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Zhang Y, Li B, Cai H, Fu Y, Zheng Y. Associations of iron metabolism and inflammation with all-cause and cardiovascular mortality in a large NHANES community sample: Moderating and mediating effects. Nutr Metab Cardiovasc Dis 2024; 34:1854-1863. [PMID: 38658228 DOI: 10.1016/j.numecd.2024.03.026] [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: 01/08/2024] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS This study aimed to assess the associations between serum iron concentration, C-reactive protein (CRP) concentration and the risk of all-cause mortality and cardiovascular mortality in the general population and to explore potential mediating and moderating effects. METHODS AND RESULTS This study analyzed data from the National Health and Nutrition Examination Survey spanning the years 1999-2010, encompassing 23,634 participants. Cox proportional hazards regression models were employed to investigate the independent associations of serum iron and CRP with all-cause and cardiovascular mortality. Moderation and mediation analyses explored the moderating effect of CRP on the association between the serum iron concentration and all-cause and cardiovascular mortality, and the mediating role of the serum iron concentration in the association between the CRP concentration and all-cause and cardiovascular mortality. After multivariate adjustments in the Cox model, serum iron and CRP levels were independently correlated with both all-cause and cardiovascular mortality risk. Moderation analyses revealed a more pronounced correlation between the serum iron concentration and both all-cause and cardiovascular mortality in participants with higher CRP levels. Mediation analysis indicated that the serum iron concentration partly mediated the impact of CRP on the risk of all-cause mortality (13.79%) and cardiovascular mortality (24.12%). CONCLUSION Serum iron and CRP are independently associated with all-cause and cardiovascular mortality. Moreover, the associations between serum iron concentrations and both all-cause and cardiovascular mortality are more pronounced in individuals with elevated CRP. Serum iron partially mediates the effect of CRP on all-cause and cardiovascular mortality.
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Affiliation(s)
- Yaoting Zhang
- Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Bing Li
- Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, 130021, China.
| | - He Cai
- Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Yu Fu
- Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Yang Zheng
- Department of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, 130021, China.
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Liu Y, Clarke R, Bennett DA, Zong G, Gan W. Iron Status and Risk of Heart Disease, Stroke, and Diabetes: A Mendelian Randomization Study in European Adults. J Am Heart Assoc 2024; 13:e031732. [PMID: 38497484 PMCID: PMC11010009 DOI: 10.1161/jaha.123.031732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The relevance of iron status biomarkers for coronary artery disease (CAD), heart failure (HF), ischemic stroke (IS), and type 2 diabetes (T2D) is uncertain. We compared the observational and Mendelian randomization (MR) analyses of iron status biomarkers and hemoglobin with these diseases. METHODS AND RESULTS Observational analyses of hemoglobin were compared with genetically predicted hemoglobin with cardiovascular diseases and diabetes in the UK Biobank. Iron biomarkers included transferrin saturation, serum iron, ferritin, and total iron binding capacity. MR analyses assessed associations with CAD (CARDIOGRAMplusC4D [Coronary Artery Disease Genome Wide Replication and Meta-Analysis Plus The Coronary Artery Disease Genetics], n=181 522 cases), HF (HERMES [Heart Failure Molecular Epidemiology for Therapeutic Targets), n=115 150 cases), IS (GIGASTROKE, n=62 100 cases), and T2D (DIAMANTE [Diabetes Meta-Analysis of Trans-Ethnic Association Studies], n=80 154 cases) genome-wide consortia. Observational analyses demonstrated J-shaped associations of hemoglobin with CAD, HF, IS, and T2D. In contrast, MR analyses demonstrated linear positive associations of higher genetically predicted hemoglobin levels with 8% higher risk per 1 SD higher hemoglobin for CAD, 10% to 13% for diabetes, but not with IS or HF in UK Biobank. Bidirectional MR analyses confirmed the causal relevance of iron biomarkers for hemoglobin. Further MR analyses in global consortia demonstrated modest protective effects of iron biomarkers for CAD (7%-14% lower risk for 1 SD higher levels of iron biomarkers), adverse effects for T2D, but no associations with IS or HF. CONCLUSIONS Higher levels of iron biomarkers were protective for CAD, had adverse effects on T2D, but had no effects on IS or HF. Randomized trials are now required to assess effects of iron supplements on risk of CAD in high-risk older people.
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Affiliation(s)
- Yunan Liu
- CAS Key Laboratory of Nutrition, Metabolism and Food SafetyShanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of SciencesShanghaiChina
| | - Robert Clarke
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Derrick A. Bennett
- Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- Medical Research Council Population Health Research Unit at the University of OxfordOxfordUnited Kingdom
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food SafetyShanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of SciencesShanghaiChina
| | - Wei Gan
- Human Genetics Centre of Excellence, Novo Nordisk Research Centre Oxford, Innovation Building, Old Road CampusOxfordUnited Kingdom
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Donat-Vargas C, Mico V, San-Cristobal R, Martínez-González MÁ, Salas-Salvadó J, Corella D, Fitó M, Alonso-Gómez ÁM, Wärnberg J, Vioque J, Romaguera D, López-Miranda J, Estruch R, Damas-Fuentes M, Lapetra J, Serra-Majem L, Bueno-Cavanillas A, Tur JA, Cinza-Sanjurjo S, Pintó X, Delgado-Rodríguez M, Matía-Martín P, Vidal J, Causso C, Ros E, Toledo E, Manzanares JM, Ortega-Azorín C, Castañer O, Peña-Orihuela PJ, Zazo JM, Muñoz Bravo C, Martinez-Urbistondo D, Chaplin A, Casas R, Cano Ibáñez N, Tojal-Sierra L, Gómez-Perez AM, Pascual Roquet-Jalmar E, Mestre C, Barragán R, Schröder H, Garcia-Rios A, Candela García I, Ruiz-Canela M, Babio N, Malcampo M, Daimiel L, Martínez A. Dietary Iron, Anemia Markers, Cognition, and Quality of Life in Older Community-Dwelling Subjects at High Cardiovascular Risk. Nutrients 2023; 15:4440. [PMID: 37892515 PMCID: PMC10610130 DOI: 10.3390/nu15204440] [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: 08/03/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Anemia causes hypo-oxygenation in the brain, which could lead to cognitive disorders. We examined dietary iron intake as well as anemia markers (i.e., hemoglobin, hematocrit, mean corpuscular volume) and diabetes coexistence in relation to neuropsychological function and quality of life. In this study, 6117 community-dwelling adults aged 55-75 years (men) and 60-75 years (women) with overweight/obesity and metabolic syndrome were involved. We performed the Mini-Mental State Examination (MMSE), the Trail Making Test parts A and B (TMT-A/B), Semantic Verbal Fluency of animals (VFT-a), Phonological Verbal Fluency of letter P (VFT-p), Digit Span Test (DST), the Clock Drawing Test (CDT), and the Short Form-36 Health Survey (SF36-HRQL test). Dietary iron intake did not influence neuropsychological function or quality of life. However, anemia and lower levels of anemia markers were associated with worse scores in all neurophysiological and SF36-HRQL tests overall, but were especially clear in the MMSE, TMT-B (cognitive flexibility), and the physical component of the SF36-HRQL test. The relationships between anemia and diminished performance in the TMT-A/B and VFT tasks were notably pronounced and statistically significant solely among participants with diabetes. In brief, anemia and reduced levels of anemia markers were linked to inferior cognitive function, worse scores in different domains of executive function, as well as a poorer physical, but not mental, component of quality of life. It was also suggested that the coexistence of diabetes in anemic patients may exacerbate this negative impact on cognition. Nevertheless, dietary iron intake showed no correlation with any of the outcomes. To make conclusive recommendations for clinical practice, our findings need to be thoroughly tested through methodologically rigorous studies that minimize the risk of reverse causality.
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Affiliation(s)
- Carolina Donat-Vargas
- ISGlobal, Campus Mar, 08036 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (A.B.-C.); (N.C.I.); (H.S.)
| | - Víctor Mico
- Cardiometabolic Nutrition Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain; (V.M.); (R.S.-C.); (M.D.-R.)
| | - Rodrigo San-Cristobal
- Cardiometabolic Nutrition Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain; (V.M.); (R.S.-C.); (M.D.-R.)
| | - Miguel Ángel Martínez-González
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008 Pamplona, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jordi Salas-Salvadó
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain; (J.S.-S.); (J.M.M.)
- Food, Nutrition, Development and Mental Health Research Group, Institut d’Investigació Pere Virgili (IISPV), 43204 Reus, Spain
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
| | - Dolores Corella
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
| | - Montserrat Fitó
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain; (O.C.); (M.M.)
| | - Ángel Maria Alonso-Gómez
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Julia Wärnberg
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- EpiPHAAN Research Group, Department of Nursing, School of Health Sciences, University of Málaga-IBIMA (Instituto de Investigación Biomédica de Málaga), 29071 Málaga, Spain
| | - Jesús Vioque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (A.B.-C.); (N.C.I.); (H.S.)
- Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernández (ISABIAL-UMH), 03010 Alicante, Spain
| | - Dora Romaguera
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - José López-Miranda
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain
| | - Ramon Estruch
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Internal Medicine, Institut d’Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Miguel Damas-Fuentes
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, 29016 Málaga, Spain
| | - José Lapetra
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
| | - Luís Serra-Majem
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas, Spain
| | - Aurora Bueno-Cavanillas
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (A.B.-C.); (N.C.I.); (H.S.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
| | - Josep Antoni Tur
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
- Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Sergio Cinza-Sanjurjo
- CS Milladoiro, Área Sanitaria de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
- Instituto de Investigación de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Departamento de Medicina, Universidad de Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Xavier Pintó
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Miguel Delgado-Rodríguez
- Cardiometabolic Nutrition Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain; (V.M.); (R.S.-C.); (M.D.-R.)
