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Awujoola AO, Mokikan MT, Odebunmi OO, Mamudu HM, Stewart DW, Husari G, Singh K, Grant C, Budoff M, Paul TK. Factors Associated With Myocardial Infarction in a Rural Population With Peripheral Arterial Diseases. Angiology 2024:33197241232608. [PMID: 38319736 DOI: 10.1177/00033197241232608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Peripheral arterial disease (PAD) studies in rural populations are limited. The incidence of myocardial infarction (MI) is higher in patients with PAD. This study examined the association between sociodemographic and clinical risk factors and MI in patients with PAD in Central Appalachia, comprising of 230 counties across six states in the United States. Data from electronic medical records of 13,455 patients with PAD were extracted from a large health system in Central Appalachia. Bivariate and logistic regression analyses were conducted. The final sample consisted of 5574 patients with PAD, of whom 24.85% were also diagnosed with MI. The mean age was 71 ± 11.23 years, and the majority were male (56.40%). After adjusting for confounders, patients with hypertension had three times higher odds of MI (adjusted Odds Ratio [aOR] = 3.21; 95% CI: 2.50-4.14) compared with those without hypertension. The likelihood of MI increased by 51% among patients with diabetes (aOR = 1.51; 95% CI: 1.33-1.71), 34% among ever-smokers (aOR = 1.34; 95% CI: 1.18-1.52), and 45% in males (aOR = 1.45; 95% CI: 1.27-1.65). Hypertension, diabetes, smoking, and male sex were identified as significant risk factors for MI. Screening and effective management of these risk factors in rural areas could potentially prevent MI incidence among patients with PAD.
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Affiliation(s)
| | | | | | - Hadii M Mamudu
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - David W Stewart
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Ghaith Husari
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Department of Computer Science, East Tennessee State University, Johnson City, TN, USA
| | - Krishna Singh
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Cori Grant
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | | | - Timir K Paul
- Center for Cardiovascular Risk Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- University of Tennessee Health Sciences Center at Nashville, Nashville, TN, USA
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Scierka LE, Peri-Okonny PA, Romain G, Mena-Hurtado C, Smolderen KG. Obesity prevalence and variability in management practices for patients with symptomatic peripheral artery disease. Obes Res Clin Pract 2023:S1871-403X(23)00039-X. [PMID: 37225553 DOI: 10.1016/j.orcp.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
Obesity has been associated with poor disease outcomes in patients with lower extremity peripheral arterial disease (PAD). Given evolving treatments for obesity, evaluating its prevalence and treatment practices are key to develop a holistic management of PAD. We aimed to examine prevalence of obesity and variability of management strategies in symptomatic PAD patients enrolled in the international multicenter PORTRAIT registry from 2011 to 2015. Obesity management strategies studied included weight and/or dietary counseling and prescription of weight loss medications (orlistat, lorcaserin, phentermine-topiramate, naltrexone-buproprion, and liraglutide). Use frequency of obesity management strategies were calculated by country and compared across centers using adjusted median odds ratios (MOR). Of 1002 patients included, 36 % had obesity. No patients received weight loss medications. Weight and/or dietary counseling was prescribed in only 20 % of patients with obesity with significant variability in practices between centers (range 0.0-39.7 %; MOR 3.6, 95 % CI 2.04-9.95, p = < 0.001). In conclusion, obesity is a prevalent modifiable comorbidity in PAD that is hardly addressed during PAD management, with significant variability across practices. As obesity prevalence rates are growing, along with treatment modalities to treat it, especially in those with PAD, building systems to integrate systematic evidence-based weight and dietary management strategies in PAD are essential to close this gap in care.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, United States of America
| | - Poghni A Peri-Okonny
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, United States of America
| | - Gaelle Romain
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, United States of America
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, United States of America
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, United States of America; Department of Psychiatry, Yale University, New Haven, CT, United States of America.
