kuller L, Shin C, Ueshima H, Sekikawa A. Association of alcohol consumption and aortic calcification in healthy men aged 40-49 years for the ERA JUMP Study. Atherosclerosis 2018; 268:84-91. [PMID: 29195109 PMCID: PMC5869702 DOI: 10.1016/j.atherosclerosis.2017.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Several studies have reported a significant inverse association of light to moderate alcohol consumption with coronary heart disease (CHD). However, studies assessing the relationship between alcohol consumption and atherosclerosis have reported inconsistent results. The current study was conducted to determine the relationship between alcohol consumption and aortic calcification. METHODS We addressed the research question using data from the population-based ERA-JUMP Study, comprising of 1006 healthy men aged 40-49 years, without clinical cardiovascular diseases, from four race/ethnicities: 301 Whites, 103 African American, 292 Japanese American, and 310 Japanese in Japan. Aortic calcification was assessed by electron-beam computed tomography and quantified using the Agatston method. Alcohol consumption was categorized into four groups: 0 (non-drinkers), ≤1 (light drinkers), >1 to ≤3 (moderate drinkers) and >3 drinks per day (heavy drinkers) (1 drink = 12.5 g of ethanol). Tobit conditional regression and ordinal logistic regression were used to investigate the association of alcohol consumption with aortic calcification after adjusting for cardiovascular risk factors and potential confounders. RESULTS The study participants consisted of 25.6% nondrinkers, 35.3% light drinkers, 23.5% moderate drinkers, and 15.6% heavy drinkers. Heavy drinkers [Tobit ratio (95% CI) = 2.34 (1.10, 4.97); odds ratio (95% CI) = 1.67 (1.11, 2.52)] had significantly higher expected aortic calcification score compared to nondrinkers, after adjusting for socio-demographic and confounding variables. There was no significant interaction between alcohol consumption and race/ethnicity on aortic calcification. CONCLUSIONS Our findings suggest that heavy alcohol consumption may be an independent risk factor for atherosclerosis.
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Affiliation(s)
- Hemant Mahajan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA.
| | - Jina Choo
- Department of Nursing, College of Nursing, Korea University, Seoul, South Korea
| | - Kamal Masaki
- Department of Research, Kuakini Medical Center, and Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Jingchuan Guo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Takashi Hisamatsu
- Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Rhobert Evans
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Siyi Shangguan
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bradley Willcox
- Department of Research, Kuakini Medical Center, and Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Abhishek Vishnu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Vasudha Ahuja
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Lewis Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Chol Shin
- Sleep and Critical Care Medicine, Department of Internal Medicine, Korea, University Ansan Hospital, Ansan, South Korea
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Akira Sekikawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
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Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018; 6:51-59. [PMID: 29129576 PMCID: PMC5953512 DOI: 10.1016/s2213-8587(17)30367-4] [Citation(s) in RCA: 399] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mineralocorticoid receptor (MR) antagonists are the recommended medical therapy for primary aldosteronism. Whether this recommendation effectively reduces cardiometabolic risk is not well understood. We aimed to investigate the risk of incident cardiovascular events in patients with primary aldosteronism treated with MR antagonists compared with patients with essential hypertension. METHODS We did a cohort study using patients from a research registry from Brigham and Women's Hospital, Massachusetts General Hospital, and their affiliated partner hospitals. We identified patients with primary aldosteronism using International Classification of Disease, 9th and 10th Revision codes, who were assessed between the years 1991-2016 and were at least 18 years of age. We excluded patients who underwent surgical adrenalectomy, had a previous cardiovascular event, were not treated with MR antagonists, or had no follow-up visits after study entry. From the same registry, we identified a population with essential hypertension that was frequency matched by decade of age at study entry. We extracted patient cohort data and collated it into a de-identified database. The primary outcome was an incident cardiovascular event, defined as a composite of incident myocardial infarction or coronary revascularisation, hospital admission with congestive heart failure, or stroke, which was assessed using adjusted Cox regression models. Secondary outcomes were the individual components of the composite cardiovascular outcome, as well as incident atrial fibrillation, incident diabetes, and death. FINDINGS We identified 602 eligible patients with primary aldosteronism treated with MR antagonists and 41 853 age-matched patients with essential hypertension from the registry. The two groups of patients had comparable cardiovascular risk profiles and blood pressure throughout the study. The incidence of cardiovascular events was higher in patients with primary aldosteronism on MR antagonists than in patients with essential hypertension (56·3 [95% CI 48·8-64·7] vs 26·6 [26·1-27·2] events per 1000 person-years, adjusted hazard ratio 1·91 [95% CI 1·63-2·25]; adjusted 10-year cumulative incidence difference 14·1 [95% CI 10·1-18·0] excess events per 100 people). Patients with primary aldosteronism also had higher adjusted risks for incident mortality (hazard ratio [HR] 1·34 [95% CI 1·06-1·71]), diabetes (1·26 [1·01-1·57]), and atrial fibrillation (1·93 [1·54-2·42]). Compared with essential hypertension, the excess risk for cardiovascular events and mortality was limited to patients with primary aldosteronism whose renin activity remained suppressed (<1 μg/L per h) on MR antagonists (adjusted HR [2·83 [95% CI 2·11-3·80], and 1·79 [1·14-2·80], respectively) whereas patients who were treated with higher MR antagonist doses and had unsuppressed renin (≥1 μg/L per h) had no significant excess risk. INTERPRETATION The current practice of MR antagonist therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension. Titration of MR antagonist therapy to raise renin might mitigate this excess risk. FUNDING US National Institutes of Health.