- Division of Preventive Medicine, Faculty of Medicine, University of Jaén, 23071 Jaén, Spain
| | - Pilar Matía-Martín
- Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Josep Vidal
- Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
- Biomedical Research Centre for Diabetes and Metabolic Diseases Network (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Claudia Causso
- Servicio de Endocrinologia Hospital General de Villalba, 28400 Madrid, Spain;
| | - Emilio Ros
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, 08036 Barcelona, Spain
| | - Estefanía Toledo
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008 Pamplona, Spain
| | - Josep Maria Manzanares
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain; (J.S.-S.); (J.M.M.)
| | - Carolina Ortega-Azorín
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
| | - Olga Castañer
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain; (O.C.); (M.M.)
| | - Patricia Judith Peña-Orihuela
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain
| | - Juan Manuel Zazo
- Department of Preventive Medicine and Public Health, School of Medicine, Instituto de Investigación Biomédica de Málaga, University of Málaga, 29590 Málaga, Spain;
| | - Carlos Muñoz Bravo
- Department of Public Health and Psychiatry, University of Malaga-IBIMA (Instituto de Investigación Biomédica de Málaga), 29071 Málaga, Spain
| | | | - Alice Chaplin
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Rosa Casas
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Internal Medicine, Institut d’Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Naomi Cano Ibáñez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (A.B.-C.); (N.C.I.); (H.S.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain
| | - Lucas Tojal-Sierra
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country UPV/EHU, 01009 Vitoria-Gasteiz, Spain
| | - Ana María Gómez-Perez
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria Hospital, University of Málaga, 29016 Málaga, Spain
| | | | - Cristina Mestre
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain; (J.S.-S.); (J.M.M.)
- Food, Nutrition, Development and Mental Health Research Group, Institut d’Investigació Pere Virgili (IISPV), 43204 Reus, Spain
| | - Rocío Barragán
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
| | - Helmut Schröder
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.V.); (A.B.-C.); (N.C.I.); (H.S.)
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain; (O.C.); (M.M.)
| | - Antonio Garcia-Rios
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain
| | | | - Miguel Ruiz-Canela
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Preventive Medicine and Public Health, University of Navarra, IDISNA, 31008 Pamplona, Spain
| | - Nancy Babio
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Unitat de Nutrició Humana, Departament de Bioquímica i Biotecnologia, Universitat Rovira i Virgili, 43201 Reus, Spain; (J.S.-S.); (J.M.M.)
- Food, Nutrition, Development and Mental Health Research Group, Institut d’Investigació Pere Virgili (IISPV), 43204 Reus, Spain
| | - Mireia Malcampo
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d’Investigació Médica (IMIM), 08003 Barcelona, Spain; (O.C.); (M.M.)
| | - Lidia Daimiel
- Nutritional Control of the Epigenome Group, Precision Nutrition and Obesity Program, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain;
| | - Alfredo Martínez
- Cardiometabolic Nutrition Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain; (V.M.); (R.S.-C.); (M.D.-R.)
- Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.Á.M.-G.); (D.C.); (M.F.); (Á.M.A.-G.); (J.W.); (D.R.); (J.L.-M.); (R.E.); (M.D.-F.); (J.L.); (L.S.-M.); (J.A.T.); (X.P.); (E.R.); (E.T.); (C.O.-A.); (P.J.P.-O.); (A.C.); (R.C.); (L.T.-S.); (A.M.G.-P.); (C.M.); (R.B.); (A.G.-R.); (M.R.-C.); (N.B.)
- Department of Nutrition, Food Sciences and Physiology, University of Navarra, 31008 Pamplona, Spain
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Zhang J, Gao S. Clinical analysis of 908 patients with aortic dissection under different Stanford types: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35219. [PMID: 37713852 PMCID: PMC10508451 DOI: 10.1097/md.0000000000035219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
This study aims to investigate the difference of clinical characteristics and risk factors in aortic dissection (AD) of patients with 2 Stanford subtypes. A retrospective analysis was conducted on 908 patients admitted to Tongji Hospital from July 2019 to January 2021, and the aortic computed tomography angiography was used to clearly diagnose the artery dissection. Patient basic information as well as blood test indicators containing leukocytes, neutrophils, lymphocytes, hemoglobin, myoglobin, hypersensitive cardiac troponin, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, ultrasensitive C-reactive protein, glucose were recorded and analyzed. There was no significant difference in gender, heart rate, smoking history, hypertension history and diabetes history between the 2 groups (P > .05), however, compared with type A patients, type B patients were older, and had a significantly higher frequency of alcohol consumption (P < .05); On laboratory tests, type A patients had significantly higher mean leukocytes and neutrophils (P < .05), and significantly lower frequency of reduced hemoglobin than type B patients (P < .05), although there was no statistical difference in lymphocyte, γ-glutamyl transferase, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein and glucose counts between the 2 groups. Additionally, type A patients had a significantly higher number of abnormal myoglobin, hypersensitive cardiac troponin and ultrasensitive C-reactive protein test results than type B patients (P < .05). The receiver operating characteristic curve analysis showed that the area under the curve for each parameter was 0.605 (0.538-0.673) for hemoglobin, 0.610 (0.543-0.677) for leukocytes and 0.627 (0.561-0.693) for neutrophils. Understanding the relevant clinical indicators and risk factors of patients with different types of AD can provide a new perspective to assist the classification and diagnosis of AD and a basis for effective and rational treatment.
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Affiliation(s)
- Jinhua Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sikang Gao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yazdani AN, Pletsch M, Chorbajian A, Zitser D, Rai V, Agrawal DK. Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease. Expert Rev Cardiovasc Ther 2023; 21:675-692. [PMID: 37772751 PMCID: PMC10615890 DOI: 10.1080/14779072.2023.2264779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Coronary Artery Disease (CAD) is a prevalent condition characterized by the presence of atherosclerotic plaques in the coronary arteries of the heart. The global burden of CAD has increased significantly over the years, resulting in millions of deaths annually and making it the leading health-care expenditure and cause of mortality in developed countries. The lack of cost-effective strategies for monitoring the prognosis of CAD warrants a pressing need for accurate and efficient markers to assess disease severity and progression for both reducing health-care costs and improving patient outcomes. AREA COVERED To effectively monitor CAD, prognostic biomarkers and imaging techniques play a vital role in risk-stratified patients during acute treatment and over time. However, with over 1,000 potential markers of interest, it is crucial to identify the key markers with substantial utility in monitoring CAD progression and evaluating therapeutic interventions. This review focuses on identifying and highlighting the most relevant markers for monitoring CAD prognosis and disease severity. We searched for relevant literature using PubMed and Google Scholar. EXPERT OPINION By utilizing the markers discussed, health-care providers can improve patient care, optimize treatment plans, and ultimately reduce health-care costs associated with CAD management.
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Affiliation(s)
- Armand N. Yazdani
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Michaela Pletsch
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Abraham Chorbajian
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - David Zitser
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Vikrant Rai
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
| | - Devendra K. Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766
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Wang MM, Gai MT, Wang BZ, Yesitayi G, Ma YT, Ma X. A prediction model to predict in-hospital mortality in patients with acute type B aortic dissection. BMC Cardiovasc Disord 2023; 23:257. [PMID: 37198546 DOI: 10.1186/s12872-023-03260-5] [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: 10/18/2022] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Acute type B aortic dissection (ABAD) is a life-threatening cardiovascular disease. A practicable and effective prediction model to predict and evaluate the risk of in-hospital death for ABAD is required. The present study aimed to construct a prediction model to predict the risk of in-hospital death in ABAD patients. METHODS A total of 715 patients with ABAD were recruited in the first affiliated hospital of Xinjiang medical university from April 2012 to May 2021. The information on the demographic and clinical characteristics of all subjects was collected. The logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and nomogram were applied to screen the appropriate predictors and to establish a prediction model for the risk of in-hospital mortality in ABAD. The receiver operator characteristic curve and calibration plot were applied to validate the performance of the prediction model. RESULTS Of 53 (7.41%) subjects occurred in-hospital death in 715 ABAD patients. The variables including diastolic blood pressure (DBP), platelets, heart rate, neutrophil-lymphocyte ratio, D-dimer, C-reactive protein (CRP), white blood cell (WBC), hemoglobin, lactate dehydrogenase (LDH), procalcitonin, and left ventricular ejection fraction (LVEF) were shown a significant difference between the in-hospital death group and the in-hospital survival group (all P < 0.05). Furthermore, all these factors which existed differences, except CRP, were associated with in-hospital deaths in ABAD patients (all P < 0.05). Then, parameters containing LVEF, WBC, hemoglobin, LDH, and procalcitonin were identified as independent risk factors for in-hospital deaths in ABAD patients by adjusting compound variables (all P < 0.05). In addition, these independent factors were qualified as predictors to build a prediction model (AUC > 0.5, P < 0.05). The prediction model was shown a favorable discriminative ability (C index = 0.745) and demonstrated good consistency. CONCLUSIONS The novel prediction model combined with WBC, hemoglobin, LDH, procalcitonin, and LVEF, was a practicable and valuable tool to predict in-hospital deaths in ABAD patients.
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Affiliation(s)
- Meng-Meng Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Min-Tao Gai
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
- Xinjiang Key Laboratory of Medical Animal Model Research, Urumqi, 830011, China
| | - Bao-Zhu Wang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Gulinazi Yesitayi
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China.
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Xinjiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China.
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Zhou J, Zhao R, Wang D, Gao Q, Zhao D, Ouyang B, Hao L, Peng X. Sex-Specific Association Between Iron Status and the Predicted 10-Year Risk for Atherosclerotic Cardiovascular Disease in Hypertensive Patients. Biol Trace Elem Res 2022; 200:4594-4607. [PMID: 35067842 PMCID: PMC9492579 DOI: 10.1007/s12011-021-03060-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/10/2021] [Indexed: 12/20/2022]
Abstract
Serum ferritin (SF) and haemoglobin (Hb) are widely used in clinical practice to assess iron status. Studies exploring the relationship of SF and Hb with atherosclerotic cardiovascular disease (ASCVD) risk have yielded conflicting results, and some indicated sex specificity. Hypertensive patients have abnormal iron status. However, research on patients with hypertension is limited. We aim to investigate the sex-specific links of SF and Hb with the predicted 10-year ASCVD risk in hypertensive patients. This cross-sectional study included 718 hypertensive men and 708 hypertensive women. The predicted 10-year ASCVD risk was calculated based on the China-PAR equation. The dose-response curves were illustrated by fitting linear and quadratic models. In hypertensive men, the iron status fits for a quadratic model for ASCVD risk, showing a U-shape. After adjusting for potential confounding factors, the regression coefficients and 95% confidence intervals (95% CI) across tertile of SF were 0.0 (reference), - 0.99 (- 1.65, - 0.33) and - 0.22 (- 0.88, 0.44), and of Hb were 0.0 (reference), - 0.74 (- 1.41, - 0.08) and - 0.77 (- 1.46, - 0.08). In hypertensive women, iron status was linearly and positively associated with ASCVD risk. Per one unit increment of log-transformed SF as well as Hb was associated with a 1.22 (95% CI: 0.97, 1.48) and 0.04 (95% CI: 0.02, 0.07) increased in ASCVD risk score, respectively. A significant interaction between iron status and inflammation on ASCVD risk was observed in hypertensive women. SF and Hb showed a U-shape with ASCVD risk in hypertensive men; however, a positive linear relationship was observed in hypertensive women.