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Aursulesei Onofrei V, Ceasovschih A, Marcu DTM, Adam CA, Mitu O, Mitu F. Mortality Risk Assessment in Peripheral Arterial Disease-The Burden of Cardiovascular Risk Factors over the Years: A Single Center's Experience. Diagnostics (Basel) 2022; 12:2499. [PMID: 36292188 PMCID: PMC9600417 DOI: 10.3390/diagnostics12102499] [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: 09/02/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Atherosclerosis is the basis of the cardiovascular continuum in peripheral artery disease (PAD) patients. Limiting functional decline and increasing quality of life are the main objectives for these patients. We conducted a prospective cohort study on 101 patients with PAD admitted to a single center in Northeast Romania. We used an index score to evaluate the 10-year mortality risk assessment and based on the scores we divided the patients into two groups: a low and low-intermediate risk mortality group (49 cases, 48.5%) and a high-intermediate and high-risk mortality group (52 cases, 51.5%). We analyzed demographics, comorbidities, clinical and paraclinical parameters and we aimed to identify the parameters associated with an unfavorable prognosis. Patients in the high-intermediate and high-risk mortality group were associated more with cardiovascular risk factors. Hypertension (p = 0.046), dyslipidemia (p < 0.001), diabetes mellitus (p < 0.001), and tobacco use (p = 0.018) were statistically significant factors. Lipid profile (low-density lipoprotein cholesterol, p = 0.005) and fasting blood glucose (p = 0.013) had higher mean serum values in the high-intermediate and high-risk mortality group, with a positive correlation between them and the ankle-brachial index value (p = 0.003). A multidisciplinary assessment and, especially, correction of associated cardiovascular risk factors prevent complications, and thus, improve the prognosis in the medium and long term.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iasi, Romania
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Alexandr Ceasovschih
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iasi, Romania
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania
| | - Ovidiu Mitu
- “St. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iasi, Romania
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania
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Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease. Nat Rev Cardiol 2022; 19:456-474. [PMID: 34997200 DOI: 10.1038/s41569-021-00663-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/15/2022]
Abstract
Approximately 6% of adults worldwide have atherosclerosis and thrombosis of the lower limb arteries (peripheral artery disease (PAD)) and the prevalence is rising. PAD causes leg pain, impaired health-related quality of life, immobility, tissue loss and a high risk of major adverse events, including myocardial infarction, stroke, revascularization, amputation and death. In this Review, I describe the pathophysiology, presentation, outcome, preclinical research and medical management of PAD. Established treatments for PAD include antithrombotic drugs, such as aspirin and clopidogrel, and medications to treat dyslipidaemia, hypertension and diabetes mellitus. Randomized controlled trials have demonstrated that these treatments reduce the risk of major adverse events. The drug cilostazol, exercise therapy and revascularization are the current treatment options for the limb symptoms of PAD, but each has limitations. Novel therapies to promote collateral and new capillary growth and treat PAD-related myopathy are under investigation. Methods to improve the implementation of evidence-based medical management, novel drug therapies and rehabilitation programmes for PAD-related pain, functional impairment and ischaemic foot disease are important areas for future research.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. .,The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia. .,The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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Outcomes and Costs of Open and Endovascular Revascularisation for Chronic Limb Ischaemia in an Australian Cohort. Heart Lung Circ 2021; 30:1552-1561. [PMID: 34045140 DOI: 10.1016/j.hlc.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 03/26/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The costs of open and endovascular revascularisation to treat peripheral artery disease (PAD) have not been fully established. This study examined the costs of both the index admission and any readmissions to hospital within 30 days of discharge for people having revascularisation at a single centre in Australia. METHODS This was a retrospective analysis of prospectively collected data. Eligible participants were those presenting with chronic limb ischaemia requiring revascularisation between 2002 and 2017. Generalised linear modelling was used to estimate mean (95% confidence interval [95% CI]) hospital costs for the index and readmission hospital treatments. RESULTS A total of 302 participants presenting with intermittent claudication (n=219; 72.5%) or chronic limb threatening ischaemia (n=83; 27.5%) treated by open (n=116; 38.4%) or endovascular (n=186; 61.6%) revascularisation were included. Forty-eight (48) (15.9%) participants were readmitted within 30 days of discharge from their index admission. The mean estimated index admission hospital cost was AUD$13,827 (95% CI, $11,935-$15,818) per person. This cost was significantly greater for open as compared to endovascular revascularisation (p<0.001). The mean estimated hospital cost was AUD$15,324 ($10,944-$19,966) per person readmitted. When comparing participants treated before and after 2010, the total hospital costs decreased, mainly due to decreased lengths of hospital stay for open procedures. CONCLUSIONS In this study the hospital costs were less for endovascular than open revascularisation of chronic limb ischaemia. Costs decreased over time. Readmission is an important contributor to the overall costs of peripheral revascularisation.
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Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep 2020; 22:25. [DOI: 10.1007/s11886-020-1273-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Taylor RM, Haslam RL, Burrows TL, Duncanson KR, Ashton LM, Rollo ME, Shrewsbury VA, Schumacher TL, Collins CE. Issues in Measuring and Interpreting Diet and Its Contribution to Obesity. Curr Obes Rep 2019; 8:53-65. [PMID: 30877574 DOI: 10.1007/s13679-019-00336-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review summarises the issues related to the measurement and interpretation of dietary intake in individuals with overweight and obesity, as well as identifies future research priorities. RECENT FINDINGS Some aspects of the assessment of dietary intake have improved through the application of technology-based methods and the use of dietary biomarkers. In populations with overweight and obesity, misreporting bias related to social desirability is a prominent issue. Future efforts should focus on combining technology-based dietary methods with the use of dietary biomarkers to help reduce and account for the impact of these biases. Future research will be important in terms of strengthening methods used in the assessment and interpretation of dietary intake data in the context of overweight and obesity.
