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Shao Y, Hu H, Li Q, Cao C, Liu D, Han Y. Link between triglyceride-glucose-body mass index and future stroke risk in middle-aged and elderly chinese: a nationwide prospective cohort study. Cardiovasc Diabetol 2024; 23:81. [PMID: 38402161 PMCID: PMC10893757 DOI: 10.1186/s12933-024-02165-7] [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: 12/14/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE Current literature is deficient in robust evidence delineating the correlation between the triglyceride glucose-body mass index (TyG-BMI) and the incidence of stroke. Consequently, this investigation seeks to elucidate the potential link between TyG-BMI and stroke risk in a cohort of middle-aged and senior Chinese individuals. METHODS This study employs longitudinal data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, encompassing 8,698 participants. The CHARLS cohort was assembled using a multistage probability sampling technique. Participants underwent comprehensive evaluations through standardized questionnaires administered via face-to-face interviews. Our analytic strategy involved the application of Cox proportional hazards regression models to investigate the association between TyG-BMI and the risk of stroke. To discern potential non-linear relationships, we incorporated Cox proportional hazards regression with smooth curve fitting. Additionally, we executed a battery of sensitivity and subgroup analyses to validate the robustness of our findings. RESULTS Our study utilized a multivariate Cox proportional hazards regression model and found a significant correlation between the TyG-BMI and the risk of stroke. Specifically, a 10-unit increase in TyG-BMI corresponded to a 4.9% heightened risk of stroke (HR = 1.049, 95% CI 1.029-1.069). The analysis also uncovered a non-linear pattern in this relationship, pinpointed by an inflection point at a TyG-BMI value of 174.63. To the left of this inflection point-meaning at lower TyG-BMI values-a 10-unit hike in TyG-BMI was linked to a more substantial 14.4% rise in stroke risk (HR 1.144; 95% CI 1.044-1.253). Conversely, to the right of the inflection point-at higher TyG-BMI values-each 10-unit increment was associated with a smaller, 3.8% increase in the risk of stroke (HR 1.038; 95% CI 1.016-1.061). CONCLUSIONS In the middle-aged and elderly Chinese population, elevated TyG-BMI was significantly and positively associated with stroke risk. In addition, there was also a specific non-linear association between TyG-BMI and stroke (inflection point 174.63). Further reduction of TyG-BMI below 174.63 through lifestyle changes and dietary control can significantly reduce the risk of stroke.
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Affiliation(s)
- Yuankai Shao
- Department of Emergency, Shenzhen Second People's Hospital,The First Affiliated Hospital of Shenzhen University, No. 3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Qiming Li
- Department of Emergency, Shenzhen Second People's Hospital,The First Affiliated Hospital of Shenzhen University, No. 3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, 518000, Guangdong, China
| | - Dehong Liu
- Department of Emergency, Shenzhen Second People's Hospital,The First Affiliated Hospital of Shenzhen University, No. 3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong, China.
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital,The First Affiliated Hospital of Shenzhen University, No. 3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong, China.
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Tuwar MN, Chen WH, Yeh HL, Bai CH. Association between Brain-Derived Neurotrophic Factor and Lipid Profiles in Acute Ischemic Stroke Patients. Int J Mol Sci 2024; 25:2380. [PMID: 38397057 PMCID: PMC10889431 DOI: 10.3390/ijms25042380] [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: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Ischemic stroke, the most prevalent form of stroke, leads to neurological impairment due to cerebral ischemia and affects 55-90% of the population. Brain-derived neurotrophic factor (BDNF) plays a crucial role in the central nervous system and regulates cardiometabolic risk factors, including lipids. This single-center study aimed to explore the relationship between lipid profiles and BDNF levels in 90 patients who had experienced AIS for the first time. The results show that the high BDNF group (≥3.227 ng/mL) had significantly higher HbA1C and TG levels; ratios of TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C; and percentage of hyperlipidemia (60%) as well as lower levels of HDL-C, with an OR of 1.903 (95% CI: 1.187-3.051) for TG/HDL-C, 1.975 (95% CI: 1.188-3.284) for TC/HDL-C, and 2.032 (95% CI: 1.113-3.711) for LDL-C/HDL-C. Plasma BDNF levels were found to be significantly positively correlated with TG and negatively with HDL-C, with OR values of 1.017 (95% CI: 1.003-1.030) and 0.926 (95% CI: 0.876-0.978), respectively. TC/HDL-C, TG/HDL-C, and LDL-C/HDL-C ratios are associated with BDNF levels in AIS patients. The results also indicate that, in AIS patients, higher BDNF levels are associated with lower HDL and higher TG concentrations.
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Affiliation(s)
- Mayuri N. Tuwar
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 106236, Taiwan;
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan
| | - Hsu-Ling Yeh
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 106236, Taiwan;
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 106236, Taiwan
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Gkantzios A, Kokkotis C, Tsiptsios D, Moustakidis S, Gkartzonika E, Avramidis T, Tripsianis G, Iliopoulos I, Aggelousis N, Vadikolias K. From Admission to Discharge: Predicting National Institutes of Health Stroke Scale Progression in Stroke Patients Using Biomarkers and Explainable Machine Learning. J Pers Med 2023; 13:1375. [PMID: 37763143 PMCID: PMC10532952 DOI: 10.3390/jpm13091375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
As a result of social progress and improved living conditions, which have contributed to a prolonged life expectancy, the prevalence of strokes has increased and has become a significant phenomenon. Despite the available stroke treatment options, patients frequently suffer from significant disability after a stroke. Initial stroke severity is a significant predictor of functional dependence and mortality following an acute stroke. The current study aims to collect and analyze data from the hyperacute and acute phases of stroke, as well as from the medical history of the patients, in order to develop an explainable machine learning model for predicting stroke-related neurological deficits at discharge, as measured by the National Institutes of Health Stroke Scale (NIHSS). More specifically, we approached the data as a binary task problem: improvement of NIHSS progression vs. worsening of NIHSS progression at discharge, using baseline data within the first 72 h. For feature selection, a genetic algorithm was applied. Using various classifiers, we found that the best scores were achieved from the Random Forest (RF) classifier at the 15 most informative biomarkers and parameters for the binary task of the prediction of NIHSS score progression. RF achieved 91.13% accuracy, 91.13% recall, 90.89% precision, 91.00% f1-score, 8.87% FNrate and 4.59% FPrate. Those biomarkers are: age, gender, NIHSS upon admission, intubation, history of hypertension and smoking, the initial diagnosis of hypertension, diabetes, dyslipidemia and atrial fibrillation, high-density lipoprotein (HDL) levels, stroke localization, systolic blood pressure levels, as well as erythrocyte sedimentation rate (ESR) levels upon admission and the onset of respiratory infection. The SHapley Additive exPlanations (SHAP) model interpreted the impact of the selected features on the model output. Our findings suggest that the aforementioned variables may play a significant role in determining stroke patients' NIHSS progression from the time of admission until their discharge.
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Affiliation(s)
- Aimilios Gkantzios
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (D.T.); (I.I.); (K.V.)
- Department of Neurology, Korgialeneio—Benakeio “Hellenic Red Cross” General Hospital of Athens, 11526 Athens, Greece;
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (S.M.); (N.A.)
| | - Dimitrios Tsiptsios
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (D.T.); (I.I.); (K.V.)
| | - Serafeim Moustakidis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (S.M.); (N.A.)
| | - Elena Gkartzonika
- School of Philosophy, University of Ioannina, 45110 Ioannina, Greece;
| | - Theodoros Avramidis
- Department of Neurology, Korgialeneio—Benakeio “Hellenic Red Cross” General Hospital of Athens, 11526 Athens, Greece;
| | - Gregory Tripsianis
- Laboratory of Medical Statistics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Ioannis Iliopoulos
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (D.T.); (I.I.); (K.V.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (S.M.); (N.A.)
| | - Konstantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (D.T.); (I.I.); (K.V.)
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Chen M, Miao G, Zhang Y, Umans JG, Lee ET, Howard BV, Fiehn O, Zhao J. Longitudinal Lipidomic Profile of Hypertension in American Indians: Findings From the Strong Heart Family Study. Hypertension 2023; 80:1771-1783. [PMID: 37334699 PMCID: PMC10526703 DOI: 10.1161/hypertensionaha.123.21144] [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: 02/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Dyslipidemia is an important risk factor for hypertension and cardiovascular disease. Standard lipid panel cannot reflect the complexity of blood lipidome. The associations of individual lipid species with hypertension remain to be determined in large-scale epidemiological studies, especially in a longitudinal setting. METHODS Using liquid chromatography-mass spectrometry, we repeatedly measured 1542 lipid species in 3699 fasting plasma samples at 2 visits (1905 at baseline, 1794 at follow-up, ~5.5 years apart) from 1905 unique American Indians in the Strong Heart Family Study. We first identified baseline lipids associated with prevalent and incident hypertension, followed by replication of top hits in Europeans. We then conducted repeated measurement analysis to examine the associations of changes in lipid species with changes in systolic blood pressure, diastolic blood pressure, and mean arterial pressure. Network analysis was performed to identify lipid networks associated with the risk of hypertension. RESULTS Baseline levels of multiple lipid species, for example, glycerophospholipids, cholesterol esters, sphingomyelins, glycerolipids, and fatty acids, were significantly associated with both prevalent and incident hypertension in American Indians. Some lipids were confirmed in Europeans. Longitudinal changes in multiple lipid species, for example, acylcarnitines, phosphatidylcholines, fatty acids, and triacylglycerols, were significantly associated with changes in blood pressure measurements. Network analysis identified distinct lipidomic patterns associated with the risk of hypertension. CONCLUSIONS Baseline plasma lipid species and their longitudinal changes are significantly associated with hypertension development in American Indians. Our findings shed light on the role of dyslipidemia in hypertension and may offer potential opportunities for risk stratification and early prediction of hypertension.
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Affiliation(s)
- Mingjing Chen
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Guanhong Miao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jason G. Umans
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Elisa T. Lee
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Barbara V. Howard
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California-Davis, CA
| | - Jinying Zhao
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL
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Shao K, Zhang F, Li Y, Cai H, Paul Maswikiti E, Li M, Shen X, Wang L, Ge Z. A Nomogram for Predicting the Recurrence of Acute Non-Cardioembolic Ischemic Stroke: A Retrospective Hospital-Based Cohort Analysis. Brain Sci 2023; 13:1051. [PMID: 37508983 PMCID: PMC10377670 DOI: 10.3390/brainsci13071051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Non-cardioembolic ischemic stroke (IS) is the predominant subtype of IS. This study aimed to construct a nomogram for recurrence risks in patients with non-cardioembolic IS in order to maximize clinical benefits. From April 2015 to December 2019, data from consecutive patients who were diagnosed with non-cardioembolic IS were collected from Lanzhou University Second Hospital. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection. Multivariable Cox regression analyses were used to identify the independent risk factors. A nomogram model was constructed using the "rms" package in R software via multifactor Cox regression. The accuracy of the model was evaluated using the receiver operating characteristic (ROC), calibration curve, and decision curve analyses (DCA). A total of 729 non-cardioembolic IS patients were enrolled, including 498 (68.3%) male patients and 231 (31.7%) female patients. Among them, there were 137 patients (18.8%) with recurrence. The patients were randomly divided into training and testing sets. The Kaplan-Meier survival analysis of the training and testing sets consistently revealed that the recurrence rates in the high-risk group were significantly higher than those in the low-risk group (p < 0.01). Moreover, the receiver operating characteristic curve analysis of the risk score demonstrated that the area under the curve was 0.778 and 0.760 in the training and testing sets, respectively. The nomogram comprised independent risk factors, including age, diabetes, platelet-lymphocyte ratio, leukoencephalopathy, neutrophil, monocytes, total protein, platelet, albumin, indirect bilirubin, and high-density lipoprotein. The C-index of the nomogram was 0.752 (95% CI: 0.705~0.799) in the training set and 0.749 (95% CI: 0.663~0.835) in the testing set. The nomogram model can be used as an effective tool for carrying out individualized recurrence predictions for non-cardioembolic IS.
