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Mellat-Ardakani M, Atighi K, Rahmani S, Simiyari S, Salahshour F. Burden of aortic aneurysm in Iran from 1990 to 2019: an analysis based on global burden of disease study. Ann Med Surg (Lond) 2024; 86:5007-5016. [PMID: 39239029 PMCID: PMC11374288 DOI: 10.1097/ms9.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/29/2024] [Indexed: 09/07/2024] Open
Abstract
Background Limited studies have been conducted on the epidemiology of aortic aneurysms in Iran. In this study, the authors aimed to comprehensively evaluate the burden and epidemiology of aortic aneurysms across various age groups, sexes, and provinces in Iran from 1990 to 2019. Materials and methods The authors used global burden of disease (GBD) study data in the current study. The authors retrieved data on the burden of aortic aneurysms across sexes and age groups at national and subnational levels from 1990 to 2019. The authors extracted mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life year (DALY), numbers, rates, and age-standardized rates. Additionally, the authors extracted the burden of AA attributable to its risk factors, such as lead exposure, high systolic blood pressure, high dietary intake of sodium, and smoking. Results National ASDR (age-standardized DALY rate) was also observed to be reduced from 1990 [22.20 (17.46-26.86)] to 2019 [19.97 (17.98-21.98)]. However, the inclinations were evaluated to be slighter than the world (%change ASDR=-19.5%). In 2019, three leading risk factors yielding death in AA patients were smoking [ASMR attributable=0.73 (0.67-0.80)], high sodium intake [ASMR attributable=0.11 (0.03-0.27)], and lead exposure [ASMR attributable=0.04 (0.02-0.07)]. Conclusion Mortality and DALYs due to AA both decreased slightly during the last three decades. Considering the role of smoking in the burden of AA in Iran, interventions targeting smoking cessation among high-risk groups, such as males, may be helpful to reduce the burden of AA in Iran in the coming years.
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Affiliation(s)
- Milad Mellat-Ardakani
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Kaveh Atighi
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Shahryar Rahmani
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Saba Simiyari
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS)
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Leinweber ME, Geisbuesch P, Balzer K, Schmandra T, Karl T, Popp S, Hoffmann J, Schmitz-Rixen T, Jung G, Oikonomou K, Storck M, Balzer K, Kugelmann U, Schneider C, Engelhardt M, Petzold M, Weis-Mueller B, Wortmann M, Popp S, Grotemeyer D, Wenk H, Shayesteh-Kheslat R, Torsello G, Böckler D, Meisenbacher K, Hoffmann J, Schelzig H, Roopa Y, Strohschneider T, Noppeney T, Reichert V, Lorenz U, Pfister K, Damirchi S, Stojanovic T, Oberhuber A, Lobenstein B, Sagban TA, Pfeiffer T, Koller J, Sprenger C, Kruschwitz T, Schmedt CG, Marquardt F, Schmandra T, Bail D. Sex disparities in popliteal artery aneurysms. J Vasc Surg 2024; 79:1179-1186.e1. [PMID: 38145634 DOI: 10.1016/j.jvs.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Only 5% of patients with popliteal artery aneurysms (PAAs) are female. Evidence on PAA treatment and outcomes in women is therefore scarce. The POPART Registry provides one of Europe's largest data collections regarding PAA treatment. Data on clinical presentation, aneurysm morphology, and perioperative outcomes after open surgical PAA repair in women will be presented. METHODS POPART is a multicenter, noninterventional registry for open and endovascular PAA repair, with 42 participating centers in Germany and Luxembourg. All patients aged >18 years who have been treated for PAA since 2010 are eligible for study inclusion. Data collection is based on an online electronic case report form. RESULTS Of the 1236 PAAs, 58 (4.8%) were in women. There were no significant differences in age or cardiopulmonary comorbidities. However, female patients had a lower prevalence of contralateral PAAs and abdominal aortic aneurysms (P < .05). PAAs in women were more likely to be symptomatic before surgery (65.5% vs 49.4%; P = .017), with 19% of women presenting with acute limb ischemia (vs 11%; P = .067). Women had smaller aneurysm diameters than men (22.5 mm vs 27 mm; P = .004) and became symptomatic at smaller diameters (20 mm vs 26 mm; P = .002). Only 8.6% of women and 11.6% of men underwent endovascular aneurysm repair (P > .05); therefore, the perioperative outcome analysis focused on open surgical repair. In total, 23.5% of women and 16.9% of men developed perioperative complications (P > .05). There were no differences in major cardiovascular events (P > .05), but women showed a higher incidence of impaired wound healing (15.7% vs 7.2%; P = .05) and major amputation (5.9% vs 1.1%; P = .027). Female sex was significantly associated with the need for nonvascular reinterventions within 30 days after surgery (odds ratio: 2.48, 95% confidence interval: 1.26-4.88), whereas no significant differences in the odds for vascular reinterventions were observed (odds ratio: 1.98, 95% confidence interval: 0.68-5.77). In the multiple logistic regression model, female sex, symptomatic PAAs, poor quality of outflow vessels, and graft material other than vein graft were independently associated with perioperative reinterventions. CONCLUSIONS Women have smaller PAAs, are more likely to be symptomatic before treatment, and are more often affected by nonvascular reinterventions in the perioperative course. As our understanding of aneurysmatic diseases in women continues to expand, sex-specific treatment strategies and screening options for women in well-selected cohorts with modified screening protocols should be continuously re-evaluated.
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Affiliation(s)
| | - Phillip Geisbuesch
- Department of Vascular and Endovascular Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Kai Balzer
- Department of Vascular and Endovascular Surgery, St. Marien-Hospital, GFO-Kliniken, Bonn, Germany
| | - Thomas Schmandra
- Department of Vascular Surgery, Sana Klinikum Offenbach, Offenbach, Germany
| | - Thomas Karl
- Department of Vascular and Endovascular Surgery, Klinikum am Plattenwald, SLK-Kliniken Heilbronn GmbH, Bad Friedrichshall, Germany
| | - Sebastian Popp
- Department of Vascular Surgery, RoMed Klinik Wasserburg am Inn, Wasserburg am Inn, Germany
| | - Johannes Hoffmann
- Department of Vascular Surgery and Phlebology, Contilia Herz und Gefaeßzentrum, Essen, Germany
| | | | - Georg Jung
- Department of Vascular and Endovascular Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
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Jiang H, Xu H, Xu Z. Sex-related differences in outcome of thoracic aortic surgery. J Cardiothorac Surg 2024; 19:226. [PMID: 38627818 PMCID: PMC11020790 DOI: 10.1186/s13019-024-02735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sex-related dissimilarities' influence on outcomes following thoracic aortic surgery is poorly understood. Our aim is to examine sex-related disparities in patients undergoing thoracic aortic aneurysm (TAA). METHODS A total of 455 cases undergoing thoracic aortic aneurysm (TAA) surgery were consecutively enrolled between December 2009 and December 2015 in a Chinese hospital. Primary outcomes, including overall mortality and related risk factors, were evaluated. Cox regression is utilized to recognize the independent risk factor of these consequences. RESULTS Females, compared to males, had greater indexed aortic diameters and higher aortic transvalvular pressure differences. For the location of aortic aneurysms, females had a higher rate of aortic arch involvement, while males had a higher rate of root involvement. Females underwent less frequent complex proximal aortic operations compared with males (29.5% versus 46.9%; p < 0.001). Women and men both had a lower rate of aortic transvalvular pressure difference and LV volume index 7 days after thoracic aortic surgery. The overall mortality for the women's groups (11%) was suggestively greater compared to 4.9% for the men's groups (p = 0.026). Renal failure and aortic arch involvement were the main risk factors associated with males' survival, while maximum indexed aortic diameter and cross-clamp time were the risk factors associated with females' survival. CONCLUSIONS The outcome after TAA surgery was less favorable in women with significantly increased overall mortality. It highlights the need to focus on implementing personalized surgery strategies and gender-specific guidelines in treating female patients following TAA surgery.
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Affiliation(s)
- Hongxue Jiang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongjie Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200168, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200168, China.
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Qiu Y, Hou Y, Wei X, Wang M, Yin Z, Xie M, Duan A, Ma C, Si K, Wang Z. Causal association between gut microbiomes and different types of aneurysms: a Mendelian randomization study. Front Microbiol 2024; 15:1267888. [PMID: 38659992 PMCID: PMC11039950 DOI: 10.3389/fmicb.2024.1267888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Background Previous studies suggests that gut microbiomes are associated with the formation and progression of aneurysms. However, the causal association between them remains unclear. Methods A two-sample Mendelian randomization was conducted to investigate whether gut microbiomes have a causal effect on the risk of intracerebral aneurysm (IA), thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA), and aortic aneurysm (AA). Single nucleotide polymorphisms (SNPs) smaller than the locus-wide significance level (1 × 10-5) were selected as instrumental variables. We used inverse-variance weighted (IVW) test as the primary method for the evaluation of causal association. MR-Egger, weighted median, weighted mode, and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) methods were conducted for sensitive analysis. The p-value was adjusted by the false discovery rate (FDR) which adjust the results of multiple comparisons, a p < 0.05 and q < 0.1 was considered a significant causal association. Additionally, a p < 0.05 and q > 0.1 was considered a suggestive causal effect. Additionally, reverse MR was also performed to exclude the possibility of reverse causality. Results The phylum Firmicutes (OR = 0.62; 95% CI, 0.48-0.81), class Lentisphaeria (OR = 0.75; 95% CI, 0.62-0.89), and order Victivallales (OR = 0.75; 95% CI, 0.62-0.89) have a causal protective effect on the risk of AAA. Additionally, class Verrucomicrobia, class Deltaproteobacteria, order Verrucomicrobiale, family Verrucomicrobiacea, genus Eubacterium rectale group, genus Akkermansia, and genus Clostridium innocuum group were negatively associated with the risk of different types of aneurysms, whereas class Negativicutes, order Selenomonadales, and genus Roseburia had positive causal association with different types of aneurysms (p < 0.05; q > 0.1). Further sensitivity analysis validated the robustness of our MR results, and no reverse causality was found with these gut microbiomes (p > 0.05). Conclusion Our MR analysis confirmed the causal association of specific gut microbiomes with AAA, and these microbiomes were considered as protective factors. Our result may provide novel insights and theoretical basis for the prevention of aneurysms through regulation of gut microbiomes.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yucheng Hou
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingzhou Wei
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Menghan Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chao Ma
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ke Si
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Chao C, Dang C, Reddy N, Alharbi S, Doan J, Karthikeyan A, Applewhite B, Jiang B. Characterization of a phenol-based model for denervation of the abdominal aorta and its implications for aortic remodeling. JVS Vasc Sci 2024; 5:100202. [PMID: 38694477 PMCID: PMC11061754 DOI: 10.1016/j.jvssci.2024.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/11/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Sympathetic innervation plays a pivotal role in regulating cardiovascular health, and its dysregulation is implicated in a wide spectrum of cardiovascular diseases. This study seeks to evaluate the impact of denervation of the abdominal aorta on its morphology and wall homeostasis. Methods Male and female Sprague-Dawley rats (N = 12), aged 3 months, underwent midline laparotomy for infrarenal aorta exposure. Chemical denervation was induced via a one-time topical application of 10% phenol (n = 6), whereas sham controls received phosphate-buffered saline (n = 6). Animals were allowed to recover and subsequently were sacrificed after 6 months for analysis encompassing morphology, histology, and immunohistochemistry. Results At 6 months post-treatment, abdominal aortas subjected to phenol denervation still exhibited a significant reduction in nerve fiber density compared with sham controls. Denervated aortas demonstrated reduced intima-media thickness, increased elastin fragmentation, decreased expression of vascular smooth muscle proteins (α-SMA and MYH11), and elevated adventitial vascular density. Sex-stratified analyses revealed additional dimorphic responses, particularly in aortic collagen and medial cellular density in female animals. Conclusions Single-timepoint phenol-based chemical denervation induces alterations in abdominal aortic morphology and vascular remodeling over a 6-month period. These findings underscore the potential of the sympathetic nervous system as a therapeutic target for aortic pathologies. Clinical Relevance Aortic remodeling remains an important consideration in the pathogenesis of aortic disease, including occlusive, aneurysmal, and dissection disease states. The paucity of medical therapies for the treatment of aortic disease has driven considerable interest in elucidating the pathogenesis of these conditions; new therapeutic targets are critically needed. Here, we show significant remodeling after phenol-induced denervation with morphologic, histologic, and immunohistochemical features. Future investigations should integrate sympathetic dysfunction as a potential driver of pathologic aortic wall changes with additional consideration of the sympathetic nervous system as a therapeutic target.