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Affiliation(s)
- Rachael M Taylor
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Rebecca L Haslam
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Kerith R Duncanson
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Lee M Ashton
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Vanessa A Shrewsbury
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Tracy L Schumacher
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
- Faculty of Health and Medicine, Department of Rural Health, University of Newcastle, Tamworth, NSW, 2340, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia.
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In vitro effect of leptin on human cardiac contractility. J Nutr Sci 2019; 8:e12. [PMID: 31019683 PMCID: PMC6465679 DOI: 10.1017/jns.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/12/2022] Open
Abstract
Leptin, a hormone produced by adipose tissue, has been linked to many regulatory pathways. Its role in the complex relationship between obesity and CVD is not yet clear. The aim of the present study was to evaluate whether leptin interferes directly with cardiac function regulation, altering its contractile force character, and hence contributing to different pathological processes. Muscle samples were obtained from human atrial myocardium. Each trial included two samples from the same patient. They were simultaneously electrically stimulated under sustained perfusion to perform isometric contractions. One sample was treated with a high concentration of human recombinant leptin (1 µg/ml). The other was treated with placebo and served as a control. The exhibited contraction forces (CF) and the contraction duration (CD) after 20 min of treatment were normalised by dividing them by the values before the treatment and reported as a percentage. A total of ten successful trials were conducted. Exposure to leptin did not yield a statistically significant variation in both CF and CF. In the treatment group, CF% measured 108 (95 % CI 91, 125) % and CD% measured 95 (95 % CI 90, 101) % after 20 min. In the control group, CF% measured 105 (90 % CI 84, 126) % and CD% measured 92 (95 % CI 80, 105) % after 20 min. We concluded that leptin does not alter the contractile character of human atrial tissues, even in supraphysiological dosage. These results suggest that leptin does not play a role in short-term cardiac regulation.
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「高齢者肥満症診療ガイドライン2018」. Nihon Ronen Igakkai Zasshi 2018. [PMID: 30464154 DOI: 10.3143/geriatrics.55.g1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Hong X, Lin J, Gu W. Risk factors and therapies in vascular diseases: An umbrella review of updated systematic reviews and meta‐analyses. J Cell Physiol 2018; 234:8221-8232. [PMID: 30317627 DOI: 10.1002/jcp.27633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Xing‐yu Hong
- Department of Vascular Surgery China‐Japan Union Hospital of JiLin University ChangChun China
| | - Jie Lin
- Department of Vascular Surgery China‐Japan Union Hospital of JiLin University ChangChun China
| | - Wei‐wei Gu
- Department of Hepatopancreatobility Surgery China‐Japan Union Hospital of JiLin University ChangChun China
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Meltzer AJ, Sedrakyan A, Connolly PH, Ellozy S, Schneider DB. Risk Factors for Suboptimal Utilization of Statins and Antiplatelet Therapy in Patients Undergoing Revascularization for Symptomatic Peripheral Arterial Disease. Ann Vasc Surg 2017; 46:234-240. [PMID: 28602895 DOI: 10.1016/j.avsg.2017.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/13/2017] [Accepted: 05/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The objective of this study was to identify risk factors for suboptimal medical therapy (defined as reported antiplatelet and statin use) among patients undergoing lower extremity bypass (LEB) and peripheral vascular interventions (PVIs) for symptomatic peripheral arterial disease (PAD). METHODS The Vascular Study Group of Greater New York (VSGGNY) database was used to identify all patients undergoing PVI or LEB for PAD (2011-2013). Bivariate analyses were performed to identify characteristics of patients who were not prescribed statins and/or antiplatelet agents before revascularization. Multivariate relative risk regression models were developed to identify patients at risk for suboptimal therapy, with regards to antiplatelet and statin therapy. RESULTS About 1,030 patients underwent endovascular therapy (n = 822; 80%) or surgical bypass (n = 208; 20%) for symptomatic PAD (57.2% claudication; 15% rest pain and 27.8% tissue loss). Overall, preoperative statin use was observed in 59%. Preoperative antiplatelet therapy was observed in 79% of patients. Bivariate analysis revealed comparatively reduced statin use among patients without other cardiovascular risk factors including hypertension (63% vs. 39.3%; P < 0.0001) and coronary artery disease (CAD) with or without prior cardiac revascularization (coronary artery bypass grafting [CABG]/percutaneous coronary intervention [PCI]; 75.2% vs. 47.4%; P < 0.0001). Multivariate relative risk regression confirmed higher rates of statin use among patients with other cardiovascular risk factors including hypertension (1.14 [1.02-1.27]; P = 0.02) and CAD with prior CABG/PCI (1.22 [1.13-1.31]; P < 0.0001). Reduced statin use was observed in patients over 80 years old. (0.92 [0.84-0.1.0]; P = 0.059). By multivariate regression, antiplatelet therapy use was associated with CAD and/or prior CABG/PCI (1.11 [1.04-1.17]; P = 0.0015) and prior peripheral revascularization (1.07 [1.01-1.13]; P = 0.03). CONCLUSIONS Patients with symptomatic PAD, but without an antecedent cardiovascular history, are less likely to be optimally managed with statins and antiplatelet therapy preoperatively. Given the established role of these medications in the optimal medical management of patients with PAD, this presents an opportunity for improvement in the overall vascular care of patients undergoing intervention for symptomatic PAD at VSGGNY centers.
