1
|
Koh JM, Song K, Kwak MK, Suh S, Kim BJ, Sung TY, Hong JH, Jeong BC, Kim JH, Lee SH. Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients With Mild Autonomous Cortisol Secretion: Results of an Randomized Controlled Trial by the Co-work of Adrenal Research (COAR) Study. Ann Surg 2024; 279:945-952. [PMID: 38126763 DOI: 10.1097/sla.0000000000006183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS). BACKGROUND Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only 2 randomized prospective studies with some limitations to date. METHODS A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing syndrome but with serum cortisol >50 nmol/L after a 1 mg overnight dexamethasone suppression test into an adrenalectomy group (n = 66) or control group (n = 66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP). RESULTS Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3-66), the adrenalectomy group (n = 46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared with the control group (n = 46; 6.5%, P = 0.002; 15.2%, P = 0.002; and 23.9%, P = 0.029, respectively) after matching for age and sex. Adrenalectomy [odds ratio (OR) = 10.38, 95% CI = 2.09-51.52, P = 0.004], body mass index (OR = 1.39, 95% CI = 1.08-1.79, P = 0.010), and cortisol after a 1 mg overnight dexamethasone suppression test levels (OR = 92.21, 95% CI = 5.30-1604.07, P = 0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR = 5.30, 95% CI = 1.63-17.25, P = 0.006) and diabetes (OR = 8.05, 95% CI = 2.34-27.65, P = 0.001) were independently associated with improved glucose control. Adrenalectomy (OR = 2.27, 95% CI = 0.87-5.94, P = 0.095) and hypertension (OR = 10.77, 95% CI = 3.65-31.81, P < 0.001) demonstrated associations with improved BP control. CONCLUSIONS adrenalectomy improved weight, glucose, and BP control in patients with MACS.
Collapse
Affiliation(s)
- Jung-Min Koh
- Department of Medicine, Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keeho Song
- Department of Medicine, Division of Endocrinology and Metabolism, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Mi Kyung Kwak
- Department of Medicine, Division of Endocrinology and Metabolism, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea
| | - Sunghwan Suh
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Beom-Jun Kim
- Department of Medicine, Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Department of Medicine, Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Department of Medicine, Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Deng T, He W, Yao X, Chen J, Liu X, Liu L, Zhang T, Lu H. Safety and efficacy of short-term dual antiplatelet therapy combined with intensive rosuvastatin in acute ischemic stroke. Clinics (Sao Paulo) 2023; 78:100171. [PMID: 36738644 PMCID: PMC9932359 DOI: 10.1016/j.clinsp.2023.100171] [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: 07/12/2022] [Revised: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of short-term (7-day) Dual Antiplatelet Therapy (DAPT) with intensive rosuvastatin in Acute Ischemic Stroke (AIS). METHODS In this study, patients with AIS in the emergency department of the hospital from October 2016 to December 2019 were registered and divided into the control group (Single Antiplatelet Therapy [SAPT] + rosuvastatin) and the study group (7-day DAPT + intensive rosuvastatin) according to the therapy regimens. The generalized linear model was used to compare the National Institute of Health Stroke Scale (NIHSS) scores between the two groups during the 21-day treatment. A Cox regression model was used to compare recurrent ischemic stroke, bleeding events, Statin-Induced Liver Injury (SILI), and Statin-Associated Myopathy (SAM) between the two groups during the 90-day follow-up. RESULTS Comparison of NIHSS scores after 21-day treatment: NIHSS scores in the study group decreased significantly, 0.273-times as much as that in the control group (Odds Ratio [OR] 0.273; 95% Confidence Interval [95% CI] 0.208-0.359; p < 0.001). Comparison of recurrent ischemic stroke during the 90-day follow-up: The therapy of the study group reduced the risk of recurrent stroke by 65% (7.76% vs. 22.82%, Hazard Ratio [HR] 0.350; 95% CI 0.167-0.730; p = 0.005). Comparison of bleeding events: There was no statistical difference between the two groups (7.79% vs. 6.71%, HR = 1.076; 95% CI 0.424-2.732; p = 0.878). No cases of SILI and SAM were found. CONCLUSIONS Short-term DAPT with intensive rosuvastatin effectively relieved the clinical symptoms and significantly reduced the recurrent stroke for patients with mild-to-moderate AIS within 90 days, without increasing bleeding events, SILI and SAM.
Collapse
Affiliation(s)
- Ting Deng
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Wei He
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Xiaohua Yao
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Jingmian Chen
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Xiaomeng Liu
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Lushan Liu
- Emergency Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China
| | - Tong Zhang
- Neurology Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China.
| | - Haitao Lu
- Neurology Department, China Rehabilitation Research Center Beijing Bo'ai Hospital, Beijing, China.
| |
Collapse
|
3
|
Sandhu AT, Rodriguez F, Maron DJ, Heidenreich PA. Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke. Am J Prev Cardiol 2022; 12:100426. [PMID: 36304918 PMCID: PMC9593274 DOI: 10.1016/j.ajpc.2022.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/15/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alexander T. Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
- Palo Alto Veteran's Affairs Healthcare System, Palo Alto, CA, USA
- Corresponding author at: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305.
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - David J. Maron
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Paul A. Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
- Palo Alto Veteran's Affairs Healthcare System, Palo Alto, CA, USA
| |
Collapse
|
4
|
Rea F, Ronco R, Martini N, Maggioni AP, Corrao G. Cost-Effectiveness of Posthospital Management of Acute Coronary Syndrome: A Real-World Investigation From Italy. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:185-193. [PMID: 35094791 DOI: 10.1016/j.jval.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness profile of adherence to recommendations for the community management of patients discharged with a diagnosis of acute coronary syndrome (ACS). METHODS The cohort of 50 282 residents in the Lombardy Region (Italy) who were discharged with a diagnosis of ACS during 2011 to 2015 was followed up until 2018. Adherence to selected recommendations including drug therapies (DTs), outpatient controls, and rehabilitation, experienced during the first year after index discharge, was considered. Adherent and nonadherent cohort members were matched on high-dimensional propensity scores. Composite clinical outcomes (cardiovascular hospital admissions and all-cause mortality) and healthcare costs were assessed for a time horizon of 5 years. Cost-effectiveness profile of adherence to recommendations was measured through the incremental cost-effectiveness ratio, that is, the incremental cost for 1 day free from the composite clinical outcome. RESULTS Adherence to DTs, outpatient controls, and rehabilitation, respectively, regarded 39%, 81%, and 3% of cohort members. Compared with nonadherent patients, those adherent to DTs, outpatient controls, and rehabilitation had (1) a delay in the occurrence of the composite clinical outcome of 50, 43, and 73 days, respectively, and (2) lower (on average, €199 per year for DTs) and higher costs (€292 and €1024 for outpatient controls and rehabilitation). Cost-effectiveness profiles were better for patients with myocardial infarction than those with angina and for patients with more severe clinical complexity than those with milder conditions. CONCLUSIONS Health-related and economic benefits are expected from improving adherence to international guidelines recommendations concerning outpatient treatments and monitoring of patients with ACS.