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Affiliation(s)
- Calvin Chao
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Caitlyn Dang
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nidhi Reddy
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sara Alharbi
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jimmy Doan
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, IL
| | - Akashraj Karthikeyan
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, IL
| | - Brandon Applewhite
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, IL
| | - Bin Jiang
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Evanston, IL
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6
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Weaver LM, Stewart MJ, Ding K, Loftin CD, Zheng F, Zhan CG. A highly selective mPGES-1 inhibitor to block abdominal aortic aneurysm progression in the angiotensin mouse model. Sci Rep 2024; 14:6959. [PMID: 38521811 PMCID: PMC10960802 DOI: 10.1038/s41598-024-57437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
Abdominal aortic aneurysm (AAA) is a deadly, permanent ballooning of the aortic artery. Pharmacological and genetic studies have pointed to multiple proteins, including microsomal prostaglandin E2 synthase-1 (mPGES-1), as potentially promising targets. However, it remains unknown whether administration of an mPGES-1 inhibitor can effectively attenuate AAA progression in animal models. There are still no FDA-approved pharmacological treatments for AAA. Current research stresses the importance of both anti-inflammatory drug targets and rigor of translatability. Notably, mPGES-1 is an inducible enzyme responsible for overproduction of prostaglandin E2 (PGE2)-a well-known principal pro-inflammatory prostanoid. Here we demonstrate for the first time that a highly selective mPGES-1 inhibitor (UK4b) can completely block further growth of AAA in the ApoE-/- angiotensin (Ang)II mouse model. Our findings show promise for the use of a mPGES-1 inhibitor like UK4b as interventional treatment of AAA and its potential translation into the clinical setting.
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Affiliation(s)
- Lauren M Weaver
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
- Molecular Modeling and Biopharmaceutical Center, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
| | - Madeline J Stewart
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
- Molecular Modeling and Biopharmaceutical Center, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
| | - Kai Ding
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
| | - Charles D Loftin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
| | - Fang Zheng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
- Molecular Modeling and Biopharmaceutical Center, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA
| | - Chang-Guo Zhan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA.
- Molecular Modeling and Biopharmaceutical Center, College of Pharmacy, University of Kentucky, 789 South Limestone Street, Lexington, KY, 40536, USA.
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Crosier R, Lopez Laporte MA, Unni RR, Coutinho T. Female-Specific Considerations in Aortic Health and Disease. CJC Open 2024; 6:391-406. [PMID: 38487044 PMCID: PMC10935703 DOI: 10.1016/j.cjco.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
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Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Rudy R. Unni
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Kang S, Yeon B, Kim MS, Yoo M, Kim B, Yu YM. Aneurysm and Artery Dissection After Oral VEGFR-TKI Use in Adults With Cancer. JAMA Netw Open 2023; 6:e2345977. [PMID: 38019511 PMCID: PMC10687660 DOI: 10.1001/jamanetworkopen.2023.45977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
Importance The association of tyrosine kinase inhibitors targeting vascular endothelial growth factor receptors (VEGFR-TKIs) with aneurysm and artery dissection (AAD) has been frequently reported in spontaneous reporting databases. Objective To investigate the risk and incidence of AAD occurrence in patients with cancer treated with oral VEGFR-TKIs, with capecitabine as an active comparator. Design, Setting, and Participants This national, historical cohort study was conducted using national claims data from the National Health Insurance Service in Korea from 2007 to 2020, with a 1-year follow-up. Patients with cancer aged 40 years or older prescribed oral VEGFR-TKIs or capecitabine were enrolled. Data were analyzed from September 2022 through April 2023. Exposure Oral VEGFR-TKIs (sorafenib, regorafenib, vandetanib, sunitinib, lenvatinib, axitinib, and pazopanib) or capecitabine as a comparator. Main Outcomes and Measures Hazard ratios (HRs) were used to investigate the association between VEGFR-TKI use and AAD after propensity score matching. The primary outcome was AAD, and secondary outcomes were aortic aneurysm and dissection and AAD with rupture. Outcomes were defined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes. Results Among 127 710 patients with cancer eligible for the study (80 386 males [62.9%]; mean [SD] age, 62.6 [10.9] years), 37 308 patients received VEGFR-TKIs and 90 402 patients received capecitabine. Among 27 535 matched patients receiving VEGFR-TKIs, the incidence of AAD within 1 year of treatment initiation was 6.0 per 1000 person-years. The median (IQR) time to AAD onset in the matched AAD group was 114 (67-257) days after treatment initiation, with the highest incidence observed during the first 3 months (45 incidents vs 31, 17, and 16 incidents during 3- to 6-month, 6- to 9-month, and 9- to 12-month periods, respectively). Cox regression modeling showed that the risk of AAD occurrence was significantly higher among patients prescribed VEGFR-TKIs than those receiving capecitabine (HR, 1.48; 95% CI, 1.08-2.02); similar results were obtained among females (HR, 2.08; 95% CI, 1.26-3.42), older adults (aged ≥65 years; HR, 1.42; 95% CI, 1.01-1.99), and patients with dyslipidemia (HR, 1.58; 95% CI, 1.11-2.24). Conclusions and Relevance In this study, the use of oral VEGFR-TKIs was associated with an increased risk of AAD occurrence. These findings elucidate vascular toxic effects and may provide a substantial reference for reducing the socioeconomic burden of adverse events associated with VEGFR-TKI use.
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Affiliation(s)
- Soyoung Kang
- Department of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Gyeonggi-do, Republic of Korea
| | - Bora Yeon
- Department of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Gyeonggi-do, Republic of Korea
| | - Myo-Song Kim
- Department of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Gyeonggi-do, Republic of Korea
| | - Myungsik Yoo
- Department of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Gyeonggi-do, Republic of Korea
| | - Bonggi Kim
- Department of Drug Safety Information, Korea Institute of Drug Safety and Risk Management, Gyeonggi-do, Republic of Korea
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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Giacobbe G, Granata V, Trovato P, Fusco R, Simonetti I, De Muzio F, Cutolo C, Palumbo P, Borgheresi A, Flammia F, Cozzi D, Gabelloni M, Grassi F, Miele V, Barile A, Giovagnoni A, Gandolfo N. Gender Medicine in Clinical Radiology Practice. J Pers Med 2023; 13:jpm13020223. [PMID: 36836457 PMCID: PMC9966684 DOI: 10.3390/jpm13020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Gender Medicine is rapidly emerging as a branch of medicine that studies how many diseases common to men and women differ in terms of prevention, clinical manifestations, diagnostic-therapeutic approach, prognosis, and psychological and social impact. Nowadays, the presentation and identification of many pathological conditions pose unique diagnostic challenges. However, women have always been paradoxically underestimated in epidemiological studies, drug trials, as well as clinical trials, so many clinical conditions affecting the female population are often underestimated and/or delayed and may result in inadequate clinical management. Knowing and valuing these differences in healthcare, thus taking into account individual variability, will make it possible to ensure that each individual receives the best care through the personalization of therapies, the guarantee of diagnostic-therapeutic pathways declined according to gender, as well as through the promotion of gender-specific prevention initiatives. This article aims to assess potential gender differences in clinical-radiological practice extracted from the literature and their impact on health and healthcare. Indeed, in this context, radiomics and radiogenomics are rapidly emerging as new frontiers of imaging in precision medicine. The development of clinical practice support tools supported by artificial intelligence allows through quantitative analysis to characterize tissues noninvasively with the ultimate goal of extracting directly from images indications of disease aggressiveness, prognosis, and therapeutic response. The integration of quantitative data with gene expression and patient clinical data, with the help of structured reporting as well, will in the near future give rise to decision support models for clinical practice that will hopefully improve diagnostic accuracy and prognostic power as well as ensure a more advanced level of precision medicine.
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Affiliation(s)
- Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Piero Trovato
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Federica Flammia
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
| | - Francesca Grassi
- Division of Radiology, “Università degli Studi della Campania Luigi Vanvitelli”, 80138 Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
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Tedjawirja VN, Hooijer GKJ, Savci-Heijink CD, Kovac K, Balm R, de Waard V. Inadequate detection of the FSHR complicates future research on extragonadal FSHR localization. Front Endocrinol (Lausanne) 2023; 14:1095031. [PMID: 36875462 PMCID: PMC9978812 DOI: 10.3389/fendo.2023.1095031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Recently, follicle stimulating hormone (FSH) through interaction with its receptor (FSHR) has been proposed to play a role in postmenopausal osteoporosis and cardiovascular disease, rather than the loss of estrogen. To explore this hypothesis, unravelling which cells express extragonadal FSHR on protein level is key. METHODS We used two commercial anti-FSHR antibodies and validated them by performing immunohistochemistry on positive (ovary, testis) and negative controls (skin). RESULTS The monoclonal anti-FSHR antibody could not identify the FSHR in ovary or testis. The polyclonal anti-FSHR antibody stained the granulosa cells (ovary) and Sertoli cells (testis), yet there was equally intense staining of other cells/extracellular matrix. Furthermore, the polyclonal anti-FSHR antibody also stained skin tissue extensively, suggesting that the antibody stains more than just FSHR. DISCUSSION The findings in this study may add accuracy to literature on extragonadal FSHR localization and warrants attention to the use of inadequate anti-FSHR antibodies to value the potential role of FSH/FSHR in postmenopausal disease.