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Affiliation(s)
- Andrew J Meltzer
- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY.
| | - Art Sedrakyan
- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY
| | - Peter H Connolly
- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY
| | - Sharif Ellozy
- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY
| | - Darren B Schneider
- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY
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- Vascular and Endovascular Surgery, Weill Cornell Medical College, New York City, NY
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Wilke T, Mueller S, Groth A, Berg B, Hammar N, Tsai K, Fuchs A, Stephens S, Maywald U. Effectiveness of sulphonylureas in the therapy of diabetes mellitus type 2 patients: an observational cohort study. J Diabetes Metab Disord 2016; 15:28. [PMID: 27486568 PMCID: PMC4969981 DOI: 10.1186/s40200-016-0251-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND We compared all-cause mortality, major macrovascular events (MACE) and diabetes-related hospitalizations in T2DM-incident patients newly treated with metformin (MET) versus sulphonylureas (SU) monotherapy and in T2DM-prevalent patients newly treated with MET+SU versus MET+DPP4-inhibitor combination therapy. METHODS We analysed anonymized data obtained from a German health fund. Patients were included when they had started MET versus SU therapy or MET+SU versus MET+DPP4 therapy between 01/07/2010 and 31/12/2011. Observation started with the first MET/SU prescription or the first prescription of the second agent of a MET+SU/MET+DPP4 combination therapy. Follow-up time lasted until the end of data availability (a minimum of 12 months), death or therapy discontinuation. RESULTS In total, 434,291 T2DM-prevalent and 35,661 T2DM-incident patients were identified. Of the identified T2DM-incident patients, 904/7,874 started SU/MET monotherapy, respectively, with a mean age of 70.1/61.4 years (54.6/50.3 % female; Charlson Comorbidity Index (CCI) 1.4/2.2; 933/7,350 observed SU/MET patient years). 4,157/1,793 SU+MET/DPP4+MET therapy starters had a mean age of 68.1/62.2 years (53.4/50.8 % female; CCI 2.8/2.6; 4,556/1,752 observed SU+MET/ DPP4+MET patient years). In a propensity score matched (PSM) comparison, the HRs (95 % CIs) associated with SU monotherapy compared to MET monotherapy exposure were 1.4 (0.9-2.3) for mortality, 1.4 (0.9-2.2) for MACE, 4.1 (1.5-10.9) for T2DM hospitalizations and 1.6 (1.2-2.3) for composite event risk. In a multivariable Cox regression model, SU monotherapy was associated with higher mortality (aHR 2.0; 1.5-2.6), higher MACE (aHR 1.3; 1.0-1.7) and higher T2DM hospitalizations (aHR 2.8; 1.8-4.4), which corresponded with a higher composite event risk (aHR 1.8; 1.5-2.1). No significant differences in event rates were observed in the PSM comparison between DPP4+MET/SU+MET combination therapy starters and in the multivariable Cox regression analysis. CONCLUSIONS Our results show that SU monotherapy may be associated with increased mortality, MACE and T2DM hospitalizations, compared to MET monotherapy. When considering SU therapy, the associated cardiovascular risk should also be taken into account.