Collapse
Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Ronco
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Nello Martini
- Research and Health Foundation (Fondazione ReS [Ricerca e Salute]), Bologna, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
5
|
Solomon MD, Leong TK, Levin E, Rana JS, Jaffe MG, Sidney S, Sung SH, Lee C, DeMaria A, Go AS. Cumulative Adherence to Secondary Prevention Guidelines and Mortality After Acute Myocardial Infarction. J Am Heart Assoc 2020; 9:e014415. [PMID: 32131689 PMCID: PMC7335507 DOI: 10.1161/jaha.119.014415] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
Background The survival benefit associated with cumulative adherence to multiple clinical and lifestyle-related guideline recommendations for secondary prevention after acute myocardial infarction (AMI) is not well established. Methods and Results We examined adults with AMI (mean age 68 years; 64% men) surviving at least 30 (N=25 778) or 90 (N=24 200) days after discharge in a large integrated healthcare system in Northern California from 2008 to 2014. The association between all-cause death and adherence to 6 or 7 secondary prevention guideline recommendations including medical treatment (prescriptions for β-blockers, renin-angiotensin-aldosterone system inhibitors, lipid medications, and antiplatelet medications), risk factor control (blood pressure <140/90 mm Hg and low-density lipoprotein cholesterol <100 mg/dL), and lifestyle approaches (not smoking) at 30 or 90 days after AMI was evaluated with Cox proportional hazard models. To allow patients time to achieve low-density lipoprotein cholesterol <100 mg/dL, this metric was examined only among those alive 90 days after AMI. Overall guideline adherence was high (35% and 34% met 5 or 6 guidelines at 30 days; and 31% and 23% met 6 or 7 at 90 days, respectively). Greater guideline adherence was independently associated with lower mortality (hazard ratio, 0.57 [95% CI, 0.49-0.66] for those meeting 7 and hazard ratio, 0.69 [95% CI, 0.61-0.78] for those meeting 6 guidelines versus 0 to 3 guidelines in 90-day models, with similar results in the 30-day models), with significantly lower mortality per each additional guideline recommendation achieved. Conclusions In a large community-based population, cumulative adherence to guideline-recommended medical therapy, risk factor control, and lifestyle changes after AMI was associated with improved long-term survival. Full adherence was associated with the greatest survival benefit.
Collapse
Affiliation(s)
- Matthew D. Solomon
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Division of CardiologyKaiser Permanente Oakland Medical CenterOaklandCA
| | - Thomas K. Leong
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Eleanor Levin
- Division of CardiologyKaiser Permanente Santa Clara Medical CenterSanta ClaraCA
| | - Jamal S. Rana
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Division of CardiologyKaiser Permanente Oakland Medical CenterOaklandCA
| | - Marc G. Jaffe
- Division of EndocrinologyKaiser
Permanente South San Francisco Medical CenterSan FranciscoCA
| | - Stephen Sidney
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Sue Hee Sung
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Catherine Lee
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Anthony DeMaria
- Division of CardiologyUniversity of California at San DiegoCA
| | - Alan S. Go
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
- Departments of Epidemiology, Biostatistics and MedicineUniversity of CaliforniaSan FranciscoCA
- Departments of Medicine, Health Research and PolicyStanford UniversityPalo AltoCA
| |
Collapse
|
6
|
Hadi A, Askarpour M, Ziaei R, Venkatakrishnan K, Ghaedi E, Ghavami A. Impact of flaxseed supplementation on plasma lipoprotein(a) concentrations: A systematic review and meta‐analysis of randomized controlled trials. Phytother Res 2020; 34:1599-1608. [DOI: 10.1002/ptr.6640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Amir Hadi
- Halal Research Center of IRI, FDA Tehran Iran
| | - Moein Askarpour
- Department of Cellular and molecular Nutrition, School of Nutritional sciences and DieteticsTehran University of Medical Sciences Tehran Iran
| | - Rahele Ziaei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research CenterIsfahan University of Medical Sciences Isfahan Iran
| | | | - Ehsan Ghaedi
- Department of Cellular and molecular Nutrition, School of Nutritional sciences and DieteticsTehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC)Tehran University of Medical Sciences (TUMS) Tehran Iran
| | - Abed Ghavami
- Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical Sciences Isfahan Iran
| |
Collapse
|
7
|
Malyala R, Rapi L, Nash MM, Prasad GVR. Serum Apolipoprotein B and A1 Concentrations Predict Late-Onset Posttransplant Diabetes Mellitus in Prevalent Adult Kidney Transplant Recipients. Can J Kidney Health Dis 2019; 6:2054358119850536. [PMID: 31205732 PMCID: PMC6535897 DOI: 10.1177/2054358119850536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/06/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Glucose metabolism links closely to cholesterol metabolism. Posttransplant diabetes mellitus (PTDM) adversely affects posttransplant outcomes, but its risk factors in relation to cholesterol metabolism have not been fully delineated. The apolipoprotein B/A1 (Apo B/A1) ratio, which is associated with insulin resistance, has not been evaluated in kidney transplant recipients as a risk factor for PTDM. OBJECTIVE The objective of this study was to determine whether serum apolipoprotein profiles predict late PTDM, defined as a new onset diabetes occurring greater than 3 months posttransplant. DESIGN Retrospective chart review of a prevalent population of kidney transplant recipients. SETTING Large transplant center in Ontario, Canada. PATIENTS We identified 1104 previously nondiabetic adults who received a kidney transplant between January 1, 1998, and December 1, 2015, and were followed at 1 transplant center. MEASUREMENTS Recipients provided testing for serum apolipoprotein B (Apo B) and apolipoprotein A1 (Apo A1) concentrations from 2010, either at 3 months posttransplant for new transplant recipients or the next clinic visit for prevalent recipients. Late PTDM defined using Canadian Diabetes Association criteria as occurring ≥3 months posttransplant was recorded until May 1, 2016. METHODS All analyses were conducted with R, version 3.4.0 (The R Foundation for Statistical Computing). Comparisons were made using Student t test, Fisher exact test or chi-square test, Kaplan-Meier methodology with the logrank test, or Cox proportional hazards analysis as appropriate. Covariates for the multivariate Cox proportional hazards models of PTDM as the outcome variable were selected based on significance of the univariate associations and biological plausibility. RESULTS There were 53 incident late PTDM cases, or 1.71 cases per 100 patient-years. Incident late PTDM differed between the highest and lowest quartiles for Apo B/A1 ratio, 2.47 per 100 patient-years vs 0.88 per 100 patient-years (P = .005 for difference). In multiple Cox regression analysis, first measured serum Apo B/A1 concentration better predicted subsequent PTDM than low-density lipoprotein cholesterol (LDL-C; hazard ratio [HR] = 7.80 per unit increase, P = .039 vs HR = 1.05 per unit increase, P = .774). Non-high-density lipoprotein cholesterol (HDL-C) concentrations also did not predict PTDM (P = .136). By contrast to Apo B, Apo A1 was protective against PTDM in statin users (HR = 0.17 per unit increase, P = .016). LIMITATIONS Posttransplant diabetes mellitus cases occurring before apolipoprotein testing was implemented were not included in the analysis. CONCLUSIONS Apolipoproteins B and A1 better predict late PTDM than conventional markers of cholesterol metabolism.