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Affiliation(s)
- Kangmei Shao
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Fan Zhang
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Hongbin Cai
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Ewetse Paul Maswikiti
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Mingming Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Xueyang Shen
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Longde Wang
- Expert Workstation of Academician Wang Longde, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Zhaoming Ge
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1190] [Impact Index Per Article: 1190.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Altered Effective Connectivity of the Primary Motor Cortex in Transient Ischemic Attack. Neural Plast 2022; 2022:2219993. [PMID: 36437903 PMCID: PMC9699783 DOI: 10.1155/2022/2219993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study is aimed at exploring alteration in motor-related effective connectivity in individuals with transient ischemic attack (TIA). Methods A total of 48 individuals with TIA and 41 age-matched and sex-matched healthy controls (HCs) were recruited for this study. The participants were scanned using MRI, and their clinical characteristics were collected. To investigate motor-related effective connectivity differences between individuals with TIA and HCs, the bilateral primary motor cortex (M1) was used as the regions of interest (ROIs) to perform a whole-brain Granger causality analysis (GCA). Furthermore, partial correlation was used to evaluate the relationship between GCA values and the clinical characteristics of individuals with TIA. Results Compared with HCs, individuals with TIA demonstrated alterations in the effective connectivity between M1 and widely distributed brain regions involved in motor, visual, auditory, and sensory integration. In addition, GCA values were significantly correlated with high- and low-density lipoprotein cholesterols in individuals with TIA. Conclusion This study provides important evidence for the alteration of motor-related effective connectivity in TIA, which reflects the abnormal information flow between different brain regions. This could help further elucidate the pathological mechanisms of motor impairment in individuals with TIA and provide a new perspective for future early diagnosis and intervention for TIA.
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Gong X, Chen L, Song B, Han X, Xu W, Wu B, Sheng F, Lou M. Associations of lipid profiles with the risk of ischemic and hemorrhagic stroke: A systematic review and meta-analysis of prospective cohort studies. Front Cardiovasc Med 2022; 9:893248. [DOI: 10.3389/fcvm.2022.893248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background and purposeThe associations of lipid profiles with the risk of ischemic stroke (IS) or hemorrhagic stroke (HS) are controversial. In this study, we aimed to illustrate the optimal level for lipid levels in the risk of IS and HS.Materials and methodsWe searched the electronic database of PubMed, Embase, and the Cochrane library from inception until November 2020. Prospective cohort studies published in English for the associations of lipid profiles (TC, TG, LDL-C, HDL-C, and non–HDL-C) with the risk of IS and HS were eligible for this study, and the publication status was not restricted. We calculated the pooled effect estimates using the random-effects model. We tested the associations of lipid profiles with IS and HS and compared their differences.ResultsWe retrieved 50 prospective cohort studies containing 3,301,613 individuals. An increase in total cholesterol (TC) is associated with an increased IS risk (P < 0.001) and a reduced HS risk (P < 0.001). Similarly, an increase in triglyceride links with a greater IS risk (P < 0.001) but with a lower HS risk (P = 0.014). On the opposite, high-density lipoprotein cholesterol (HDL-C) correlates with a reduced IS risk (P = 0.004) but has no significant association with the HS risk (P = 0.571). Moreover, an increase in low-density lipoprotein cholesterol (LDL-C) or non–high-density lipoprotein cholesterol has no statistically significant effect on both IS and HS. The pooled effect estimates on the risk of IS and HS revealed that TC and LDL-C levels should be controlled under 6.0 and 3.5 mmol/L, respectively, to reduce worsening effects on the IS risk while maintaining potential beneficial effects on reducing the HS risk.ConclusionWe revealed comprehensive relationships between lipid profiles and the risk of stroke, suggesting controlling the TC and LDL-C levels under 6.0 and 3.5 mmol/L, respectively, to balance both the IS and HS risk.
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Zhang B, Wang X, Gu Y, Zhang Q, Liu L, Meng G, Wu H, Zhang S, Zhang T, Li H, Zhang J, Sun S, Wang X, Zhou M, Jia Q, Song K, Huang J, Huo J, Zhang B, Ding G, Niu K. The association between grip strength and incident carotid atherosclerosis in middle-aged and older adults: The TCLSIH cohort study. Maturitas 2022; 167:53-59. [DOI: 10.1016/j.maturitas.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/03/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
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Shi L, Bi D, Luo J, Chen W, Yang C, Zheng Y, Hao J, Chang K, Li B, Liu C, Ta D. Associations between electrocardiogram and carotid ultrasound parameters: a healthy chinese group study. Front Physiol 2022; 13:976254. [PMID: 36003640 PMCID: PMC9393264 DOI: 10.3389/fphys.2022.976254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Electrocardiogram (ECG) and carotid ultrasound (CUS) are important tools for the diagnosis and prediction of cardiovascular disease (CVD). This study aimed to investigate the associations between ECG and CUS parameters and explore the feasibility of assessing carotid health with ECG. Methods: This cross-sectional cohort study enrolled 319 healthy Chinese subjects. Standard 12-lead ECG parameters (including the ST-segment amplitude [STA]), CUS parameters (intima-media thickness [IMT] and blood flow resistance index [RI]), and CVD risk factors (including sex, age, and systolic blood pressure [SBP]) were collected for analysis. Participants were divided into the high-level RI group (average RI ≥ 0.76, n = 171) and the normal RI group (average RI < 0.76, n = 148). Linear and stepwise multivariable regression models were performed to explore the associations between ECG and CUS parameters. Results: Statistically significant differences in sex, age, SBP, STA and other ECG parameters were observed in the normal and the high-level RI group. The STA in lead V3 yielded stronger significant correlations (r = 0.27–0.42, p < 0.001) with RI than STA in other leads, while ECG parameters yielded weak correlations with IMT (|r| ≤ 0.20, p < 0.05). STA in lead V2 or V3, sex, age, and SBP had independent contributions (p < 0.01) to predicting RI in the stepwise multivariable models, although the models for IMT had only CVD risk factors (age, body mass index, and triglyceride) as independent variables. The prediction model for RI in the left proximal common carotid artery (CCA) had higher adjusted R2 (adjusted R2 = 0.31) than the model for RI in the left middle CCA (adjusted R2 = 0.29) and the model for RI in the right proximal CCA (adjusted R2 = 0.20). Conclusion: In a cohort of healthy Chinese individuals, the STA was associated with the RI of CCA, which indicated that ECG could be utilized to assess carotid health. The utilization of ECG might contribute to a rapid screening of carotid health with convenient operations.
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Affiliation(s)
- Lingwei Shi
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Dongsheng Bi
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Jingchun Luo
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Wei Chen
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Cuiwei Yang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yan Zheng
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Ju Hao
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Ke Chang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Boyi Li
- Academy for Engineering and Technology, Fudan University, Shanghai, China
- *Correspondence: Boyi Li, ; Chengcheng Liu,
| | - Chengcheng Liu
- Academy for Engineering and Technology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Fudan University, Shanghai, China
- *Correspondence: Boyi Li, ; Chengcheng Liu,
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
- Academy for Engineering and Technology, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Fudan University, Shanghai, China
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11
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Molecular mechanisms underlying some major common risk factors of stroke. Heliyon 2022; 8:e10218. [PMID: 36060992 PMCID: PMC9433609 DOI: 10.1016/j.heliyon.2022.e10218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Ischemic and hemorrhagic strokes are the most common known cerebrovascular disease which can be induced by modifiable and non-modifiable risk factors. Age and race are the most common non-modifiable risk factors of stroke. However, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and cardiovascular disorders are major modifiable risk factors. Understanding the molecular mechanism mediating each of these risk factors is expected to contribute significantly to reducing the risk of stroke, preventing neural damage, enhancing rehabilitation, and designing suitable treatments. Abnormalities in the structure of the blood-brain barrier and blood vessels, thrombosis, vasoconstriction, atherosclerosis, reduced cerebral blood flow, neural oxidative stress, inflammation, and apoptosis, impaired synaptic transmission, excitotoxicity, altered expression/activities of many channels and signaling proteins are the most knows mechanisms responsible for stroke induction. However, the molecular role of risk factors in each of these mechanisms is not well understood and requires a lot of search and reading. This review was designed to provide the reader with a single source of information that discusses the current update of the prevalence, pathophysiology, and all possible molecular mechanisms underlying some major risk factors of stroke namely, hypertension, diabetes mellitus, dyslipidemia, and lipid fraction, and physical inactivity. This provides a full resource for understanding the molecular effect of each of these risk factors in stroke.
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12
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Zhu X, Xing P, Zhang P, Zhang M, Shen H, Chen L, Shen F, Jiang Y, Yuan H, Zhang L, Wang J, Wu X, Zhou Y, Wu T, Deng B, Liu J, Zhang Y, Yang P. Fine-tuning of microglia polarization prevents diabetes-associated cerebral atherosclerosis. Front Immunol 2022; 13:948457. [PMID: 35935990 PMCID: PMC9353938 DOI: 10.3389/fimmu.2022.948457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Diabetes increases the occurrence and severity of atherosclerosis. When plaques form in brain vessels, cerebral atherosclerosis causes thickness, rigidity, and unstableness of cerebral artery walls, leading to severe complications like stroke and contributing to cognitive impairment. So far, the molecular mechanism underlying cerebral atherosclerosis is not determined. Moreover, effective intervention strategies are lacking. In this study, we showed that polarization of microglia, the resident macrophage in the central nervous system, appeared to play a critical role in the pathological progression of cerebral atherosclerosis. Microglia likely underwent an M2c-like polarization in an environment long exposed to high glucose. Experimental suppression of microglia M2c polarization was achieved through transduction of microglia with an adeno-associated virus (serotype AAV-PHP.B) carrying siRNA for interleukin-10 (IL-10) under the control of a microglia-specific TMEM119 promoter, which significantly attenuated diabetes-associated cerebral atherosclerosis in a mouse model. Thus, our study suggests a novel translational strategy to prevent diabetes-associated cerebral atherosclerosis through in vivo control of microglia polarization.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pengfei Yang
- *Correspondence: Yongwei Zhang, ; Pengfei Yang, ;
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13
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Hu X, Liu J, Li W, Wang C, Li G, Zhou Y, Dong H. Elevated serum uric acid was associated with pre-inflammatory state and impacted the role of HDL-C on carotid atherosclerosis. Nutr Metab Cardiovasc Dis 2022; 32:1661-1669. [PMID: 35469728 DOI: 10.1016/j.numecd.2022.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) are positively and negatively associated with atherosclerosis, respectively. UA and HDL-C are involved in the balance of proinflammatory and anti-inflammatory processes in atherosclerosis. However, it is still unclear whether UA affects the effect of HDL-C on atherosclerosis. METHODS AND RESULTS In this retrospective study, we enrolled 1437 patients with multiple risk factors for atherosclerosis. Patients were categorized into two groups according to their baseline UA level. Multivariate logistic regression analysis and restricted cubic spline curves were used to assess the relationship between HDL-C and carotid atherosclerosis (abnormal carotid intima-media thickness [cIMT] and carotid artery plaque) at different UA levels. Compared to patients with normouricemia, patients with hyperuricemia were older and had a more extensive history of disease and unhealthy behavior. In the normouricemia group, multivariate-adjusted odds ratios (95% CIs) for HDL-C were 0.55 (0.33-0.92) for abnormal mean cIMT, 0.59 (0.35-1.00) for abnormal maximum cIMT, and 0.53 (0.29-0.94) for the occurrence of carotid artery plaque, while the correlation between each of these three indicators with HDL-C were not significant in those with hyperuricemia. Spline regression models yielded similar results. The effect of UA on the association between HDL-C and carotid atherosclerosis remained in the subset of patients with optimal low-density lipoprotein cholesterol. CONCLUSION Elevated UA marks a pre-inflammatory state and impacts the role of HDL-C on carotid atherosclerosis.