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Affiliation(s)
- Thomas Wilke
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Sabrina Mueller
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Antje Groth
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Bjoern Berg
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Niklas Hammar
- AstraZeneca R&D Mölndal, Pepparedsleden 1, Mölndal, 431 83 Sweden
| | - Katherine Tsai
- AstraZeneca R&D, 101 Orchard Ridge Drive, 2207K, Gaithersburg, MD 20878 USA
| | | | | | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067 Dresden, Germany
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Baum O, Torchetti E, Malik C, Hoier B, Walker M, Walker PJ, Odriozola A, Graber F, Tschanz SA, Bangsbo J, Hoppeler H, Askew CD, Hellsten Y. Capillary ultrastructure and mitochondrial volume density in skeletal muscle in relation to reduced exercise capacity of patients with intermittent claudication. Am J Physiol Regul Integr Comp Physiol 2016; 310:R943-51. [DOI: 10.1152/ajpregu.00480.2015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/17/2016] [Indexed: 01/26/2023]
Abstract
Intermittent claudication (IC) is the most commonly reported symptom of peripheral arterial disease (PAD). Impaired limb blood flow is a major casual factor of lower exercise tolerance in PAD but cannot entirely explain it. We hypothesized that IC is associated with structural changes of the capillary-mitochondria interface that could contribute to the reduction of exercise tolerance in IC patients. Capillary and mitochondrial morphometry were performed after light and transmission electron microscopy using vastus lateralis muscle biopsies of 14 IC patients and 10 age-matched controls, and peak power output (PPO) was determined for all participants using an incremental single-leg knee-extension protocol. Capillary density was lower (411 ± 90 mm−2 vs. 506 ± 95 mm−2; P ≤ 0.05) in the biopsies of the IC patients than in those of the controls. The basement membrane (BM) around capillaries was thicker (543 ± 82 nm vs. 423 ± 97 nm; P ≤ 0.01) and the volume density of mitochondria was lower (3.51 ± 0.56% vs. 4.60 ± 0.74%; P ≤ 0.01) in the IC patients than the controls. In the IC patients, a higher proportion of capillaries appeared with collapsed slit-like lumen and/or swollen endothelium. PPO was lower (18.5 ± 9.9 W vs. 33.5 ± 9.4 W; P ≤ 0.01) in the IC patients than the controls. We suggest that several structural alterations in skeletal muscle, either collectively or separately, contribute to the reduction of exercise tolerance in IC patients.
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Affiliation(s)
- Oliver Baum
- Institute of Physiology, CharitéCrossOver (CCO), Berlin, Germany
- Institute of Anatomy, University of Bern, Switzerland
| | | | - Corinna Malik
- Institute of Anatomy, University of Bern, Switzerland
| | - Birgitte Hoier
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Meegan Walker
- School of Health and Sport Sciences, University of the Sunshine Coast, Australia
| | - Philip J. Walker
- Discipline of Surgery, School of Medicine and Centre for Clinical Research, The University of Queensland, Australia; and
- National Health and Medical Research Council, Centre of Research Excellence for Peripheral Arterial Diseases, Australia
| | | | | | | | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Hans Hoppeler
- Institute of Anatomy, University of Bern, Switzerland
| | - Christopher D. Askew
- School of Health and Sport Sciences, University of the Sunshine Coast, Australia
- National Health and Medical Research Council, Centre of Research Excellence for Peripheral Arterial Diseases, Australia
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
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15
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Yeboah K, Puplampu P, Yorke E, Antwi DA, Gyan B, Amoah AGB. Body composition and ankle-brachial index in Ghanaians with asymptomatic peripheral arterial disease in a tertiary hospital. BMC OBESITY 2016; 3:27. [PMID: 27239322 PMCID: PMC4866025 DOI: 10.1186/s40608-016-0107-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ankle-brachial index (ABI) and indices of obesity are both use to indicate cardiovascular risk. However, association between body composition indices and ABI, a measure of peripheral arterial disease, is inconsistent in various study reports. In this study, we investigated the relationship between ABI and general and central indices of obesity in Ghanaians without history of cardiovascular diseases. METHOD In a case-control design, ABI was measured in a total of 623 subjects and categorised into PAD (ABI ≤ 0.9, n = 261) and non-PAD (ABI > 0.9, n = 362) groups. Anthropometric indices, BMI, waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) were also measured. RESULTS PAD subjects had higher mean BMI (29.8 ± 8.7 vs. 26.5 ± 7.6 kg/m(2), p = 0.043) and waist circumference (95 ± 15 vs. 92 ± 24 cm, p = 0.034) than non-PAD subjects. In multivariable logistic regression models, having BMI ≥ 30 kg/m(2) increased the odds of both unilateral [OR (95 % CI): 2 (1.14-3.51), p < 0.01] and overall PAD [2 (1.22-3.27), p < 0.01]. CONCLUSION In indigenous Ghanaians in our study, PAD participants had higher BMI and waist circumference than non-PAD participants. Also, halving BMI ≥ 30 kg/m(2) was associated with twofold increase in the odds of PAD.