Collapse
Affiliation(s)
- Rohit Malyala
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
| | - Lindita Rapi
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
| | - Michelle M. Nash
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
| | - G. V. Ramesh Prasad
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| |
Collapse
|
8
|
Application of Organometallic Catalysts in API Synthesis. TOP ORGANOMETAL CHEM 2019. [DOI: 10.1007/3418_2019_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Prakash SK, Milewicz DM. X Marks the Spot: The Profound Impact of Sex on Aortic Disease. Arterioscler Thromb Vasc Biol 2018; 38:9-11. [PMID: 29282246 DOI: 10.1161/atvbaha.117.310433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Siddharth K Prakash
- From the Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston.
| | - Dianna M Milewicz
- From the Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| |
Collapse
|
10
|
Clemens KK, Shariff SZ, McArthur E, Hegele RA. Ezetimibe prescriptions in older Canadian adults after an acute myocardial infarction: a population-based cohort study. Lipids Health Dis 2018; 17:8. [PMID: 29310674 PMCID: PMC5759247 DOI: 10.1186/s12944-017-0649-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022] Open
Abstract
Background The utility of ezetimibe in preventing cardiovascular outcomes remains controversial. To guide future assessments of the effectiveness of ezetimibe in routine care, we evaluated how this medication has been prescribed to high-risk older adults in Ontario, Canada. Methods Using linked healthcare databases, we carried out a population-based cohort study of older adults who were discharged from hospital following an acute myocardial infarction from 2005 until 2014. We ascertained the rate of ezetimibe initiation within 6 months of their discharge. We also examined the characteristics of new ezetimibe prescriptions, as well as the predictors for receiving the therapy. Results Seventy one thousand one hundred twenty five older adults were hospitalized for an acute myocardial infarction between 2005 and 2014 (mean age 78.36 ± 7.71 years, 45.8% women). Only 1230 (1.7%) patients were newly prescribed ezetimibe within 6 months of their hospital discharge. The median duration of continuous use of ezetimibe was 1.2 years (IQR 0.3–3.5 years). Ezetimibe was prescribed more often to patients living in rural areas, with a history of coronary artery disease, on high-potency statins, and, with evidence of healthcare follow-up after hospital discharge. Prescriptions were less common in men, older patients, those living in long-term care facilities, those with a history of congestive heart failure, and those who were hospitalized for a myocardial infarction in more recent years. Conclusions Real-world drug effectiveness studies can help to complement the findings of randomized controlled trials. In our region however, only a small proportion of high-risk older adults received a prescription for ezetimibe following a myocardial infarction. Clinical and research implications are discussed. Electronic supplementary material The online version of this article (10.1186/s12944-017-0649-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kristin K Clemens
- St. Joseph's Health Care London, PO BOX 5777, STN B, London, ON, N6A 4V2, Canada. .,Department of Medicine, Division of Endocrinology, Western University, London, ON, Canada. .,Institute for Clinical Evaluative Sciences, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
| | | | - Eric McArthur
- Institute for Clinical Evaluative Sciences, ON, Canada
| | - Robert A Hegele
- St. Joseph's Health Care London, PO BOX 5777, STN B, London, ON, N6A 4V2, Canada.,Robarts Research Institute, 100 Perth Drive, London, ON, N6K 5K8, Canada
| |
Collapse
|
11
|
How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD. J Am Coll Cardiol 2017; 70:2171-2185. [DOI: 10.1016/j.jacc.2017.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022]
|
12
|
Juega-Mariño J, Bonjoch A, Pérez-Alvarez N, Negredo E, Bayes B, Bonet J, Clotet B, Romero R. Prevalence, evolution, and related risk factors of kidney disease among Spanish HIV-infected individuals. Medicine (Baltimore) 2017; 96:e7421. [PMID: 28906351 PMCID: PMC5604620 DOI: 10.1097/md.0000000000007421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Prevalence of kidney disease (KD) is increasing among human immunodeficiency virus (HIV)-infected population. Different factors have been related, varying on different published series.The objectives were to study prevalence of KD in those patients, its evolution, and associated risk factors.An observational cohort study of 1596 HIV-positive patients with cross-sectional data collection in 2008 and 2010 was conducted. We obtained clinical and laboratory markers, and registered previous or current treatment with tenofovir (TDF) and indinavir (IDV). The sample was divided according to estimated glomerular filtration rate (eGFR) by modification of diet in renal disease (MDRD) equation. Group 1: eGFR ≤60 mL/min/1.73 m; group 2: eGFR >60 mL/min/1.73 m.Among the patients, 76.4% were men, mean age (SD) 45 ± 9 years, time since diagnose of HIV 14 ± 7 years, and 47.2% of the patients received previous treatment with TDF and 39.1% with IDV. In 2008, eGFR ≤60: 4.9% (91.4% of them in chronic kidney disease [CKD] stage 3, eGFR 59-30 mL/min); this group was older, presented higher fibrinogen levels, and more patients were treated previously with TDF and IDV. In 2010, eGFR ≤60: 3.9% (87.1% stage 3 CKD). The 2.4% of cohort showed renal improvement and 1.3% decline of renal function over time. The absence of hypertension and treatment with TDF were associated with improvement in eGFR. Increased age, elevated fibrinogen, decreased albumin, diabetes mellitus, hyperTG, and worse virological control were risk factors for renal impairment.The HIV-positive patients in our area have a CKD prevalence of 4% to 5% (90% stage 3 CKD) associated with ageing, inflammation, worse immune control of HIV, TDF treatment, and metabolic syndrome.
Collapse
Affiliation(s)
- Javier Juega-Mariño
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona
- Universitat Autónoma de Barcelona
| | - Anna Bonjoch
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona
| | - Nuria Pérez-Alvarez
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona
| | - Eugenia Negredo
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona
- Universitat de Vic-Universitat Central de Catalunya, Barcelona
| | - Beatriu Bayes
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona
| | - Josep Bonet
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona
- Universitat Autónoma de Barcelona
| | - Buenaventura Clotet
- Unitat VIH, Fundació Lluita contra la SIDA, Servicio de Medicina Interna, Hospital Germans Trias i Pujol, Badalona
- Universitat de Vic-Universitat Central de Catalunya, Barcelona
- IrsiCaixa Foundation, Badalona, Spain
| | - Ramon Romero
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona
- Universitat Autónoma de Barcelona
| |
Collapse
|
13
|
Guidelines for Management of Hyperlipidemia: Implications for Treatment of Patients with Stroke Secondary to Atherosclerotic Disease. Curr Neurol Neurosci Rep 2016; 16:24. [PMID: 26838351 DOI: 10.1007/s11910-016-0621-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
After careful review of randomized cardiovascular outcomes trial data, the 2013 ACC/AHA cholesterol guideline focused on using the appropriate intensity of statin therapy to reduce atherosclerotic cardiovascular disease (ASCVD) risk and moved away from recommending specific low-density lipoprotein cholesterol (LDL-C) treatment targets. In patients who have had a stroke or other clinical ASCVD event, a high-intensity statin should be initiated up to age 75 years unless there are safety concerns, including a history of hemorrhagic stroke. A moderate-intensity statin is recommended if there are safety concerns or age is greater than 75 years. Atorvastatin 40-80 mg and rosuvastatin 20-40 mg are considered high-intensity statins. These new guidelines avoid unnecessary usage of non-statins to achieve specific LDL-C values, thus avoiding potential adverse effects or use of an inadequate statin intensity in patients who are "at goal." When non-statins are considered for additional LDL-C lowering, ezetimibe is the only non-statin clearly shown to further reduce ASCVD risk when added to background statin therapy.