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Affiliation(s)
- Juan Zhou
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518051, China
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dongxia Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qin Gao
- Department of Public Health, Jining Medical University, Jining, 272067, China
| | - Dan Zhao
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518051, China
| | - Binfa Ouyang
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518051, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaolin Peng
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518051, China.
- Department of Oncology, Injury Prevention and Nutrition, Shenzhen Nanshan Center for Chronic Disease Control, 7 Huaming Road, Shenzhen, 518051, China.
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Xu C, Li W, Li T, Yuan J, Pang X, Liu T, Liang B, Cheng L, Sun X, Dong S. Iron metabolism-related genes reveal predictive value of acute coronary syndrome. Front Pharmacol 2022; 13:1040845. [PMID: 36330096 PMCID: PMC9622999 DOI: 10.3389/fphar.2022.1040845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022] Open
Abstract
Iron deficiency has detrimental effects in patients with acute coronary syndrome (ACS), which is a common nutritional disorder and inflammation-related disease affects up to one-third people worldwide. However, the specific role of iron metabolism in ACS progression is opaque. In this study, we construct an iron metabolism-related genes (IMRGs) based molecular signature of ACS and to identify novel iron metabolism gene markers for early stage of ACS. The IMRGs were mainly collected from Molecular Signatures Database (mSigDB) and two relevant studies. Two blood transcriptome datasets GSE61144 and GSE60993 were used for constructing the prediction model of ACS. After differential analysis, 22 IMRGs were differentially expressed and defined as DEIGs in the training set. Then, the 22 DEIGs were trained by the Elastic Net to build the prediction model. Five genes, PADI4, HLA-DQA1, LCN2, CD7, and VNN1, were determined using multiple Elastic Net calculations and retained to obtain the optimal performance. Finally, the generated model iron metabolism-related gene signature (imSig) was assessed by the validation set GSE60993 using a series of evaluation measurements. Compared with other machine learning methods, the performance of imSig using Elastic Net was superior in the validation set. Elastic Net consistently scores the higher than Lasso and Logistic regression in the validation set in terms of ROC, PRC, Sensitivity, and Specificity. The prediction model based on iron metabolism-related genes may assist in ACS early diagnosis.
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Affiliation(s)
- Cong Xu
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
| | - Wanyang Li
- School of Mathematics, South China University of Technology, Guangzhou, China
| | - Tangzhiming Li
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
| | - Jie Yuan
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
| | - Xinli Pang
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
| | - Tao Liu
- International Digital Economy Academy, Shenzhen, China
| | - Benhui Liang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Lixin Cheng
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
- *Correspondence: Lixin Cheng, ; Xin Sun, ; Shaohong Dong,
| | - Xin Sun
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
- *Correspondence: Lixin Cheng, ; Xin Sun, ; Shaohong Dong,
| | - Shaohong Dong
- Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, China
- *Correspondence: Lixin Cheng, ; Xin Sun, ; Shaohong Dong,
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Skrzypczak T, Skrzypczak A, Michałowicz J. The Relationship Between Iron Status and Atherosclerotic Cardiovascular Disease Risk in Non-anemic Patients Without a History of Cardiovascular Diseases: A Cross-Sectional Study. Cureus 2022; 14:e29439. [PMID: 36312608 PMCID: PMC9595251 DOI: 10.7759/cureus.29439] [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] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Iron deficiency (ID) and iron status in non-anemic patients with atherosclerotic cardiovascular disease (ASCVD) risk without a history of cardiovascular diseases is still weakly explored. In this study, the authors evaluated the most common ID definitions in this group of patients. A total of 533 participants from the National Health and Nutrition Examination Survey (NHANES) were collected from 2005-2006, 2017-2018, and 2017-2020 records. Participants were divided according to their ASCVD risk score to the following groups: low (n=168, 32%), borderline (n=43, 8%), intermediate (n=200, 37%), and high (n=122, 23%). There was a higher prevalence of ID in low- and borderline-risk groups in contrast to intermediate- and high-risk groups. Higher serum ferritin concentrations were observed in groups with a greater ASCVD risk score. Transferrin saturation (TSAT) was comparable in all ASCVD categories. Lack of ID, defined by three different guidelines that are mainly based on serum ferritin levels, predisposed to a higher ASCVD risk category. Normal iron status, defined by these three guidelines, was positively associated with the male gender. The opposite association was observed for non-Hispanic Whites. The analyzed criteria of ID, based mostly on serum ferritin levels, demonstrated limited usefulness in patients with increased ASCVD risk. Further studies should be done to determine proper ID diagnostic criteria in non-anemic patients without a previous cardiovascular history with elevated ASCVD risk.
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Affiliation(s)
| | - Anna Skrzypczak
- Faculty of Dentistry, Wroclaw Medical University, Wroclaw, POL
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10
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Wischmann P, Bruno RR, Wernly B, Wolff G, Afzal S, Rezar R, Cramer M, Heramvand N, Kelm M, Jung C. Relevance of pre-existing anaemia for patients admitted for acute coronary syndrome to an intensive care unit: a retrospective cohort analysis of 7418 patients. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac040. [PMID: 35919579 PMCID: PMC9260305 DOI: 10.1093/ehjopen/oeac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/14/2022]
Abstract
Aims Patients with acute coronary syndrome (ACS) frequently suffer from anaemia, but its role in patients admitted to an intensive care unit (ICU) is unclear. This analysis evaluates the prognostic relevance of different degrees of anaemia and their specific impact on disease severity and the outcome in critically ill ACS patients. Methods and results and results The multi-centre electronic Intensive Care Unit Collaborative Research Database was used, and all patients admitted with ACS were included in a retrospective analysis. Anaemia and its degrees were defined according to the criteria by the World Health Organization. A multi-level logistic regression analysis was used to fit three sequential regression models for the binary primary outcome of hospital mortality. A total of 7418 patients were included; 3437 patients (46%) had anaemia on admission. Patients with anaemia were significantly older [61 (53–70) vs. 70 (61–78) years, P < 0.001], more often female (P < 0.001), and required an increased rate of vasopressor use (P < 0.001) and mechanical ventilation (P < 0.001). With the higher Sequential organ failure assessment score (1 vs. 2; P < 0.001) and Acute Physiology And Chronic Health Evaluation (35 vs. 47; P < 0.001) scores, a higher degree of anaemia was associated with prolonged ICU stay (2 vs. 5 days, P < 0.001). Even patients with mild anaemia needed significantly from more intensive treatment and suffered worse outcome. Intensive care unit and hospital mortality were inversely associated with haemoglobin levels. Conclusion Nearly half of critically ill patients with ACS suffer from anaemia, which is associated with increased illness severity, complex ICU procedures, and mortality—even in mild anaemia. Haemoglobin on admission is an independent factor for adverse outcome.
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Affiliation(s)
- Patricia Wischmann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Bernhard Wernly
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University , Strubergasse 21, 5020 Salzburg , Austria
- Center for Public Health and Healthcare Research, Paracelsus Medical University Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg , Strubergasse 21, 5020 Salzburg , Austria
| | - Mareike Cramer
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Nadia Heramvand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Heinrich Heine University , Moorenstraße 5, 40225 Duesseldorf , Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf , Moorenstr. 5, 40225 Düsseldorf , Germany
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11
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Huang L, Yang W, Li L, Feng X, Cheng H, Ge X, Liu C, Chen X, Mo Z, Yang X. Causal relationships between blood calcium, iron, magnesium, zinc, selenium, phosphorus, copper, and lead levels and multisystem disease outcomes in over 400,000 Caucasian participants. Clin Nutr 2022; 41:1015-1024. [PMID: 35390725 DOI: 10.1016/j.clnu.2022.02.020] [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: 11/03/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND & AIMS Metal elements have been associated with a wide range of clinical outcomes. The available epidemiological evidence for these associations is often inconsistent and suffers from confounding and reverse causation. We aimed to explore the broad clinical effects of varying blood metal element levels and possible underlying mechanisms. METHODS We performed a two-sample Mendelian randomization (MR) analysis by using metal element-associated genetic loci as instrumental variable to evaluate the causal associations between blood metal element levels and 1050 disease outcomes in a UK Biobank cohort. A total of 408,910 White British participants were enrolled in the analysis. We further used the metal element-related genes and disease-related genes to construct a protein-protein interaction (PPI) network. RESULTS Eight metal elements were associated with 63 diseases in total. Notably, we found nine pairs of suggestive evidence between two different metal elements for the same disease. Selenium and lead share some of the associated clinical outcomes, including diabetes mellitus, type 2 diabetes, lymphoid leukemia, and acute pharyngitis. Lead and zinc share the associated disease of acquired hypothyroidism. Iron and copper share the associated disease of arthropathies. Copper and zinc share the associated disease of occlusion of cerebral arteries. Calcium and zinc share the associated disease of arthropathies. In addition, the PPI network provided potential links between metal elements and disease outcomes at the genetic level. CONCLUSIONS Our MR study of eight metal elements comprehensively characterized their shared and unique clinical effects, highlighting their potential causal roles in multiple diseases. Given the modifiable nature of blood metal elements and the potential for clinical interventions, these findings warrant further investigation.