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Affiliation(s)
- Victoria N. Tedjawirja
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Victoria N. Tedjawirja,
| | - Gerrit K. J. Hooijer
- Department of Pathology, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - C. Dilara Savci-Heijink
- Department of Pathology, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Kristina Kovac
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Ron Balm
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
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12
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Chou EL, Pettinger M, Haring B, Allison MA, Mell MW, Hlatky MA, Wactawski-Wende J, Wild RA, Shadyab AH, Wallace RB, Snetselaar LG, Madsen TE, Eagleton MJ, Conrad MF, Liu S. Association of Premature Menopause With Risk of Abdominal Aortic Aneurysm in the Women's Health Initiative. Ann Surg 2022; 276:e1008-e1016. [PMID: 33156064 DOI: 10.1097/sla.0000000000004581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if premature menopause and early menarche are associated with increased risk of AAA, and to explore potential effect modification by smoking history. SUMMARY OF BACKGROUND DATA Despite worse outcomes for women with AAA, no studies have prospectively examined sex-specific risk factors, such as premature menopause and early menarche, with risk of AAA in a large, ethnically diverse cohort of women. METHODS This was a post-hoc analysis of Women's Health Initiative participants who were beneficiaries of Medicare Parts A&B fee-for-service. AAA cases and interventions were identified from claims data. Follow-up period included Medicare coverage until death, end of follow-up or end of coverage inclusive of 2017. RESULTS Of 101,119 participants included in the analysis, the mean age was 63 years and median follow-up was 11.3 years. Just under 10,000 (9.4%) women experienced premature menopause and 22,240 (22%) experienced early men-arche. Women with premature menopause were more likely to be overweight, Black, have >20 pack years of smoking, history of cardiovascular disease, hypertension, and early menarche. During 1,091,840 person-years of follow-up, 1125 women were diagnosed with AAA, 134 had premature menopause (11.9%), 93 underwent surgical intervention and 45 (48%) required intervention for ruptured AAA. Premature menopause was associated with increased risk of AAA [hazard ratio 1.37 (1.14, 1.66)], but the association was no longer significant after multivariable adjustment for demographics and cardiovascular disease risk factors. Amongst women with ≥20 pack year smoking history (n = 19,286), 2148 (11.1%) had premature menopause, which was associated with greater risk of AAA in all models [hazard ratio 1.63 (1.24, 2.23)]. Early menarche was not associated with increased risk of AAA. CONCLUSIONS This study finds that premature menopause may be an important risk factor for AAA in women with significant smoking history. There was no significant association between premature menopause and risk of AAA amongst women who have never smoked. These results suggest an opportunity to develop strategies for better screening, risk reduction and stratification, and outcome improvement in the comprehensive vascular care of women.
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Affiliation(s)
- Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bernhard Haring
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Matthew W Mell
- Division of Vascular Surgery, University of California Davis Medical Center, Sacramento, California
| | - Mark A Hlatky
- Department of Health Research and Policy, Campus Drive, Stanford University School of Medicine, Stanford, California
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Tracy E Madsen
- Department of Emergency Medicine, Division of Sex and Gender, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Simin Liu
- Departments of Epidemiology, Surgery, and Medicine, Brown University, Providence, Rhode Island
- Department of Internal Medicine, University of Würzburg, Würzburg, Germany
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13
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Boczar KE, Boodhwani M, Beauchesne L, Dennie C, Chan K, Wells GA, Coutinho T. Estimated Aortic Pulse Wave Velocity Is Associated With Faster Thoracic Aortic Aneurysm Growth: A Prospective Cohort Study With Sex-Specific Analyses. Can J Cardiol 2022; 38:1664-1672. [PMID: 35948193 DOI: 10.1016/j.cjca.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thoracic aortic aneurysm (TAA) is associated with high morbidity and mortality, and there is a critical need for improved tools for risk assessment and prognostication. We have previously shown that aortic stiffness, measured from arterial tonometry (carotid-femoral pulse wave velocity [cfPWV]), is independently associated with TAA expansion. To increase clinical applicability, we sought to determine the association of mathematically estimated aortic pulse wave velocity (e-PWV) with TAA expansion. METHODS One-hundred and five consecutive unoperated subjects with TAA were recruited. We used arterial tonometry to measure cfPWV and used mean arterial pressure and age to calculate e-PWV according to validated equations. Multivariable linear regression assessed associations of baseline e-PWV with future aneurysm growth. Given sex differences in TAA outcomes, sex-stratified analyses were performed. RESULTS Seventy-eight percent of subjects were men. Mean ± standard deviation (SD) age, baseline aneurysm size, and follow-up time were 62.6 ± 11.4 years, 46.2 ± 3.8 mm, and 2.9 ± 1.0 years, respectively. Aneurysm growth was 0.43 ± 0.37 mm per year; e-PWV was independently associated with future aneurysm expansion (β ± SE: 0.240 ± 0.085, P = 0.006). In sex-specific analyses, e-PWV was associated with aneurysm growth in both men (β ± standard error (SE) : 0.076 ± 0.022, P = 0.001) and women (β ± SE : 0.145 ± 0.050, P = 0.012), but the strength of association nearly twice as strong in women as in men. CONCLUSIONS Greater aortic stiffness reflects worse aortic health and provides novel insights into disease activity; e-PWV is independently associated with TAA growth. This finding increases clinical applicability, as e-PWV can be estimated simply, quickly, and free of cost without the need for specialized equipment.
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Affiliation(s)
- Kevin E Boczar
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Luc Beauchesne
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carole Dennie
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada; Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwan Chan
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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14
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Allen AJ, Russell D, Lombardi ME, Duchesneau ED, Agala CB, McGinigle KL, Marston WA, Farber MA, Parodi FE, Wood J, Pascarella L. Gender Disparities in Aortoiliac Revascularization in Patients with Aortoiliac Occlusive Disease. Ann Vasc Surg 2022; 86:199-209. [PMID: 35605762 PMCID: PMC10681021 DOI: 10.1016/j.avsg.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Gender disparities have been previously reported in aortic aneurysm and critical limb ischemia outcomes; however, limited info is known about disparities in aortoiliac occlusive disease. We sought to characterize potential disparities in this specific population. MATERIAL AND METHODS Patients who underwent aortobifemoral bypass and aortic thromboendarterectomy (Current Procedural Terminology codes 35646 and 35331) between 2012 and 2019 were identified in the National Surgical Quality Improvement Program database. A binomial regression model was used to estimate gender differences in 30-day morbidity and mortality. Inverse probability weighting was used to standardize demographic and surgical characteristics. RESULTS We identified 1,869 patients, of which 39.8% were female and the median age was 61 years. Age, body composition, and other baseline characteristics were overall similar between genders; however, racial data were missing for 26.1% of patients. Females had a higher prevalence of preexisting chronic obstructive pulmonary disease (20.9% vs. 14.7%, prevalence difference 6.1%, P < 0.01), diabetes mellitus (25.4% vs. 19.4%, prevalence difference 6.0%, P < 0.01), and high-risk anatomical features (39.4% vs. 33.7%, prevalence difference 5.8%, P = 0.01). Preprocedural medications included a statin in only 68.2% of patients and antiplatelet agent in 76.7% of patients. Females also had a higher incidence of bleeding events when compared to males (25.2% vs. 17.5%, standardized risk difference 7.2%, P < 0.01), but were less likely to have a prolonged hospitalization greater than 10 days (18.2% vs. 20.9%, standardized risk difference -5.0%, P = 0.01). The 30-day mortality rate was not significantly different between genders (4.7% vs. 3.6%, standardized risk difference 1.2%, P = 0.25). CONCLUSIONS Female patients treated with aortobifemoral bypass or aortic thromboendarterectomy are more likely to have preexisting chronic obstructive pulmonary disease, diabetes mellitus, and high-risk anatomical features. Regardless of a patient's gender, there is poor adherence to preoperative medical optimization with both statins and antiplatelet agents. Female patients are more likely to have postoperative bleeding complications while males are more likely to have a prolonged hospital stay greater than 10 days. Future work could attempt to further delineate disparities using databases with longer follow-up data and seek to create protocols for reducing these observed disparities.
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Affiliation(s)
- Austin J Allen
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Devin Russell
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Megan E Lombardi
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emilie D Duchesneau
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chris B Agala
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Katharine L McGinigle
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - William A Marston
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mark A Farber
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Federico E Parodi
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jacob Wood
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Luigi Pascarella
- Department of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
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15
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Association of abdominal aortic aneurysm diameter indexed to patient height with symptomatic presentation and mortality. J Vasc Surg 2021; 75:1606-1615.e2. [PMID: 34793921 DOI: 10.1016/j.jvs.2021.10.055] [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: 11/09/2020] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The current guidelines have recommended repair of abdominal aortic aneurysms (AAAs) according to the maximal AAA diameter and/or its growth rate. However, many studies have suggested that the AAA diameter alone is not sufficient to predict the risk of rupture or symptomatic presentation. Several investigators have attempted to relate the AAA diameter to the body surface area in predicting for rupture. However, these calculations have not resulted in conclusive evidence. We sought in the present analysis to introduce a novel diameter-to-height index (DHI) and test its utility in predicting for symptomatic presentations, including rupture and 30-day and 5-year mortality. METHODS The Vascular Quality Initiative database (2003-2020) was used to identify patients who had undergone open or endovascular AAA repair. The DHI was defined as the AAA diameter in centimeters divided by the height in centimeters, yielding a score of 1 to 10. Multivariable logistic regression analysis was performed to assess the risk of symptomatic presentation, including rupture and 30-day mortality. Receiver operating characteristic curves were plotted, and survival analysis techniques were used to determine the hazard of 5-year mortality. RESULTS A total of 64,595 patients were identified, of whom, 16.3% had presented with symptomatic AAAs, including rupture. Endovascular AAA repair was performed for 69.8% of the symptomatic AAAs and 84.3% of asymptomatic AAAs (P < .001). The symptomatic group were more likely to be women (24.6% vs 19.8%; P < .001) and Black (7.81% vs 4.44%; P < .001). The mean DHI was higher in the symptomatic group than in the asymptomatic group (mean DHI, 3.92 ± 1.1 vs 3.24 ± 0.7; P < .001). The adjusted odds of a symptomatic presentation increased with an increasing DHI (adjusted odds ratio [aOR], 1.70; 95% confidence interval [CI], 1.59-1.83; P < .001). Active smoking increased the risk of a symptomatic presentation (aOR, 1.38; 95% CI, 1.28-1.51; P < .001). However, the use of preoperative statins and beta-blockers significantly reduced the odds of a symptomatic presentation (aOR, 0.58; 95% CI, 0.53-0.64; P < .001; and aOR, 0.76; 95% CI, 0.69-0.84; P < .001), respectively. Compared with the AAA diameter, the receiver operating characteristic curve for the DHI to predict for symptomatic status was slightly, but significantly, higher (aOR, 0.702; 95% CI, 0.695-0.708; vs aOR, 0.695; 95% CI, 0.688-0.701; P < .001). The DHI increment was associated with a 1.08 greater odds of 30-day mortality (aOR, 1.08; 95% CI, 1.01-1.15; P < .001) for those with symptomatic AAAs. Similarly, the hazard of 5-year mortality was increased with an increasing DHI (adjusted hazard ratio, 1.20; 95% CI, 1.13-1.29; P < .001) only for those with asymptomatic AAAs. CONCLUSIONS The DHI is a simple tool that could be more effective than the AAA diameter in predicting for symptomatic presentations. The DHI varied by sex and race, which could collectively help to provide an individualized prognosis. The DHI can additionally predict the 5-year mortality after AAA repair for those with asymptomatic AAAs only. However, the odds of 30-day mortality remained similar in both groups.