Collapse
|
14
|
Kunutsor SK, Khan H, Nyyssönen K, Laukkanen JA. Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: A new prospective cohort study. Int J Cardiol 2016; 220:718-25. [PMID: 27393854 DOI: 10.1016/j.ijcard.2016.06.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an established and independent risk factor for cardiovascular outcomes. However, the relationship of Lp(a) with risk of sudden cardiac death (SCD) is unknown. We aimed to assess the association of Lp(a) with risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of 1881 men aged 42-61years at recruitment. METHODS AND RESULTS Plasma Lp(a) concentration was assessed at baseline and repeat measurements made several years apart. After a median follow-up of 24.7years, 141 SCDs were recorded. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed and were corrected for within-person variability in Lp(a) levels. The regression dilution ratio of loge Lp(a) adjusted for age was 0.84 (95% CI: 0.81-0.88). Lipoprotein(a) levels were log-linearly associated with risk of SCD. In analyses adjusted for established risk factors, the HR (95% CI) for SCD per 1 standard deviation (3.56-fold) higher baseline loge Lp(a) was 1.24 (1.05-1.47; P=0.013). This remained consistent on further adjustment for alcohol consumption, resting heart rate, lipids, and C-reactive protein 1.23 (1.04-1.46; P=0.018). HRs remained unchanged after accounting for incident coronary events and did not vary importantly in several relevant clinical subgroups. Adding Lp(a) to a SCD risk prediction model did not significantly improve risk discrimination beyond established risk factors, but improved the continuous net reclassification 30.2% (1.1 to 59.2%, P=0.042). CONCLUSIONS Available evidence shows a continuous and independent association between Lp(a) levels and risk of SCD. Further research is needed to replicate these findings.
Collapse
Affiliation(s)
- Setor K Kunutsor
- School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, UK.
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kristiina Nyyssönen
- Eastern Finland Laboratory Center, and Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Central Hospital, Jyväskylä, Finland
| |
Collapse
|
15
|
Reviriego J, Vázquez LA, Goday A, Cabrera M, García-Margallo MT, Calvo E. Prevalence of impaired fasting glucose and type 1 and 2 diabetes mellitus in a large nationwide working population in Spain. ACTA ACUST UNITED AC 2016; 63:157-63. [PMID: 26948542 DOI: 10.1016/j.endonu.2015.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To report the prevalence of impaired fasting glucose (IFG), undiagnosed and diagnosed diabetes, and their association to occupational categories in a representative sample of working population in Spain. MATERIALS AND METHODS A cross-sectional study of workers who attended routine medical check-ups from January 2007 to December 2007. A structured questionnaire was completed, and physical examinations and routine serum biochemical tests were performed. IFG was defined as fasting glucose levels ranging from 100 to 125 mg/dl with no diagnosis of T1DM or T2DM; T1DM was defined as previous diagnosis of T1DM; and T2DM as previous diagnosis of T2DM, treatment with oral antidiabetic drugs or insulin or fasting glucose levels ≥126 mg/dl, according to ADA criteria. RESULTS Of the 371,997 participants (median age 35 [interquartile range 29-44] years), 72.4% were male. Raw prevalence rates (95% CI) of IFG, undiagnosed (UKDM), and previously known type 2 (KDM2) and type 1 (KDM1) diabetes were 10.4% (10.3-10.5%), 1.3% (1.2-1.3%), 1.1% (1.1-1.2%), and 0.3% (0.3-0.3%), respectively. With the exception of KDM1, prevalence of these conditions increased with age and was greater among manual/blue-collar workers (12.1%, 1.5%, 1.3% and 0.3%, respectively) as compared to non-manual/white-collar workers (7.3%, 0.8%, 0.8% and 0.3%, respectively). Age- and sex-adjusted prevalence rates of IFG, UKDM and KDM2 were 13.1%, 2.0% and 2.4%, respectively. DISCUSSION In this sample of Spanish working population, impaired glycemic profiles were common. Prevalence rates of IFG and T2DM were high among blue-collar workers (except for T1DM). These data emphasize the need for earlier structured preventive schemes.
Collapse
Affiliation(s)
- Jesús Reviriego
- Department of Clinical Research, Lilly, S.A., Alcobendas, Spain
| | | | - Albert Goday
- Endocrinology and Nutrition Unit, Hospital del Mar, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CiberOBN CIBER Fisiopatología Nutrición y Obesidad, ISCIII, Spain
| | | | | | - Eva Calvo
- Ibermutuamur, Mutual of Work-Related Accidents and Diseases Social Security No. 274, Madrid, Spain
| |
Collapse
|
16
|
Wu NQ, Li JJ. Clinical considerations of lipid target and goal in dyslipidemia control. Chronic Dis Transl Med 2016; 2:3-6. [PMID: 29063017 PMCID: PMC5643590 DOI: 10.1016/j.cdtm.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China
| |
Collapse
|
17
|
Stone NJ, Wilkins J, Kazmi S. Metabolic Profiles—Based on the 2013 Prevention Guidelines. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
18
|
Anyfanti P, Triantafyllou A, Panagopoulos P, Triantafyllou G, Pyrpasopoulou A, Chatzimichailidou S, Koletsos N, Botis I, Aslanidis S, Douma S. Predictors of impaired quality of life in patients with rheumatic diseases. Clin Rheumatol 2015; 35:1705-11. [PMID: 26700441 DOI: 10.1007/s10067-015-3155-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/28/2022]
Abstract
Quality of life (QoL) is a complex outcome and rheumatologic patients typically exhibit several comorbidities with a negative impact. In this study, we analyzed with respect to QoL for the first time a wide range of physical and psychological factors, including individual, clinical and disease-related parameters, mental health disorders, sexual dysfunction, and cardiovascular comorbidities among consecutive rheumatologic patients. QoL was evaluated using the EuroQol 5D (EQ-5D) utility index. The Health Assessment Questionnaire (HAQ) Disability Index, and the HAQ Pain Visual Analogue Scale were used as measures of physical disability and arthritis-related pain, respectively. The Hamilton Anxiety Scale and Zung Self-Rating Depression Scale, the International Index of Erectile Function and the Female Sexual Functioning Index were completed by all patients. In total, 360 patients were included, 301 females and 59 males. In the univariate analysis, pain, physical disability (p < 0.001 for both), disease duration (p = 0.014), anxiety and depression (p < 0.001 for both), as well as sexual dysfunction (p = 0.001 for females, p = 0.042 for males), correlated with QoL. Female sex (p < 0.001), advanced age (p = 0.029), lower educational level (p = 0.005), and cardiovascular factors (hypertension, dyslipidemia, diabetes, lack of systemic exercise) also appeared to negatively affect QoL. However, in the multiple regression model, only anxiety, pain, physical disability (p < 0.001 for all), and disease duration (p = 0.019) remained significant predictors of QoL. The emotional side and the disease-related physiological mode of rheumatic diseases appear as major independent correlates of QoL among rheumatologic patients, who may thus benefit the most from combined supportive psychological and pain-relieving interventions.
