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Andersson C, Schou M, Schwartz B, Vasan RS, Christiansen MN, D'Souza M, Weeke P, Køber L, Christensen AH, Gislason GH, Torp-Pedersen C. Incidence rates of dilated cardiomyopathy in adult first-degree relatives versus matched controls. IJC HEART & VASCULATURE 2022; 41:101065. [PMID: 35663623 PMCID: PMC9160477 DOI: 10.1016/j.ijcha.2022.101065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 12/20/2022]
Abstract
Background The incidence rates and importance of traditional risk factors in dilated cardiomyopathy among first-degree relatives are unknown. Methods and Results We identified all probands with dilated cardiomyopathy (n = 13,714, mean age at diagnosis 63 years) from the Danish nationwide registries between 1994 and 2017. Incidence rates among first-degree relatives (n = 29,671, mean age 38 years) and for up to 10 age- and sex-matched controls were calculated. Totally 233 (0.8%) first-degree relatives and 285 (0.1%) controls developed dilated cardiomyopathy during a median follow-up of 8.2 (Q1-Q3 4.4-13.3) years. Incidence rates (per 100,000 person-years) were 86.4 (95% confidence interval 73.9-101.0) and 111.1 (79.4-128.7) for first-degree relatives aged < 50 and ≥ 50 years, respectively, versus 7.5 (6.4-8.9) and 19.7 (16.8-23.2) for controls. Atrial fibrillation, diabetes, ischemic heart disease, and hypertension were associated with increased risks of developing dilated cardiomyopathy both in first-degree relatives and controls. Population attributable fractions for the 4 risk factors were 27.7% for first-degree relatives and 37.3% for controls aged < 50 years, and 46.4% versus 58.4% for first-degree relatives and controls among people aged ≥ 50 years, respectively. Conclusions The absolute incidence rates of dilated cardiomyopathy in first-degree relatives to patients with dilated cardiomyopathy were low, but significantly higher than in matched controls and elevated by the presence of additional risk factors, especially atrial fibrillation. Additional investigations are warranted to assess whether aggressive treatment of risk factors translates into a reduction of dilated cardiomyopathy in first-degree relatives.
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Affiliation(s)
- Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark,Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA,Corresponding author at: Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, 73 East Concord Street, cardiovascular section, 7th floor, Boston 02118, MA, USA.
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Brian Schwartz
- Department of Medicine, Section of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Ramachandran S. Vasan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA,Section of Preventive Medicine, Evans Department of Medicine, Boston University School of Medicine, Boston, MA, USA,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Maria D'Souza
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
| | - Peter Weeke
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex H. Christensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Gunnar H. Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark,The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Affiliation(s)
- Chuyan Long
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Xiao Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Qinmei Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - YuHao Su
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University
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Robertson J, Schaufelberger M, Lindgren M, Adiels M, Schiöler L, Torén K, McMurray J, Sattar N, Åberg M, Rosengren A. Higher Body Mass Index in Adolescence Predicts Cardiomyopathy Risk in Midlife. Circulation 2019; 140:117-125. [PMID: 31132859 PMCID: PMC6635044 DOI: 10.1161/circulationaha.118.039132] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Modifiable lifestyle factors in relation to risk for cardiomyopathy, a common and increasing cause of heart failure in the young, have not been widely studied. We sought to investigate a potential link between obesity, a recognized predictor of early heart failure, in adolescence and being diagnosed with cardiomyopathy in adulthood. Methods: This was a nationwide register-based prospective cohort study of 1 668 893 adolescent men (mean age, 18.3 years; SD, 0.7 years) who enlisted for compulsory military service from 1969 to 2005. At baseline, body mass index (BMI), blood pressure, and medical disorders were registered, along with test results for fitness and muscle strength. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register during an up to 46-year follow-up and divided into categories: dilated, hypertrophic, alcohol/drug-induced, and other. Hazard ratios were calculated with Cox proportional hazards models. Results: During follow-up (median, 27 years; Q1–Q3, 19–35 years), 4477 cases of cardiomyopathy were identified, of which 2631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Increasing BMI was strongly associated with elevated risk of cardiomyopathy, especially dilated, starting at levels considered normal (BMI, 22.5–<25 kg/m2; hazard ratio, 1.38 [95% CI, 1.22–1.57]), adjusted for age, year, center, and baseline comorbidities, and with a >8-fold increased risk at BMI ≥35 kg/m2 compared with BMI of 18.5 to <20 kg/m2. For each 1-unit increase in BMI, similarly adjusted hazard ratios were 1.15 (95% CI, 1.14–1.17) for dilated cardiomyopathy, 1.09 (95% CI, 1.06–1.12) for hypertrophic cardiomyopathy, and 1.10 (1.06–1.13) for alcohol/drug-induced cardiomyopathy. Conclusions: Even mildly elevated body weight in late adolescence may contribute to being diagnosed with cardiomyopathy in adulthood. The already marked importance of weight control in youth is further strengthened by these findings, as well as greater evidence for obesity as a potential important cause of adverse cardiac remodeling that is independent of clinically evident ischemic heart disease.