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Erdmann J, Kujaciński M, Wiciński M. Beneficial Effects of Ursolic Acid and Its Derivatives-Focus on Potential Biochemical Mechanisms in Cardiovascular Conditions. Nutrients 2021; 13:3900. [PMID: 34836155 PMCID: PMC8622438 DOI: 10.3390/nu13113900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022] Open
Abstract
Ursolic acid (UA) is a natural pentacyclic triterpenoid found in a number of plants such as apples, thyme, oregano, hawthorn and others. Several in vitro and in vivo studies have presented its anti-inflammatory and anti-apoptotic properties. The inhibition of NF-κB-mediated inflammatory pathways and the increased scavenging of reactive oxygen species (ROS) in numerous ways seem to be the most beneficial effects of UA. In mice and rats, administration of UA appears to slow down the development of cardiovascular diseases (CVDs), especially atherosclerosis and cardiac fibrosis. Upregulation of endothelial-type nitric oxide synthase (eNOS) and cystathionine-λ-lyase (CSE) by UA may suggest its vasorelaxant property. Inhibition of metalloproteinases activity by UA may contribute to better outcomes in aneurysms management. UA influence on lipid and glucose metabolism remains inconsistent, and additional studies are essential to verify its efficacy. Furthermore, UA derivatives appear to have a beneficial impact on the cardiovascular system. This review aims to summarize recent findings on beneficial effects of UA that may make it a promising candidate for clinical trials for the management of CVDs.
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Affiliation(s)
- Jakub Erdmann
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland; (M.K.); (M.W.)
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Neutrophils as Regulators and Biomarkers of Cardiovascular Inflammation in the Context of Abdominal Aortic Aneurysms. Biomedicines 2021; 9:biomedicines9091236. [PMID: 34572424 PMCID: PMC8467789 DOI: 10.3390/biomedicines9091236] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
Neutrophils represent up to 70% of circulating leukocytes in healthy humans and combat infection mostly by phagocytosis, degranulation and NETosis. It has been reported that neutrophils are centrally involved in abdominal aortic aneurysm (AAA) pathogenesis. The natural course of AAA is growth and rupture, if left undiagnosed or untreated. The rupture of AAA has a very high mortality and is currently among the leading causes of death worldwide. The use of noninvasive cardiovascular imaging techniques for patient screening, surveillance and postoperative follow-up is well established and recommended by the current guidelines. Neutrophil-derived biomarkers may offer clinical value to the monitoring and prognosis of AAA patients, allowing for potential early therapeutic intervention. Numerous promising biomarkers have been studied. In this review, we discuss neutrophils and neutrophil-derived molecules as regulators and biomarkers of AAA, and our aim was to specifically highlight diagnostic and prognostic markers. Neutrophil-derived biomarkers may potentially, in the future, assist in determining AAA presence, predict size, expansion rate, rupture risk, and postoperative outcome once validated in highly warranted future prospective clinical studies.
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18
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Zhu D, Yao S, Wu H, Ke X, Zhou X, Geng S, Dong S, Chen H, Yang T, Cheng Y, Guo Y. A transcriptome-wide association study identifies novel susceptibility genes for psoriasis. Hum Mol Genet 2021; 31:300-308. [PMID: 34409462 DOI: 10.1093/hmg/ddab237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/17/2023] Open
Abstract
Although more than 80 psoriasis genetic risk loci have been reported through genome-wide association studies (GWASs), the genetic mechanism of psoriasis remains unclear. To identify novel candidate genes associated with psoriasis and reveal the potential effects of genetic factors in the development of psoriasis, we conducted a transcriptome-wide association study (TWAS) based on summary statistics from GWAS of psoriasis (5175 cases and 447 089 controls) and gene expression levels from six tissues datasets (blood and skin). We identified 11 conditionally independent genes for psoriasis after Bonferroni corrections, such as the most significant genes UBLCP1 (PYFS = 2.98 × 10-16), and LCE3C (PSNSE = 9.72 × 10-12, PSSE = 6.24 × 10-12). The omnibus test identified additional 5 genes associated with psoriasis via the joint association model from multiple reference tissues. Among the 16 identified genes, 5 genes (CTSW, E1F1AD, KLRC3, FIBP, and EFEMP2) were regarded as novel genes for psoriasis. We evaluated the 16 candidate genes by querying public databases and identified 11 differentially expressed genes and 8 genes proved by the knockout mice models. Through GO enrichment analyses, we found that TWAS genes were enriched in the known GO terms associated with skin development, such as cornified envelope (P = 4.80 × 10-8) and peptide cross-linking (P = 1.50 × 10-7). Taken together, our results detected multiple novel candidate genes for psoriasis, providing clues for understanding the genetic mechanism of psoriasis.
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Affiliation(s)
- Dongli Zhu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Shi Yao
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Hao Wu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Xin Ke
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Xiaorong Zhou
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Shanshan Dong
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Hao Chen
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,Research Institute of Xi'an Jiaotong University, Hangzhou, Zhejiang, 311215, P.R. China
| | - Tielin Yang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
| | - Ying Cheng
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China
| | - Yan Guo
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, P. R. China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, P. R. China
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19
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Mukherjee K, Pingili AK, Singh P, Dhodi AN, Dutta SR, Gonzalez FJ, Malik KU. Testosterone Metabolite 6β-Hydroxytestosterone Contributes to Angiotensin II-Induced Abdominal Aortic Aneurysms in Apoe-/- Male Mice. J Am Heart Assoc 2021; 10:e018536. [PMID: 33719500 PMCID: PMC8174379 DOI: 10.1161/jaha.120.018536] [Citation(s) in RCA: 4] [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] [Indexed: 12/21/2022]
Abstract
Background Sex is a prominent risk factor for abdominal aortic aneurysms (AAAs), and angiotensin II (Ang II) induces AAA formation to a greater degree in male than in female mice. We previously reported that cytochrome P450 1B1 contributes to the development of hypertension, as well as AAAs, in male mice. We also found that a cytochrome P450 1B1‐generated metabolite of testosterone, 6β‐hydroxytestosterone (6β‐OHT), contributes to Ang II‐induced hypertension and associated cardiovascular and renal pathogenesis in male mice. The current study was conducted to determine the contribution of 6β‐OHT to Ang II‐induced AAA development in Apoe–/– male mice. Methods and Results Intact or castrated Apoe–/–/Cyp1b1+/+ and Apoe–/–/Cyp1b1–/– male mice were infused with Ang II or its vehicle for 28 days, and administered 6β‐OHT every third day for the duration of the experiment. Abdominal aortas were then evaluated for development of AAAs. We observed a significant increase in the incidence and severity of AAAs in intact Ang II‐infused Apoe–/–/Cyp1b1+/+ mice, compared with vehicle‐treated mice, which were minimized in castrated Apoe–/–/Cyp1b1+/+ and intact Apoe–/–/Cyp1b1–/– mice infused with Ang II. Treatment with 6β‐OHT significantly restored the incidence and severity of AAAs in Ang II‐infused castrated Apoe–/–/Cyp1b1+/+ and intact Apoe–/–/Cyp1b1–/– mice. However, administration of testosterone failed to increase AAA incidence and severity in Ang II‐infused intact Apoe–/–/Cyp1b1–/– mice. Conclusions Our results indicate that the testosterone‐cytochrome P450 1B1‐generated metabolite 6β‐OHT contributes to Ang II‐induced AAA development in Apoe–/– male mice.
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Affiliation(s)
- Kamalika Mukherjee
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Ajeeth K Pingili
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Purnima Singh
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Ahmad N Dhodi
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
| | - Shubha R Dutta
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
| | | | - Kafait U Malik
- Department of Pharmacology Addiction Science and Toxicology College of Medicine University of Tennessee Health Science Center Memphis TN
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20
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Luo S, Zhu Y, Xie E, Ding H, Yang F, Chen L, Liu J, Liu Y, Xue L, Fan R, Luo J, Chen J. Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection. Angiology 2021; 72:556-564. [PMID: 33504166 DOI: 10.1177/0003319720987956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients (P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score-matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.
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Affiliation(s)
- Songyuan Luo
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yi Zhu
- Department of Cardiology, 477093Guangzhou Panyu Central Hospital, Guangzhou, People's Republic of China
| | - Enmin Xie
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Huanyu Ding
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Fan Yang
- Department of Emergency and Critical Care Medicine, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Lyufan Chen
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jitao Liu
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yuan Liu
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Ling Xue
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - JianFang Luo
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jiyan Chen
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, 569066Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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21
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Gavish L, Gilon D, Beeri R, Zuckerman A, Nachman D, Gertz SD. Photobiomodulation and estrogen stabilize mitochondrial membrane potential in angiotensin-II challenged porcine aortic smooth muscle cells. JOURNAL OF BIOPHOTONICS 2021; 14:e202000329. [PMID: 32888351 DOI: 10.1002/jbio.202000329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
Rupture of Abdominal aortic aneurysm (AAA) is among the 15 leading causes of death after age 65. Using high frequency ultrasound, we showed that photobiomodulation (PBM) prevents formation and progression of AAA in the angiotensin-II (Ang-II)-infused, apolipoprotein-e-deficient mouse model. In the current study we report that while challenge of porcine aortic Smooth Muscle Cells (SMCs) with Ang-II (1 μM) resulted in a marked decay in mitochondrial membrane potential (MitMP) vs non-challenged cells, treatment with PBM (continuous diode laser, 780 nm, 6.7 mW/cm2 , 5 minutes, 2 J/cm2 ) or pre-incubation with estrogen (50 nM, 1 hour) significantly attenuated this deterioration in MitMP. We also report that PBM and estrogen markedly affected porcine aortic SMC contraction and modified mitochondrial dispersion reflecting important influence on SMC function. These studies provide strong evidence of the important underlying role of mitochondria in the preventive effect of PBM on formation and progression of AAA and its reduced incidence and delayed onset in women.