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Affiliation(s)
- Gregory L Hundemer
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary C Curhan
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicholas Yozamp
- Department of Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Ko MJ, Jo AJ, Park CM, Kim HJ, Kim YJ, Park DW. Level of Blood Pressure Control and Cardiovascular Events: SPRINT Criteria Versus the 2014 Hypertension Recommendations. J Am Coll Cardiol 2017; 67:2821-31. [PMID: 27311520 DOI: 10.1016/j.jacc.2016.03.572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood pressure (BP) targets from the SPRINT (Systolic Blood Pressure Intervention Trial) differ from targets of the 2014 hypertension (HTN) recommendations of the Eighth Joint National Committee. OBJECTIVES The goal of this study was to estimate the proportion of hypertensive adults with who would meet BP goals under the SPRINT criteria and under the 2014 recommendations, and to determine related effects on cardiovascular morbidity and mortality. METHODS We used data from the Korean National Health and Nutrition Examination Survey of 2008 to 2013 (n = 13,346), as well as the Korean National Health Insurance Service health examinee cohort of 2007 (n = 67,965), to estimate the proportion of subjects meeting BP goals of each of the criteria. Using data from the Korean National Health Insurance Service health examinee cohort of 2007 (n = 67,965), we compared risks of major cardiovascular events (composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) associated with different BP control goals. RESULTS A substantially lower proportion of hypertensive adults met BP goals of the SPRINT criteria compared with the 2014 recommendations (11.9% vs. 70.8%, respectively). Ten-year predicted cardiovascular risks were lowest in the intensive control group (below SPRINT BP goals), intermediate in the less-intensive group (above SPRINT goals but below 2014 recommendation goals), and highest in the uncontrolled group (above 2014 recommendations) (6.15%, 7.65%, and 9.39%, respectively; p < 0.001). After multivariable adjustment, the less-intensive and uncontrolled groups had a greater risk of major cardiovascular events (hazard ratios 1.17 and 1.62, respectively; p value for trend, <0.001) than the intensive group. CONCLUSIONS Substantially fewer hypertensive adults would meet SPRINT BP goals than would meet 2014 recommendation goals. Stricter BP control is associated with a decreased risk of major cardiovascular events.
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Affiliation(s)
- Min Jung Ko
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Ae Jung Jo
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Chan Mi Park
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hyo Jeong Kim
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Yun Jung Kim
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine and National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
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Hardy ST, Holliday KM, Chakladar S, Engeda JC, Allen NB, Heiss G, Lloyd-Jones DM, Schreiner PJ, Shay CM, Lin D, Zeng D, Avery CL. Heterogeneity in Blood Pressure Transitions Over the Life Course: Age-Specific Emergence of Racial/Ethnic and Sex Disparities in the United States. JAMA Cardiol 2017; 2:653-661. [PMID: 28423153 PMCID: PMC5634332 DOI: 10.1001/jamacardio.2017.0652] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Many studies have assessed racial/ethnic and sex disparities in the prevalence of elevated blood pressure (BP) from childhood to adulthood, yet few have examined differences in age-specific transitions between categories of BP over the life course in contemporary, multiracial/multiethnic populations. Objective To estimate age, racial/ethnic, and sex-specific annual net transition probabilities between categories of BP using Markov modeling of cross-sectional data from the National Health and Nutrition Examination Survey. Design, Setting, and Participants National probability sample (National Health and Nutrition Examination Survey in 2007-2008, 2009-2010, and 2011-2012) of 17 747 African American, white American, and Mexican American participants aged 8 to 80 years. The data were analyzed from September 2014 to November 2015. Main Outcomes and Measures Age-specific American Heart Association-defined BP categories. Results Three National Health and Nutrition Examination Survey cross-sectional samples were used to characterize the ages at which self-reported African American (n = 4973), white American (n = 8886), and Mexican American (n = 3888) populations transitioned between ideal BP, prehypertension, and hypertension across the life course. At age 8 years, disparities in the prevalence of ideal BP were observed, with the prevalence being lower among boys (86.6%-88.8%) compared with girls (93.0%-96.3%). From ages 8 to 30 years, annual net transition probabilities from ideal to prehypertension among male individuals were more than 2 times the net transition probabilities of their female counterparts. The largest net transition probabilities for ages 8 to 30 years occurred in African American young men, among whom a net 2.9% (95% CI, 2.3%-3.4%) of those with ideal BP transitioned to prehypertension 1 year later. Mexican American young women aged 8 to 30 years experienced the lowest ideal to prehypertension net transition probabilities (0.6%; 95% CI, 0.3%-0.8%). After age 40 years, ideal to prehypertension net transition probabilities stabilized or decreased (range, 3.0%-4.5%) for men, whereas net transition probabilities for women increased rapidly (range, 2.6%-13.0%). Mexican American women exhibited the largest ideal to prehypertension net transition probabilities after age 60 years. The largest prehypertension to hypertension net transition probabilities occurred at young ages in boys of white race/ethnicity and African Americans, approximately age 8 years and age 25 years, respectively, while net transition probabilities for white women and Mexican Americans increased over the life course. Conclusions and Relevance Heterogeneity in net transition probabilities from ideal BP emerge during childhood, with associated rapid declines in ideal BP observed in boys and African Americans, thus introducing disparities. Primordial prevention beginning in childhood and into early adulthood is necessary to preempt the development of prehypertension and hypertension, as well as associated racial/ethnic and sex disparities.