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Affiliation(s)
- Lulu Huang
- Department of Radiotherapy, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenjun Yang
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application,Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Longman Li
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Department of Urology, Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiuming Feng
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Hong Cheng
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoting Ge
- Department of Public Health, School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Chaoqun Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Chen
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Zengnan Mo
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Department of Urology, Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaobo Yang
- Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China; Department of Public Health, School of Medicine, Guangxi University of Science and Technology, Liuzhou, Guangxi, China.
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12
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Zhu S, Liu C, Zhao C, Chen G, Meng S, Hong M, Xiang M, Xie Y. Increased Serum Soluble Transferrin Receptor Levels Were Associated With High Prevalence of Cardiovascular Diseases: Insights From the National Health and Nutrition Examination Survey 2017–2018. Front Cell Dev Biol 2022; 10:874846. [PMID: 35493097 PMCID: PMC9039157 DOI: 10.3389/fcell.2022.874846] [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: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 01/06/2023] Open
Abstract
Background: Iron deficiency is common in cardiovascular diseases (CVD), e.g., heart failure and coronary heart disease. Soluble transferrin receptor (sTfR) is a promising marker representing unmet cellular iron demands. However, whether higher serum sTfR is associated with increased risk of CVDs needs further investigation. Methods: In the present cross-sectional study, we analyzed data of 4,867 adult participants of the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Linear regression models were employed to identify possible correlations between sTfR and other characteristics. The association between sTfR and CVDs was assessed with univariable and multivariable logistics regression models. Results: The prevalence of CVDs was 9.5% among participants, and higher sTfR levels were found in participants with CVDs (p < 0.001). Linear regression models revealed positive associations between sTfR and age, body mass index, systolic blood pressure, glycated hemoglobulin A1c, and insulin resistance (all p < 0.001). In the multivariable logistics regression model, the adjusted odds ratio of sTfR for CVDs was 2.05 (per 1 log2 mg/L, 95% confidence interval: 1.03∼4.05, p = 0.046). Further subgroup analysis identified the associations of sTfR and CVDs were only significant in participants ≥60 years old, or with hypertension (all p < 0.05). Conclusion: Our study demonstrated that increased serum sTfR levels were associated with a high prevalence of cardiovascular diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yao Xie
- *Correspondence: Meixiang Xiang, ; Yao Xie,
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13
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Barywani SB, Östgärd Thunström E, Mandalenakis Z, Hansson PO. Body iron stores had no impact on coronary heart disease outcomes: a middle-aged male cohort from the general population with 21-year follow-up. Open Heart 2022; 9:openhrt-2021-001928. [PMID: 35410912 PMCID: PMC9003602 DOI: 10.1136/openhrt-2021-001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/22/2022] [Indexed: 11/03/2022] Open
Abstract
BackgroundBody iron stores (BISs) have been proposed to be related to the development of cardiovascular diseases. However, results from epidemiological studies are conflicting. Knowledge on the long-term impact of BIS on cardiovascular outcomes in the general population is lacking.PurposeThe aim of this study was to explore the relationship between BIS and coronary heart disease (CHD) including death due to CHD.MethodsThis investigation is part of ‘The Study of Men Born in 1943’, a longitudinal prospective study of men living in the city of Gothenburg, Sweden. This random population sample was examined in 1993 (all at 50 years of age at baseline). A medical examination was performed, and questionnaires were used to evaluate lifestyle factors. Biomarkers for iron stores (serum ferritin and serum transferrin receptor) was analysed from frozen blood samples in 2014. All hospital admissions were registered through national registers during the entire follow-up from 1993 to 2014. HRs were estimated by Cox proportional-hazard regression analyses.ResultsDuring the 21 years follow-up period, 120 participants (15.2%) developed CHD and 16 patients (2%) died due to CHD. The all-cause mortality was 15.2% (n=120) including 40 cardiovascular deaths (5.1%). In a multivariable Cox regression analysis, the daily smoking, hypertension and the increased resting heart rate was independent predictors of CHD, while no significant association was found between BIS and risk of CHD.ConclusionsIn a cohort of middle-aged men from the general population with well validated and prospectively collected data, we did not find any association between serum ferritin or serum transferrin receptor as markers of BIS and CHD events after 21 years of follow-up.Trail registration numberNCT03138122.
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Affiliation(s)
- Salim Bary Barywani
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Medicine, Gothemburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Region VästraGötaland, Medicine, Gothenburg, Sweden
| | - Erik Östgärd Thunström
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Medicine, Gothemburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Region VästraGötaland, Medicine, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Medicine, Gothemburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Region VästraGötaland, Medicine, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Medicine, Gothemburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Region VästraGötaland, Medicine, Gothenburg, Sweden
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14
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Wang Q, Feng W, Kuang J, Wu J, Yang J, Li C, Fan R. Prediction model for postoperative severe acute lung injury in patients undergoing acute type A aortic dissection surgery. J Card Surg 2022; 37:1602-1610. [PMID: 35348246 DOI: 10.1111/jocs.16447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to establish a risk assessment model to predict postoperative severe acute lung injury (ALI) risk in patients with acute type A aortic dissection (ATAAD). METHODS Consecutive patients with ATAAD admitted to our hospital were included in this retrospective assessment and placed in the postoperative severe ALI and nonsevere ALI groups based on the presence or absence of ALI within 72 h postoperatively (oxygen index [OI] ≤ 100 mmHg). Patients were then randomly divided into training and validation groups in a ratio of 8:2. Univariate and multivariate stepwise forward logistic regression analyses were used to statistically assess data and establish the prediction model. The prediction model's effectiveness was evaluated via 10-fold cross-validation of the validation group to facilitate the construction of a nomogram. RESULTS After the screening, 479 patients were included in the study: 132 (27.6%) in the postoperative severe ALI group and 347 (72.4%) in the postoperative nonsevere ALI group. Based on multivariate logistics regression analyses, the following variables were included in the model: coronary heart disease, cardiopulmonary bypass (CPB) ≥ 257.5 min, left atrium diameter ≥ 35.5 mm, hemoglobin ≤ 139.5 g/L, preCPB OI ≤ 100 mmHg, intensive care unit OI ≤ 100 mmHg, left ventricular posterior wall thickness ≥ 10.5 mm, and neutrophilic granulocyte percentage ≥ 0.824. The area under the receiver operating characteristic (ROC) curve of the modeling group was 0.805 and differences between observed and predicted values were not deemed statistically significant via the Hosmer-Lemeshow test (χ2 = 6.037, df = 8, p = .643). For the validation group, the area under the ROC curve was 0.778, and observed and predicted value differences were insignificant when assessed using the Hosmer-Lemeshow test (χ2 = 3.3782, df = 7; p = .848). The average 10-fold cross-validation score was 0.756. CONCLUSIONS This study established a prediction model and developed a nomogram to determine the risk of postoperative severe ALI after ATAAD. Variables used in the model were easy to obtain clinically and the effectiveness of the model was good.
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Affiliation(s)
- Qiuji Wang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of clinical medicine, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weiqi Feng
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of clinical medicine, School of Medicine, South China University of Technology, Guangzhou, China
| | - Juntao Kuang
- Department of Cardiovascular Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Jinlin Wu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jue Yang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chenxi Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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15
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Lanser L, Fuchs D, Kurz K, Weiss G. Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis-Mechanistic Insights into Anemia of Inflammation and Its Treatment. Nutrients 2021; 13:3732. [PMID: 34835988 PMCID: PMC8619077 DOI: 10.3390/nu13113732] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Anemia is very common in patients with inflammatory disorders. Its prevalence is associated with severity of the underlying disease, and it negatively affects quality of life and cardio-vascular performance of patients. Anemia of inflammation (AI) is caused by disturbances of iron metabolism resulting in iron retention within macrophages, a reduced erythrocyte half-life, and cytokine mediated inhibition of erythropoietin function and erythroid progenitor cell differentiation. AI is mostly mild to moderate, normochromic and normocytic, and characterized by low circulating iron, but normal and increased levels of the storage protein ferritin and the iron hormone hepcidin. The primary therapeutic approach for AI is treatment of the underlying inflammatory disease which mostly results in normalization of hemoglobin levels over time unless other pathologies such as vitamin deficiencies, true iron deficiency on the basis of bleeding episodes, or renal insufficiency are present. If the underlying disease and/or anemia are not resolved, iron supplementation therapy and/or treatment with erythropoietin stimulating agents may be considered whereas blood transfusions are an emergency treatment for life-threatening anemia. New treatments with hepcidin-modifying strategies and stabilizers of hypoxia inducible factors emerge but their therapeutic efficacy for treatment of AI in ill patients needs to be evaluated in clinical trials.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (K.K.)
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (K.K.)
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, 6020 Innsbruck, Austria; (L.L.); (K.K.)
- Christian Doppler Laboratory for Iron Metabolism and Anemia Research, Medical University of Innsbruck, 6020 Innsbruck, Austria
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16
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Michalak SS, Wolny-Rokicka E, Nowakowska E, Michalak M, Gil L. Clinical Implications of the Coexistence of Anemia and Diabetes Mellitus in the Elderly Population. J Diabetes Res 2021; 2021:8745968. [PMID: 34708130 PMCID: PMC8545586 DOI: 10.1155/2021/8745968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/23/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
Diabetes mellitus (DM) and also anemia are common in the elderly and have a negative impact on the clinical outcomes of patients. The coexistence of anemia and DM seems to be insufficiently recognized; therefore, the aim of our study is to analyze the incidence and clinical consequences of this coexistence, including mortality, in the population of people aged ≥60. A retrospective study was conducted on 981 primary care clinic patients aged ≥60 during 2013-2014. The prevalence of coexistence of DM and anemia (defined in accordance with WHO) and data on the incidence of comorbidities, hospitalization, medical procedures, and all-cause mortality were analyzed. In the study population, 25% had DM, while 5.4% had both DM and anemia. Peripheral artery disease (PAD) was found in 48 patients (4.89%) of the entire study population, more often in men (p < 0.001). Diabetic patients with anemia compared to nonanemic diabetics had more comorbidities (median 4 (4, 5) vs. 3 (2-4); p < 0.001)-PAD more often (p = 0.004), more hospitalization (median 2 (0-11) vs. 0 (0-11); p < 0.001), and more frequent medical procedures (e.g., percutaneous coronary intervention (p < 0.001), coronary artery bypass surgery (p = 0.027), arteriography (p < 0.001), and bypass surgery or endovascular treatments of lower limb ischemia (p < 0.001)). The cumulative survival of patients with both DM and anemia vs. nonanemic diabetics at 36 months was 86.4% vs. 99.3% (p < 0.001). A multivariate logistic regression model showed anemia to be a significant risk factor for death in diabetic patients (p = 0.013). Patients with both DM and anemia have more comorbidities than nonanemic diabetic patients; they are more often hospitalized, require medical procedures more frequently, and are at a higher risk of death. Effective treatment of anemia in patients with DM is advisable and may well improve the prognosis of patients.