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Affiliation(s)
- Lilach Gavish
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Gilon
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Beeri
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiology, Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ayelet Zuckerman
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dean Nachman
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S David Gertz
- Institute for Research in Military Medicine (IRMM) of The Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
- The Saul and Joyce Brandman Cardiovascular Research Hub of the Institute for Medical Research (IMRIC), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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22
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Tedjawirja VN, Nieuwdorp M, Yeung KK, Balm R, de Waard V. A Novel Hypothesis: A Role for Follicle Stimulating Hormone in Abdominal Aortic Aneurysm Development in Postmenopausal Women. Front Endocrinol (Lausanne) 2021; 12:726107. [PMID: 34721292 PMCID: PMC8548664 DOI: 10.3389/fendo.2021.726107] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta, which can potentially be fatal due to exsanguination following rupture. Although AAA is less prevalent in women, women with AAA have a more severe AAA progression compared to men as reflected by enhanced aneurysm growth rates and a higher rupture risk. Women are diagnosed with AAA at an older age than men, and in line with increased osteoporosis and cardiovascular events, the delayed AAA onset has been attributed to the reduction of the protective effect of oestrogens during the menopausal transition. However, new insights have shown that a high follicle stimulating hormone (FSH) level during menopause may also play a key role in those diseases. In this report we hypothesize that FSH may aggravate AAA development and progression in postmenopausal women via a direct and/or indirect role, promoting aorta pathology. Since FSH receptors (FSHR) are reported on many other cell types than granulosa cells in the ovaries, it is feasible that FSH stimulation of FSHR-bearing cells such as aortic endothelial cells or inflammatory cells, could promote AAA formation directly. Indirectly, AAA progression may be influenced by an FSH-mediated increase in osteoporosis, which is associated with aortic calcification. Also, an FSH-mediated decrease in cholesterol uptake by the liver and an increase in cholesterol biosynthesis will increase the cholesterol level in the circulation, and subsequently promote aortic atherosclerosis and inflammation. Lastly, FSH-induced adipogenesis may lead to obesity-mediated dysfunction of the microvasculature of the aorta and/or modulation of the periaortic adipose tissue. Thus the long term increased plasma FSH levels during the menopausal transition may contribute to enhanced AAA disease in menopausal women and could be a potential novel target for treatment to lower AAA-related events in women.
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Affiliation(s)
- Victoria N. Tedjawirja
- Department of Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
- *Correspondence: Victoria N. Tedjawirja,
| | - Max Nieuwdorp
- Departments of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kak Khee Yeung
- Department of Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Ron Balm
- Department of Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
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23
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Risk Factors and Mouse Models of Abdominal Aortic Aneurysm Rupture. Int J Mol Sci 2020; 21:ijms21197250. [PMID: 33008131 PMCID: PMC7583758 DOI: 10.3390/ijms21197250] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/19/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) rupture is an important cause of death in older adults. In clinical practice, the most established predictor of AAA rupture is maximum AAA diameter. Aortic diameter is commonly used to assess AAA severity in mouse models studies. AAA rupture occurs when the stress (force per unit area) on the aneurysm wall exceeds wall strength. Previous research suggests that aortic wall structure and strength, biomechanical forces on the aorta and cellular and proteolytic composition of the AAA wall influence the risk of AAA rupture. Mouse models offer an opportunity to study the association of these factors with AAA rupture in a way not currently possible in patients. Such studies could provide data to support the use of novel surrogate markers of AAA rupture in patients. In this review, the currently available mouse models of AAA and their relevance to the study of AAA rupture are discussed. The review highlights the limitations of mouse models and suggests novel approaches that could be incorporated in future experimental AAA studies to generate clinically relevant results.
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24
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Zhang H, Yin D, Zhao Y, Li Y, Yao D, Sun D. Relationship between total plasma homocysteine and the risk of aneurysms - a meta-analysis. VASA 2020; 50:110-115. [PMID: 32933402 DOI: 10.1024/0301-1526/a000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.
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Affiliation(s)
- Hanji Zhang
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Dexin Yin
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Yue Zhao
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Yezhou Li
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Dejiang Yao
- Department of Chinese medicine, Third department of surgery, The Center Hospital of Enshi Tujia and Miao Autonomous Prefecture, Wuhan University, Enshi City, Hubei Province, China
| | - Dajun Sun
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
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25
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Ruptured Aortic Aneurysm and Dissection Related Death: an Autopsy Database Analysis. Pathol Oncol Res 2020; 26:2391-2399. [PMID: 32548697 PMCID: PMC7471188 DOI: 10.1007/s12253-020-00835-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 03/22/2020] [Accepted: 05/27/2020] [Indexed: 01/15/2023]
Abstract
Acute aortic catastrophes (AAC), mainly ruptured aneurysms and dissections, lead all other vascular conditions in morbidity and mortality, even if intervention occurs. The aim of our study was to give a descriptive overview of the demographic and pathological characteristics of AAC. Between 1994 and 2013, 80,469 autopsies were performed at Semmelweis University hospitals in Budapest. After collecting the autopsy reports we were able to create the AAC database upon which we conducted our analysis. We found 567 cases of AAC. The cause of death in 120 of them was classified as a non-ruptured aorta with malperfusion or distal embolization. Of the remaining 447 cases, in 305 the cause of death was a ruptured aortic aneurysm (rAA), and in 142 it was a ruptured aortic dissection (rAD). The distribution of rAA cases was 34.4% thoracal, 4.3% thoracoabdominal, and 61.3% abdominal. We found female dominance where the rAA was thoracal. In rAD cases, 84% were Stanford A and 16% Stanford B type. In both groups we found different pathological distributions. In the prehospital group, the number of thoracal ruptures was considerable. 88% of the patients with Stanford A dissection died in the prehospital or perioperative period. The most progressive AACs were ruptures of intrapericardial aneurysms and Stanford A dissections., however survival rate can be elevated by using rapid imaging examination and immediate surgical intervention. We want to highlight that our study contains such gender differences, which are worth to be taken into consideration.
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26
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Multicentre Covariate Adjustment Analysis of Short-Term and 5-Year Outcomes after Endovascular Repair according to Sex. Surg Res Pract 2020; 2020:8970759. [PMID: 32232118 PMCID: PMC7085369 DOI: 10.1155/2020/8970759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Several studies have reported worse outcomes in women compared to men after endovascular aneurysm repair (EVAR). This study aimed to evaluate sex-specific short-term and 5-year outcomes after EVAR. Methods A total of 409 consecutive patients underwent elective EVAR from 2004 to 2017 at two tertiary hospitals in Western Australia. Baseline, intraoperative, and postoperative variables were examined retrospectively according to sex. The primary outcome was 30-day mortality (death within 30 days after EVAR). Secondary outcomes were 30-day composite endpoint, length of stay after EVAR, 5-year survival, freedom from reintervention, residual aneurysm size after EVAR, and major adverse event rate at 5-year follow-up. Results A cohort of 409 patients, comprising 57 women (14%) and 352 men (86%), was analysed. Female patients were older (median age, 76.8 versus 73.5 years, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%, p=0.017). Male patients were more likely to be past smokers (40.9% versus 22.8%. Conclusion This study found no significant differences in 30-day and 5-year outcomes between female and male patients treated with EVAR, implying that EVAR remains a safe treatment choice for female patients.
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27
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Jabłońska A, Neumayer C, Bolliger M, Burghuber C, Klinger M, Demyanets S, Nanobachvili J, Huk I. Insight into the expression of toll-like receptors 2 and 4 in patients with abdominal aortic aneurysm. Mol Biol Rep 2020; 47:2685-2692. [PMID: 32146682 DOI: 10.1007/s11033-020-05366-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/29/2020] [Indexed: 12/15/2022]
Abstract
An abdominal aortic aneurysm (AAA) is a relatively common, life-threatening disease prevalent in persons over the age of 65. In recent years, an increasing number of studies have suggested that pattern-recognition receptors (PRRs), including Toll-like receptors (TLRs), may serve as important regulators in the development of AAAs. In this study, we evaluated the TLR2 and TLR4 expression in the aortic wall and blood of patients with AAA. The TLR2 and TLR4 mRNA expression were significantly higher in the blood of patients with AAA than in the blood of healthy volunteers (p = 0.009 and p = 0.010, respectively). The expression of TLR2 and TLR4 transcripts was also higher in the blood compared with the aortic wall tissue of AAA patients (p = 0.001 for both). Higher TLR2 protein expression was observed in the aortic wall of AAA patients compared with the blood (p = 0.026). A significantly higher concentration of TNF-α and IL-4 in patients with AAA than in healthy volunteers (p < 0.001 for both) was noticed. This study suggests that TLR2 may play a role in the inflammatory response in the aorta, both locally and systemically, in patients with AAA.
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Affiliation(s)
- Agnieszka Jabłońska
- Laboratory of Virology, Institute of Medical Biology, Polish Academy of Sciences, 106 St., 93-232, Lodz, Poland. .,Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Michael Bolliger
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christopher Burghuber
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Markus Klinger
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Josif Nanobachvili
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ihor Huk
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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28
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Chen S, Zhao Y, Jin H, Qi X, He J, Huang J, Ding Y, Chen W, Wu C, Ding X, Chen S, Zhang H, Shang Y, Du D, Zhao J. TROVE2 strengthens the anti-inflammatory effect via macrophage polarization by estrogen induction in abdominal aortic aneurysm. Life Sci 2020; 242:117207. [DOI: 10.1016/j.lfs.2019.117207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/08/2019] [Accepted: 12/17/2019] [Indexed: 01/27/2023]
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29
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de Guerre LEVM, Varkevisser RRB, Swerdlow NJ, Liang P, Li C, Dansey K, van Herwaarden JA, Schermerhorn ML. Sex differences in perioperative outcomes after complex abdominal aortic aneurysm repair. J Vasc Surg 2020; 71:374-381. [PMID: 31280978 PMCID: PMC6942245 DOI: 10.1016/j.jvs.2019.04.479] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/14/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Female sex is associated with worse outcomes after infrarenal abdominal aortic aneurysm (AAA) repair. However, the impact of female sex on complex AAA repair is poorly characterized. Therefore, we compared outcomes between female and male patients after open and endovascular treatment of complex AAA. METHODS We identified all patients who underwent complex aneurysm repair between 2011 and 2017 in the American College of Surgeons National Surgical Quality Improvement Program targeted vascular module. Complex repairs were defined as those for juxtarenal, pararenal, or suprarenal aneurysms. We compared rates of perioperative adverse events between female and male patients stratified by open AAA repair and endovascular aneurysm repair (EVAR). We calculated propensity scores and used inverse probability-weighted logistic regression to identify independent associations between female sex and our outcomes. RESULTS We identified 2270 complex aneurysm repairs, of which 1260 were EVARs (21.4% female) and 1010 were open repairs (30.7% female). After EVAR, female patients had higher rates of perioperative mortality (6.3% vs 2.4%; P = .001) and major complications (15.9% vs 7.6%; P < .001) compared with male patients. In contrast, after open repair, perioperative mortality was not significantly different (7.4% vs 5.6%; P = .3), and the rate of major complications was similar (29.4% vs 27.4%; P = .53) between female and male patients. Furthermore, even though perioperative mortality was significantly lower after EVAR compared with open repair for male patients (2.4% vs 5.6%; P = .001), this difference was not significant for women (6.3% vs 7.4%; P = .60). On multivariable analysis, female sex remained independently associated with higher perioperative mortality (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3-4.9; P = .007) and major complications (OR, 2.0; 95% CI, 1.3-3.2; P = .002) in patients treated with EVAR but showed no significant association with mortality (OR, 0.9; 95% CI, 0.5-1.6; P = .69) or major complications (OR, 1.1; 95% CI, 0.8-1.5; P = .74) after open repair. However, the association of female sex with higher perioperative mortality in patients undergoing complex EVAR was attenuated when diameter was replaced with aortic size index in the multivariable analysis (OR, 1.9; 95% CI, 0.9-3.9; P = .091). CONCLUSIONS Female sex is associated with higher perioperative mortality and more major complications than for male patients after complex EVAR but not after complex open repair. Continuous efforts are warranted to improve the sex discrepancies in patients undergoing endovascular repair of complex AAA.