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Affiliation(s)
- Josefina Robertson
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
| | - Martin Adiels
- Department of Public Health and Community Medicine/Primary Health Care (J.R., M.A.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine (L.S., K.T.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre (J.M.), University of Glasgow.,Department of Cardiology, Western Infirmary, Glasgow, UK (J.M.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (N.S.), University of Glasgow
| | - Maria Åberg
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (M.S., M.L., M.A., A.R.), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Sahlgrenska University Hospital, Gothenburg, Sweden (J.R., M.S., M.L., A.R.)
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4
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Regitz-Zagrosek V. Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women. Korean Circ J 2018; 48:792-812. [PMID: 30146804 DOI: 10.4070/kcj.2018.0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
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Affiliation(s)
- Vera Regitz-Zagrosek
- CHARITÉ Universitätsmedizin Berlin, Institute of Gender in Medicine and CCR, and DZHK (partner site Berlin), Berlin, Germany.
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Regitz-Zagrosek V, Kararigas G. Mechanistic Pathways of Sex Differences in Cardiovascular Disease. Physiol Rev 2017; 97:1-37. [PMID: 27807199 DOI: 10.1152/physrev.00021.2015] [Citation(s) in RCA: 417] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Major differences between men and women exist in epidemiology, manifestation, pathophysiology, treatment, and outcome of cardiovascular diseases (CVD), such as coronary artery disease, pressure overload, hypertension, cardiomyopathy, and heart failure. Corresponding sex differences have been studied in a number of animal models, and mechanistic investigations have been undertaken to analyze the observed sex differences. We summarize the biological mechanisms of sex differences in CVD focusing on three main areas, i.e., genetic mechanisms, epigenetic mechanisms, as well as sex hormones and their receptors. We discuss relevant subtypes of sex hormone receptors, as well as genomic and nongenomic, activational and organizational effects of sex hormones. We describe the interaction of sex hormones with intracellular signaling relevant for cardiovascular cells and the cardiovascular system. Sex, sex hormones, and their receptors may affect a number of cellular processes by their synergistic action on multiple targets. We discuss in detail sex differences in organelle function and in biological processes. We conclude that there is a need for a more detailed understanding of sex differences and their underlying mechanisms, which holds the potential to design new drugs that target sex-specific cardiovascular mechanisms and affect phenotypes. The comparison of both sexes may lead to the identification of protective or maladaptive mechanisms in one sex that could serve as a novel therapeutic target in one sex or in both.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Georgios Kararigas
- Institute of Gender in Medicine & Center for Cardiovascular Research, Charite University Hospital, and DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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6
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Regitz-Zagrosek V, Oertelt-Prigione S, Prescott E, Franconi F, Gerdts E, Foryst-Ludwig A, Maas AHEM, Kautzky-Willer A, Knappe-Wegner D, Kintscher U, Ladwig KH, Schenck-Gustafsson K, Stangl V. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2015; 37:24-34. [PMID: 26530104 DOI: 10.1093/eurheartj/ehv598] [Citation(s) in RCA: 431] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany International Society for Gender Medicine DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Eva Prescott
- Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Flavia Franconi
- International Society for Gender Medicine Dep Scienze Biomediche, Regione Basilicata and National Laboratory of Gender Medicine, Consorzio Interuniversitario INBB, University of Sassari, Via Muroni 23a, 07100 Sassari, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, PO Box 7804, 5020 Bergen, Norway
| | - Anna Foryst-Ludwig
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Route 616, 6525 GA Nijmegen, The Netherlands
| | - Alexandra Kautzky-Willer
- International Society for Gender Medicine Gender Medicine Unit, Internal Medicine III, Endocrinology, Medical University of Vienna, International Society for Gender Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dorit Knappe-Wegner
- International Society for Gender Medicine University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Kintscher
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Institute of Pharmacology, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Hessische Str. 3-4, 10115 Berlin, Germany
| | - Karl Heinz Ladwig
- Helmholtz Center Munich, Institute of Epidemiology II, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karin Schenck-Gustafsson
- International Society for Gender Medicine Karolinska Institutet Stockholm, Centre for Gender Medicine, Thorax N3:05, International Society for Gender Medicine, 17176 Stockholm, Sweden
| | - Verena Stangl