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Affiliation(s)
- Kwame Yeboah
- />Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Peter Puplampu
- />Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- />Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Daniel A. Antwi
- />Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Ben Gyan
- />Department of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Albert G. B. Amoah
- />Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
- />National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
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16
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Huang Y, Xu M, Xie L, Wang T, Huang X, Lv X, Chen Y, Ding L, Lin L, Wang W, Bi Y, Sun Y, Zhang Y, Ning G. Obesity and peripheral arterial disease: A Mendelian Randomization analysis. Atherosclerosis 2016; 247:218-24. [DOI: 10.1016/j.atherosclerosis.2015.12.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/25/2015] [Accepted: 12/23/2015] [Indexed: 01/25/2023]
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17
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Al-Daghri NM, Al-Attas OS, Wani K, Alnaami AM, Sabico S, Al-Ajlan A, Chrousos GP, Alokail MS. Sensitivity of various adiposity indices in identifying cardiometabolic diseases in Arab adults. Cardiovasc Diabetol 2015; 14:101. [PMID: 26249167 PMCID: PMC4566864 DOI: 10.1186/s12933-015-0265-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022] Open
Abstract
Background Obesity is a recognized risk factor for various cardiometabolic
diseases and several indices are used clinically to assess overall cardiometabolic
risk. This study aims to determine the sensitivity of six anthropometric indices
[Body mass index (BMI), waist, waist-to-hip ratio (WHR), waist-to-height ratio
(WHtR), body adiposity index (BAI) and visceral adiposity index (VAI)] in
determining diabetes mellitus type 2, coronary heart disease, dyslipidemia,
hypertension and metabolic syndrome (MetS) in Saudi adults recruited from two
independent cohorts (2008–2009 and 2013–2014). Methods A total of 6,821 Saudi adults [2008–2009, N = 3,971 (1,698 males and
2,273 females); 2013–2014, N = 2,850 (926 males and 1,924 females)] aged
18–70 years old were included in this descriptive, cross-sectional study.
Anthropometrics were obtained and fasting blood samples analyzed for glucose and
lipids. BMI, WHR, WHtR, BAI and VAI were computed mathematically. Results VAI was the most sensitive index in determining DMT2 (AUC 0.72;
p < 0.001) in the 2008–2009 cohort and MetS (AUC = 0.84; p < 0.001) in the
2013–2014 cohort. WHR was most discriminating for CHD in both cohorts (AUC 0.70
and 0.84 for 2008–2009 and 2013–2014, p values <0.001, respectively). WHtR was
most sensitive but rather modest in determining hypertension (AUC 0.66;
p < 0.001), while waist circumference was most sensitive for dyslipidemia (AUC
0.72; p < 0.001) in the 2008–2009 cohort and MetS (AUC 0.85; p < 0.001) in
the 2013–2014 cohort. BAI was the least sensitive adiposity index. Conclusion Sensitivity of adiposity indices regarding cardiometabolic diseases
highlight the importance of body fat distribution in determining overall
cardiometabolic risk, with indices involving abdominal obesity being more
clinically significant than BMI and BAI. The sensitivity of these adiposity
indices should be noted in assessing a particular cardiometabolic disease. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0265-5) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Omar S Al-Attas
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Kaiser Wani
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Abdullah M Alnaami
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Abdulrahman Al-Ajlan
- Department of Clinical Lab Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - George P Chrousos
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,First Department of Pediatrics, Athens University Medical School, 11527, Athens, Greece.
| | - Majed S Alokail
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia. .,Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
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18
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Ellsworth DL, Mamula KA, Blackburn HL, McDyer FA, Jellema GL, van Laar R, Costantino NS, Engler RJM, Vernalis MN. Importance of substantial weight loss for altering gene expression during cardiovascular lifestyle modification. Obesity (Silver Spring) 2015; 23:1312-9. [PMID: 25960328 DOI: 10.1002/oby.21079] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/13/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine relationships between weight loss through changes in lifestyle and peripheral blood gene expression profiles. METHODS A prospective nonrandomized trial was conducted over 1 year in participants undergoing intensive lifestyle modification to reverse or stabilize progression of coronary artery disease. Cardiovascular risk factors, inflammatory biomarkers, and gene expression as a function of weight loss were assessed in 89 lifestyle participants and 71 retrospectively matched controls undergoing usual care. RESULTS Substantial weight loss (-15.2 ± 3.8%) in lifestyle participants (n = 33) was associated with improvement in selected cardiovascular risk factors and significant changes in peripheral blood gene expression from pre- to post-intervention: 132 unique genes showed significant expression changes (false discovery rate corrected P-value <0.05 and fold-change ≥1.4). Altered molecular pathways were related to immune function and inflammatory responses involving endothelial activation. In contrast, participants losing minimal weight (-3.1 ± 2.5%, n = 32) showed only minor changes in cardiovascular risk factors and markers of inflammation and no changes in gene expression compared to non intervention controls after 1 year. CONCLUSIONS Weight loss (≥10%) during lifestyle modification is associated with down-regulation of genetic pathways governing interactions between circulating immune cells and the vascular endothelium and may be required to successfully reduce CVD risk.