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Affiliation(s)
- Livia E V M de Guerre
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Rens R B Varkevisser
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Nicholas J Swerdlow
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Patric Liang
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Chun Li
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Kirsten Dansey
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | | | - Marc L Schermerhorn
- Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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Ovariectomy increases the incidence and diameter of abdominal aortic aneurysm in a hypoperfusion-induced abdominal aortic aneurysm animal model. Sci Rep 2019; 9:18330. [PMID: 31797986 PMCID: PMC6892790 DOI: 10.1038/s41598-019-54829-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a vascular disease characterized by weakening of the vascular walls. Male sex is a risk factor for AAA, and peak AAA incidence occurs in men 10 years earlier than in women. However, the growth rate of AAA is faster in women, and women have a higher mortality due to AAA rupture. The mechanisms underlying sex-related differences in AAA remain unknown. Herein, we evaluated the effects of ovariectomy (OVX) on AAA in rats. Upon evaluation of the effects of OVX and AAA induction, AAA incidence rate and the aneurysm diameter increased in the OVX group. However, the histopathology in the developed AAA wall was not different between groups. When the effects of OVX on the vascular wall without AAA induction were evaluated, elastin and collagen levels were significantly decreased. Furthermore, the level of matrix metalloproteinase-9 significantly increased in the OVX group. According to our results, it is speculated that decreased levels of collagen and elastin fibers induced by OVX might be involved in increased incidence rate and diameter of AAA. Weakening of the vascular wall before the onset of AAA might be one reason for the faster rate of AAA growth in women.
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31
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Shutze WP, Shutze R, Dhot P, Forge M, Salazar A, Ogola GO. Sex as an independent risk factor for long-term survival after endovascular aneurysm repair. J Vasc Surg 2019; 69:1080-1089.e1. [DOI: 10.1016/j.jvs.2018.07.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/15/2018] [Indexed: 12/30/2022]
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32
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Guo S, Zhou Y, Zeng P, Xu G, Wang G, Cui Q. Identification and analysis of the human sex-biased genes. Brief Bioinform 2019; 19:188-198. [PMID: 28028006 DOI: 10.1093/bib/bbw125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Indexed: 01/28/2023] Open
Abstract
Tremendous differences between human sexes are universally observed. Therefore, identifying and analyzing the sex-biased genes are becoming basically important for uncovering the mystery of sex differences and personalized medicine. Here, we presented a computational method to identify sex-biased genes from public gene expression databases. We obtained 1407 female-biased genes (FGs) and 1096 male-biased genes (MGs) across 14 different tissues. Bioinformatics analysis revealed that compared with MGs, FGs have higher evolutionary rate, higher single-nucleotide polymorphism density, less homologous gene numbers and smaller phyletic age. FGs have lower expression level, higher tissue specificity and later expressed stage in body development. Moreover, FGs are highly involved in immune-related functions, whereas MGs are more enriched in metabolic process. In addition, cellular network analysis revealed that MGs have higher degree, more cellular activating signaling and tend to be located in cellular inner space, whereas FGs have lower degree, more cellular repressing signaling and tend to be located in cellular outer space. Finally, the identified sex-biased genes and the discovered biological insights together can be a valuable resource helpful for investigating sex-biased physiology and medicine, for example sex-biased disease diagnosis and therapy, which represents one important aspect of personalized and precision medicine.
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Affiliation(s)
- Sisi Guo
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, MOE Key Lab of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, 38 Xueyuan Rd, Beijing, China
| | - Yuan Zhou
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, MOE Key Lab of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, 38 Xueyuan Rd, Beijing, China
| | - Pan Zeng
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, MOE Key Lab of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, 38 Xueyuan Rd, Beijing, China
| | - Guoheng Xu
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, MOE Key Lab of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, 38 Xueyuan Rd, Beijing, China
| | - Guoqing Wang
- Department of Pathogenobiology, College of Basic Medicine, Jilin University, Changchun, Jilin, China
| | - Qinghua Cui
- Department of Biomedical Informatics, Department of Physiology and Pathophysiology, MOE Key Lab of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University, 38 Xueyuan Rd, Beijing, China
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33
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Abstract
Abdominal aortic aneurysm (AAA) is a local dilatation of the abdominal aortic vessel wall and is among the most challenging cardiovascular diseases as without urgent surgical intervention, ruptured AAA has a mortality rate of >80%. Most patients present acutely after aneurysm rupture or dissection from a previously asymptomatic condition and are managed by either surgery or endovascular repair. Patients usually are old and have other concurrent diseases and conditions, such as diabetes mellitus, obesity, and hypercholesterolemia making surgical intervention more difficult. Collectively, these issues have driven the search for alternative methods of diagnosing, monitoring, and treating AAA using therapeutics and less invasive approaches. Noncoding RNAs-short noncoding RNAs (microRNAs) and long-noncoding RNAs-are emerging as new fundamental regulators of gene expression. Researchers and clinicians are aiming at targeting these microRNAs and long noncoding RNAs and exploit their potential as clinical biomarkers and new therapeutic targets for AAAs. While the role of miRNAs in AAA is established, studies on long-noncoding RNAs are only beginning to emerge, suggesting their important yet unexplored role in vascular physiology and disease. Here, we review the role of noncoding RNAs and their target genes focusing on their role in AAA. We also discuss the animal models used for mechanistic understanding of AAA. Furthermore, we discuss the potential role of microRNAs and long noncoding RNAs as clinical biomarkers and therapeutics.
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Affiliation(s)
- Sandeep Kumar
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Institute of Technology, Atlanta, GA, USA
| | - Reinier A. Boon
- Institute for Cardiovascular Regeneration, Center of
Molecular Medicine, Goethe University, Frankfurt, Germany
- Department of Physiology, Amsterdam Cardiovascular
Sciences, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The
Netherlands
- German Center of Cardiovascular Research DZHK, Frankfurt,
Germany
| | - Lars Maegdefessel
- Department of Medicine, Karolinska Institute, Stockholm,
Sweden
- Department of Vascular and Endovascular Surgery, Technical
University Munich, Munich, Germany
- German Center for Cardiovascular Research DZHK, Munich,
Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Center of
Molecular Medicine, Goethe University, Frankfurt, Germany
- German Center of Cardiovascular Research DZHK, Frankfurt,
Germany
- Corresponding authors: Hanjoong Jo, PhD, John and Jan Portman
Professor, Wallace H. Coulter Department of Biomedical Engineering, Emory
University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, GA
30322, , Stefanie Dimmeler, PhD, Institute for
Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany,
| | - Hanjoong Jo
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Institute of Technology, Atlanta, GA, USA
- Division of Cardiology, Emory University, Atlanta, GA,
USA
- Corresponding authors: Hanjoong Jo, PhD, John and Jan Portman
Professor, Wallace H. Coulter Department of Biomedical Engineering, Emory
University and Georgia Institute of Technology, 1760 Haygood Drive, Atlanta, GA
30322, , Stefanie Dimmeler, PhD, Institute for
Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University
Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt, Germany,
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34
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Boczar KE, Cheung K, Boodhwani M, Beauchesne L, Dennie C, Nagpal S, Chan K, Coutinho T. Sex Differences in Thoracic Aortic Aneurysm Growth. Hypertension 2019; 73:190-196. [DOI: 10.1161/hypertensionaha.118.11851] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kevin E. Boczar
- From the Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (K.E.B., L.B., K.C., T.C.)
| | - Katie Cheung
- The Department of Health Research Methods, Evidence, and Impact (HEI) at McMaster University, Hamilton, ON, Canada (K.C.)
| | - Munir Boodhwani
- Division of Cardiac Surgery (M.B.), University of Ottawa Heart Institute, ON, Canada
| | - Luc Beauchesne
- From the Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (K.E.B., L.B., K.C., T.C.)
| | - Carole Dennie
- Department of Radiology (C.D.), The Ottawa Hospital, ON, Canada
| | - Sudhir Nagpal
- Division of Vascular Surgery (S.N.), The Ottawa Hospital, ON, Canada
| | - Kwan Chan
- From the Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (K.E.B., L.B., K.C., T.C.)
| | - Thais Coutinho
- From the Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (K.E.B., L.B., K.C., T.C.)
- Division of Cardiac Prevention and Rehabilitation (T.C.), University of Ottawa Heart Institute, ON, Canada
- Canadian Women’s Heart Health Centre (T.C.), University of Ottawa Heart Institute, ON, Canada
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35
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Staiculescu MC, Cocciolone AJ, Procknow JD, Kim J, Wagenseil JE. Comparative gene array analyses of severe elastic fiber defects in late embryonic and newborn mouse aorta. Physiol Genomics 2018; 50:988-1001. [PMID: 30312140 PMCID: PMC6293116 DOI: 10.1152/physiolgenomics.00080.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/17/2023] Open
Abstract
Elastic fibers provide reversible elasticity to the large arteries and are assembled during development when hemodynamic forces are increasing. Mutations in elastic fiber genes are associated with cardiovascular disease. Mice lacking expression of the elastic fiber genes elastin ( Eln-/-), fibulin-4 ( Efemp2-/-), or lysyl oxidase ( Lox-/-) die at birth with severe cardiovascular malformations. All three genetic knockout models have elastic fiber defects, aortic wall thickening, and arterial tortuosity. However, Eln-/- mice develop arterial stenoses, while Efemp2-/- and Lox-/- mice develop ascending aortic aneurysms. We performed comparative gene array analyses of these three genetic models for two vascular locations and developmental stages to determine differentially expressed genes and pathways that may explain the common and divergent phenotypes. We first examined arterial morphology and wall structure in newborn mice to confirm that the lack of elastin, fibulin-4, or lysyl oxidase expression provided the expected phenotypes. We then compared gene expression levels for each genetic model by three-way ANOVA for genotype, vascular location, and developmental stage. We found three genes upregulated by genotype in all three models, Col8a1, Igfbp2, and Thbs1, indicative of a common response to severe elastic fiber defects in developing mouse aorta. Genes that are differentially regulated by vascular location or developmental stage in all three models suggest mechanisms for location or stage-specific disease pathology. Comparison of signaling pathways enriched in all three models shows upregulation of integrins and matrix proteins involved in early wound healing, but not of mature matrix molecules such as elastic fiber proteins or fibrillar collagens.