Collapse
Affiliation(s)
- Panagiota Anyfanti
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos str, 54643, Thessaloniki, Greece.
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Panagopoulos
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Pyrpasopoulou
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos str, 54643, Thessaloniki, Greece
| | - Sophia Chatzimichailidou
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos str, 54643, Thessaloniki, Greece
| | - Nikolaos Koletsos
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Botis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos str, 54643, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
19
|
van Capelleveen JC, van der Valk FM, Stroes ESG. Current therapies for lowering lipoprotein (a). J Lipid Res 2015; 57:1612-8. [PMID: 26637277 DOI: 10.1194/jlr.r053066] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Indexed: 01/21/2023] Open
Abstract
Lipoprotein (a) [Lp(a)] is a human plasma lipoprotein with unique structural and functional characteristics. Lp(a) is an assembly of two components: a central core with apoB and an additional glycoprotein, called apo(a). Ever since the strong association between elevated levels of Lp(a) and an increased risk for CVD was recognized, interest in the therapeutic modulation of Lp(a) levels has increased. Here, the past and present therapies aiming to lower Lp(a) levels will be reviewed, demonstrating that these agents have had varying degrees of success. The next challenge will be to prove that Lp(a) lowering also leads to cardiovascular benefit in patients with elevated Lp(a) levels. Therefore, highly specific and potent Lp(a)-lowering strategies are awaited urgently.
Collapse
Affiliation(s)
| | - Fleur M van der Valk
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Sumegi K, Jaromi L, Magyari L, Kovesdi E, Duga B, Szalai R, Maasz A, Matyas P, Janicsek I, Melegh B. Functional variants of lipid level modifier MLXIPL, GCKR, GALNT2, CILP2, ANGPTL3 and TRIB1 genes in healthy Roma and Hungarian populations. Pathol Oncol Res 2015; 21:743-9. [PMID: 25573592 DOI: 10.1007/s12253-014-9884-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 12/22/2014] [Indexed: 01/15/2023]
Abstract
The role of triglyceride metabolism in different diseases, such as cardiovascular or cerebrovascular diseases is still under extensive investigations. In genome-wide studies several polymorphisms have been reported, which are highly associated with plasma lipid level changes. Our goal was to examine eight variants: rs12130333 at the ANGPTL3, rs16996148 at the CILP2, rs17321515 at the TRIB1, rs17145738 and rs3812316 of the MLXIPL, rs4846914 at GALNT2, rs1260326 and rs780094 residing at the GCKR loci. A total of 399 Roma (Gypsy) and 404 Hungarian population samples were genotyped using PCR-RFLP method. Significant differences were found between Roma and Hungarian population samples in both MLXIPL variants (C allele frequency of rs17145738: 94.1% vs. 85.6%, C allele frequency of rs3812316: 94.2% vs. 86.8% in Romas vs. in Hungarians, p < 0.05), in ANGPTL3 (T allele frequency of rs1213033: 12.2% vs. 18.5% in Romas vs. Hungarians, p < 0.05) and GALNT2 (G allele frequency of rs4846914: 46.6% vs. 54.5% Romas vs. in Hungarians, p < 0.05), while no differences over SNPs could be verified and the known minor alleles showed no correlation with triglyceride levels in any population samples. The current study revealed fundamental differences of known triglyceride modifying SNPs in Roma population. Failure of finding evidence for affected triglyceride metabolism shows that these susceptibility genes are much less effective compared for example to the apolipoprotein A5 gene.
Collapse
Affiliation(s)
- Katalin Sumegi
- Department of Medical Genetics, Clinical Centre, University of Pecs, Szigeti u. 12, Pecs, H-7624, Hungary,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Effect of elastin-derived peptides on the production of tissue inhibitor of metalloproteinase-1, -2, and -3 and the ratios in various endothelial cell lines. Exp Ther Med 2015; 9:2245-2250. [PMID: 26136968 DOI: 10.3892/etm.2015.2429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 02/05/2015] [Indexed: 12/25/2022] Open
Abstract
Tissue inhibitors of metalloproteinases (TIMPs) control the activity of metalloproteinases. Elastin-derived peptides (EDPs) are generated as a result of the degradation of elastin fibers. The EDPs bind to the elastin receptor and exert numerous biological effects. The aim of the present study was to compare the production of TIMP-1, TIMP-2 and TIMP-3 and their ratios in human endothelial cells (ECs) derived from three clinically important vascular localizations (coronary arteries, aorta and iliac artery), and evaluate the influence of a well-known EDP, κ-elastin. The highest concentration of TIMP-1 was identified in the aortic ECs, while the lowest concentration was observed in the ECs derived from the coronary artery. The opposite pattern was observed for TIMP-2 production. When the TIMP-3 concentration was analyzed in the three EC lines, no statistically significant differences were observed. Application of κ-elastin was found to decrease the TIMP-1 concentration in the aortic ECs, while an increase in the TIMP-1 concentration was observed in the ECs derived from the iliac artery. The most significant decrease in TIMP-2 concentration following κ-elastin administration was observed in the ECs obtained from the coronary arteries. Furthermore, the highest concentration of κ-elastin resulted in an increase in TIMP-3 production in the ECs derived from the coronary arteries. The following ratios of the TIMP concentrations were calculated: TIMP-1/TIMP-2, TIMP-1/TIMP-3 and TIMP-2/TIMP-3. Each ratio presented different values for the ECs obtained from the various localizations. In the majority of cases, the addition of κ-elastin did not significantly change these proportions. Therefore, these indicators may be characteristic features that can be used to describe ECs in various clinically important vascular localizations.