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Affiliation(s)
- Darrell L Ellsworth
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Kimberly A Mamula
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Heather L Blackburn
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | | | | | - Ryan van Laar
- Bioinformatics Department, ChipDX LLC, New York, New York, USA
| | - Nicholas S Costantino
- Integrative Cardiac Health Program, Windber Research Institute, Windber, Pennsylvania, USA
| | - Renata J M Engler
- Integrative Cardiac Health Program, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Marina N Vernalis
- Integrative Cardiac Health Program, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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19
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Wilke T, Mueller S, Groth A, Fuchs A, Seitz L, Kienhöfer J, Maywald U, Lundershausen R, Wehling M. Treatment-dependent and treatment-independent risk factors associated with the risk of diabetes-related events: a retrospective analysis based on 229,042 patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:14. [PMID: 25645749 PMCID: PMC4343042 DOI: 10.1186/s12933-015-0179-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to analyse which factors predict the real-world macro-/microvascular event, hospitalisation and death risk in patients with type 2 diabetes mellitus. Furthermore, we aimed to investigate whether there exists both an under- and over-treatment risk of these patients. METHODS We used a German claims/clinical data set covering the years 2010-12. Diabetes-related events were defined as (1) macro-, (2) microvascular events leading to inpatient hospitalisation, (3) other hospitalisations with type 2 diabetes mellitus as main diagnosis, (4) all-cause death and (5) a composite outcome including all event categories 1-4. Factors associated with event risk were analysed by a Kaplan-Meier curve analysis and by multivariable Cox regression models. RESULTS 229,042 patients with type 2 diabetes mellitus (mean age 70.2 years; mean CCI 6.03) were included. Among factors that increased the event risk were patients' age, male gender, the adapted Charlson Comorbidity Index, the adapted Diabetes Complication Severity Index, previous events, and number of prescribed chronic medications. For systolic blood pressure/HbA1C, a double-J/U-curve pattern was detected: HbA1C of 6-6.5% (42-48 mmol/mol) and systolic blood pressure of 130-140 mmHg (17.3-18.7kPa) were associated with the lowest event risk, values below/above that range were associated with higher risk. However, this pattern was mainly driven by the death risk and was much less clearly observed for the macrovascular/microvascular/hospitalization risk and for young/less comorbid patients. CONCLUSIONS Both blood pressure and HbA1C seem to be very important treatment targets, especially in comorbid old patients. It is of particular clinical importance that both over- and under-treatment pose a threat to patients with type 2 diabetes mellitus.
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Affiliation(s)
- Thomas Wilke
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | - Sabrina Mueller
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | - Antje Groth
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | | | - Lisa Seitz
- Novo Nordisk Pharma GmbH, Brucknerstraße 1, 55127, Mainz, Germany.
| | | | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067, Dresden, Germany.
| | | | - Martin Wehling
- Clinical Pharmacology, Mannheim/Center for Gerontopharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstr. 14, 68169, Mannheim, Germany.
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20
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Xin G, Shong L, Hui L. Effect of genetic and non-genetic factors, including aging, on waist circumference and BMI, and inter-indicator differences in risk assessment. Exp Gerontol 2014; 60:83-6. [PMID: 25305560 DOI: 10.1016/j.exger.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the effect of genetic and non-genetic factors on indicators derived from waist circumference (WC) and body mass index (BMI) as well as inter-indicator differences in risk assessment age-related diseases including diabetes mellitus, coronary heart disease and liver cancer. METHODS Height, weight and WC were measured in 100 families (students and their two parents), 41 subjects with regular physical exercise routines, and 170 patients with diabetes mellitus, coronary heart disease or liver cancer. The BMI, waist-height ratio (WHtR) and waist circumference density index (WCDI) were calculated for each subject. RESULTS BMI was less affected by genetic factors, while WHtR and WCDI were greatly affected by genetic factors as revealed using multiple regression analysis. BMI, WHtR and WCDI were all sensitive to physical exercise according to ROC analysis; among these factors, the most sensitive indicator was WHtR. However, ROC analysis demonstrated that WCDI was more effective than BMI and WHtR for assessing the risk of three diseases. CONCLUSIONS WCDI more accurately reflects the roles of both genetic and non-genetic factors, including aging, which can better predict disease.