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Affiliation(s)
| | - Austin J Cocciolone
- Department of Biomedical Engineering, Washington University , St. Louis, Missouri
| | - Jesse D Procknow
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
| | - Jungsil Kim
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
| | - Jessica E Wagenseil
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
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36
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Boczar KE, Coutinho T. Sex Considerations in Aneurysm Formation, Progression, and Outcomes. Can J Cardiol 2018; 34:362-370. [DOI: 10.1016/j.cjca.2017.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 01/11/2023] Open
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37
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Zhai M, Guo J, Ma H, Shi W, Jou D, Yan D, Liu T, Tao J, Duan J, Wang Y, Li S, Lv J, Li C, Lin J, Zhang C, Lin L. Ursolic acid prevents angiotensin II-induced abdominal aortic aneurysm in apolipoprotein E-knockout mice. Atherosclerosis 2018; 271:128-135. [PMID: 29499360 DOI: 10.1016/j.atherosclerosis.2018.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Abdominal aortic aneurysms (AAA) is a chronic inflammatory disease in which signal transducer and activator of transcription 3 (STAT3), and disintegrin and metalloproteinase 17 (ADAM17) play important roles. However, it remains unclear whether ursolic acid (UA), a natural pentacyclic triterpenoid carboxylic acid, can have an impact on STAT3 and ADAM17 and hence influence the formation of AAA. The objective of this study was to characterize the potential effect of UA on the pathogenesis of AAA and on STAT3 and ADAM17. METHODS Male ApoE-/- mice were infused with angiotensin II (AngII) (1000 ng/kg/min) for 4 weeks to induce AAAs. Daily intragastric gavage with 100 mg/kg UA or tap water containing Tween 80 as controls was provided. Immunohistochemistry, cell viability assay, colony formation, wound healing assay, and Western blot were used to explore the potential effect of UA on AAA. RESULTS UA decreased the incidence of AngII-induced AAA in mice. UA alleviated the degradation of elastin fibers and inflammation and decreased the expression of MMP2, MMP9, ADAM17 and phospho-STAT3 (pSTAT3) in aorta of mice induced with AngII. UA inhibited the constitutive and stimuli-induced (AngII and tumor necrosis factor-α) expression of MMP2, MMP9, ADAM17 and pSTAT3 in vascular smooth muscle cells (VSMCs). Furthermore, UA decreased cell viability, and suppressed colony formation and wound healing in vitro. CONCLUSIONS We demonstrated that UA ameliorated the severity of AAA and exhibited an inhibitory effect on the expression of pSTAT3 and ADAM17. UA might emerge as a promising agent contributing to the prevention or treatment of AAA.
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MESH Headings
- ADAM17 Protein/metabolism
- Angiotensin II
- Animals
- Anti-Inflammatory Agents/pharmacology
- Aorta, Abdominal/drug effects
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/chemically induced
- Aortic Aneurysm, Abdominal/genetics
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/prevention & control
- Cell Line
- Cell Proliferation/drug effects
- Disease Models, Animal
- Elastin/metabolism
- Male
- Matrix Metalloproteinase 2/metabolism
- Matrix Metalloproteinase 9/metabolism
- Mice, Knockout, ApoE
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Phosphorylation
- STAT3 Transcription Factor/metabolism
- Signal Transduction/drug effects
- Triterpenes/pharmacology
- Vascular Remodeling/drug effects
- Wound Healing/drug effects
- Ursolic Acid
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Affiliation(s)
- Maocai Zhai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junyi Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyan Ma
- Division of Cardiology, Department of Internal Medicine, First People's Hospital of Shangqiu, Shangqiu, China
| | - Wei Shi
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - David Jou
- Center for Childhood Cancer, The Research Institute at Nationwide Children's Hospital, Department of Pediatrics, College of Medicine, The Ohio State University, Columbus OH, USA
| | - Dan Yan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianshu Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingwen Tao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jialin Duan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yina Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiagao Lv
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenglong Li
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville FL, USA
| | - Jiayuh Lin
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore MD, USA
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Li Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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38
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Villard C, Hultgren R. Abdominal aortic aneurysm: Sex differences. Maturitas 2017; 109:63-69. [PMID: 29452784 DOI: 10.1016/j.maturitas.2017.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Abdominal aortic aneurysm (AAA) predominantly affects an elderly male population. Even so, AAA appears more detrimental in women, who experience a higher risk of aneurysm rupture and a worse outcome after surgery than men. Why women are privileged from yet are worse off once affected has been attributed to an effect of sex hormones. This review summarizes the knowledge of sex differences in AAA and addresses the changes in the aneurysm wall from a gender perspective. METHOD Standard reporting guidelines set by the PRISMA Group were followed to identify studies examining AAA from a gender perspective. Relevant reports were identified using two electronic databases: PubMed and Web of Science. The systematic search was performed in two stages: firstly, using the terms AAA and gender/sex/women; and secondly, adding the terms "elastin", "collagen" and "vascular smooth muscle cells", in order to filter the search for studies relevant to our focus on the aneurysm wall. CONCLUSION Current studies support the theory that sex has an effect on aneurysm formation, yet are inconclusive about whether or not aneurysm formation is dependent on female/male sex hormones or a lack thereof. The studies in women are scarce and out of those most reports primarily address other end-points, which limit their ability to illuminate an effect of sex on aneurysm formation. The complexity of the human menstrual cycle and menopausal transition are difficult to mimic in animal models, which limit their applicability to AAA formation in humans.
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Affiliation(s)
- Christina Villard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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39
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Zafar MA, Li Y, Rizzo JA, Charilaou P, Saeyeldin A, Velasquez CA, Mansour AM, Bin Mahmood SU, Ma WG, Brownstein AJ, Tranquilli M, Dumfarth J, Theodoropoulos P, Thombre K, Tanweer M, Erben Y, Peterss S, Ziganshin BA, Elefteriades JA. Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm. J Thorac Cardiovasc Surg 2017; 155:1938-1950. [PMID: 29395211 DOI: 10.1016/j.jtcvs.2017.10.140] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 08/31/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. We previously introduced the aortic size index (ASI), defined as aortic size/body surface area (BSA), as a predictor of aortic dissection, rupture, and death. However, weight might not contribute substantially to aortic size and growth. We seek to evaluate the height-based aortic height index (AHI) versus ASI for risk estimation and revisit our natural history calculations. METHODS Aortic diameters and long-term complications of 780 patients with TAAA were analyzed. Growth rate estimates, yearly complication rates, and survival were assessed. Risk stratification was performed using regression models. The predictive value of AHI and ASI was compared. RESULTS Patients were stratified into 4 categories of yearly risk of complications based on their ASI and AHI. ASIs (cm/m2) of ≤2.05, 2.08 to 2.95, 3.00 to 3.95 and ≥4, and AHIs (cm/m) of ≤2.43, 2.44 to 3.17, 3.21 to 4.06, and ≥4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. Five-year complication-free survival was progressively worse with increasing ASI and AHI. Both ASI and AHI were shown to be significant predictors of complications (P < .05). AHI categories 3.05 to 3.69, 3.70 to 4.34, and ≥4.35 cm/m were associated with a significantly increased risk of complications (P < .05). The overall fit of the model using AHI was modestly superior according to the concordance statistic. CONCLUSIONS Compared with indices including weight, the simpler height-based ratio (excluding weight and BSA calculations) yields satisfactory results for evaluating the risk of natural complications in patients with TAAA.
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Affiliation(s)
- Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Yupeng Li
- Department of Political Sciences and Economics, Rowan University, Glassboro, NJ
| | - John A Rizzo
- Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Paris Charilaou
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Ayman Saeyeldin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Camilo A Velasquez
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Ahmed M Mansour
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Syed Usman Bin Mahmood
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Adam J Brownstein
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Julia Dumfarth
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | | | - Kabir Thombre
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Maryam Tanweer
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Young Erben
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, Conn
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
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40
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Alsiraj Y, Thatcher SE, Blalock E, Fleenor B, Daugherty A, Cassis LA. Sex Chromosome Complement Defines Diffuse Versus Focal Angiotensin II-Induced Aortic Pathology. Arterioscler Thromb Vasc Biol 2017; 38:143-153. [PMID: 29097367 DOI: 10.1161/atvbaha.117.310035] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aortic pathologies exhibit sexual dimorphism, with aneurysms in both the thoracic and abdominal aorta (ie, abdominal aortic aneurysm [AAA]) exhibiting higher male prevalence. Women have lower prevalence of aneurysms, but when they occur, aneurysms progress rapidly. To define mechanisms for these sex differences, we determined the role of sex chromosome complement and testosterone on the location and progression of angiotensin II (AngII)-induced aortic pathologies. APPROACH AND RESULTS We used transgenic male mice expressing Sry (sex-determining region Y) on an autosome to create Ldlr (low-density lipoprotein receptor)-deficient male mice with an XY or XX sex chromosome complement. Transcriptional profiling was performed on abdominal aortas from XY or XX males, demonstrating 1746 genes influenced by sex chromosomes or sex hormones. Males (XY or XX) were either sham-operated or orchiectomized before AngII infusions. Diffuse aortic aneurysm pathology developed in XY AngII-infused males, whereas XX males developed focal AAAs. Castration reduced all AngII-induced aortic pathologies in XY and XX males. Thoracic aortas from AngII-infused XY males exhibited adventitial thickening that was not present in XX males. We infused male XY and XX mice with either saline or AngII and quantified mRNA abundance of key genes in both thoracic and abdominal aortas. Regional differences in mRNA abundance existed before AngII infusions, which were differentially influenced by AngII between genotypes. Prolonged AngII infusions resulted in aortic wall thickening of AAAs from XY males, whereas XX males had dilated focal AAAs. CONCLUSIONS An XY sex chromosome complement mediates diffuse aortic pathology, whereas an XX sex chromosome complement contributes to focal AngII-induced AAAs.
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Affiliation(s)
- Yasir Alsiraj
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Sean E Thatcher
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Eric Blalock
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Bradley Fleenor
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Alan Daugherty
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington
| | - Lisa A Cassis
- From the Department of Pharmacology and Nutritional Sciences (Y.A., S.E.T., E.B., L.A.C.), Department of Kinesiology (B.F.), Department of Physiology (A.D.), and Saha Cardiovascular Research Center (A.D.), University of Kentucky, Lexington.