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Affiliation(s)
- Xiangming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Jieliang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Wei Li
- Department of Cardiology, Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519040, Guangdong, China
| | - Chenyang Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Guang Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
| | - Yingling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
| | - Haojian Dong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
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14
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The Impact of Dietary Diversity, Lifestyle, and Blood Lipids on Carotid Atherosclerosis: A Cross-Sectional Study. Nutrients 2022; 14:nu14040815. [PMID: 35215465 PMCID: PMC8876384 DOI: 10.3390/nu14040815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/23/2022] Open
Abstract
Carotid atherosclerosis is a common arterial wall lesion that causes narrowing and occlusion of the arteries and is the basis of cardiovascular events. Dietary habits, lifestyle, and lipid metabolism should be considered integrally in the context of carotid atherosclerosis (CAS). However, this area has been investigated less often in China. To understand the prevalence of CAS in China and the impact of dietary diversity and habits, lifestyle, and lipid metabolism on CAS as well as its predictive factors, a cross-sectional study was performed in two northern and southern Chinese tertiary hospitals from 2017 to 2019. Included participants underwent carotid artery color Doppler ultrasonography, blood lipid examination and dietary evaluation. In total, 11,601 CAS patients and 27,041 individuals without carotid artery lesions were included. The prevalence of CAS was 30.0% in this group. High BMI (OR: 1.685, 95% CI [1.315-2.160]), current (1.148 [1.077-1.224]) or ex-smoking (1.349 [1.190-1.529]), abstinence from alcohol ((1.223 [1.026-1.459]), social engagement (1.122 [1.050-1.198]), hypertension (1.828 [1.718-1.945]), and total cholesterol (1.438 [1.298-1.594]) were risk factors for CAS, while higher dietary diversity according to DDS-2 (0.891 [0.805-0.989]), HDL-C (0.558 [0.487-0.639]), sugar-sweetened beverages (0.734 [0.696-0.774]), and no midnight snack consumption (0.846 [0.792-0.903]) were protective factors. This current study demonstrated that higher dietary diversity was a protective factor against CAS in a healthy population. In addition, current recommendations of healthy lifestyle and dietary habits for preventing CAS should be strengthened. In addition, dietary diversity should concentrate on food attributes and dietary balance, rather than increased quantities.
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15
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2414] [Impact Index Per Article: 1207.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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16
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 33160722 DOI: 10.1016/j.nrl.2020.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, España.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari; Departamento de Medicina, Universidad de Barcelona. Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, España
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, España
| | - B Fuentes
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón. Universidad Complutense de Madrid, Madrid, España
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, España
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, España
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, España
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, España
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - M A de Leciñana
- Servicio de Neurología, Centro de ictus, Hospital Universitario La Paz. IdiPAZ. Universidad Autónoma de Madrid, Madrid, España
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17
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Palacio-Portilla EJ, Roquer J, Amaro S, Arenillas JF, Ayo-Martín O, Castellanos M, Freijo MM, Fuentes B, García-Pastor A, Gomis M, Gómez-Choco M, López-Cancio E, Martínez-Sánchez P, Morales A, Rodríguez-Yáñez M, Segura T, Serena J, Vivancos-Mora J, de Leciñana MA. Dyslipidemias and stroke prevention: Recommendations of the Study Group of Cerebrovascular Diseases of the Spanish Society of Neurology. Neurologia 2022; 37:61-72. [PMID: 35074190 DOI: 10.1016/j.nrleng.2020.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/19/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We present an update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia. DEVELOPMENT We performed a systematic review to evaluate the main aspects of the management of dyslipidaemias in primary and secondary stroke prevention and establish a series of recommendations. CONCLUSIONS In primary prevention, the patient's vascular risk should be determined in order to define target values for low-density lipoprotein cholesterol. In secondary prevention after an atherothrombotic stroke, a target value <55 mg/dL is recommended; in non-atherothombotic ischaemic strokes, given the unclear relationship with dyslipidaemia, target value should be established according to the vascular risk group of each patient. In both primary and secondary prevention, statins are the drugs of first choice, and ezetimibe and/or PCSK9 inhibitors may be added in patients not achieving the target value.
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Affiliation(s)
- E J Palacio-Portilla
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - J Roquer
- Servicio de Neurología, IMIM-Hospital del Mar, Barcelona, Spain.
| | - S Amaro
- Servicio de Neurología, Hospital Clínic i Universitari, Departamento de Medicina, Universidad de Barcelona, Instituto de Investigación Biomédica Augut Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J F Arenillas
- Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - O Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, Spain
| | - M M Freijo
- Servicio de Neurología, Hospital Universitario de Cruces, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - B Fuentes
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - A García-Pastor
- Servicio de Neurología, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - M Gomis
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - M Gómez-Choco
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - E López-Cancio
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - P Martínez-Sánchez
- Servicio de Neurología, Hospital Universitario Torrecárdenas, Almería, Spain
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biomédica (IMIB), El Palmar, Murcia, Spain
| | - M Rodríguez-Yáñez
- Servicio de Neurología, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - J Serena
- Servicio de Neurología, Biomedical Research Institute of Girona, Hospital Universitario Doctor Josep Trueta, Girona, Spain
| | - J Vivancos-Mora
- Servicio de Neurología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - M A de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
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18
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The Role of Lipid-Lowering Treatment in the Secondary Prevention of Ischemic Stroke. Diseases 2021; 10:diseases10010003. [PMID: 35076490 PMCID: PMC8788422 DOI: 10.3390/diseases10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 01/03/2023] Open
Abstract
Dyslipidemia is a major modifiable risk factor for ischemic stroke. Treatment with statins reduces the incidence of recurrent ischemic stroke and also reduces coronary events in patients with a history of ischemic stroke. Therefore, statins represent an important component of secondary prevention of ischemic stroke. In patients who do not achieve low-density lipoprotein cholesterol (LDL-C) targets despite treatment with the maximal tolerated dose of a potent statin, ezetimibe should be added to their lipid-lowering treatment and also appears to reduce the risk of cardiovascular events. Selected patients who do not achieve LDL-C targets despite statin/ezetimibe combination are candidates for receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Finally, it appears that adding icosapent ethyl might also reduce cardiovascular morbidity in patients who have achieved LDL-C targets but have persistently elevated triglyceride levels.
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19
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Koch M, Aroner SA, Fitzpatrick AL, Longstreth WT, Furtado JD, Mukamal KJ, Jensen MK. HDL (High-Density Lipoprotein) Subspecies, Prevalent Covert Brain Infarcts, and Incident Overt Ischemic Stroke: Cardiovascular Health Study. Stroke 2021; 53:1292-1300. [PMID: 34645286 DOI: 10.1161/strokeaha.121.034299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Whether HDL (high-density lipoprotein) is associated with risk of vascular brain injury is unclear. HDL is comprised of many apo (apolipoprotein) species, creating distinct subtypes of HDL. METHODS We utilized sandwich ELISA to determine HDL subspecies from plasma collected in 1998/1999 from 2001 CHS (Cardiovascular Health Study) participants (mean age, 80 years). RESULTS In cross-sectional analyses, participants with higher apoA1 in plasma and lower apoE in HDL were less likely to have prevalent covert magnetic resonance imaging-defined infarcts: odds ratio for apoA1 Q4 versus Q1, 0.68 (95% CI, 0.50-0.93), and odds ratio for apoE Q4 versus Q1, 1.36 (95% CI, 1.01-1.84). Similarly, apoA1 in the subspecies of HDL that lacked apoC3, apoJ, or apoE was inversely related to covert infarcts, and apoE in the subspecies of HDL that lacked apoC3 or apoJ was directly related to covert infarcts in prospective analyses. In contrast, the concentrations of apoA1 and apoE in the complementary subspecies of HDL that contained these apos were unrelated to covert infarcts. Patterns of associations between incident overt ischemic stroke and apoA1, apoE, and apoA1 and apoE in subspecies of HDL were similar to those observed for covert infarcts but less pronounced. CONCLUSIONS This study highlights HDL subspecies defined by apo content as relevant biomarkers of covert and overt vascular brain injury.
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Affiliation(s)
- Manja Koch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.)
| | - Sarah A Aroner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (S.A.A.)
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle. (A.L.F.).,Department of Epidemiology, University of Washington, Seattle. (A.L.F.).,Department of Global Health, University of Washington, Seattle. (A.L.F.)
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle. (W.T.L.).,Department of Epidemiology, University of Washington, Seattle. (W.T.L.)
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.)
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark (M.K.J.)
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20
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Qie R, Liu L, Zhang D, Han M, Wang B, Zhao Y, Liu D, Guo C, Li Q, Zhou Q, Tian G, Huang S, Wu X, Qin P, Li J, Cao J, Zhang M, Huang J, Lu J, Hu D. Dose-Response Association Between High-Density Lipoprotein Cholesterol and Stroke: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Prev Chronic Dis 2021; 18:E45. [PMID: 33988499 PMCID: PMC8139481 DOI: 10.5888/pcd18.200278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Studies investigating the effect of high-density lipoprotein cholesterol (HDL-C) on stroke and stroke subtypes have reached inconsistent conclusions. The purpose of our study was to clarify the dose-response association between HDL-C level and risk of total stroke and stroke subtypes by a systematic review and meta-analysis. METHODS We performed a systematic search of PubMed, Embase, and Web of Science databases through July 30, 2020, for prospective cohort studies that reported the HDL-C-stroke association and extracted the estimate that was adjusted for the greatest number of confounding factors. Restricted cubic splines were used to evaluate the linear and nonlinear dose-response associations. RESULTS We included 29 articles, which reported on 62 prospective cohort studies including 900,501 study participants and 25,678 with stroke. The summary relative risk per 1-mmol/L increase in HDL-C level for total stroke was 0.82 (95% CI, 0.76-0.89; I2 = 42.9%; n = 18); ischemic stroke (IS), 0.75 (95% CI, 0.69-0.82; I2 = 50.1%; n = 22); intracerebral hemorrhage (ICH), 1.21 (95% CI, 1.04-1.42; I2 = 33.4%; n = 10); and subarachnoid hemorrhage (SAH), 0.98 (95% CI, 0.96-1.00; I2 = 0%; n = 7). We found a linear inverse association between HDL-C level and risk of total stroke and SAH, a nonlinear inverse association for IS risk, but a linear positive association for ICH risk. The strength and the direction of the effect size estimate for total stroke, IS, ICH, and SAH remained stable for most subgroups. We found no publication bias with Begg's test and Egger's test for the association of HDL-C level with risk of total stroke, IS, and ICH. CONCLUSION A high HDL-C level is associated with reduced risk of total stroke and IS and an increased risk of ICH.
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Affiliation(s)
- Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Leilei Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongdong Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bingyuan Wang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qionggui Zhou
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Pei Qin
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jianxin Li
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Cao
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jianfeng Huang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Kexue Avenue, Gaoxin District, Zhengzhou, Henan 450001, People's Republic of China.
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21
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Zeki Al Hazzouri A, Caunca MR, Jawadekar N, Grasset L, Elfassy T, Odden MC, Wu C, Elbejjani M, Launer L, Yaffe K. Associations between 20-year lipid variability throughout young adulthood and midlife cognitive function and brain integrity. J Gerontol A Biol Sci Med Sci 2021; 77:114-121. [PMID: 33839774 DOI: 10.1093/gerona/glab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about long-term lipid variability in young adulthood in relation to cognitive function and brain integrity in midlife. METHODS We studied 3,328 adults from the Coronary Artery Risk Development in Young Adults. We defined low- and high- density lipoprotein (LDL, HDL) variability as the intra-individual standard deviation of lipid measurements over 20 years of young adulthood (1985-2005). Cognitive tests were administered in 2010. Brain scans were performed in 2010 on 714 participants. To facilitate comparison, cognitive tests and brain metrics were z-scored. RESULTS Mean age at baseline was 25.4 years. Higher 20-year LDL variability was associated with worse verbal memory in midlife (β=-0.25, 95% CI [-0.42, -0.08]), adjusted for important covariates. Higher 20-year HDL variability was associated with worse processing speed in midlife (β=-0.80, 95% CI [-1.18, -0.41]) and brain integrity, e.g. smaller total brain volume (β=-0.58, 95% CI [-0.82, -0.34]) and worse total brain fractional anisotropy (β=-1.13, 95% CI [-1.87, -0.39]). CONCLUSIONS Higher long-term lipid variability in adulthood was associated with worse cognition and brain integrity in midlife, in a relatively young cohort.