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Affiliation(s)
- Ge Xin
- College of Medical Laboratory, Dalian Medical University, Dalian 116044, China
| | - Liu Shong
- College of Medical Laboratory, Dalian Medical University, Dalian 116044, China
| | - Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian 116044, China.
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21
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Kocyigit I, Gungor O, Unal A, Yasan M, Orscelik O, Tunca O, Eroglu E, Sipahioglu MH, Tokgoz B, Ozdogru I, Dogan A, Oymak O. A low serum free triiodothyronine level is associated with epicardial adipose tissue in peritoneal dialysis patients. J Atheroscler Thromb 2014; 21:1066-74. [PMID: 24898381 DOI: 10.5551/jat.23259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cardiovascular disease is a major cause of mortality in dialysis patients. Epicardial adipose tissue (EAT) has been proposed as a cardiovascular risk marker in this population. Subclinical hypothyroidism and low free triiodothyronine (fT3) levels are associated with EAT in patients without chronic renal failure. The aim of this study was to investigate the relationship between EAT and low free T3 levels in peritoneal dialysis (PD) patients. METHODS A total of 125 prevalent PD patients were enrolled in this cross-sectional study. The epicardial fat thickness (EFT) was measured by echocardiography, and the endothelial function was assessed by flow mediated dilatation (FMD). Thyroid function tests were performed by an enzyme immunoassay. RESULTS The mean age of the patients was 51 ± 13, and the time on PD was 36 months. The mean EFT was 6.7 ± 2.9 mm. The EFT correlated positively with the patient age, systolic blood pressure (BP), mean BP, high sensitivity C-reactive protein (hs-CRP) level and body mass index (BMI), and negatively with the fT3 level and FMD. The median fT3 value was 2.53, and patients were divided according to their serum fT3 values (within the normal range and below the reference level). Compared with patients in the low fT3 group, the subjects in the normal fT3 group had higher serum albumin levels and FMD, but a lower BMI, plasma fasting glucose level, EFT, TSH level, hs-CRP level, low density lipoprotein (LDL) cholesterol level and mean BP in office measurements, and both the diastolic BP and mean BP by ambulatory blood pressure measurement. A multivariate linear regression analysis showed that the EFT was predicted by the hs-CRP and fT3 levels. CONCLUSION Low free T3 levels are associated with the epicardial fat thickness in PD patients. Further studies are needed to evaluate the pathogenesis and to support these findings.
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Affiliation(s)
- Ismail Kocyigit
- Department of Nephrology, Erciyes University Medical Faculty
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22
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Cronin O, Bradshaw B, Iyer V, Cunningham M, Buttner P, Walker PJ, Golledge J. The association of visceral adiposity with cardiovascular events in patients with peripheral artery disease. PLoS One 2013; 8:e82350. [PMID: 24386093 PMCID: PMC3873921 DOI: 10.1371/journal.pone.0082350] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/29/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have suggested that patients with peripheral artery disease (PAD) suffer from a high incidence of cardiovascular events (CVE). Visceral adiposity has been implicated in promoting CVEs. This study aimed to assess the association of relative visceral adipose volume with incident cardiovascular events in patients with peripheral artery disease. METHODS This was a prospective cohort study including 260 patients with PAD who presented between 2003 and 2012. Cases were patients with diagnosed PAD including symptomatic lower limb athero-thrombosis and asymptomatic abdominal aortic aneurysm. All patients underwent computed tomography angiography (CTA). Abdominal visceral to total adipose volume ratio (relative visceral adipose volume) was estimated from CTAs using a previously validated workstation protocol. Cardiovascular risk factors were recorded at entry. The association of visceral adiposity with major CVEs (death, non-fatal myocardial infarction or stroke) was examined using Kaplan Meier and Cox proportional hazard analyses. RESULTS A total of 92 major CVEs were recorded in 76 patients during a median follow-up of 2.8 (IQR 1.2 to 4.8) years, including myocardial infarction (n = 26), stroke (n = 10) and death (n = 56). At 3 years the incidence of major CVEs stratified by relative visceral adipose volume quartiles were 15% [Quartile (Q) 1], 17% (Q2), 11% (Q3) and 15% (Q4) (P = 0.517). Relative visceral adipose volume was not associated with major CVEs after adjustment for other risk factors. CONCLUSION This study suggests that visceral adiposity does not play a central role in the predisposition for major CVEs in patients with PAD.
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Affiliation(s)
- Oliver Cronin
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Barbara Bradshaw
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Vikram Iyer
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Cunningham
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Petra Buttner
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Queensland, Australia
| | - Philip J. Walker
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Discipline of Surgery and Centre for Clinical Research, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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