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Lagman C, Chung LK, Chitale RV, Yang I. Dural Arteriovenous Fistula and Foix-Alajouanine Syndrome: Assessment of Functional Scores with Review of Pathogenesis. World Neurosurg 2017; 106:206-210. [DOI: 10.1016/j.wneu.2017.06.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 12/16/2022]
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Ye Z, Austin E, Schaid DJ, Bailey KR, Pellikka PA, Kullo IJ. ADAB2IPgenotype: sex interaction is associated with abdominal aortic aneurysm expansion. J Investig Med 2017; 65:1077-1082. [DOI: 10.1136/jim-2016-000404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
Abstract
A faster expansion rate of abdominal aortic aneurysm (AAA) increases the risk of rupture. Women are at higher risk of rupture than men, but the mechanisms underlying this increased risk are unknown. We investigated whether genetic variants that influence susceptibility for AAA (CDKN2A-2B,SORT1,DAB2IP,LRP1andLDLR) are associated with AAA expansion and whether these associations differ by sex in 650 patients with AAA (mean age 70±8 years, 17% women) enrolled in the Mayo Clinic Vascular Disease Biorepository. Women had a mean aneurysm expansion 0.41 mm/year greater than men after adjustment for baseline AAA size. In addition to baseline size, mean arterial pressure (MAP), non-diabetic status,SORT1-rs599839[G] andDAB2IP-rs7025486[A] were associated with greater aneurysm expansion (all p<0.05). The associations of MAP and rs599839[G] were similar in both sexes, while the associations of baseline size, pulse pressure (PP) and rs7025486[A] were stronger in women than men (all p-sexinteraction≤0.02). A three-way interaction of PP*sex* rs7025486[A] was noted in a full-factorial analysis (p=0.007) independent of baseline size and MAP. In the high PP group (≥median), women had a mean growth rate 0.68 mm/year greater per [A] of rs7025486 than men (p-sexinteraction=0.003), whereas there was no difference in the low PP group (p-sexinteraction=0.8). We demonstrate that variantsDAB2IP-rs7025486[A] andSORT1-rs599839[G] are associated with AAA expansion. The association of rs7025486[A] is stronger in women than men and amplified by high PP, contributing to sex differences in aneurysm expansion.
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Robert M, Juillière Y, Gabet A, Kownator S, Olié V. Time trends in hospital admissions and mortality due to abdominal aortic aneurysms in France, 2002-2013. Int J Cardiol 2017; 234:28-32. [PMID: 28256324 DOI: 10.1016/j.ijcard.2017.02.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/05/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAA) are serious disease with a high fatality rate but recent epidemiologic data showed a decrease of AAA mortality. Our objective was to estimate, in France, the hospitalization, inhospital mortality and mortality rates due to AAA and to analyze their trends over time. METHODS Hospitalization data were extracted from the hospital discharge summaries in the national database between 2002 and 2013. The analysis covered all patients hospitalized for AAA as a principal diagnosis. During the same period, all death certificates mentioning AAA as an initial cause of death were included in the study. Crude and standardized rates were calculated according to age and sex. Poisson regression was used to analyze the average annual percent change. RESULTS In 2013, there were 8853 patients hospitalized for AAA in France (7986 unruptured and 867 ruptured). Between 2002 and 2013, the rate of patients hospitalized for unruptured AAA decreased slightly in men (-5.0%) but increased in women (+5.2%). By contrast, the rate of patients hospitalized for ruptured AAA has decreased by >20% in men and women. The proportion of endovascular treatment of unruptured AAA rose from <10% in 2005 to 35% in women and 40% in men in 2013. In 2013, 939 deaths from AAA were recorded. Mortality for this disease declined significantly from 2002 to 2013 in men and women. CONCLUSION The unfavorable epidemiological trends in women and important evolution of the management of AAA call for an epidemiological surveillance of this disease.
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Affiliation(s)
- M Robert
- The French Public Health Agency, France
| | - Y Juillière
- Department of Cardiology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - A Gabet
- The French Public Health Agency, France
| | | | - V Olié
- The French Public Health Agency, France.
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Arnold AP, Cassis LA, Eghbali M, Reue K, Sandberg K. Sex Hormones and Sex Chromosomes Cause Sex Differences in the Development of Cardiovascular Diseases. Arterioscler Thromb Vasc Biol 2017; 37:746-756. [PMID: 28279969 DOI: 10.1161/atvbaha.116.307301] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 02/15/2017] [Indexed: 12/25/2022]
Abstract
This review summarizes recent evidence concerning hormonal and sex chromosome effects in obesity, atherosclerosis, aneurysms, ischemia/reperfusion injury, and hypertension. Cardiovascular diseases occur and progress differently in the 2 sexes, because biological factors differing between the sexes have sex-specific protective and harmful effects. By comparing the 2 sexes directly, and breaking down sex into its component parts, one can discover sex-biasing protective mechanisms that might be targeted in the clinic. Gonadal hormones, especially estrogens and androgens, have long been found to account for some sex differences in cardiovascular diseases, and molecular mechanisms mediating these effects have recently been elucidated. More recently, the inherent sexual inequalities in effects of sex chromosome genes have also been implicated as contributors in animal models of cardiovascular diseases, especially a deleterious effect of the second X chromosome found in females but not in males. Hormonal and sex chromosome mechanisms interact in the sex-specific control of certain diseases, sometimes by opposing the action of the other.
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Affiliation(s)
- Arthur P Arnold
- From the Department of Integrative Biology and Physiology, University of California, Los Angeles (A.P.A.); Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington (L.A.C.); Department of Anesthesiology (M.E.) and Department of Human Genetics (K.R.), David Geffen School of Medicine at UCLA, Los Angeles, CA; and Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.).
| | - Lisa A Cassis
- From the Department of Integrative Biology and Physiology, University of California, Los Angeles (A.P.A.); Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington (L.A.C.); Department of Anesthesiology (M.E.) and Department of Human Genetics (K.R.), David Geffen School of Medicine at UCLA, Los Angeles, CA; and Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.)
| | - Mansoureh Eghbali
- From the Department of Integrative Biology and Physiology, University of California, Los Angeles (A.P.A.); Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington (L.A.C.); Department of Anesthesiology (M.E.) and Department of Human Genetics (K.R.), David Geffen School of Medicine at UCLA, Los Angeles, CA; and Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.)
| | - Karen Reue
- From the Department of Integrative Biology and Physiology, University of California, Los Angeles (A.P.A.); Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington (L.A.C.); Department of Anesthesiology (M.E.) and Department of Human Genetics (K.R.), David Geffen School of Medicine at UCLA, Los Angeles, CA; and Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.)
| | - Kathryn Sandberg
- From the Department of Integrative Biology and Physiology, University of California, Los Angeles (A.P.A.); Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington (L.A.C.); Department of Anesthesiology (M.E.) and Department of Human Genetics (K.R.), David Geffen School of Medicine at UCLA, Los Angeles, CA; and Department of Medicine, Georgetown University Medical Center, Washington, DC (K.S.)
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Tripathi R, Sainathan S, Ziganshin BA, Elefteriades JA. Thoracic Aortic Aneurysm from Chronic Antiestrogen Therapy. Int J Angiol 2017; 26:60-63. [PMID: 28255218 DOI: 10.1055/s-0036-1583522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/24/2016] [Indexed: 01/03/2023] Open
Abstract
Aortic aneurysms are a common but often undetected pathology prevalent in the population. They are often detected as incidental findings on imaging studies performed for unrelated pathologies. Estrogens have been shown to exert a protective influence on aortic tissue. Pharmacological agents blocking the actions of estrogens may thus be implicated in causing aortic pathologies. We present the case of an elderly woman with breast carcinoma treated for 18 years with antiestrogen therapy who subsequently developed acute thoracic aortic deterioration (enlargement and wall disruption).
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Affiliation(s)
- Rishi Tripathi
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Sandeep Sainathan
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
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Deery SE, Soden PA, Zettervall SL, Shean KE, Bodewes TCF, Pothof AB, Lo RC, Schermerhorn ML. Sex differences in mortality and morbidity following repair of intact abdominal aortic aneurysms. J Vasc Surg 2016; 65:1006-1013. [PMID: 27986477 DOI: 10.1016/j.jvs.2016.08.100] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/07/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Medicare studies have shown increased perioperative mortality in women compared with men following endovascular and open abdominal aortic aneurysm (AAA) repair. However, a recent regional study of high-volume centers, adjusting for anatomy but limited in sample size, did not show sex to be predictive of worse outcomes. This study aimed to evaluate sex differences after intact AAA repair in a national clinical registry. METHODS The targeted vascular module of the National Surgical Quality Improvement Program was queried to identify patients undergoing endovascular aneurysm repair (EVAR) or open repair for intact, infrarenal AAA from 2011 to 2014. Univariate analysis was performed using the Fisher exact test and Mann-Whitney test. Multivariable logistic regression was used to account for differences in comorbidities, aneurysm details, and operative characteristics. RESULTS We identified 6611 patients (19% women) who underwent intact AAA repair (87% EVAR; 83% women vs 88% men; P < .001). Women were older (median age, 76 vs 73 years; P < .001), had smaller aneurysms (median, 5.4 vs 5.5 cm; P < .001), and had more chronic obstructive pulmonary disease (22% vs 17%; P < .001). Among patients undergoing EVAR, women had longer operative times (median, 138 [interquartile range, 103-170] vs 131 [106-181] minutes; P < .01) and more often underwent renal (6.3% vs 4.1%; P < .01) and lower extremity (6.6% vs 3.8%; P < .01) revascularization. After open repair, women had shorter operative time (215 [177-304] vs 226 [165-264] minutes; P = .02), but women less frequently underwent lower extremity revascularization (3.1% vs 8.2%; P = .03). Thirty-day mortality was higher in women after EVAR (3.2% vs 1.2%; P < .001) and open repair (8.0% vs 4.0%; P = .04). After adjusting for repair type, age, aneurysm diameter, and comorbidities, female sex was independently associated with mortality (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6; P = .02) and major complications (OR, 1.4; CI, 1.1-1.7; P < .01) after intact AAA repair. However, after adjusting for aortic size index rather than for aortic diameter, the association between female sex and mortality (OR, 1.5; CI, 0.98-2.4; P = .06) and major complications (OR, 1.1; CI, 0.9-1.4; P = .24) was reduced. CONCLUSIONS Women were at higher risk for 30-day death and major complications after intact AAA repair. Some of this disparity may be explained by differences in aortic size index, which should be further evaluated to determine the ideal threshold for repair.
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Affiliation(s)
- Sarah E Deery
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Peter A Soden
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Sara L Zettervall
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Katie E Shean
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Thomas C F Bodewes
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Alexander B Pothof
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Ruby C Lo
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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Makrygiannis G, Labalue P, Erpicum M, Schlitz M, Seidel L, El Hachemi M, Gangolf M, Albert A, Defraigne JO, Lindholt JS, Sakalihasan N. Extending Abdominal Aortic Aneurysm Detection to Older Age Groups: Preliminary Results from the Liège Screening Programme. Ann Vasc Surg 2016; 36:55-63. [DOI: 10.1016/j.avsg.2016.02.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/01/2015] [Accepted: 02/17/2016] [Indexed: 12/28/2022]
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Timaran DE, Knowles M, Soto-Gonzalez M, Modrall JG, Tsai S, Kirkwood M, Rectenwald J, Timaran CH. Gender and perioperative outcomes after fenestrated endovascular repair using custom-made and off-the-shelf devices. J Vasc Surg 2016; 64:267-272. [DOI: 10.1016/j.jvs.2016.02.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/23/2016] [Indexed: 11/27/2022]
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Maekawa H, Serrone JC, Tjahjadi M, Hernesniemi J. RETRACTED ARTICLE: The role of estrogen on the pathology of cerebral aneurysms. Expert Rev Neurother 2016; 16:927-35. [DOI: 10.1080/14737175.2016.1189827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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