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany Clinic for Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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7
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Barasa A, Schaufelberger M, Lappas G, Swedberg K, Dellborg M, Rosengren A. Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden. Eur Heart J 2013; 35:25-32. [PMID: 23900697 PMCID: PMC3877433 DOI: 10.1093/eurheartj/eht278] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe trends in incidence and case fatality among younger (18-54 years) and older (55-84 years) Swedish patients with heart failure (HF). METHODS AND RESULTS Through linking the Swedish national hospital discharge and the cause-specific death registries, we identified patients aged 18-84 years that were discharged 1987-2006 with a diagnosis of HF. Age-specific mean incidence rates per 100 000 person-years were calculated in four 5-year periods. Kaplan-Meier survival curves were plotted up to 3 years. From 1987 to 2006, there were 443 995 HF hospitalizations among adults 18-84 years. Of these, 4660 (1.0%) and 13 507 (3.0%) occurred in people aged 18-44 and 45-54 years (31.6% women), respectively. From the first to the last 5-year period, HF incidence increased by 50 and 43%, among people aged 18-34 and 35-44 years, respectively. Among people ≥45 years, incidence peaked in the mid-1990s and then decreased. Heart failure in the presence of cardiomyopathy increased more than two-fold among all age groups. Case fatality decreased for all age groups until 2001, after which no further significant decrease <55 years was observed. CONCLUSION Increasing HF hospitalization in young adults in Sweden opposes the general trend seen in older patients, a finding which may reflect true epidemiological changes. Cardiomyopathy accounted for a substantial part of this increase. High case fatality and lack of further case fatality reduction after 2001 are causes for concern.
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Affiliation(s)
- Anders Barasa
- Corresponding author. Anders Barasa, Tel: +46 313434000, Fax: +46 31191416,
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8
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Fairweather D, Cooper LT, Blauwet LA. Sex and gender differences in myocarditis and dilated cardiomyopathy. Curr Probl Cardiol 2013; 38:7-46. [PMID: 23158412 DOI: 10.1016/j.cpcardiol.2012.07.003] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart failure due to nonischemic dilated cardiomyopathy (DCM) contributes significantly to the global burden of cardiovascular disease. Myocarditis is, in turn, a major cause of acute DCM in both men and women. However, recent clinical and experimental evidence suggests that the pathogenesis and prognosis of DCM differ between the sexes. This seminar provides a contemporary perspective on the immune mediators of myocarditis, including interdependent elements of the innate and adaptive immune response. The heart's acute response to injury is influenced by sex hormones that appear to determine the subsequent risk of chronic DCM. Preliminary data suggest additional genetic variations may account for some of the differences in epidemiology, left ventricular recovery, and survival between men and women. We highlight the gaps in our knowledge regarding the management of women with acute DCM and discuss emerging therapies, including bromocriptine for the treatment of peripartum cardiomyopathy.
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10
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Honors and Awards * Bibliography of Peer-Reviewed Journal Articles. Am J Epidemiol 2008. [DOI: 10.1093/aje/kwn247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Towards risk factor assessment in inflammatory dilated cardiomyopathy: the SFB/TR 19 study. ACTA ACUST UNITED AC 2008; 14:686-93. [PMID: 17925629 DOI: 10.1097/hjr.0b013e32816f7726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with idiopathic dilated cardiomyopathy (DCMid) account for about one-third of patients with heart failure. Recent studies found a myocardial viral genomic persistence in up to 67% of DCMid patients, indicating a possible inflammatory etiology (DCMi). Considering the importance of DCMi, we aimed to study the present knowledge on risk factors in DCMi. METHODS Review of published literature on risk factors for DCMi/DCMid from 1989 through 2005 in Medline database and the Cochrane library (search terms 'epidemiology', 'risk factors', 'inflammatory dilated cardiomyopathy' and 'idiopathic dilated cardiomyopathy'). RESULTS An extended array of risk factors in DCMid has been investigated in 11 studies. No studies addressing specifically DCMi, however, were found. Consistent associations with DCMid were reported only for diabetes mellitus, black race, male sex and estimated low income. Inconsistent results were observed for the presence of asthma, hypertension and smoking. Few studies addressed potential risk factors such as low education level, infectious diseases and environmental factors. CONCLUSIONS Considering the high number of potential DCMi patients among patients with DCMid, results on risk factors for DCMid are likely relevant to at least a number of patients with DCMi. Future studies of risk factors in DCMi should include specific case classification and the application of standardized instruments for risk-factor assessment. The four-center SFB/TR 19 study aims to establish a prospective cohort of DCMi patients validated by endomyocardial biopsy.