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Affiliation(s)
- Shakia T Hardy
- Department of Epidemiology, The University of North Carolina at Chapel Hill
| | - Katelyn M Holliday
- Department of Epidemiology, The University of North Carolina at Chapel Hill
| | - Sujatro Chakladar
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Joseph C Engeda
- Department of Epidemiology, The University of North Carolina at Chapel Hill
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Gerardo Heiss
- Department of Epidemiology, The University of North Carolina at Chapel Hill
| | | | - Pamela J Schreiner
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Christina M Shay
- Department of Nutrition, The University of North Carolina at Chapel Hill
| | - Danyu Lin
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Donglin Zeng
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Christy L Avery
- Department of Epidemiology, The University of North Carolina at Chapel Hill
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6120] [Impact Index Per Article: 874.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cho EY, Myoung C, Park HS, Kim AJ, Ro H, Chang JH, Lee HH, Chung W, Jung JY. Efficacy of Statin Treatment in Early-Stage Chronic Kidney Disease. PLoS One 2017; 12:e0170017. [PMID: 28081262 PMCID: PMC5231363 DOI: 10.1371/journal.pone.0170017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022] Open
Abstract
Chronic kidney disease (CKD) represents a major medical challenge and frequently coexists with cardiovascular disease (CVD), which can be treated by statin trerapy. However, whether statin treatment affects renal progression and outcomes in CKD patients remains unclear. We retrospectively reviewed CKD patients at Gachon University Gil Medical Center from 2003–2013. From a total of 14,497 CKD patients, 858 statin users were paired with non-users and analyze with propensity score matching was performed. The outcomes of this study were creatinine doubling, renal death, all-cause mortality, and interactive factors for composite outcomes. Statins were prescribed to 13.5% of the study subjects. Hazard ratios (HRs) [95% confidence intervals (CIs)] for statin treatment for the doubling of serum creatinine levels were significant only in CKD patients with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, and were 0.744 (0.635–0.873) in the unmatched cohort and 0.767 (0.596–0.986) in the matched cohort. In analyses of secondary outcomes, the HRs (95% CIs) for all-cause mortality were 0.655 (0.502–0.855) in the unmatched cohort and 0.537 (0.297–0.973) in the matched cohort. The HRs (95% CIs) for statin therapy for composite outcomes among patients with and without an eGFR ≥30 mL/min/1.73 m2 were 0.764 (0.613–0.952) and 1.232 (0.894–1.697), respectively (P for interaction, 0.017). Thus, statin treatment may have beneficial effects on renal progression and all-cause mortality only for the patients with early- stage CKD.
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Affiliation(s)
- Eun Yeong Cho
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Chana Myoung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Hong-suk Park
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
| | - Ae Jin Kim
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Han Ro
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Jae Hyun Chang
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Hyun Hee Lee
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Wookyung Chung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University of Gil Medical Center, Incheon, Republic of Korea
- Division of Nephrology, Department of Internal Medicine Gachon University School of Medicine, Incheon, Republic of Korea
- * E-mail:
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Kilic M, Uzunçakmak T, Ede H. The effect of knowledge about hypertension on the control of high blood pressure. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3740] [Impact Index Per Article: 415.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW Hypertension is the eminent risk factor for renal and cardiovascular disease (CVD). Its management is a topic of public health priority. As either too high or too low blood pressure (BP) levels can have detrimental effects on health, optimal targets for BP continue to be controversial. The current manuscript will review relevant data published over the last year that add to this topic of controversy. RECENT FINDINGS Recent studies confirm increased CVD-related risk with increasing SBP levels more than 140 mmHg among patients with hypertension and CVD as well as those over the age of 60 years. A SBP target less than 140 mmHg conveyed lessened risk of CVD-related events. There is some evidence suggesting that the ideal BP target lies between 120 and 140 mmHg. SUMMARY Recent data support a target SBP of less than 140 mmHg among patients with hypertension or CVD, and achievement of this target might benefit those older than 60 years of age as well. Treating to SBPs below 120 mmHg may not result in further benefit. Data from randomized controlled trials specifically addressing the question whether lower BPs are associated with better outcomes are needed to further define ideal BP-target goals.
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