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Affiliation(s)
| | - Michelle R Caunca
- Departments of Neurology and Public Health Sciences, Miller School of Medicine, University of Miami, FL.,Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL
| | - Neal Jawadekar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY
| | - Leslie Grasset
- Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219, Bordeaux, France
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, University of Miami
| | - Michelle C Odden
- Department of Health Research and Policy, Stanford University, Palo Alto, CA
| | - Chenkai Wu
- Department of Global Health, Duke Kunshan University, Suzhou, China
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut, Lebanon
| | - Lenore Launer
- Laboratory of Epidemiology and Population Science, National Institute on Aging, National Institutes of Health, Bethesda, MD
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California San Francisco, CA
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22
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3047] [Impact Index Per Article: 1015.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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23
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Vojinovic D, Kalaoja M, Trompet S, Fischer K, Shipley MJ, Li S, Havulinna AS, Perola M, Salomaa V, Yang Q, Sattar N, Jousilahti P, Amin N, Satizabal CL, Taba N, Sabayan B, Vasan RS, Ikram MA, Stott DJ, Ala-Korpela M, Jukema JW, Seshadri S, Kettunen J, Kivimaki M, Esko T, van Duijn CM. Association of Circulating Metabolites in Plasma or Serum and Risk of Stroke: Meta-analysis From 7 Prospective Cohorts. Neurology 2021; 96:e1110-e1123. [PMID: 33268560 PMCID: PMC8055347 DOI: 10.1212/wnl.0000000000011236] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To conduct a comprehensive analysis of circulating metabolites and incident stroke in large prospective population-based settings. METHODS We investigated the association of metabolites with risk of stroke in 7 prospective cohort studies including 1,791 incident stroke events among 38,797 participants in whom circulating metabolites were measured by nuclear magnetic resonance technology. The relationship between metabolites and stroke was assessed with Cox proportional hazards regression models. The analyses were performed considering all incident stroke events and ischemic and hemorrhagic events separately. RESULTS The analyses revealed 10 significant metabolite associations. Amino acid histidine (hazard ratio [HR] per SD 0.90, 95% confidence interval [CI] 0.85, 0.94; p = 4.45 × 10-5), glycolysis-related metabolite pyruvate (HR per SD 1.09, 95% CI 1.04, 1.14; p = 7.45 × 10-4), acute-phase reaction marker glycoprotein acetyls (HR per SD 1.09, 95% CI 1.03, 1.15; p = 1.27 × 10-3), cholesterol in high-density lipoprotein (HDL) 2, and several other lipoprotein particles were associated with risk of stroke. When focused on incident ischemic stroke, a significant association was observed with phenylalanine (HR per SD 1.12, 95% CI 1.05, 1.19; p = 4.13 × 10-4) and total and free cholesterol in large HDL particles. CONCLUSIONS We found association of amino acids, glycolysis-related metabolites, acute-phase reaction markers, and several lipoprotein subfractions with the risk of stroke. These findings support the potential of metabolomics to provide new insights into the metabolic changes preceding stroke.
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Affiliation(s)
- Dina Vojinovic
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Marita Kalaoja
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Stella Trompet
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Krista Fischer
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Martin J Shipley
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Shuo Li
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia.
| | - Aki S Havulinna
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Markus Perola
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Veikko Salomaa
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Qiong Yang
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Naveed Sattar
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Pekka Jousilahti
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Najaf Amin
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Claudia L Satizabal
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Nele Taba
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Behnam Sabayan
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Ramachandran S Vasan
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - M Arfan Ikram
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - David J Stott
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Mika Ala-Korpela
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - J Wouter Jukema
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Sudha Seshadri
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Johannes Kettunen
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Mika Kivimaki
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Tonu Esko
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia
| | - Cornelia M van Duijn
- From the Department of Epidemiology (D.V., N.A., M.A.I., C.M.v.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Computational Medicine (M. Kalaoja, M.A.-K., J.K.), Faculty of Medicine, University of Oulu and Biocenter Oulu, Finland; Departments of Gerontology and Geriatrics (S.T.), and Cardiology (S.T., J.W.J.), Leiden University Medical Center, the Netherlands; Estonian Genome Centre (K.F., N.T., T.E.), Institute of Genomics, and Institute of Molecular and Cell Biology (N.T.), University of Tartu, Estonia; Department of Epidemiology and Public Health (M.J.S., M. Kivimaki), UCL, London, UK; Department of Biostatistics (S.L., O.Y.), School of Public Health, Boston University, MA; Department of Public Health Solutions (A.S.H., M.P., V.S., P.J., J.K.), Finnish Institute for Health and Welfare; Institute for Molecular Medicine Finland (A.S.H., M.P.), University of Helsinki; BHF Glasgow Cardiovascular Research Centre (N.S.), Faculty of Medicine, UK; Department of Neurology (B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Framingham Heart Study (C.L.S., R.S.V., S.S.), MA; Department of Radiology and Nuclear Medicine (M.A.I.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Institute of Cardiovascular and Medical Sciences (D.J.S.), College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Systems Epidemiology (M.A.-K.), Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; NMR Metabolomics Laboratory (M.A.-K.), School of Pharmacy, University of Eastern Finland, Kuopio; Population Health Science (M.A.-K.), Bristol Medical School, and Medical Research Council Integrative Epidemiology Unit (M.A.-K.), University of Bristol, UK; Department of Epidemiology and Preventive Medicine (M.A.-K.), School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Netherlands Heart Institute (J.W.J.), Utrecht, the Netherlands; Department of Neurology (C.L.S., S.S.), Boston University School of Medicine; Broad Institute of MIT and Harvard (T.E.), Boston, MA; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (C.L.S., S.S.), UT Health San Antonio, TX; Nuffield Department of Population Health (C.M.v.D.), University of Oxford, UK. D.V. is currently at the Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, the Netherlands, and K.F. is currently at the Institute of Mathematics and Statistics, University of Tartu, Estonia.
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Zhang N, Zhang L, Wang Q, Zhao J, Liu J, Wang G. Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study. BMC Neurol 2020; 20:424. [PMID: 33225904 PMCID: PMC7681954 DOI: 10.1186/s12883-020-02005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
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Affiliation(s)
- Nan Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingwei Zhao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Plubell DL, Fenton AM, Rosario S, Bergstrom P, Wilmarth PA, Clark W, Zakai NA, Quinn JF, Minnier J, Alkayed NJ, Fazio S, Pamir N. High-Density Lipoprotein Carries Markers That Track With Recovery From Stroke. Circ Res 2020; 127:1274-1287. [PMID: 32844720 PMCID: PMC7581542 DOI: 10.1161/circresaha.120.316526] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
RATIONALE Prospective cohort studies question the value of HDL-C (high-density lipoprotein cholesterol) for stroke risk prediction. OBJECTIVE Investigate the relationship between long-term functional recovery and HDL proteome and function. METHODS AND RESULTS Changes in HDL protein composition and function (cholesterol efflux capacity) in patients after acute ischemic stroke at 2 time points (24 hours, 35 patients; 96 hours, 20 patients) and in 35 control subjects were measured. The recovery from stroke was assessed by 3 months, the National Institutes of Health Stroke Scale and modified Rankin scale scores. When compared with control subject after adjustments for sex and HDL-C levels, 12 proteins some of which participate in acute phase response and platelet activation (APMAP [adipocyte plasma membrane-associated protein], GPLD1 [phosphate inositol-glycan specific phospholipase D], APOE [apolipoprotein E], IHH [Indian hedgehog protein], ITIH4 [inter-alpha-trypsin inhibitor chain H4], SAA2 [serum amyloid A2], APOA4 [apolipoprotein A-IV], CLU [clusterin], ANTRX2 [anthrax toxin receptor 2], PON1 [serum paraoxonase/arylesterase], SERPINA1 [alpha-1-antitrypsin], and APOF [apolipoprotein F]) were significantly (adjusted P<0.05) altered in stroke HDL at 96 hours. The first 8 of these proteins were also significantly altered at 24 hours. Consistent with inflammatory remodeling, cholesterol efflux capacity was reduced by 32% (P<0.001) at both time points. Baseline stroke severity adjusted regression model showed that changes within 96-hour poststroke in APOF, APOL1, APMAP, APOC4 (apolipoprotein C4), APOM (apolipoprotein M), PCYOX1 (prenylcysteine oxidase 1), PON1, and APOE correlate with stroke recovery scores (R2=0.38-0.73, adjusted P<0.05). APOF (R2=0.73) and APOL1 (R2=0.60) continued to significantly correlate with recovery scores after accounting for tPA (tissue-type plasminogen activator) treatment. CONCLUSIONS Changes in HDL proteins during early acute phase of stroke associate with recovery. Monitoring HDL proteins may provide clinical biomarkers that inform on stroke recuperation.
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Affiliation(s)
- Deanna L. Plubell
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | - Alex M. Fenton
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | - Sara Rosario
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | - Paige Bergstrom
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | | | - Wayne Clark
- Department of Neurology, Oregon Health & Science University
| | - Neil A. Zakai
- Department of Medicine, Larner College of Medicine, University of Vermont
| | | | - Jessica Minnier
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
- School of Public Health, Oregon Health & Science University
| | - Nabil J. Alkayed
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | - Sergio Fazio
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
| | - Nathalie Pamir
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University
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Yasuda M, Sato H, Hashimoto K, Osada U, Hariya T, Nakayama H, Asano T, Suzuki N, Okabe T, Yamazaki M, Uematsu M, Munakata M, Nakazawa T. Carotid artery intima-media thickness, HDL cholesterol levels, and gender associated with poor visual acuity in patients with branch retinal artery occlusion. PLoS One 2020; 15:e0240977. [PMID: 33091078 PMCID: PMC7580897 DOI: 10.1371/journal.pone.0240977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate factors associated with poor visual acuity (VA) in branch retinal artery occlusion (BRAO). METHODS This was a retrospective cross-sectional study of 72 eyes with BRAO of 72 patients. For statistical comparison, we divided the patients into worse-VA (decimal VA < 0.5) and better-VA (decimal VA > = 0.5) groups. We examined the association of clinical findings, including blood biochemical test data and carotid artery ultrasound parameters, with poor VA. RESULTS Median age, hematocrit, hemoglobin and high-density lipoprotein (HDL) differed significantly between the groups (P = 0.018, P < 0.01, P < 0.01, and P = 0.025). There was a tendency towards higher median IMT-Bmax in the worse-VA group (worse-VA vs. better-VA: 2.70 mm vs. 1.60 mm, P = 0.152). Spearman's rank correlation test revealed that logMAR VA was significantly correlated to IMT-Bmax (rs = 0.31, P < 0.01) and IMT-Cmax (rs = 0.24, P = 0.035). Furthermore, logMAR VA was significantly correlated to HDL level (rs = -0.33, P < 0.01). Multivariate logistic regression analysis revealed that IMT-Bmax (odds ratio [OR] = 2.70, P = 0.049), HDL level (OR = 0.91, P = 0.032), and female gender (OR = 15.63, P = 0.032) were independently associated with worse VA in BRAO. CONCLUSIONS We found that increased IMT-Bmax, decreased HDL, and female sex were associated with poor VA in BRAO patients. Our findings might suggest novel risk factors for visual dysfunction in BRAO and may provide new insights into the pathomechanisms underlying BRAO.