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Abstract
OBJECTIVE To review the published literature on serious adverse cardiac events associated with the atypical antipsychotic agent, clozapine, and to make recommendations for cardiac assessment of candidates for clozapine treatment and for monitoring of cardiac status after treatment is initiated. DATA SOURCES We searched the PubMed and MEDLINE databases for articles published from 1970 to 2004 that contain the keywords "clozapine and myocarditis," "clozapine and cardiomyopathy," "clozapine and cardiotoxicity," "clozapine and sudden death" or "clozapine and mortality." We also manually searched the bibliographies of these articles for related sources. STUDY SELECTION We reviewed the 30 case reports, case series, laboratory and clinical trials, data mining studies, and previous reviews identified by this search. DATA SYNTHESIS Recent evidence suggests that clozapine is associated with a low (0.015% to 0.188%) risk of potentially fatal myocarditis or cardiomyopathy. The drug is not known to be independently associated with pathologic prolongation of the QTc interval, but it may contribute to pathologic QTc prolongation in patients with other risk factors for this condition. CONCLUSIONS The low risk of a serious adverse cardiac event should be outweighed by a reduction in suicide risk for most patients taking clozapine. We provide recommendations for assessing and monitoring cardiac status in patients prior to and after initiation of treatment with clozapine.
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Affiliation(s)
- David B Merrill
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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13
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Lipshultz SE, Sleeper LA, Towbin JA, Lowe AM, Orav EJ, Cox GF, Lurie PR, McCoy KL, McDonald MA, Messere JE, Colan SD. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003; 348:1647-55. [PMID: 12711739 DOI: 10.1056/nejmoa021715] [Citation(s) in RCA: 521] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population-based data on the incidence of pediatric cardiomyopathy are rare because of the lack of large, prospective studies. METHODS Since 1996 the Pediatric Cardiomyopathy Registry sponsored by the National Heart, Lung, and Blood Institute has collected data on all children with newly diagnosed cardiomyopathy in New England and the Central Southwest region (Texas, Oklahoma, and Arkansas) of the United States. We report on all children in these regions who received this diagnosis between 1996 and 1999. RESULTS We identified 467 cases of cardiomyopathy, for an overall annual incidence of 1.13 per 100,000 children (95 percent confidence interval, 1.03 to 1.23). The incidence was significantly higher among infants younger than 1 year old than among children and adolescents who were 1 to 18 years old (8.34 vs. 0.70 per 100,000, P<0.001). The annual incidence of cardiomyopathy was lower among white children (upper-bound estimate, 1.06 cases per 100,000) than among black children (lower-bound estimate, 1.47 per 100,000; P=0.02) and higher among boys than among girls (1.32 vs. 0.92 per 100,000, P<0.001). The incidence also varied significantly by region: 1.44 cases per 100,000 in New England and 0.98 per 100,000 in the Central Southwest region (P<0.001). When categorized according to type, dilated cardiomyopathy made up 51 percent of the cases, hypertrophic cardiomyopathy 42 percent, and restrictive or other types 3 percent; 4 percent were unspecified. There was no significant difference in the incidence rates according to the year. CONCLUSIONS The estimated incidence of pediatric cardiomyopathy in two large regions of the United States is 1.13 cases per 100,000 children. Most cases are identified at an early age, and the incidence varies according to sex, region, and racial or ethnic origin.
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Affiliation(s)
- Steven E Lipshultz
- Golisano Children's Hospital at Strong and University of Rochester Medical Center, and the Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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14
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Miura K, Nakagawa H, Morikawa Y, Sasayama S, Matsumori A, Hasegawa K, Ohno Y, Tamakoshi A, Kawamura T, Inaba Y. Epidemiology of idiopathic cardiomyopathy in Japan: results from a nationwide survey. Heart 2002; 87:126-30. [PMID: 11796547 PMCID: PMC1766994 DOI: 10.1136/heart.87.2.126] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To estimate the total number of patients with idiopathic cardiomyopathy in Japan and the prevalence of the disorder. DESIGN A nationwide epidemiological survey. SETTING Hospitals selected randomly from among all hospitals in Japan. PATIENTS Patients presenting with any of the three types of idiopathic cardiomyopathy: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. MAIN OUTCOME MEASURES The total number of patients in Japan was estimated using the sampling and response rates in each stratum with respect to hospital size. The second survey was conducted for patients reported in the first survey in order to obtain detailed information, including age, sex, and specific clinical data. RESULTS Estimated patient totals and 95% confidence intervals (CI) were 17 700 (95% CI 16 500 to 18 800) for dilated cardiomyopathy, 21 900 (95% CI 20 600 to 23 200) for hypertrophic cardiomyopathy, and 300 (95% CI 250 to 350) for restrictive cardiomyopathy. Crude prevalence per 100 000 population was estimated as 14.0 for dilated cardiomyopathy, 17.3 for hypertrophic cardiomyopathy, and 0.2 for restrictive cardiomyopathy; crude incidence per 100 000 person-years was estimated as 3.58, 4.14, and 0.06, respectively. CONCLUSIONS The total number and prevalence of patients with idiopathic cardiomyopathy in Japan are estimated for the first time in a nationwide survey. The prevalence of dilated cardiomyopathy in Japan appears to be about half that of Western populations, while that of hypertrophic cardiomyopathy is about the same.