Collapse
|
22
|
de Sousa MV, Fukui R, Krustrup P, Pereira RMR, Silva PRS, Rodrigues AC, de Andrade JL, Hernandez AJ, da Silva MER. Positive effects of football on fitness, lipid profile, and insulin resistance in Brazilian patients with type 2 diabetes. Scand J Med Sci Sports 2015; 24 Suppl 1:57-65. [PMID: 24944132 DOI: 10.1111/sms.12258] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 12/19/2022]
Abstract
We evaluated the effects of recreational football training combined with calorie-restricted diet (football + diet) vs calorie-restricted diet alone (diet) on aerobic fitness, lipid profile, and insulin resistance indicators in type 2 diabetes (T2D) patients. Forty-four T2D patients aged 48-68 years (27 females, 17 males) were randomly allocated to the football + diet group (FDG; n = 22) or to the diet group (DG; n = 22), of whom 19 FDG and 15 DG subjects completed the study. The football training was performed for 3 × 40 min/week for 12 weeks. Dual-energy X-ray absorptiometry scanning, treadmill testing, and fasting blood samplings were performed pre and post-intervention. After 12 weeks, maximal oxygen uptake (VO₂max ) was elevated (P < 0.05) by 10 ± 4% in FDG but not in DG (-3 ± 4%, P < 0.05). After 12 weeks, reductions in blood triglycerides (0.4 ± 0.1 mmol/L), total cholesterol (0.6 ± 0.2 mmol/L), low-density lipoprotein, and very low-density lipoprotein levels were observed only in FDG. Fat mass decreased (P < 0.05) by 3.4 ± 0.4 kg in FDG and 3.7 ± 0.4 kg in DG. The lower (P < 0.05) glucagon and homeostatic model assessment of insulin resistance indicated an improvement in insulin sensitivity in FDG. In conclusion, football combined with restricted diet was effective in enhancing VO₂max , reducing total cholesterol and triglycerides, and increasing insulin sensitivity, potentially providing better tools for the prevention of T2D complications than diet alone.
Collapse
Affiliation(s)
- M V de Sousa
- Laboratory of Medical Investigation, LIM-18, Endocrinology Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Skoczyńska A. Postprandial decrease in LDL-cholesterol in men with metabolic syndrome. Open Med (Wars) 2015; 10:138-151. [PMID: 28352689 PMCID: PMC5153088 DOI: 10.1515/med-2015-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 03/31/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In some epidemiological studies, blood lipids are determined at non-fasting state, which may impact cardiovascular risk estimation. The aim of this study was to evaluate postprandial LDL-C changes in men with newly diagnosed metabolic syndrome (MetSy). METHODS 36 male patients were examined: 12 men with and 24 men without MetSy. The fat tolerance test was performed before and after a three-month hypolipidemic treatment. Serum lipids were measured using routine methods, lipid peroxides (LPO) colorimetrically, apolipoproteins A-I, B, and hsCRP immunoturbidimetrically. RESULTS The postprandial increase in triglycerides was associated with a decrease in LDL-C and a small decrease in apo B. In men with MetSy, the mean change in LDL-C (-19.5 ± 2.3 mg/dl) was greater than in healthy men (-5.7 ± 3.8 mg/dl). All lipid changes (ΔTG, ΔLDL-C and ΔLPO) were linearly dependent on the postprandial non-LDL-cholesterol. After three months of hypolipidemic treatment, in all men with MetSy, the apoB/apoA-I ratio remained the same as before the therapy. CONCLUSION In men diagnosed with MetSy, postprandial decreases in LDL-cholesterol may cause underestimation of cardiovascular risk. After three months of hypolipidemic treatment, there was only a partial reduction in this risk, as the apoB/apoA-I ratio remained the same.
Collapse
|
24
|
Miller GD, Isom S, Morgan TM, Vitolins MZ, Blackwell C, Brosnihan KB, Diz DI, Katula J, Goff D. Effects of a community-based weight loss intervention on adipose tissue circulating factors. Diabetes Metab Syndr 2014; 8:205-211. [PMID: 25293442 PMCID: PMC4254144 DOI: 10.1016/j.dsx.2014.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Obesity is associated with metabolic dysfunctions, which may be mediated by changes in adipose tissue signaling factors. These molecules are denoted as Adipose Tissue Generated Mediators of CardioVascular Risk (ATGMCVR) here, and include leptin, adiponectin, C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and plasminogen activator inhibitor 1 (PAI-1). This study examined the effect of a weight loss program on ATGMCVR in obese adults with prediabetes. MATERIALS AND METHODS Subjects were randomized to usual care (UC; n=15) or lifestyle weight loss groups (LWL; n=15). LWL was a community-based weight loss intervention to promote physical activity and healthy eating. ATGMCVR at 1-year were compared between groups by analysis of covariance; baseline value of the mediator was the covariate. Baseline means for ATGMCVR were compared between those with (n=21) and without (n=9) metabolic syndrome (MetS). RESULTS At baseline, subjects were 58±9 (SD) years, 70% female, with a BMI of 34±4kg/m(2). One-year weight loss (%) was 7.8±6.0% for LWL and 1.7±4.5% for UC. Group differences at 1-year were noted (adjusted means [95%CI] for UC and LWL, respectively) for adiponectin (8526.3 [7397.7, 9827]; 10,870.9 [9432.0, 12,529.3]ng/ml; p=0.02), leptin (30.4 [26.1, 35.4]; 23.7 [20.3, 27.5]ng/ml; p=0.02), IL-6 (0.4 [0.3, 0.5]; 0.2 [0.1, 0.2] pg/ml; p=0.001), and PAI-1 (50 [42.7, 58.7]; 36.2 [30.8, 42.4]pg/ml; p=0.01). No differences in baseline ATGMCVR were seen between subjects with and without MetS. CONCLUSION These findings suggest ATGMCVR can be improved with weight loss; larger studies are needed to determine if improvements in metabolic dysfunction are related to changes in ATGMCVR.
Collapse
Affiliation(s)
- Gary D Miller
- Department of Health and Exercise Science, and Translational Science Center, Wake Forest University, United States.
| | - Scott Isom
- Department of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Timothy M Morgan
- Department of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Mara Z Vitolins
- Department of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Caroline Blackwell
- Department of Public Health Sciences, Wake Forest School of Medicine, United States
| | - K Bridget Brosnihan
- Department of General Surgery and The Hypertension and Vascular Research Center, Wake Forest School of Medicine, United States
| | - Debra I Diz
- Department of General Surgery and The Hypertension and Vascular Research Center, Wake Forest School of Medicine, United States
| | - Jeff Katula
- Department of Health and Exercise Science, and Translational Science Center, Wake Forest University, United States
| | - David Goff
- Colorado School of Public Health, United States
| |
Collapse
|
25
|
Expert Panel Report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring) 2014; 22 Suppl 2:S41-410. [PMID: 24227637 DOI: 10.1002/oby.20660] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
26
|
Anyfanti P, Gavriilaki E, Pyrpasopoulou A, Triantafyllou G, Triantafyllou A, Chatzimichailidou S, Gkaliagkousi E, Aslanidis S, Douma S. Depression, anxiety, and quality of life in a large cohort of patients with rheumatic diseases: common, yet undertreated. Clin Rheumatol 2014; 35:733-9. [PMID: 24859781 DOI: 10.1007/s10067-014-2677-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 12/31/2022]
Abstract
A growing amount of literature has explored mainly the role of depression (and/or anxiety) in patients with rheumatic disorders. We aimed at determining the prevalence of depression, anxiety, and their association with quality of life among patients attending a rheumatology clinic, focusing on data regarding concomitant psychiatric treatment. Depression, anxiety, and quality of life were assessed using the Zung Self-Rating Depression Scale, the Hamilton Anxiety Scale, and the Health Assessment Questionnaire, respectively. Overall, 514 rheumatologic patients were studied. Depression and anxiety were documented in 21.8 and 30.8 % of the population, respectively, and correlated significantly with quality of life. Only 13.4 % of patients with depressive symptoms and 12.1 % of patients with anxiety symptoms were receiving antidepressant or antianxiety medication. Given the wide therapeutic armamentarium available nowadays for the management of depression and anxiety, an increased awareness among physicians dealing with rheumatologic patients is warranted in order to integrate detection and effective treatment of anxiety and depression into the routine clinical practice. Special attention should be paid to female patients, patients with longer disease duration, and/or those with established disability.