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Affiliation(s)
- Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hajime Sato
- Yaotome Sato Hajime Eye Clinic, Miyagi, Japan
| | - Kazuki Hashimoto
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Urara Osada
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takehiro Hariya
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroko Nakayama
- Department of Ophthalmology, JR Sendai Hospital, Sendai, Miyagi, Japan
| | - Toshifumi Asano
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Noriyuki Suzuki
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsu Okabe
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Ophthalmology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Mai Yamazaki
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Seiryo Eye Clinic, Miyagi, Japan
| | - Megumi Uematsu
- Department of Ophthalmology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masanori Munakata
- Division of Hypertension & Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- * E-mail:
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Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. LANCET GLOBAL HEALTH 2020; 8:e721-e729. [PMID: 32353319 DOI: 10.1016/s2214-109x(20)30117-0] [Citation(s) in RCA: 327] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Estimation of the epidemiological burden of carotid atherosclerosis can serve as a basis for prevention and management of cardiovascular disease. We aimed to provide the first estimation on the prevalence, number of cases, and risk factors for carotid atherosclerosis in the general population globally and regionally. METHODS In this systematic review, meta-analysis, and modelling study, we searched PubMed, MEDLINE, Embase, Global Health, and China National Knowledge Infrastructure for articles published from database inception until May 7, 2019, with no language restrictions, for population-based studies that quantified prevalence of carotid atherosclerosis by means of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. Studies were eligible if they included bilaterally scanned carotid arteries using ultrasonography and defined increased carotid intima-media thickness as a thickness of 1·0 mm or more, carotid plaque as a focal carotid intima-media thickness of 1·5 mm or more encroaching into the lumen or at least 0·5 mm or 50% compared with the surrounding carotid intima-media thickness values, and carotid stenosis as 50% or more stenosis. Studies were excluded if the sample was not representative of the general population. We also included studies identified in our previous systematic review and meta-analysis of the prevalence of carotid atherosclerosis in China. We estimated age-specific and sex-specific prevalences of increased carotid intima-media thickness, carotid plaque, and carotid stenosis. We used UN population data to generate the number of people affected in 2000, 2015, and 2020. We did random-effects meta-analyses to assess the effects of risk factors for increased carotid intima-media thickness and carotid plaque. We derived regional numbers of people living with increased carotid intima-media thickness and carotid plaque in 2015 using a risk factors-based model by WHO region. All analyses were done in populations aged 30-79 years due to availability of data. This systematic review and meta-analysis is registered online on PROSPERO, CRD42019134709. FINDINGS We identified 8632 articles through our database search, of which 515 were eligible for full-text review, including 37 articles from our previous study, and 59 articles were eligible for inclusion in our systematic review and meta-analysis. Overall, in people aged 30-79 years in 2020, the global prevalence of increased carotid intima-media thickness is estimated to be 27·6% (95% CI 16·9-41·3), equivalent to 1066·70 million affected people and a percentage change of 57·46% from 2000; of carotid plaque is estimated to be 21·1% (13·2-31·5), equivalent to 815·76 million affected people and a percentage change of 58·97% from 2000; and carotid stenosis is estimated to be 1·5% (1·1-2·1), equivalent to 57·79 million affected people and a percentage change of 59·13% from 2000. The prevalence of increased carotid intima-media thickness, carotid plaque, and carotid stenosis increased consistently with age and was higher in men than in women. Current smoking, diabetes, and hypertension were common risk factors for increased carotid intima-media thickness and carotid plaque. In 2015, the Western Pacific region had the largest share of global cases of increased carotid intima-media thickness (317·62 million [33·36%] of 952·13 million affected people) and carotid plaque (240·77 million [33·20%] of 725·25 million), whereas the African region had the smallest share of cases of increased carotid intima-media thickness (59·08 million [6·21%]) and the Eastern Mediterranean region had the smallest share of carotid plaque cases (44·59 million [6·15%]). INTERPRETATION A substantial global burden of carotid atherosclerosis exists. Effective strategies are needed for primary prevention and management of carotid atherosclerosis. High-quality epidemiological investigations on carotid atherosclerosis are needed to better address the global burden of carotid atherosclerosis at finer levels. FUNDING None.
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Li X, Shi W, Zhang R, Zhang S, Hou W, Wu Y, Lu R, Feng Y, Tian J, Sun L. Integrate Molecular Phenome and Polygenic Interaction to Detect the Genetic Risk of Ischemic Stroke. Front Cell Dev Biol 2020; 8:453. [PMID: 32671063 PMCID: PMC7326764 DOI: 10.3389/fcell.2020.00453] [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: 03/18/2020] [Accepted: 05/15/2020] [Indexed: 12/02/2022] Open
Abstract
Ischemic stroke (IS) is one of the leading causes of death, and the genetic risk of which are continuously calculated and detected by association study of single nucleotide polymorphism (SNP) and the phenotype relations. However, the systematic assessment of IS risk still needs the accumulation of molecular phenotype and function from the level of omics. In this study, we integrated IS phenome, polygenic interaction gene expression and molecular function to screen the risk gene and molecular function. Then, we performed a case-control study including 507 cases and 503 controls to verify the genetic associated relationship among the candidate functional genes and the IS phenotype in a northern Chinese Han population. Mediation analysis revealed that the blood pressure, high density lipoprotein (HDL) and glucose mediated the potential effect of SOCS1, CD137, ALOX5AP, RNLS, and KALRN in IS, both for the functional analysis and genetic association. And the SNP-SNP interactions analysis by multifactor dimensionality reduction (MDR) approach also presented a combination effect of IS risk. The further interaction network and gene ontology (GO) enrichment analysis suggested that CD137 and KALRN functioning in inflammatory could play an expanded role during the pathogenesis and progression of IS. The present study opens a new avenue to evaluate the underlying mechanisms and biomarkers of IS through integrating multiple omics information.
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Affiliation(s)
- Xiaoying Li
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weilin Shi
- Department of Physical Diagnosis, The Fourth Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Ruyou Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuang Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenying Hou
- Department of Ultrasound, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yingnan Wu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Rui Lu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanan Feng
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Litao Sun
- Department of Ultrasound, Shenzhen University General Hospital, Shenzhen, China
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29
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Muzurović EM, Mikhailidis DP. Diabetes Mellitus and Noncardiac Atherosclerotic Vascular Disease-Pathogenesis and Pharmacological Treatment Options. J Cardiovasc Pharmacol Ther 2020; 26:25-39. [PMID: 32666812 DOI: 10.1177/1074248420941675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diabetes mellitus (DM) is also a cause of cardiovascular (CV) disease (CVD). Addressing the atherosclerotic CVD (ASCVD) burden in DM should reduce premature death and improve quality of life. Diabetes mellitus-associated ASCVD can lead to complications in all vascular beds (carotids as well as coronary, lower extremity, and renal arteries). This narrative review considers the diagnosis and pharmacological treatment of noncardiac atherosclerotic vascular disease (mainly in patients with DM). Based on current knowledge and the fact that modern DM treatment guidelines are based on CV outcome trials, it should be noted that patients with noncardiac CVD may not have the same benefits from certain drugs compared with patients who predominantly have cardiac complications. This leads to the conclusion that in the future, consideration should be given to conducting well-designed trials that will answer which pharmacological treatment modalities will be of greatest benefit to patients with noncardiac ASCVD.
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Affiliation(s)
- Emir M Muzurović
- Department of Internal Medicine, Endocrinology Section, 274294Clinical Centre of Montenegro, Ljubljanska bb, Podgorica, Montenegro.,Faculty of Medicine, University of Montenegro, Kruševac bb, Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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30
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Abstract
Patients with stroke have a high risk of infection which may be predicted by age, procalcitonin, interleukin-6, C-reactive protein, National Institute of Health stroke scale (NHSS) score, diabetes, etc. These prediction methods can reduce unfavourable outcome by preventing the occurrence of infection.We aim to identify early predictors for urinary tract infection in patients after stroke.In 186 collected acute stroke patients, we divided them into urinary tract infection group, other infection type groups, and non-infected group. Data were recorded at admission. Independent risk factors and infection prediction model were determined using Logistic regression analyses. Likelihood ratio test was used to detect the prediction effect of the model. Receiver operating characteristic curve and the corresponding area under the curve were used to measure the predictive accuracy of indicators for urinary tract infection.Of the 186 subjects, there were 35 cases of urinary tract infection. Elevated interleukin-6, higher NIHSS, and decreased hemoglobin may be used to predict urinary tract infection. And the predictive model for urinary tract infection (including sex, NIHSS, interleukin-6, and hemoglobin) have the best predictive effect.This study is the first to discover that decreased hemoglobin at admission may predict urinary tract infection. The prediction model shows the best accuracy.
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Affiliation(s)
- Ya-ming Li
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Jian-hua Xu
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Yan-xin Zhao
- Department of Neurology, Tenth People's Hospital affiliated to Tongji University, Shanghai, China
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31
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Singh K, Chandra A, Sperry T, Joshi PH, Khera A, Virani SS, Ballantyne CM, Otvos JD, Dullaart RPF, Gruppen EG, Connelly MA, Ayers CR, Rohatgi A. Associations Between High-Density Lipoprotein Particles and Ischemic Events by Vascular Domain, Sex, and Ethnicity: A Pooled Cohort Analysis. Circulation 2020; 142:657-669. [PMID: 32804568 PMCID: PMC7425196 DOI: 10.1161/circulationaha.120.045713] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Supplemental Digital Content is available in the text. Background: High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C. Methods: We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA (Multi-Ethnic Study of Atherosclerosis; n=6632), and PREVEND (Prevention of Renal and Vascular Endstage Disease; n=5022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke. Results: In the overall population (n=15 784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors (hazard ratio [HR] for quartile 4 [Q4] versus quartile 1 [Q1], 0.64 [95% CI, 0.52–0.78]), as was HDL-C (HR for Q4 versus Q1, 0.76 [95% CI, 0.61–0.94]). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and atherosclerotic cardiovascular disease, whereas adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual end points of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR for Q4 versus Q1 for Whites, 0.49 [95% CI, 0.35–0.69]; for Blacks, 1.22 [95% CI, 0.76–1.98]; Pinteraction=0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR for Q4 versus Q1, 0.53 [95% CI, 0.36–0.78]) but had a weak direct association with MI among Black participants (HR for Q4 versus Q1, 1.75 [95% CI, 1.08–2.83]; Pinteraction<0.0001). Conclusions: Compared with HDL-C, HDL-P was consistently associated with MI and ischemic stroke in the overall population. Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that atherosclerotic cardiovascular disease risk may differ by vascular domain and ethnicity. Future studies should examine individual outcomes separately.
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Affiliation(s)
- Kavisha Singh
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Alvin Chandra
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Thomas Sperry
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Amit Khera
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.)
| | | | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (J.D.O., M.A.C.)
| | - Robin P F Dullaart
- University of Groningen and University Medical Center Groningen, The Netherlands (R.P.F.D., E.G.G.)
| | - Eke G Gruppen
- University of Groningen and University Medical Center Groningen, The Netherlands (R.P.F.D., E.G.G.)
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC (J.D.O., M.A.C.)
| | - Colby R Ayers
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
| | - Anand Rohatgi
- University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.)
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Dhungana SP, Mahato AK, Ghimire R, Shreewastav RK. Prevalence of Dyslipidemia in Patients with Acute Coronary Syndrome Admitted at Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:204-208. [PMID: 32417854 PMCID: PMC7580459 DOI: 10.31729/jnma.4765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Dyslipidemia is one of the major risk factors for acute coronary syndrome. Dyslipidemia with an increase in total cholesterol, low-density lipoprotein cholesterol, triglycerides and decrease in high-density lipoprotein cholesterol is one of the major risk factors for the acute coronary syndrome and alone account for more than 50% of population attributable risk. This study was conducted to find out the prevalence of dyslipidemia. METHODS This descriptive cross-sectional study was conducted in 105 patients admitted at the tertiary care center with a diagnosis of acute coronary syndrome from July 2018 to March 2019 after approval from the institutional review committee (Ref no. 205/2018). Fasting serum lipid profile was obtained within 24 hours of hospitalization with the convenient sampling method. Data were analyzed with the help of the Statistical Package for Social Sciences version 20. Point estimation at 95% Confidence interval was calculated along with frequency and proportion for binary data. RESULTS Out of 105 people, dyslipidemia was present in 51 (48.6%). The mean age of the participants was 59.19±12.69 years. The majority 81 (77.1%) were male. The mean total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were 183.43±35.9 mg/dl, 140.59±46.83 mg/dl, 109.9±26.38 mg/dl and 41.17±4.78 mg/dl respectively. High total cholesterol and triglyceride were found in 34 (32.4%) each, low high-density lipoprotein in 31 (29.5%) and high low-density lipoprotein in 22 (21%). CONCLUSIONS Dyslipidemia is a significant risk factor in patients with acute coronary syndrome and commonly associated with other risk factors. Careful attention to its management may help to reduce further events.