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Affiliation(s)
- S. S. Michalak
- Department of Pharmacology and Toxicology, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - E. Wolny-Rokicka
- Department of Radiotherapy, Multidisciplinary Hospital, Gorzow Wielkopolski, Poland
| | - E. Nowakowska
- Department of Pharmacology and Toxicology, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - M. Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - L. Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
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17
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Lanser L, Fuchs D, Scharnagl H, Grammer T, Kleber ME, März W, Weiss G, Kurz K. Anemia of Chronic Disease in Patients With Cardiovascular Disease. Front Cardiovasc Med 2021; 8:666638. [PMID: 34458328 PMCID: PMC8387678 DOI: 10.3389/fcvm.2021.666638] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: Anemia is often found in patients with coronary artery disease (CAD) or acute coronary syndrome (ACS) and related to disease severity. Our study investigated the relationship between anemia, iron homeostasis and inflammation in CAD and examined their influence on the outcome of patients. Patients and Methods: Markers of immune activation (neopterin, interleukin [IL]-12, IL-6, high sensitive C-reactive protein (hsCRP), fibrinogen, serum amyloid A [SAA]) and iron metabolism (ferritin, transferrin saturation, hemoglobin) were determined in 2,082 patients (68.7 % men, median age 63 years) from the Ludwigshafen Risk and cardiovascular Health (LURIC) cohort. Patients were followed-up for a median of 9.81 years. Results: 960 patients (46.1 %) presented with chronic CAD, 645 patients (31.0 %) had an ACS, and 477 patients (22.9 %) presented with no CAD in coronary angiography (CAG). Anemia (n = 357, 17.1 %) was associated with disease severity (reflected by more progressed stenosis in CAG, CCS, and NYHA classes, and a lower LV-EF), a higher cardio-cerebrovascular event rate and higher levels of inflammatory markers. Interestingly, anemia was only predictive for an adverse outcome in patients with elevated inflammatory markers. Accordingly, anemia of chronic disease (ACD) was associated with a higher cardio-cerebrovascular event-rate in the subsequent 2 years as compared to patients with other types of anemia or without anemia (14.3 vs. 6.1 vs. 4.0%, p < 0.001). Conclusions: This study confirms that anemia and immune activation are strongly related to cardiovascular disease progression and an adverse outcome. Our data suggest that the association of anemia with disease severity and outcome might mainly be due to underlying inflammation.
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Affiliation(s)
- Lukas Lanser
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz Medical University, Graz, Austria
| | - Tanja Grammer
- Medical CIinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcus E Kleber
- Medical CIinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Winfried März
- Medical CIinic V, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,SYNLAB Academy, SYNLAB Holding Deutschland GmbH, Augsburg and Mannheim, Germany
| | - Günter Weiss
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
| | - Katharina Kurz
- Department of Internal Medicine II, Innsbruck Medical University, Innsbruck, Austria
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18
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Bi Y, Ajoolabady A, Demillard LJ, Yu W, Hilaire ML, Zhang Y, Ren J. Dysregulation of iron metabolism in cardiovascular diseases: From iron deficiency to iron overload. Biochem Pharmacol 2021; 190:114661. [PMID: 34157296 DOI: 10.1016/j.bcp.2021.114661] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Abstract
Iron deficiency and iron overload are the most prevalent and opposite forms of dysregulated iron metabolism that affect approximately 30 percent of the world population, in particularly, elderly and patients with chronic diseases. Both iron deficiency and overload are frequently observed in a wide range of cardiovascular diseases, contributing to the onset and progression of these diseases. One of the devastating seqeulae for iron overload is the induction of ferroptosis, a newly defined form of regulated cell death which heavily impacts cardiac function through ferroptotic cell death in cardiomyocytes. In this review, we will aim to evaluate iron deficiency and iron overload in cardiovascular diseases. We will summarize current therapeutic strategies to tackle iron deficiency and iron overload, major pitfalls of current studies, and future perspectives.
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Affiliation(s)
- Yaguang Bi
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Amir Ajoolabady
- School of Pharmacy and Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Laurie J Demillard
- School of Pharmacy and Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Wenjun Yu
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Michelle L Hilaire
- School of Pharmacy and Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA
| | - Yingmei Zhang
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Jun Ren
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA.
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19
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Abstract
Abstract
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Affiliation(s)
- Tibor Kempf
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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20
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Gao Z, Qin Z, An Z, Hou C, Wang L, Jin J. Prognostic Value of Preoperative Hemoglobin Levels for Long-Term Outcomes of Acute Type B Aortic Dissection Post-thoracic Endovascular Aortic Repair. Front Cardiovasc Med 2020; 7:588761. [PMID: 33304931 PMCID: PMC7693721 DOI: 10.3389/fcvm.2020.588761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/29/2020] [Indexed: 01/16/2023] Open
Abstract
Background and Aims: There is scant information available about the prognostic value of preoperative hemoglobin (Hb) levels on the long-term outcomes of acute type B aortic dissection (ABAD) following thoracic endovascular aortic repair (TEVAR). Methods: A retrospective analysis of consecutive patients from 2010 to 2018 regarding the relationship between Hb level and long-term outcomes was conducted. The primary endpoint was all-cause mortality. Major adverse cardiovascular events (MACEs) included all-cause death, recurrent ruptures, and secondary procedures. Results: In total, 391 subjects treated by TEVAR were enrolled, with a mean age of 57.1 ± 12.0 years; 79.5% of them were male. Cox multivariate analysis showed that the preoperative Hb level was independently associated with all-cause death [adjusted hazard ratio (HR) 0.797 (per 1 g/dl), 95% confidence interval (CI) 0.693–0.918, p = 0.002] and MACEs (adjusted HR 0.795, 95% CI 0.672–0.871, p = 0.000). The area under the receiver operating characteristic curve of Hb for all-cause death and MACEs were 0.617 (95% CI 0.548–0.687, p = 0.008) and 0.617 (95% CI 0.551–0.684, p = 0.005), respectively. In the linear trend test, Hb concentration was significantly related to all-cause mortality (p for trend = 0.001) and MACEs (p for trend = 0.000). Moreover, in Kaplan–Meier analysis, lower Hb levels (< 12 g/dl) were significantly different from higher Hb (≥12 g/dl) levels for both all-cause death (log-rank p = 0.001) and MACEs (log-rank p = 0.001). Similar results were found when assessing the prognostic value of red blood cell count and anemia. Conclusions: Preoperative Hb may serve as a prognostic marker for long-range adverse outcomes for ABAD patients post-TEVAR.
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Affiliation(s)
- Zhichun Gao
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhexue Qin
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhixia An
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changchun Hou
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Luyu Wang
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jun Jin
- Department of Cardiology, Institute of Cardiovascular Diseases of People's Liberation Army, Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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21
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Tural K, Kara F, Avcı S, Erdoğdu Hİ. CAN COMPLETE BLOOD CELL COUNT PARAMETERS PREDICT DEEP VEIN THROMBOSIS? Acta Clin Croat 2020; 59:661-666. [PMID: 34285436 PMCID: PMC8253064 DOI: 10.20471/acc.2020.59.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/19/2018] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to evaluate complete blood cell count parameters including red blood cell indices, white blood cell subtypes, and platelet indices for predicting deep vein thrombosis (DVT). A total of 71 (44 male and 27 female) patients with acute femoral and popliteal DVT diagnosed by doppler ultrasonography during a period of seven years (2011-2017) were included in the study. By matching age and gender, 142 (88 male and 54 female) subjects diagnosed with venous insufficiency in the same time interval were assigned as control group. Data were obtained by reviewing hospital records of the study participants, including clinical and demographic characteristics and complete blood cell parameters. Frequencies of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, and coronary arterial disease were higher in DVT group as compared to non-DVT group (p<0.05). Hemoglobin and lymphocyte values were lower, and red blood cell distribution width, neutrophil, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio higher in DVT group as compared with non-DVT group (p<0.05). There was no significant between-group difference in terms of mean corpuscular volume, platelet, mean platelet volume, mean platelet volume to platelet ratio, and platelet distribution width (p>0.05). Hypertension, hemoglobin, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. We found that hypertension, anemia, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. In particular, neutrophil to lymphocyte ratio and hemoglobin may be used as novel, inexpensive, and reliable diagnostic tools for DVT.
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Affiliation(s)
| | - Fatih Kara
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Sema Avcı
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Halil İbrahim Erdoğdu
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
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22
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Sui Y, Hong CT, Chien LN, Liu HY, Chiou HY, Hsieh YC. Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7440. [PMID: 33066053 PMCID: PMC7600941 DOI: 10.3390/ijerph17207440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19-1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15-1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.
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Affiliation(s)
- Yuan Sui
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (Y.S.); (C.-T.H.)
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan; (Y.S.); (C.-T.H.)
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei 11031, Taiwan; (L.-N.C.); (H.-Y.L.)
- Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan;
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Chen Hsieh
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- PhD Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- PhD Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan
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23
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Weidmann H, Bannasch JH, Waldeyer C, Shrivastava A, Appelbaum S, Ojeda-Echevarria FM, Schnabel R, Lackner KJ, Blankenberg S, Zeller T, Karakas M. Iron Metabolism Contributes to Prognosis in Coronary Artery Disease: Prognostic Value of the Soluble Transferrin Receptor Within the AtheroGene Study. J Am Heart Assoc 2020; 9:e015480. [PMID: 32321351 PMCID: PMC7428563 DOI: 10.1161/jaha.119.015480] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Coronary heart disease is a leading cause of mortality worldwide. Iron deficiency, a frequent comorbidity of coronary heart disease, causes an increased expression of transferrin receptor and soluble transferrin receptor levels (sTfR) levels, while iron repletion returns sTfR levels to the normal physiological range. Recently, sTfR levels were proposed as a potential new marker of iron metabolism in cardiovascular diseases. Therefore, we aimed to evaluate the prognostic value of circulating sTfR levels in a large cohort of patients with coronary heart disease. Methods and Results The disease cohort comprised 3423 subjects who had angiographically documented coronary heart disease and who participated in the AtheroGene study. Serum levels of sTfR were determined at baseline using an automated immunoassay (Roche Cobas Integra 400). Two main outcomes were considered: a combined end point of myocardial infarction and cardiovascular death and cardiovascular death alone. During a median follow‐up of 4.0 years, 10.3% of the patients experienced an end point. In Cox regression analyses for sTfR levels, the hazard ratio (HR) for future cardiovascular death and/or myocardial infarction was 1.27 (95% CI, 1.11–1.44, P<0.001) after adjustment for sex and age. This association remained significant (HR, 1.23; 95% CI, 1.03–1.46, P=0.02) after additional adjustment for body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia, C‐reactive protein, and surrogates of cardiac function, size of myocardial necrosis (hs‐Tnl), and hemoglobin levels. Conclusions In this large cohort study, sTfR levels were strongly associated with future myocardial infarction and cardiovascular death. This implicates a role for sTfR in secondary cardiovascular risk prediction.
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Affiliation(s)
- Henri Weidmann
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Johannes H Bannasch
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
| | - Christoph Waldeyer
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Apurva Shrivastava
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Sebastian Appelbaum
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
| | | | - Renate Schnabel
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Karl J Lackner
- Department of Laboratory Medicine University Medical Center Johannes Gutenberg University Mainz Mainz Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main Mainz Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
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24
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Reyes C, Pons NA, Reñones CR, Gallisà JB, Val VA, Tebé C, Mateo GF. Association between serum ferritin and acute coronary heart disease: A population-based cohort study. Atherosclerosis 2019; 293:69-74. [PMID: 31865056 DOI: 10.1016/j.atherosclerosis.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Several studies aiming to determine the association between iron stores and coronary heart disease (CHD) have reported conflicting results. None of them has been performed in a Mediterranean region. Our aim is to assess the association between the level of serum ferritin and the incidence of CHD in a Mediterranean region. METHODS We performed a cohort study using a primary health care population database. Primary outcome was incidence of CHD. Subjects aged between 35 and 74 years with serum ferritin (SF) measurements at baseline (January 1, 2006 to December 31, 2008) were included. Cox regression models were used to compute hazard ratios (HRs) and 95%CIs for the associtation between SF and time until CHD outcome. RESULTS We include 242,084 subjects with SF levels at baseline. Participants were observed for a median of 8.4 years. During follow-up, 1106 incident cases of CHD were identified. Persons with elevated SF did not have an increased CHD risk at follow-up (adjusted hazard ratio = 0.99; 95%CI 0.94-1.05; p = 0.86 in men, and 0.95; 95%CI 0.81-1.13; p = 0.60 in women). CONCLUSIONS Our study, by far the largest, showed that high levels of SF do not confer an increased risk of CHD, and questions its role as a risk factor for this disease.
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Affiliation(s)
- Carlen Reyes
- GREMPAL (Grup de Recerca en Epidemiologia de les Malalties Prevalents de l'Aparell Locomotor) Research Group and CIBERFes, Spain
| | - Nuria Aranda Pons
- Departament de Ciències Mèdiques Bàsiques, Nutrition and Mental Health Research Group (NUTRISAM), Facultat de Medicina i Ciències de la Salut (FMCS), Universitat Rovira i Virgili (URV), Reus, Spain
| | - Cristina Rey Reñones
- Unitat de Suport a la Recerca Tarragona-Reus, Grup d'Investigació en Prevenció de la Diabetis, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Tarragona, Barcelona, Catalonia, Spain
| | - Josep Basora Gallisà
- Unitat de Suport a la Recerca Tarragona-Reus, Grup d'Investigació en Prevenció de la Diabetis, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Tarragona, Barcelona, Catalonia, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Arija Val
- Unitat de Suport a la Recerca Tarragona-Reus, Grup d'Investigació en Prevenció de la Diabetis, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Tarragona, Barcelona, Catalonia, Spain; Departament de Ciències Mèdiques Bàsiques, Nutrition and Mental Health Research Group (NUTRISAM), Facultat de Medicina i Ciències de la Salut (FMCS), Universitat Rovira i Virgili (URV), Reus, Spain
| | - Cristian Tebé
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Gemma Flores Mateo
- Unitat de Suport a la Recerca Tarragona-Reus, Grup d'Investigació en Prevenció de la Diabetis, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Tarragona, Barcelona, Catalonia, Spain; Unitat d'Anàlisi i Qualitat, Xarxa Sanitària I Social de Santa Tecla, Tarragona, Spain.
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25
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Gill D, Brewer CF, Monori G, Trégouët D, Franceschini N, Giambartolomei C, Tzoulaki I, Dehghan A. Effects of Genetically Determined Iron Status on Risk of Venous Thromboembolism and Carotid Atherosclerotic Disease: A Mendelian Randomization Study. J Am Heart Assoc 2019; 8:e012994. [PMID: 31310728 PMCID: PMC6761644 DOI: 10.1161/jaha.119.012994] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
Background Systemic iron status has been implicated in atherosclerosis and thrombosis. The aim of this study was to investigate the effect of genetically determined iron status on carotid intima-media thickness, carotid plaque, and venous thromboembolism using Mendelian randomization. Methods and Results Genetic instrumental variables for iron status were selected from a genome-wide meta-analysis of 48 972 subjects. Genetic association estimates for carotid intima-media thickness and carotid plaque were obtained using data from 71 128 and 48 434 participants, respectively, and estimates for venous thromboembolism were obtained using data from a study incorporating 7507 cases and 52 632 controls. Conventional 2-sample summary data Mendelian randomization was performed for the main analysis. Higher genetically determined iron status was associated with increased risk of venous thromboembolism. Odds ratios per SD increase in biomarker levels were 1.37 (95% CI 1.14-1.66) for serum iron, 1.25 (1.09-1.43) for transferrin saturation, 1.92 (1.28-2.88) for ferritin, and 0.76 (0.63-0.92) for serum transferrin (with higher transferrin levels representing lower iron status). In contrast, higher iron status was associated with lower risk of carotid plaque. Corresponding odds ratios were 0.85 (0.73-0.99) for serum iron and 0.89 (0.80-1.00) for transferrin saturation, with concordant trends for serum transferrin and ferritin that did not reach statistical significance. There was no Mendelian randomization evidence of an effect of iron status on carotid intima-media thickness. Conclusions These findings support previous work to suggest that higher genetically determined iron status is protective against some forms of atherosclerotic disease but increases the risk of thrombosis related to stasis of blood.
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Affiliation(s)
- Dipender Gill
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Grace Monori
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
| | | | - Nora Franceschini
- Department of EpidemiologyUNC Gillings Global School of Public HealthChapel HillNC
| | - Claudia Giambartolomei
- Department of Pathology and Laboratory MedicineUniversity of California, Los AngelesLos AngelesCA
| | | | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Abbas Dehghan
- Department of Epidemiology and BiostatisticsSchool of Public HealthImperial College LondonLondonUnited Kingdom
- MRC‐PHE Centre for EnvironmentSchool of Public HealthImperial College LondonLondonUnited Kingdom
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26
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Grammer TB, Scharnagl H, Dressel A, Kleber ME, Silbernagel G, Pilz S, Tomaschitz A, Koenig W, Mueller-Myhsok B, März W, Strnad P. Iron Metabolism, Hepcidin, and Mortality (the Ludwigshafen Risk and Cardiovascular Health Study). Clin Chem 2019; 65:849-861. [PMID: 30917972 DOI: 10.1373/clinchem.2018.297242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anemia has been shown to be a risk factor for coronary artery disease (CAD) and mortality, whereas the role of iron metabolism remains controversial. METHODS We analyzed iron metabolism and its associations with cardiovascular death and total mortality in patients undergoing coronary angiography with a median follow-up of 9.9 years. Hemoglobin and iron status were determined in 1480 patients with stable CAD and in 682 individuals in whom significant CAD had been excluded by angiography. RESULTS Multivariate-adjusted hazard ratios (HRs) for total mortality in the lowest quartiles of iron, transferrin saturation, ferritin, soluble transferrin receptor (sTfR), and hemoglobin were 1.22 (95% CI, 0.96-1.60), 1.23 (95% CI, 0.97-1.56), 1.27 (95% CI, 1.02-1.58), 1.26 (95% CI, 0.97-1.65), and 0.99 (95% CI, 0.79-1.24), respectively, compared to the second or third quartile, which served as reference (1.00) because of a J-shaped association. The corresponding HRs for total mortality in the highest quartiles were 1.44 (95% CI, 1.10-1.87), 1.37 (95% CI, 1.05-1.77), 1.17 (95% CI, 0.92-1.50), 1.76 (95% CI, 1.39-2.22), and 0.83 (95% CI, 0.63-1.09). HRs for cardiovascular death were similar. For hepcidin, the adjusted HRs for total mortality and cardiovascular deaths were 0.62 (95% CI, 0.49-0.78) and 0.70 (95% CI, 0.52-0.90) in the highest quartile compared to the lowest one. CONCLUSIONS In stable patients undergoing angiography, serum iron, transferrin saturation, sTfR, and ferritin had J-shaped associations and hemoglobin only a marginal association with cardiovascular and total mortality. Hepcidin was continuously and inversely related to mortality.