Collapse
Affiliation(s)
- Panagiota Anyfanti
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece.
| | - Athina Pyrpasopoulou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
| | - Sofia Chatzimichailidou
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Ring Road Nea Eukarpia, 56403, Thessaloniki, Greece
| |
Collapse
|
27
|
Lian XQ, Zhao D, Zhu M, Wang ZM, Gao W, Zhao H, Zhang DG, Yang ZJ, Wang LS. The influence of regular walking at different times of day on blood lipids and inflammatory markers in sedentary patients with coronary artery disease. Prev Med 2014; 58:64-9. [PMID: 24201089 DOI: 10.1016/j.ypmed.2013.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/25/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the influence of walking at different times of day on lipids and inflammatory markers in sedentary patients with coronary artery disease (CAD). METHODS A total of 330 patients recruited from Nanjing between September 2011 and November 2012 were randomly assigned to a control group (n=110), morning (n=110) or evening walking group (n=110). Both the walking groups were asked to walk 30 min/day or more on at least 5 days/week either in the morning or evening for 12 weeks. Lipids and inflammatory markers were measured before and after exercise intervention. RESULTS Compared with baseline, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were improved in all groups. Significances were shown in the changes of fibrinogen, high sensitivity C-reactive protein (hsCRP), white blood cell (WBC) count, TC, triglycerides, LDL-C, lipoprotein(a) between groups. The evening walking group had a larger decrease in fibrinogen (0.16 ± 0.19 g/L, P<0.001), hsCRP (1.16 ± 1.07 mg/L, P<0.001), WBC count (0.76 ± 1.53·10(9)/L, P=0.004) and LDL-C (0.34 ± 0.31 mmol/L, P<0.001) than the other two groups. CONCLUSIONS Our walking program successfully resulted in a favorable change in lipids and inflammatory markers. Patients in the evening walking group gained more benefits than those walking in the morning walking group. NCT01887093.
Collapse
Affiliation(s)
- Xiao-Qing Lian
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Di Zhao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Meng Zhu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ze-Mu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Gao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huan Zhao
- Department of Cardiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China
| | - Ding-Guo Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhi-Jian Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lian-Sheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| |
Collapse
|
28
|
Chalermchai T, Hiransuthikul N, Tangkijvanich P, Pinyakorn S, Avihingsanon A, Ananworanich J. Risk factors of chronic hepatitis in antiretroviral-treated HIV infection, without hepatitis B or C viral infection. AIDS Res Ther 2013; 10:21. [PMID: 23885958 PMCID: PMC3727961 DOI: 10.1186/1742-6405-10-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/23/2013] [Indexed: 12/15/2022] Open
Abstract
Background Increasing rates of non-AIDS defining illnesses, and in particular liver diseases, have been found after the initiation of highly active antiretroviral therapy. However, there is little evidence concerning the risk factors for and clinical characteristics of liver disease in antiretroviral (ARV)-treated HIV infection, in the absence of hepatitis B or C viral co-infection. Methods A nested case–control study of HIV infected volunteers, matched by starting date of anti-retroviral treatment, was conducted in a Thai cohort studied from Nov 2002 - July 2012. Cases were defined as those subjects with an elevated alanine aminotransferase (ALT ≥ 40 IU/L) at two consecutive visits six months apart, while controls were defined as individuals who never demonstrated two consecutive elevated ALT results and had a normal ALT result (< 40 IU/L) at their last visit. Both groups had normal ALT levels prior to ARV initiation. Clinical demographics and risk factors for chronic hepatitis including HIV-related illness, ARV treatment and metabolic diseases were collected and analyzed. Conditional logistic regression was used to determine risk factors for chronic hepatitis in HIV infection. Results A total of 124 matched pairs with HIV infection were followed over 3,195 person-years. The mean age (±SD) was 33.0 ± 7.3 years, with 41.1% of subjects being male. The incidence of chronic hepatitis was 5.4 per 100 person-years. The median time from initiation of ARV to chronic hepatitis was 1.3 years (IQR, 0.5-3.5). From univariate analysis; male sex, plasma HIV-1 RNA level > 5 log 10 copies/ml, metabolic syndrome at baseline visit, high BMI > 23 kg/m2, abnormal HDL cholesterol at time of ALT elevation and treatment experience with NNRTI plus boosted PI were selected (p value < 0.2) to the final model of multivariate analysis. Male sex had 3.1 times greater risk of chronic hepatitis than the females by multivariate analysis (adjusted OR, 95% CI: 3.1, 1.5-6.3, p =0.002). High BMI ≥ 23 kg/m2 was also associated with 2.4 times greater risk of chronic hepatitis (adjusted OR, 95% CI: 2.4, 1.2-4.8, p = 0.01). Conclusions Chronic hepatitis in ARV-treated HIV-infected patients is common and may lead to a major health care problem. Male sex and high BMI ≥ 23 kg/m2 carry higher risks for developing chronic hepatitis in this study. Therefore, these patients should be closely monitored for long-term hepatotoxicity.
Collapse
|
29
|
Lee P, Hegele RA. Current Phase II proprotein convertase subtilisin/kexin 9 inhibitor therapies for dyslipidemia. Expert Opin Investig Drugs 2013; 22:1411-23. [PMID: 23889692 DOI: 10.1517/13543784.2013.822485] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Reduction of plasma low-density lipoprotein (LDL) cholesterol concentration with statins reduces adverse cardiovascular outcomes. However, lack of efficacy and intolerance of statins in many patients requires alternative treatments. Currently available non-statin alternatives include bile acid sequestrants, the cholesterol absorption inhibitor ezetimibe, niacin-based preparations and fibrates; however, each of these has limitations. Newer agents for LDL cholesterol reduction include the cholesterol ester transfer protein inhibitors, the microsomal triglyceride transfer protein inhibitor lomitapide, the apolipoprotein B antisense oligonucleotide mipomersen and several molecules that inhibit or interfere with proprotein convertase subtilisin/kexin 9 (PCSK9). AREAS COVERED Among the various PCSK9 inhibitors, human data are available for monoclonal antibodies against PCSK9 of which the two most advanced are alirocumab (SAR236553/REGN727) and AMG 145. Phase II studies of these agents as monotherapy or in combination with statins have shown reductions of LDL cholesterol by > 70%, with acceptable safety and tolerability so far. EXPERT OPINION Despite their biochemical efficacy, clinical efficacy, reflected by reduction of cardiovascular end points, remains to be shown for two leading monoclonal antibodies against PSCK9. Other issues to be evaluated with these agents over the longer term include development of rare adverse effects and potential attenuation of efficacy.