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Affiliation(s)
- Sahadeb Prasad Dhungana
- Department of Internal Medicine and cardiology unit, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Arun Kumar Mahato
- Department of Internal Medicine, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
| | - Rinku Ghimire
- Deprtment of Pharmacology, Nobel Medical College Teaching Hospital, Biratnagar, Nepal
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Xie Z, Yang Y, He Y, Shu C, Chen D, Zhang J, Chen J, Liu C, Sheng Z, Liu H, Liu J, Gong X, Song L, Dong S. In vivo assessment of inflammation in carotid atherosclerosis by noninvasive photoacoustic imaging. Am J Cancer Res 2020; 10:4694-4704. [PMID: 32292523 PMCID: PMC7150488 DOI: 10.7150/thno.41211] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/15/2020] [Indexed: 01/22/2023] Open
Abstract
Objectives: The objective of this study was to demonstrate the feasibility of using noninvasive photoacoustic imaging technology along with novel semiconducting polymer nanoparticles for in vivo identifying inflammatory components in carotid atherosclerosis and assessing the severity of inflammation using mouse models. Methods and Results: Healthy carotid arteries and atherosclerotic carotid arteries were imaged in vivo by the noninvasive photoacoustic imaging system. Molecular probes PBD-CD36 were used to label the inflammatory cells to show the inflammation information by photoacoustic imaging. In in vivo imaging experiments, we observed the maximum photoacoustic signal enhancement of 4.3, 5.2, 8 and 16.3 times between 24 h post probe injection and that before probe injection in four carotid arteries belonging to three atherosclerotic mice models. In the corresponding carotid arteries stained with CD36, the ratio of 0.043, 0.061, 0.082 and 0.113 was found between CD36 positive (CD36(+)) expression area and intima-media area (P < 0.05). For the CD36(+) expression less than 0.008 in eight arteries, no photoacoustic signal enhancement was found due to the limited system sensitivity. The photoacoustic signal reflects CD36(+) expression in plaques, which shows the feasibility of using photoacoustic imaging for in vivo assessment of carotid atherosclerosis. Conclusion: This research demonstrates a semiconducting polymer nanoparticle along with photoacoustic technology for noninvasive imaging and assessment of inflammation of carotid atherosclerotic plaques in vivo.
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4793] [Impact Index Per Article: 1198.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5274] [Impact Index Per Article: 1054.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Barbosa CJDG, Maranhão RC, Barreiros RS, Freitas FR, Franci A, Strunz CMC, Arantes FBB, Tavoni TM, Ramires JAF, Kalil Filho R, Nicolau JC. Lipid transfer to high-density lipoproteins in coronary artery disease patients with and without previous cerebrovascular ischemic events. Clin Cardiol 2019; 42:1100-1105. [PMID: 31489679 PMCID: PMC6837020 DOI: 10.1002/clc.23259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with coronary artery disease (CAD) and previous ischemic cerebrovascular events (ICVE, ischemic stroke, or transitory ischemic attack) constitute a high-risk subgroup for cardiovascular outcomes. High-density lipoprotein cholesterol (HDL-C) levels are correlated with cardiovascular events. Lipid transfer to HDL affects structure size and HDL subclass profile. Impairment of this transfer could influence ischemic risk seen in patients with CAD + ICVE. The objective was to evaluate the HDL ability to receive the lipids in patients with CAD with or without ICVE. METHODS Patients with CAD + ICVE (n = 60) and patients with CAD only (n = 60) were matched by age, sex, acute coronary syndromes (ACS) event type, and time elapsed between the ACS event and inclusion in the study. Lipid transfer to HDL was evaluated by incubating donor lipid nanoparticles labeled with radioactive unesterified cholesterol (UC) and esterified cholesterol (EC), phospholipid (PL), and triglyceride (TG) with whole plasma. After the chemical precipitation of non-HDL fractions and nanoparticles, the supernatant was counted for HDL radioactivity. RESULTS CAD + ICVE group presented with impaired lipid transfer to HDL for PL (CAD + ICVE: 21.14 ± 2.7% vs CAD: 21.67 ± 3.1%, P = .03), TG (CAD + ICVE: 4.88 ± 0.97% vs CAD: 5.63 ± 0.92%, P = .002), and UC (CAD + ICVE: 5.55 ± 1.19% vs CAD: 6.16 ± 1.14%, P = .009). Lipid transfer to HDL was similar in both groups for EC. Adjusted models showed similar results. CONCLUSION Patients with CAD and ICVE have reduced lipid transfer to HDL compared to those with CAD only. Dysfunctional HDL may account for the higher incidence of ischemic outcomes observed in this population.
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Affiliation(s)
- Carlos J D G Barbosa
- Hospital do Coracao do Brasil, Brasília, Brazil.,Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Raul C Maranhão
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade de Ciencias Farmaceuticas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata S Barreiros
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fatima R Freitas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - André Franci
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Célia M C Strunz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Thauany M Tavoni
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José A F Ramires
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Liu X, Yang Y, Kang F, Li J, Zhou M, Ma X, Yu T, Zhang T, Xue F. Cardiovascular Disease Risk Across a Spectrum of Adverse Plasma Lipid Combinations by Gender and Glycemic Status. Am J Cardiol 2019; 124:702-708. [PMID: 31311663 DOI: 10.1016/j.amjcard.2019.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 01/17/2023]
Abstract
High triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C) and high non-HDL-C levels are risk factors for cardiovascular disease (CVD). It is unclear whether the combinations of their adverse changes are related with CVD risk in different gender and diabetes status, particularly in Chinese population. This study aims to evaluate the CVD risk associated with different adverse lipid combinations. A total of 38,989 participants from Chinese Multicenter Longitudinal Health Management Cohorts (mean age 42 years; 62% male) without baseline CVD were followed up for incident CVD from 2007 to 2015. Participants with various combinations of baseline TG, non-HDL-C, and HDL-C levels within- or out of range according to Adult Treatment Panel III were grouped into 8 distinct lipid categories. Cox models estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of different lipid categories for CVD. After multivariable adjustment, a low level of HDL-C combined with either a high level of non-HDL-C alone or TG alone were associated with increased CVD risk with adjusted HRs (95% CIs) of 1.77 (1.36 to 2.30) and 2.08 (1.30 to 3.34) in male participants. Diabetic participants with high non-HDL-C and low HDL-C levels (adjusted HR 2.93, 95% CI 1.15 to 7.46), and non-diabetic participants with high TG and low HDL-C levels (adjusted HR 1.73, 95% CI 1.33 to 2.26) had greater risk of incident CVD. These relations remained significant when limited analysis to participants with normal LDL-C levels of <3.4 mmol/L, indicating the various combinations of out-of-range lipid profiles other than LDL-C are associated with different CVD risk and the associations depend on gender and glycemic status.
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Affiliation(s)
- Xiaojuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Yachao Yang
- Health Management Center, Weihai Municipal Hospital, Weihai, China
| | - Fengling Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Jiqing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Miao Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Xiaotian Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Tao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Tao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, China; Healthcare Big Data Institute of Shandong University, Jinan, China.
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Epidemiology of Dyslipidemia Among Adult Population of Bangladesh. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: evatedEl level serum of lipids stimulate atherosclerosis, which is the risk factor for stroke, peripheral vascular taeohrrratrrocvtra disease. The aim of this study was to explore the pattern and associated factors of dyslipidemia among Bangladeshi adult population.
Material and methods: A descriptive cross-sectional study was conducted at the outpatient department (OPD) of four Medical College Hospitals, Bangladesh. 200 adults aged 20 to 65 years diagnosed case of dyslipidemia were randomly selected. Fasting CHO, HDL, LDL and TG were measured. According to the criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), dyslipidemia was classified into (a) Hyper-lipidemia: TC>200 mg/dl, TG>150 mg/dl, (b) Hyper cholesterolemia: TC>200 mg/dl, (c) Hyper-triglyceridemia: TG>150 mg/dl, and (d) Atherogenic-dyslipidemia: TG>150 mg/dl, LDLC>165 mg/dl.
Results: Study found 46% hyperlipidemia, 37% atherogenic dyslipidemia, 13.5% hypercholesterolemia and only 3.5% hypertriglyceridemia. BMI, FBS and HDL-C were significantly higher among female compare to male (p=<0.01, <0.01 and 0.04 respectively). TC and TG were significantly higher among higher calorie intake group in compare to normal intake group (p=0.04).
Conclusions: Results of this study concluded that hyperlipidemia and atherogenic dyslipidemia are common and female dyslipidemic patients are susceptible to develop higher BMI, FBS, and HDL-C.
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Karere GM, Glenn JP, Birnbaum S, Garcia R, VandeBerg JL, Cox LA. Identification of coordinately regulated microRNA-gene networks that differ in baboons discordant for LDL-cholesterol. PLoS One 2019; 14:e0213494. [PMID: 30875406 PMCID: PMC6420018 DOI: 10.1371/journal.pone.0213494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/24/2019] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Plasma low-density lipoprotein cholesterol (plasma LDL-C), vascular endothelial cells and peripheral blood mononuclear cells (PBMCs), particularly monocytes, play key roles in initiating atherosclerosis, the primary cause of cardiovascular disease (CVD). Although the mechanisms underlying development of atherosclerosis are not well understood, LDL-C is known to influence expression of endothelial microRNAs (miRNAs) and gene-targets of miRNAs to promote cell senescence. However, the impact of LDL-C on expression of PBMC miRNAs and miRNA targeted genes in response to an atherogenic diet is not known. In this study, we used unbiased methods to identify coordinately responsive PBMC miRNA- gene networks that differ between low and high LDL-C baboons when fed a high-cholesterol, high-fat (HCHF) diet. METHODS AND RESULTS Using RNA Seq, we quantified PBMC mRNAs and miRNAs from half-sib baboons discordant for LDL-C plasma concentrations (low LDL-C, n = 3; high LDL-C, n = 3) before and after a 7-week HCHF diet challenge. For low LDL-C baboons, 626 genes exhibited significant change in expression (255 down-regulated, 371 up-regulated) in response to the HCHF diet, and for high LDL-C baboons 379 genes exhibited significant change in expression (162 down-regulated, 217 up-regulated) in response to the HCHF diet. We identified 494 miRNAs identical to human miRNAs and 47 novel miRNAs. Fifty miRNAs were differentially expressed in low LDL-C baboons (21 up- and 29 down-regulated) and 20 in high LDL-C baboons (11 up- and 9 down-regulated) in response to the HCHF diet. Among the differentially expressed miRNAs were miR-221/222 and miR-34a-3p, which were down-regulated, and miR-148a/b-5p, which was up-regulated. In addition, gene-targets of these miRNAs, VEGFA, MAML3, SPARC, and DMGDH, were inversely expressed and are central hub genes in networks and signaling pathways that differ between low and high LDL-C baboon HCHF diet response. CONCLUSIONS We have identified coordinately regulated HCHF diet-responsive PBMC miRNA-gene networks that differ between baboons discordant for LDL-C concentrations. Our findings provide potential insights into molecular mechanisms underlying initiation of atherosclerosis where LDL-C concentrations influence expression of specific miRNAs, which in turn regulate expression of genes that play roles in initiation of lesions.