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Affiliation(s)
- Tanja B Grammer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany; .,Department of Internal Medicine V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Alexander Dressel
- DACH Society for the Prevention of Cardiovascular Diseases, Hamburg, Germany
| | - Marcus E Kleber
- Department of Internal Medicine V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Günther Silbernagel
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Department of Cardiology, Charité Berlin, Berlin Institute of Health and German Research Centre for Cardiovascular Research, Berlin, Germany
| | - Stefan Pilz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Bertram Mueller-Myhsok
- Max Planck Institute of Psychiatry, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Winfried März
- Department of Internal Medicine V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology), Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Holding Deutschland GmbH, Augsburg and Mannheim, Germany
| | - Pavel Strnad
- Department of Internal Medicine III and IZKF, University Hospital Aaachen, Aachen, Germany
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27
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Kvaslerud AB, Hussain AI, Auensen A, Ueland T, Michelsen AE, Pettersen KI, Aukrust P, Mørkrid L, Gullestad L, Broch K. Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis. Open Heart 2018; 5:e000901. [PMID: 30613413 PMCID: PMC6307621 DOI: 10.1136/openhrt-2018-000901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/03/2018] [Accepted: 11/12/2018] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of this study was to evaluate the prevalence and prognostic implication of iron deficiency (ID) and anaemia in patients with severe aortic stenosis (AS). Methods In an observational study of consecutive patients referred for aortic valve replacement (AVR), we assessed a wide range of biomarkers of iron status, including the definition of ID commonly applied in patients with chronic heart failure (ferritin <100 µg/L or ferritin 100–299 µg/L with a transferrin saturation <20%). The endpoints were short-term (one-year) and long-term (median 4.7 years, IQR: 3.8–5.5) mortality and major adverse cardiovascular events (MACE) within the first year after inclusion. Results 464 patients were included in this substudy. 91 patients (20%) received conservative treatment and 373 patients (80%) received AVR. ID was detected in 246 patients (53%). 94 patients (20%) had anaemia. Patients with ID had an overall worse clinical profile than patients without ID. During follow-up, 129 patients (28%) died. Neither ID as defined above, soluble transferrin receptor nor hepcidin were associated with short-term or long-term mortality or MACE independent on treatment allocation. Anaemia was associated with one-year mortality in conservatively treated patients. Conclusions ID and anaemia are prevalent in patients with severe AS. In our cohort, ID did not provide independent prognostic information on top of conventional risk factors. More studies are required to determine how to correctly diagnose ID in patients with AS. Trial registration number NCT01794832.
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Affiliation(s)
- Anette Borger Kvaslerud
- Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Cardiac Research and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Amjad Iqbal Hussain
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Andreas Auensen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Cardiac Research and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Thor Ueland
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.,K.G. Jebsen - Thrombosis Research and Expertise Center (TREC), The Faculty of Health Sciences, UT - The Arctic University of Norway, Tromsø, Norway
| | - Annika E Michelsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Pål Aukrust
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Mørkrid
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Centre for Cardiac Research and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kaspar Broch
- KG Jebsen Centre for Cardiac Research and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Long T, Peng L, Li F, Xia K, Jing R, Liu X, Xie Q, Yang T, Zhang C. Correlations of DAPT score and PRECISE-DAPT score with the extent of coronary stenosis in acute coronary syndrome. Medicine (Baltimore) 2018; 97:e12531. [PMID: 30278543 PMCID: PMC6181461 DOI: 10.1097/md.0000000000012531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Dual antiplatelet therapy (DAPT) score and PRECISE-DAPT score were recommended for decision making of optimal DAPT in discriminating the risk of thrombosis and bleeding. But the relationships between 2 scoring tools with the extent of coronary stenosis have not been established.We retrospectively enrolled 359 patients of acute coronary syndrome (ACS) who received percutaneous coronary intervention. Both DAPT score and PRECISE-DAPT score were calculated, and patients were divided by their recommended cut-offs. Gensini score and triple-vessel disease (3-VD) were chosen to evaluate the severity of coronary stenosis.Overall, 54.9% and 10.0% of the patients had higher DAPT score (≥2) or PRECISE-DAPT score (≥25). Patients with higher DAPT score had increased stent counts, total length of stents, Gensini score, and proportion of 3-VD, but decreased minimum diameter of stent. But these differences were not found in PRECISE-DAPT subgroups. When divided into quartiles of both scoring systems, the highest Gensini score and proportions of 3-VD were found in the fourth quartile of both DAPT score and PRECISE-DAPT score. Moreover, both DAPT score and PRECISE-DAPT score were independent risk factors of Gensini score after adjustment (P < .001 and P = .047). Furthermore, an increase of 1 point of DAPT score and 5 points of PRECISE-DAPT score resulted by 51% (odds ratios [OR]: 1.51, 95% confidence interval [CI]:1.19-1.91, P = .001) and 34% (OR: 1.34, 95% CI: 1.11-1.62, P = .003) increase in risk of 3-VD after adjustment.Both DAPT score and PRECISE-DAPT score were independently associated with the degree of coronary stenosis in patients with ACS.
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González-D'Gregorio J, Miñana G, Núñez J, Núñez E, Ruiz V, García-Blas S, Bonanad C, Mollar A, Valero E, Amiguet M, Sastre C, Sanchis J. Iron deficiency and long-term mortality in elderly patients with acute coronary syndrome. Biomark Med 2018; 12:987-999. [PMID: 30043644 DOI: 10.2217/bmm-2018-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIM We evaluated the relationship between iron deficiency (ID) and long-term mortality risk in elderly patients with acute coronary syndrome (ACS). METHODS In this prospective observational study, we included 252 patients older than 65 years with ACS. Transferrin saturation (TSAT) and ferritin were collected before discharge. RESULTS Mean age, hemoglobin and GRACE score were 78 ± 7 years, 12.4 ± 1.8 g/dl and 138.8 ± 25.3, respectively, 112(44.4%) patients were women, and 151(59.9%) presented ID. During the follow-up, 121 (48%) patients died. Mortality rates among TSAT quartiles were: 2.38, 1.60, 0.90 and 0.95 × 10 person-years for Q1TSAT to Q4TSAT, respectively (p < 0.001) and did not differ across ferritin quartiles (p = 0.601), whereas ID definition was borderline associated (p = 0.060). Adjusted TSAT levels remained inverse, nonlinearly associated with long-term mortality risk (p < 0.001), with an exponential increased-risk from values about 20% and below. CONCLUSION Lower TSAT levels were independently associated with increased mortality risk in these patients.
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Affiliation(s)
| | - Gema Miñana
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Vicente Ruiz
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Sergio García-Blas
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Anna Mollar
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Ernesto Valero
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Martina Amiguet
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain
| | - Clara Sastre
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department. Hospital Clínico Universitario de Valencia. Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,CIBER Cardiovascular, Madrid, Spain
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30
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Adverse Outcome Prediction of Iron Deficiency in Patients with Acute Coronary Syndrome. Biomolecules 2018; 8:biom8030060. [PMID: 30037035 PMCID: PMC6163749 DOI: 10.3390/biom8030060] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023] Open
Abstract
Acute myocardial infarction remains a leading cause of morbidity and mortality. While iron deficient heart failure patients are at increased risk of future cardiovascular events and see improvement with intravenous supplementation, the clinical relevance of iron deficiency in acute coronary syndrome remains unclear. We aimed to evaluate the prognostic value of iron deficiency in the acute coronary syndrome (ACS). Levels of ferritin, iron, and transferrin were measured at baseline in 836 patients with ACS. A total of 29.1% was categorized as iron deficient. The prevalence of iron deficiency was clearly higher in women (42.8%), and in patients with anemia (42.5%). During a median follow-up of 4.0 years, 111 subjects (13.3%) experienced non-fatal myocardial infarction (MI) and cardiovascular mortality as combined endpoint. Iron deficiency strongly predicted non-fatal MI and cardiovascular mortality with a hazard ratio (HR) of 1.52 (95% confidence interval (CI) 1.03-2.26; p = 0.037) adjusted for age, sex, hypertension, smoking status, diabetes, hyperlipidemia, body-mass-index (BMI) This association remained significant (HR 1.73 (95% CI 1.07⁻2.81; p = 0.026)) after an additional adjustment for surrogates of cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide, NT-proBNP), for the size of myocardial necrosis (troponin), and for anemia (hemoglobin). Survival analyses for cardiovascular mortality and MI provided further evidence for the prognostic relevance of iron deficiency (HR 1.50 (95% CI 1.02⁻2.20)). Our data showed that iron deficiency is strongly associated with adverse outcome in acute coronary syndrome.
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Egbuche O, Millard HR, Renelus B, Maihemuti A, Musani SK, Fox ER, Liu J, Taylor HA, Bidulescu A. Serum Ferritin Levels in Blacks Without Known Cardiovascular Disease (from the Jackson Heart Study). Am J Cardiol 2017; 120:1533-1540. [PMID: 28865891 DOI: 10.1016/j.amjcard.2017.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
There has been conflicting results regarding the role of ferritin, a nonspecific marker of systemic inflammation, in the development of coronary heart disease (CHD). We aimed to evaluate the association of serum ferritin with incident CHD, incident stroke, and subclinical measurements of atherosclerosis among blacks. For our prospective study, we utilized data from the Jackson Heart Study. Eligible participants (n = 4,659) who were free from CHD were enrolled in 2000 to 2004. The participants' baseline serum ferritin levels were obtained, and they were followed up for an average of 8 years to identify incident CHD events and incident stroke. We used multivariate linear regression and Cox proportional hazard models to evaluate the association of serum ferritin with incident CHD events and incident stroke. The age-adjusted correlations between ferritin and specific study covariates, including carotid intima-media thickness, coronary artery calcium, and abdominal aortic calcium, were obtained. During an average of 8 years of follow-up, 161 incident CHD events and 117 incident stroke events were documented. There was no significant association between ferritin levels and incident CHD events (p = 0.54 in men and p = 0.31 in women) and incident stroke (p = 0.17 in men and p = 0.56 in women), or both considered together (p = 0.70 in men and p = 0.69 in women). Ferritin was significantly correlated with abdominal aortic calcium (r = 0.09, p <0.01) in women but not in men. In conclusion, a higher serum ferritin level was not associated with an increased risk of incident CHD events or incident stroke, and may not be an independent predictor of incident CHD or stroke in blacks.