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Affiliation(s)
- K Miura
- Department of Public Health, Kanazawa Medical University, Ishikawa, Japan.
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15
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Agarwal AK, Venugopalan P, Meharali AK, de Debono D. Idiopathic dilated cardiomyopathy in an Omani population of the Arabian Peninsula: prevalence, clinical profile and natural history. Int J Cardiol 2000; 75:147-58; discussion 158-9. [PMID: 11077126 DOI: 10.1016/s0167-5273(00)00315-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have analysed prospectively the prevalence and clinical profile of idiopathic dilated cardiomyopathy (IDC) in a circumscribed native population of the Sultanate of Oman over 3 years (1992-1994). Identified patients were followed up for a period ranging from 1 to 8 years (median 4 years) and the variables related to outcome determined. IDC was diagnosed in 97 patients, giving a prevalence of 43.2/100,000 population during the study period. 84.5% of patients were aged over 35 years and males outnumbered females (M/F=1.4:1). Factors related to poor outcome were an initial left ventricular ejection fraction </=30% (P=0.01), severe symptoms, i.e. NYHA functional class III or IV at presentation (P=0.04), and significant ventricular tachycardia during follow up (P=0.02). However, multivariate regression analysis yielded only low LVEF as the predictor of poor outcome (P=0.01). When analysed from age of onset of symptoms, survival figures were 94% at 1 year (95% CI 88 to 99%), 76% at 5 years (95% CI 67 to 86%) and 68% at 8 years (95% CI 54 to 82%). Mean survival was 6.5 years (95% CI 6 to 7 years). Patients were still at risk of fatal ventricular arrhythmia even when haemodynamically stable and had left ventricular ejection fraction >30%.
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Affiliation(s)
- A K Agarwal
- Department of Cardiology, Sultan Qaboos University, Muscat, Oman.
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Benton RE, Coughlin SS, Tefft MC. Predictors of coronary angiography in patients with idiopathic dilated cardiomyopathy: the Washington, DC Dilated Cardiomyopathy Study. J Clin Epidemiol 1994; 47:501-11. [PMID: 7730876 DOI: 10.1016/0895-4356(94)90297-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although a number of clinical and demographic factors have been associated with the performance of angiography in cardiac patients, clinical studies of idiopathic dilated cardiomyopathy (DCM) have often excluded patients who have not undergone coronary angiography to rule out coronary artery disease (CAD). To examine the impact of this diagnostic criterion on population-based studies of idiopathic DCM, we examined characteristics of probable cases of DCM who did or did not have a recorded history of angiography. The cases (n = 129) were ascertained from five medical centers in the Washington, DC metropolitan area over the period 1 July 1990 through 29 February 1992. All of these cases had evidence of ventricular dilation and hypokinesis, with a left ventricular ejection fraction of less than 40%. Cases with a history of known CAD, congenital heart disease, valvular heart disease, or secondary cardiomyopathy were excluded. Sixty-two (48%) of the cases had a recorded history of angiography. Age, educational level, diabetes, alcohol use, insurance status, and type of hospital were significantly associated with angiography in bivariate analysis (p < 0.05). Diabetes and hypertension were inversely associated with history of angiography among black cases, and positively associated with angiography among whites. In logistic regression analysis, age was the strongest independent predictor of angiography (p < 0.025). The associations with educational attainment and alcohol use were of borderline significance (p < 0.10). Thus, in epidemiologic studies of idiopathic DCM, particularly in biracial populations, the exclusion of cases who have not undergone angiography may bias risk estimates and result in the underestimation of incidence and prevalence.
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Affiliation(s)
- R E Benton
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
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