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Affiliation(s)
- Genesio M. Karere
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States of America
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Jeremy P. Glenn
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Shifra Birnbaum
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Roy Garcia
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - John L. VandeBerg
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, School of Medicine,The University of Texas Rio Grande Valley, Brownsville/Harlingen/Edinburg, TX, United States of America
| | - Laura A. Cox
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, United States of America
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States of America
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Rabeya R, Zaman S, Chowdhury A, Nabi M, Hawlader M. Magnitude and Determinants of Hypothyroidism among Dyslipidemic Patients in Bangladesh: A Hospital-Based Cross-Sectional Study. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000499379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Dyslipidemia is one of the most commonly experienced metabolic disorders, and it is strongly related to atherosclerotic cardiovascular disease. Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones. Several studies from developed countries provide evidence that the rate of hypothyroidism in dyslipidemic patients is higher, but there is a scarcity of data from Bangladesh. <b><i>Objectives:</i></b> The aim of this study was to evaluate the prevalence and determinants of hypothyroidism in the adult dyslipidemic Bangladeshi population. <b><i>Method:</i></b> We examined the thyroid function of outpatients who were advised for fasting lipid profile and who were found to be dyslipidemic at a tertiary care hospital in Savar, Bangladesh, by a cross-sectional study conducted from July 2016 to June 2017. A total of 200 outpatients aged 20–65 years were enrolled in this study. A standard questionnaire was used to take record of sociodemographic, socioeconomic, and behavioral features. Body mass index (BMI) and blood pressure were examined with standard procedures. Biochemical parameters, such as fasting lipid profile and thyroid function markers, thyroid-stimulating hormone (TSH) and free thyroxine (fT4), were determined using standard assay methods. A <i>p</i> value < 0.05 was considered to be statistically significant. <b><i>Results:</i></b> Among the participants, 56% were male and 44% were female. 11.5% of the dyslipidemic subjects had hypothyroidism, among which 9.5% had subclinical hypothyroidism and only 2% had overt hypothyroidism. We also found that serum mean ± SD levels of TSH were significantly higher in the obese group of patients (<i>p</i> = 0.02). There was a significantly positive association of BMI and diastolic blood pressure with serum levels of TSH (<i>p</i> < 0.01) and fT4 (<i>p</i> = 0.02), respectively. <b><i>Conclusion:</i></b> Dyslipidemic patients should have more regular checkups. The findings of this study might be helpful in setting up the clinical management of dyslipidemias with or without normal thyroid function.
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Wang SY, Zha XJ, Zhu XY, Li WB, Ma J, Wu ZW, Wu H, Jiang MF, Wen YF. Metabolic syndrome and its components with neuron-specific enolase: a cross-sectional study in large health check-up population in China. BMJ Open 2018; 8:e020899. [PMID: 29643166 PMCID: PMC5898352 DOI: 10.1136/bmjopen-2017-020899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study was aimed at investigating the relationship between neuron-specific enolase (NSE) and components of metabolic syndrome (MS). DESIGN Cross-sectional study. SETTING Chinese health check-up population. PARTICIPANTS 40 684 health check-up people were enrolled in this study from year 2014 to 2016. MAIN OUTCOME MEASURES OR and coefficient for MS. RESULTS The percentage of abnormal NSE and MS was 26.85% and 8.85%, respectively. There were significant differences in sex, body mass index, drinking habit, triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), blood pressure and MS between low-NSE and high-NSE groups. In logistic regression analysis, elevated NSE was present in MS, higher body mass index, hypertriglyceridaemia, hypertension and low-HDL groups. Stepwise linear analysis showed a negative correlation between NSE and fasting blood glucose (FBG) (<6.0 mmol/L), and a positive correlation between NSE and TGs (<20 mmol/L), systolic blood pressure (75-200 mm Hg), HDL-C (0.75-2.50 mmol/L), diastolic blood pressure (<70 mm Hg) and FBG (6.00-20.00 mmol/L). Furthermore, MS was positively correlated with NSE within the range of 2.00-7.50 ng/mL, but had a negative correlation with NSE within the range of 7.50-23.00 ng/mL. CONCLUSION There are associations between NSE with MS and its components. The result suggests that NSE may be a potential predictor of MS. Further research could be conducted in discussing the potential mechanism involved.
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Affiliation(s)
- Shu-Yi Wang
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Xiao-Juan Zha
- Medical Examination Center, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, Anhui Province, China
| | - Xin-Ying Zhu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Wen-Bo Li
- School of Clinical Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Jun Ma
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Ze-Wei Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Huan Wu
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Ming-Fei Jiang
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
| | - Yu-Feng Wen
- School of Laboratory Medicine, Wannan Medical College, Wuhu, Anhui Province, China
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Wei W, Li S, San F, Zhang S, Shen Q, Guo J, Zhang L. Retrospective analysis of prognosis and risk factors of patients with stroke by TOAST. Medicine (Baltimore) 2018; 97:e0412. [PMID: 29642209 PMCID: PMC5908632 DOI: 10.1097/md.0000000000010412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/09/2018] [Accepted: 03/18/2018] [Indexed: 01/21/2023] Open
Abstract
To determine differences in 90-day mortality and identify risk factors among different etiological classifications of ischemic stroke using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.Our retrospective analysis included 538 ischemic stroke patients. The cause of stroke was categorized according to the TOAST criteria, and 90-day mortality rates were obtained through the patient follow-up. Age, sex, previous medical history, and clinical features were used in the analysis of potential risk factors.There were 38 deaths during the 90-day follow-up period. Patients in the undetermined cause subgroups experienced significantly higher mortality rate than those in subgroups with small artery occlusion and large artery atherosclerosis. Factors independently associated with 90-day mortality for patients with the large artery atherosclerosis stroke subtype were age (95% confidence interval [CI], 1.010-1.192, P = .028), history of hypertension (95% CI, 3.030-99.136, P = .001), high blood glucose (95% CI, 1.273-2.354, P < .001), high cholesterol (95% CI, 0.017-0.462, P = .004), high uric acid (95% CI, 2.360-64.389, P = .003), and National Institute of Health Stroke Scale(95% CI, 1.076-1.312, P = .001). Age (95% CI, 1.012-1.358, P = .034) and high cholesterol (95% CI, 0.011-0.496, P = .007) were independently associated with 90-day mortality for patients with the small artery occlusion subtype of stroke.Our analysis identified that certain risk factors and 90-day mortality differ significantly among different stroke subtypes, as classified by the TOAST criteria. These risk factors must be considered carefully to provide the best clinical management of these patients and thus reduce mortality.
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Affiliation(s)
| | - Suting Li
- Department of Emergency, The Zengcheng People's Hospital (Boji-Affiliated Hospital of Sun Yat-sen University), Guangzhou
| | | | | | | | | | - Li Zhang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China
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Hindy G, Engström G, Larsson SC, Traylor M, Markus HS, Melander O, Orho-Melander M. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes: A Mendelian Randomization Study. Stroke 2018; 49:820-827. [PMID: 29535274 PMCID: PMC5895121 DOI: 10.1161/strokeaha.117.019653] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/19/2018] [Accepted: 02/15/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Statin therapy is associated with a lower risk of ischemic stroke supporting a causal role of low-density lipoprotein (LDL) cholesterol. However, more evidence is needed to answer the question whether LDL cholesterol plays a causal role in ischemic stroke subtypes. In addition, it is unknown whether high-density lipoprotein cholesterol and triglycerides have a causal relationship to ischemic stroke and its subtypes. Our aim was to investigate the causal role of LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides in ischemic stroke and its subtypes through Mendelian randomization (MR). METHODS Summary data on 185 genome-wide lipids-associated single nucleotide polymorphisms were obtained from the Global Lipids Genetics Consortium and the Stroke Genetics Network for their association with ischemic stroke (n=16 851 cases and 32 473 controls) and its subtypes, including large artery atherosclerosis (n=2410), small artery occlusion (n=3186), and cardioembolic (n=3427) stroke. Inverse-variance-weighted MR was used to obtain the causal estimates. Inverse-variance-weighted multivariable MR, MR-Egger, and sensitivity exclusion of pleiotropic single nucleotide polymorphisms after Steiger filtering and MR-Pleiotropy Residual Sum and Outlier test were used to adjust for pleiotropic bias. RESULTS A 1-SD genetically elevated LDL cholesterol was associated with an increased risk of ischemic stroke (odds ratio: 1.12; 95% confidence interval: 1.04-1.20) and large artery atherosclerosis stroke (odds ratio: 1.28; 95% confidence interval: 1.10-1.49) but not with small artery occlusion or cardioembolic stroke in multivariable MR. A 1-SD genetically elevated high-density lipoprotein cholesterol was associated with a decreased risk of small artery occlusion stroke (odds ratio: 0.79; 95% confidence interval: 0.67-0.90) in multivariable MR. MR-Egger indicated no pleiotropic bias, and results did not markedly change after sensitivity exclusion of pleiotropic single nucleotide polymorphisms. Genetically elevated triglycerides did not associate with ischemic stroke or its subtypes. CONCLUSIONS LDL cholesterol lowering is likely to prevent large artery atherosclerosis but may not prevent small artery occlusion nor cardioembolic strokes. High-density lipoprotein cholesterol elevation may lead to benefits in small artery disease prevention. Finally, triglyceride lowering may not yield benefits in ischemic stroke and its subtypes.
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Affiliation(s)
- George Hindy
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.).
| | - Gunnar Engström
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Susanna C Larsson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Matthew Traylor
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Hugh S Markus
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Olle Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Marju Orho-Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4483] [Impact Index Per Article: 747.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Richardson J, Tang A, Guyatt G, Thabane L, Xie F, Sahlas D, Hart R, Fleck R, Hladysh G, Macrae L. FIT for FUNCTION: study protocol for a randomized controlled trial. Trials 2018; 19:39. [PMID: 29335013 PMCID: PMC5769391 DOI: 10.1186/s13063-017-2416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The current state of evidence suggests that community-based exercise programs are beneficial in improving impairment, function, and health status, and are greatly needed for persons with stroke. However, limitations of these studies include risk of bias, feasibility, and cost issues. METHODS/DESIGN This single-blinded, randomized controlled trial (RCT) of 216 participants with stroke will compare the effectiveness of a 12-week YMCA community-based wellness program (FIT for FUNCTION) specifically designed for community-dwelling persons with stroke to persons who receive a standard YMCA membership. The primary outcome will be community reintegration using the Reintegration to Normal Living Index at 12 and 24 weeks. Secondary outcomes include measurement of physical activity level using the Rapid Assessment of Physical Activity and accelerometry; balance using the Berg Balance Scale; lower extremity function using the Short Physical Performance Battery; exercise capacity using the 6-min walk test; grip strength and isometric knee extension strength using hand held dynamometry; and health-related quality of life using the European Quality of Life 5-Dimension Questionnaire. We are also assessing cardiovascular health and lipids; glucose and inflammatory markers will be collected following 12-h fast for total cholesterol, insulin, glucose, and glycated hemoglobin. Self-efficacy for physical activity will be assessed with a single question and self-efficacy for managing chronic disease will be assessed using the Stanford 6-item Scale. The Patient Activation Measure will be used to assess the patient's level of knowledge, skill, and confidence for self-management. Healthcare utilization and costs will be evaluated. Group, time, and group × time interaction effects will be estimated using generalized linear models for continuous variables, including relevant baseline variables as covariates in the analysis that differ appreciably between groups at baseline. Cost data will be treated as non-parametric and analyzed using a Mann-Whitney U test. DISCUSSION This is a RCT with broad study eligibility criteria intended to recruit a wide spectrum of individuals living in the community with stroke. If positive benefits are demonstrated, results will provide strong research evidence to support the implementation of structured, community-based exercise and education/self-management programs for a broad range of people living in the community with stroke. TRIAL REGISTRATION ClinicalTrials.gov, NCT02703805 . Registered on 14 October 2014.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Centre for Evaluation of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Programs for Assessment of Technology in Health Research Institute, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Demetrios Sahlas
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | - Robert Hart
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Population Health Research Institute, Hamilton, ON Canada
| | - Rebecca Fleck
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | | | - Louise Macrae
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
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Yamamoto R, Sacks FM, Hu FB, Rosner B, Furtado JD, Aroner SA, Ferrannini E, Baldi S, Kozakova M, Balkau B, Natali A, Jensen MK. High density lipoprotein with apolipoprotein C-III is associated with carotid intima-media thickness among generally healthy individuals. Atherosclerosis 2018; 269:92-99. [PMID: 29351856 DOI: 10.1016/j.atherosclerosis.2017.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/28/2017] [Accepted: 12/21/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS About 6-7% of high density lipoprotein (HDL) has a protein called apolipoprotein (apo) C-III that regulates lipoprotein metabolism and can provoke an inflammatory response. HDL without apoC-III is inversely associated with coronary heart disease (CHD), whereas HDL with apoC-III is directly associated with CHD. We investigated how the presence of apoC-III affects the association between HDL and early stages of atherosclerosis measured as carotid intima-media thickness (cIMT). METHODS We examined the cross-sectional associations between the apoA-I concentrations of HDL subspecies with and without apoC-III and cIMT measured by high resolution B-mode carotid ultrasonography among 847 participants from the European multi-center Relationship between Insulin Sensitivity and Cardiovascular disease (RISC) study. RESULTS HDL with and without apoC-III demonstrated significantly opposite associations with both cIMT indexes (p-heterogeneity of associations comparing the two subspecies was 0.002 for cIMT at common carotid artery (cIMT at CCA) and 0.006 for the maximum cIMT in any carotid segment (cIMT max)). Compared to the lowest quintile, the highest quintile of apoA-I in HDL without apoC-III was associated with 3.7% lower cIMT at CCA (p-trend = 0.01) or 7.3% lower cIMT max (p-trend = 0.003), while the highest quintile of apoA-I in HDL with apoC-III was associated with 4.4% higher cIMT at CCA (p-trend = 0.001) or 7.9% higher cIMT max (p-trend = 0.002). Total apoA-I as well as total HDL cholesterol was not associated with cIMT whereas higher levels of total apoC-III and apoC-III contained in HDL were significantly associated with higher cIMT (p-trend<0.01). CONCLUSIONS HDL apoC-III is a promising target for atherosclerosis prevention and treatment.