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Affiliation(s)
- Obiora Egbuche
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia.
| | - Heather R Millard
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Benjamin Renelus
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Axiyan Maihemuti
- Department of Cardiology, Bridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
| | - Solomon K Musani
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Ctr, Jackson, Mississippi
| | - Jiankang Liu
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Herman A Taylor
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health Bloomington, Bloomington, Indiana
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33
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Abstract
Ferritin and increased iron stores first appeared on the list of cardiovascular risk factors more than 30 years ago and their causal role in the pathogenesis of atherosclerosis has been heavily discussed since the early 1990s. It seems that besides traditional factors such as hyperlipoproteinemia, hypertension, diabetes mellitus, obesity, physical inactivity, smoking and family history, high iron stores represent an additional parameter that could modify individual cardiovascular risk. The role of iron in the pathogenesis of atherosclerosis was originally primarily associated with its ability to catalyze the formation of highly reactive free oxygen radicals and the oxidation of atherogenic lipoproteins. Later, it became clear that the mechanism is more complex. Atherosclerosis is a chronic fibroproliferative inflammatory process and iron, through increased oxidation stress as well as directly, can control both native and adaptive immune responses. Within the arterial wall, iron affects all of the cell types that participate in the atherosclerotic process (monocytes/macrophages, endothelial cells, vascular smooth muscle cells and platelets). Most intracellular iron is bound in ferritin, whereas redox-active iron forms labile iron pool. Pro-inflammatory and anti-inflammatory macrophages within arterial plaque differ with regard to the amount of intracellular iron and most probably with regard to their labile iron pool. Yet, the relation between plasma ferritin and intracellular labile iron pool has not been fully clarified. Data from population studies document that the consumption of meat and lack of physical activity contribute to increased iron stores. Patients with hereditary hemochromatosis, despite extreme iron storage, do not show increased manifestation of atherosclerosis probably due to the low expression of hepcidin in macrophages.
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Affiliation(s)
- P Kraml
- Second Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic.
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34
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Kadoglou NPE, Biddulph JP, Rafnsson SB, Trivella M, Nihoyannopoulos P, Demakakos P. The association of ferritin with cardiovascular and all-cause mortality in community-dwellers: The English longitudinal study of ageing. PLoS One 2017; 12:e0178994. [PMID: 28591160 PMCID: PMC5462410 DOI: 10.1371/journal.pone.0178994] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/22/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ferritin constitutes a sensitive iron-storage index and multi-functional protein. Evidence on its association with mortality in general population is scarce and conflicting. We investigated the sex-specific associations of ferritin levels with all-cause and cardiovascular mortality in a population-based cohort. METHODS Data came from the English Longitudinal Study of Ageing and the national mortality registry. The sample comprised 5,471 participants aged ≥52 years. Blood concentration of ferritin was measured at baseline in 2004-05. Sex-specific Cox proportional hazards models were estimated with adjustment for age, major chronic diseases, marital status, educational attainment, total net household wealth, anemia, inflammatory markers, body mass index, smoking, and physical activity. Stratified analyses by chronic disease status were also performed. RESULTS We categorized ferritin in sex-specific quartiles. In men, we used, the following categorization: lowest (2-69ng/ml), second lowest (70-118ng/ml), second highest (reference category) (119-193ng/ml) and highest (194-598ng/ml) ferritin quartiles. In women, ferritin was categorized as follows: lowest (2-44ng/ml), second lowest (45-73ng/ml), second highest (reference category) (74-115ng/ml) and highest (116-341ng/ml) ferritin quartiles. 841 deaths of which 262 cardiovascular disease-related were recorded over a mean follow-up time of 7.7 years. Risk for all-cause mortality was found increased in men with hyperferritinemia (194-598ng/ml) and no history of major chronic diseases compared with the reference group [fully-adjusted HR: 1.49 (95%CI 1.03-2.16)]. Among women, those in the lowest ferritin quartile (2-44ng/ml) had increased risk for all-cause mortality [fully-adjusted HR: 1.59 (95%CI 1.18-2.13)] compared with the reference group after adjustment for all covariates. Regarding cardiovascular mortality, we observed a positive association with ferritin levels in men, which was blunted after adjustment for inflammatory markers and lifestyle parameters. Men with no major chronic diseases who were in the highest ferritin quartile had a significantly increased risk of cardiovascular mortality. No association between ferritin levels and cardiovascular mortality was detected in women. CONCLUSION Circulating ferritin levels showed sex-specific prognostic patterns. High ferritin levels in men with no major chronic disease and low ferritin levels in all women were associated with increased all-cause mortality after adjusting for covariates. High ferritin levels in men with no major chronic diseases were also independently associated with an increased risk of cardiovascular mortality. Future research is needed to clarify the prognostic role of ferritin.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
- Centre for Statistics in Medicine, BOTNAR Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jane P. Biddulph
- Research Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Snorri B. Rafnsson
- Research Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Marialena Trivella
- Centre for Statistics in Medicine, BOTNAR Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Panayotes Demakakos
- Research Department of Epidemiology and Public Health, University College London, United Kingdom
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The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology. DISEASE MARKERS 2015; 2015:824624. [PMID: 26379362 PMCID: PMC4563066 DOI: 10.1155/2015/824624] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 12/30/2022]
Abstract
Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D3 and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.
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36
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von Haehling S, Jankowska EA, van Veldhuisen DJ, Ponikowski P, Anker SD. Iron deficiency and cardiovascular disease. Nat Rev Cardiol 2015; 12:659-69. [DOI: 10.1038/nrcardio.2015.109] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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37
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Galesloot TE, Janss LL, Burgess S, Kiemeney LALM, den Heijer M, de Graaf J, Holewijn S, Benyamin B, Whitfield JB, Swinkels DW, Vermeulen SH. Iron and hepcidin as risk factors in atherosclerosis: what do the genes say? BMC Genet 2015; 16:79. [PMID: 26159428 PMCID: PMC4498499 DOI: 10.1186/s12863-015-0246-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/30/2015] [Indexed: 01/05/2023] Open
Abstract
Background Previous reports suggested a role for iron and hepcidin in atherosclerosis. Here, we evaluated the causality of these associations from a genetic perspective via (i) a Mendelian randomization (MR) approach, (ii) study of association of atherosclerosis-related single nucleotide polymorphisms (SNPs) with iron and hepcidin, and (iii) estimation of genomic correlations between hepcidin, iron and atherosclerosis. Results Analyses were performed in a general population sample. Iron parameters (serum iron, serum ferritin, total iron-binding capacity and transferrin saturation), serum hepcidin and genome-wide SNP data were available for N = 1,819; non-invasive measurements of atherosclerosis (NIMA), i.e., presence of plaque, intima media thickness and ankle-brachial index (ABI), for N = 549. For the MR, we used 12 iron-related SNPs that were previously identified in a genome-wide association meta-analysis on iron status, and assessed associations of individual SNPs and quartiles of a multi-SNP score with NIMA. Quartile 4 versus quartile 1 of the multi-SNP score showed directionally consistent associations with the hypothesized direction of effect for all NIMA in women, indicating that increased body iron status is a risk factor for atherosclerosis in women. We observed no single SNP associations that fit the hypothesized directions of effect between iron and NIMA, except for rs651007, associated with decreased ferritin concentration and decreased atherosclerosis risk. Two of six NIMA-related SNPs showed association with the ratio hepcidin/ferritin, suggesting that an increased hepcidin/ferritin ratio increases atherosclerosis risk. Genomic correlations were close to zero, except for hepcidin and ferritin with ABI at rest [−0.27 (SE 0.34) and −0.22 (SE 0.35), respectively] and ABI after exercise [−0.29 (SE 0.34) and −0.30 (0.35), respectively]. The negative sign indicates an increased atherosclerosis risk with increased hepcidin and ferritin concentrations. Conclusions Our results suggest a potential causal role for hepcidin and ferritin in atherosclerosis, and may indicate that iron status is causally related to atherosclerosis in women. Electronic supplementary material The online version of this article (doi:10.1186/s12863-015-0246-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tessel E Galesloot
- Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Luc L Janss
- Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark.
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Lambertus A L M Kiemeney
- Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Martin den Heijer
- Department of Internal Medicine, VU Medical Centre, Amsterdam, The Netherlands.
| | - Jacqueline de Graaf
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud university medical center, Nijmegen, The Netherlands.
| | - Suzanne Holewijn
- Department of General Internal Medicine, Division of Vascular Medicine, Radboud university medical center, Nijmegen, The Netherlands. .,Research Vascular Center Rijnstate, Arnhem, The Netherlands.
| | - Beben Benyamin
- The University of Queensland, Queensland Brain Institute, St Lucia, Queensland, 4072, Australia. .,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4029, Australia.
| | - John B Whitfield
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4029, Australia.
| | - Dorine W Swinkels
- Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Sita H Vermeulen
- Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
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38
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Silverberg DS, Wexler D, Schwartz D. Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure? Int J Mol Sci 2015; 16:14056-74. [PMID: 26096008 PMCID: PMC4490538 DOI: 10.3390/ijms160614056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/05/2015] [Accepted: 06/11/2015] [Indexed: 12/18/2022] Open
Abstract
Anemia is present in about 40% of heart failure (HF) patients. Iron deficiency (ID) is present in about 60% of the patients with anemia (about 24% of all HF patients) and in about 40% of patients without anemia (about 24% of all HF patients). Thus ID is present in about half the patients with HF. The ID in HF is associated with reduced iron stores in the bone marrow and the heart. ID is an independent risk factor for severity and worsening of the HF. Correction of ID with intravenous (IV) iron usually corrects both the anemia and the ID. Currently used IV iron preparations are very safe and effective in treating the ID in HF whereas little information is available on the effectiveness of oral iron. In HF IV iron correction of ID is associated with improvement in functional status, exercise capacity, quality of life and, in some studies, improvement in rate of hospitalization for HF, cardiac structure and function, and renal function. Large long-term adequately-controlled intervention studies are needed to clarify the effect of IV iron in HF. Several heart associations suggest that ID should be routinely sought for in all HF patients and corrected if present. In this paper we present our approach to diagnosis and treatment of iron deficiency in heart failure.
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Affiliation(s)
| | - Dov Wexler
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv 64239, Israel.
| | - Doron Schwartz
- Department of Nephrology, Tel Aviv Medical Center, Tel Aviv 64239, Israel.
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