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Affiliation(s)
- Rain Yamamoto
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Frank M Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Bernard Rosner
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Sarah A Aroner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | | | - Simona Baldi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Andrea Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.
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47
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Iannuzzi A, Gentile M, Iannuzzo G, Covetti G, Panico C, Mattiello A, Fata EL, D'Elia L, Michele MD, Rubba P. Atherogenic Lipoprotein Subfractions and Carotid Atherosclerosis in Menopausal Women. Angiology 2017; 69:666-671. [PMID: 29179568 DOI: 10.1177/0003319717744315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate the relationship between cholesterol contained in very-low-density lipoproteins (VLDL-C), intermediate-density lipoproteins (IDL-C), low-density lipoproteins, high-density lipoproteins, and carotid intima-media thickness (cIMT) and carotid plaques in 228 postmenopausal women (63.1 ± 8.2 years) who participated in the ATENA Project and underwent clinical, biochemical (including the assay of lipoproteins using the Lipoprint system), and carotid ultrasound tests. Very-low-density lipoprotein cholesterol had a statistically significant linear association with cIMT ( P < .001), which remained significant after adjustment for age, smoking, systolic blood pressure, glucose, and body mass index ( r2 = .20, P < .05). Higher concentrations of IDL-C and cholesterol contained in triglyceride-rich lipoproteins (TRL-C, ie, VLDL-C + IDL-C) were associated with plaques in the common carotid (tertile III/tertile I: odds ratio [OR] = 2.52, 95% confidence interval [CI] = 1.21-5.32, P < .02; OR = 2.30, 95% CI = 1.05-5.01, P < .05, respectively), after adjustment for main cardiovascular risk factors. In conclusion, high concentrations of VLDL-C and TRL-C are independently associated with the presence of carotid plaques. Their assay represents a useful tool for improving our knowledge on the role of different classes of lipoproteins in atherosclerosis.
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Affiliation(s)
- Arcangelo Iannuzzi
- 1 Department of Medicine and Medical Specialties, Antonio Cardarelli Hospital, Naples, Italy
| | - Marco Gentile
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriella Iannuzzo
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Covetti
- 1 Department of Medicine and Medical Specialties, Antonio Cardarelli Hospital, Naples, Italy
| | - Camilla Panico
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Amalia Mattiello
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ersilia La Fata
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lanfranco D'Elia
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Paolo Rubba
- 2 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Wang H, Chen Y, Guo X, Chang Y, Sun Y. Usefulness of cardiometabolic index for the estimation of ischemic stroke risk among general population in rural China. Postgrad Med 2017; 129:834-841. [PMID: 28870109 DOI: 10.1080/00325481.2017.1375714] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Cardiometabolic index (CMI) has been recognized as a novel and practical marker for the assessment of cardiometabolic risk as it is independently related to diabetes and atherosclerotic progression. This study tested the hypothesis that CMI represents a risk of ischemic stroke in a general population of rural China. METHODS From July 2012 to August 2013, we examined data from a large cross-sectional study of 11,345 participants (mean age 53.8 years; 60.8% females) who underwent biochemical determinations and anthropometric measurements in rural areas of northeast China. Ischemic stroke was documented as a history of cerebrovascular events and verified by medical record review. RESULTS The prevalence of ischemic stroke was given to 3.1% of females and 3.2% of males. The cardio-metabolic profile was notably more adverse in ischemic stroke groups, irrespective of gender. A dose-response manner was detected for the prevalence of ischemic stroke, exhibiting a significant increase from the lowest to the highest quartiles of CMI (1.2% to 6.4% in females, P for trend<0.001; 2.3% to 4.3% in males, P for trend = 0.017). In multivariable analysis, for every 1 SD increment in CMI, the probability of ischemic stroke increased by 18% in females and 14% in males, respectively. The odds ratios for ischemic stroke comparing the top versus bottom quartiles of CMI were 2.047 (95%CI: 1.168-3.587) for females and 1.722 (95%CI: 1.019-2.910) for males. According to the area under receiver operating characteristic (AUC), the discrimination power of CMI in predicting ischemic stroke was relatively higher for females (AUC: 0.685) than males (AUC: 0.573). CONCLUSION The strong and independent association of CMI with ischemic stroke in females, in comparison with the much lesser degree in males, provides further insight to better stratify by sex in investigations of ischemic stroke and solidly corroborates the potential role of ischemic stroke prevention targeted at CMI.
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Affiliation(s)
- Haoyu Wang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , People's Republic of China
| | - Yintao Chen
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , People's Republic of China
| | - Xiaofan Guo
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , People's Republic of China
| | - Ye Chang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , People's Republic of China
| | - Yingxian Sun
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , People's Republic of China
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Gao YY, Jin L, Peng H, Xu LH, Wang QX, Ji J, Wang CK, Bi YZ. Xanthophylls increased HDLC level and nuclear factor PPARγ, RXRγ and RARα expression in hens and chicks. J Anim Physiol Anim Nutr (Berl) 2017; 102:e279-e287. [PMID: 28503816 DOI: 10.1111/jpn.12739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/09/2017] [Indexed: 11/27/2022]
Abstract
This study was designed to investigate effects of xanthophylls on serum lipid profile (triglyceride, TG; cholesterol, CHO; high-density lipoprotein cholesterol, HDLC; and low-density lipoprotein cholesterol, LDLC) and nuclear factor (peroxisome proliferator-activated receptor gamma, PPARγ; PPAR gamma coactivator 1 alpha, PGC1α; retinoid X receptor gamma, RXRγ; and retinoic acid receptor alpha, RARα) gene expression of breeding hens and chicks. In experiment 1, 432 hens were divided into three groups and fed diets supplemented with 0 (as control group), 20 or 40 mg/kg xanthophylls. Blood was sampled at 7, 14, 21, 28 and 35 days of trial. Liver, duodenum, jejunum and ileum were sampled at 35 days of trial. Results showed that serum HDLC level of hens was increased after dietary 40 mg/kg xanthophyll addition for 21, 28 and 35 days, while serum TG, CHO and LDLC were not affected. Xanthophyll addition also increased PPARγ expression in jejunum, RXRγ expression in duodenum and jejunum, and RARα expression in liver and duodenum. Experiment 2 was a 2 × 2 factorial design. Male chicks hatched from 0 or 40 mg/kg xanthophyll diet of hens were fed diet containing either 0 or 40 mg/kg xanthophylls. Liver, duodenum, jejunum and ileum were sampled at 0, 7, 14 and 21 days after hatching. Blood samples were also collected at 21 days. Results showed that in ovo xanthophylls elevated PPARγ in duodenum and jejunum, and RXRγ and RARα in liver of chicks mainly within 1 week after hatching, while dietary xanthophylls increased serum HDLC level and PPARγ and RXRγ in liver from 2 weeks onwards. In conclusion, our research suggested xanthophylls can regulate serum lipid profile and nuclear factor expression in hens and chicks.
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Affiliation(s)
- Y-Y Gao
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - L Jin
- China National Engineering Research Center of JUNCAO Technology, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - H Peng
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - L-H Xu
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - Q-X Wang
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - J Ji
- China-UK-NYNU-Rres Joint Libratory of Insect Biology, Nanyang Normal University, Nanyang, Henan, China
| | - C-K Wang
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - Y-Z Bi
- College of Animal Science, South China Agricultural University, Guangzhou, Guangdong, China
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50
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Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Tsopozidi M, Savopoulos C, Hatzitolios AI. Prognostic significance of major lipids in patients with acute ischemic stroke. Metab Brain Dis 2017; 32:395-400. [PMID: 27771869 DOI: 10.1007/s11011-016-9924-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023]
Abstract
Although dyslipidemia increases the risk for ischemic stroke, previous studies reported conflicting data regarding the association between lipid levels and stroke severity and outcome. To evaluate the predictive value of major lipids in patients with acute ischemic stroke. We prospectively studied 790 consecutive patients who were admitted with acute ischemic stroke (41.0 % males, age 79.4 ± 6.8 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Moderate/severe stroke was defined as NIHSS ≥5. The outcome was assessed with dependency rates at discharge (modified Rankin scale between 2 and 5) and with in-hospital mortality. Independent predictors of moderate/severe stroke were age (relative risk (RR) 1.05, 95 % confidence interval (CI) 1.02-1.08, p < 0.001), atrial fibrillation (RR 1.71, 95 % CI 1.19-2.47, p < 0.005), heart rate (RR 1.02, 95 % CI 1.01-1.04, p < 0.001), log-triglyceride (TG) levels (RR 0.24, 95 % CI 0.08-0.68, p < 0.01) and high-density lipoprotein cholesterol (HDL-C) levels (RR 0.97, 95 % CI 0.95-0.98, p < 0.001). Major lipids did not predict dependency at discharge. Independent predictors of in-hospital mortality were atrial fibrillation (RR 2.35, 95 % CI 1.09-5.04, p < 0.05), diastolic blood pressure (RR 1.05, 95 % CI 1.02-1.08, p < 0.001), log-TG levels (RR 0.09, 95 % CI 0.01-0.87, p < 0.05) and NIHSS at admission (RR 1.19, 95 % CI 1.14-1.24, p < 0.001). Low-density lipoprotein cholesterol levels were not associated with stroke severity or outcome. Lower TG and HDL-C levels are associated with more severe stroke. Lower TG levels also appear to predict in-hospital mortality in patients with acute ischemic stroke.
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Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece.
| | - Vasilios Giampatzis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stella D Bouziana
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Marianna Spanou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stavroula Kostaki
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Maria Papadopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Stella-Maria Angelopoulou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Maria Tsopozidi
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi street, 54636, Thessaloniki, Greece
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