Collapse
Affiliation(s)
- Paul Lee
- University of Western Ontario, Schulich School of Medicine and Dentistry, Department of Medicine and Robarts Research Institute , London, Ontario, N6A 5K8 , Canada
| | | |
Collapse
|
30
|
Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC, Gulati M, Madan K, Rhodes J, Thompson PD, Williams MA. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128:873-934. [PMID: 23877260 DOI: 10.1161/cir.0b013e31829b5b44] [Citation(s) in RCA: 1205] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
31
|
Licht CMM, de Geus EJC, Penninx BWJH. Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome. J Clin Endocrinol Metab 2013; 98:2484-93. [PMID: 23553857 DOI: 10.1210/jc.2012-3104] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Stress is suggested to lead to metabolic dysregulations as clustered in the metabolic syndrome. Although dysregulation of the autonomic nervous system is found to associate with the metabolic syndrome and its dysregulations, no longitudinal study has been performed to date to examine the predictive value of this stress system in the development of the metabolic syndrome. OBJECTIVE We examined whether autonomic nervous system functioning predicts 2-year development of metabolic abnormalities that constitute the metabolic syndrome. DESIGN Data of the baseline and 2-year follow-up assessment of a prospective cohort: the Netherlands Study of Depression and Anxiety was used. SETTING Participants were recruited in the general community, primary care, and specialized mental health care organizations. PARTICIPANTS A group of 1933 participants aged 18-65 years. MAIN OUTCOME MEASURES The autonomic nervous system measures included heart rate (HR), respiratory sinus arrhythmia (RSA; high RSA reflecting high parasympathetic activity), pre-ejection period (PEP; high PEP reflecting low sympathetic activity), cardiac autonomic balance (CAB), and cardiac autonomic regulation (CAR). Metabolic syndrome was based on the updated Adult Treatment Panel III criteria and included high waist circumference, serum triglycerides, blood pressure, serum glucose, and low high-density lipoprotein (HDL) cholesterol. RESULTS Baseline short PEP, low CAB, high HR, and CAR were predictors of an increase in the number of components of the metabolic syndrome during follow-up. High HR and low CAB were predictors of a 2-year decrease in HDL cholesterol, and 2-year increase in diastolic and systolic blood pressure. Short PEP and high CAR also predicted a 2-year increase in systolic blood pressure, and short PEP additionally predicted 2-year increase in diastolic blood pressure. Finally, a low baseline RSA was predictive for subsequent decreases in HDL cholesterol. CONCLUSION Increased sympathetic activity predicts an increase in metabolic abnormalities over time. These findings suggest that a dysregulation of the autonomic nervous system is an important predictor of cardiovascular diseases and diabetes through dysregulating lipid metabolism and blood pressure over time.
Collapse
Affiliation(s)
- Carmilla M M Licht
- Department of Psychiatry, Vrije Universiteit (VU) University Medical Center Amsterdam, The Netherlands.
| | | | | |
Collapse
|
32
|
Chehade JM, Gladysz M, Mooradian AD. Dyslipidemia in Type 2 Diabetes: Prevalence, Pathophysiology, and Management. Drugs 2013; 73:327-39. [DOI: 10.1007/s40265-013-0023-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
33
|
Romero WG, Da Silva FB, Borgo MV, Bissoli NS, Gouvêa SA, Abreu GR. Tamoxifen alters the plasma concentration of molecules associated with cardiovascular risk in women with breast cancer undergoing chemotherapy. Oncologist 2012; 17:499-507. [PMID: 22491005 DOI: 10.1634/theoncologist.2011-0369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of tamoxifen on blood markers that are associated with cardiovascular risk, such as C-reactive protein (CRP), apolipoprotein A-1 (Apo-A), and apolipoprotein B-100 (Apo-B), in women undergoing chemotherapy for breast cancer. METHODS Over a period of 12 months, we followed 60 women with breast cancer. The women were divided into the following groups: a group that received only chemotherapy (n = 23), a group that received chemotherapy plus tamoxifen (n = 21), and a group that received only tamoxifen (n = 16). Plasma CRP levels were assessed at 0, 3, 6, and 12 months, and Apo-A and Apo B levels as well as the Apo-B/Apo-A ratio were assessed at 0 and 12 months. RESULTS We found increases in the plasma concentration of CRP in the chemotherapy alone and chemotherapy plus tamoxifen groups after 3 and 6 months of treatment (before the introduction of tamoxifen). However, after 12 months of treatment, women who used tamoxifen (the chemotherapy plus tamoxifen and tamoxifen alone groups) showed a significant reduction in CRP and Apo-B levels and a decrease in the Apo-B/Apo-A ratio. A significant increase in serum Apo-A levels was observed in the group receiving chemotherapy alone as a treatment for breast cancer. CONCLUSION The use of tamoxifen after chemotherapy for the treatment of breast cancer significantly reduces the levels of cardiovascular disease risk markers (CRP, Apo-B, and the Apo-B/Apo-A ratio).
Collapse
Affiliation(s)
- Walckiria G Romero
- Department Ciências Fisiológicas, Centro de Ciências da Saúde, UFES, Avenida Marechal Campos 1468, 29042-755 Vitória, ES, Brazil
| | | | | | | | | | | |
Collapse
|
34
|
Kiser EJ, Magano J, Shine RJ, Chen MH. Kilogram-Lab-Scale Oxindole Synthesis via Palladium-Catalyzed C–H Functionalization. Org Process Res Dev 2012. [DOI: 10.1021/op200332p] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Javier Magano
- Chemical Research and Development, Pfizer Inc., Eastern Point Road, Groton, Connecticut
06340, United States
| | - Russell J. Shine
- Chemical Research and Development, Pfizer Inc., Eastern Point Road, Groton, Connecticut
06340, United States
| | | |
Collapse
|
35
|
Valente EA, Sheehy ME, Avila JJ, Gutierres JA, Delmonico MJ, Lofgren IE. The effect of the addition of resistance training to a dietary education intervention on apolipoproteins and diet quality in overweight and obese older adults. Clin Interv Aging 2011; 6:235-41. [PMID: 21966218 PMCID: PMC3180520 DOI: 10.2147/cia.s23583] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives The aim of the study was to examine the additive effect of resistance training (RT) to a dietary education (DE) intervention on emerging coronary heart disease (CHD) risk factors, concentration of apolipoproteins B (apoB) and A-I (apoA-I), and Dietary Approaches to Stop Hypertension (DASH) Diet Index scores in overweight and obese older adults. Patients and methods This was an ancillary study of a randomized clinical trial held in the Fall of 2008 at the University of Rhode Island. Participants were overweight or obese subjects (mean body mass index [BMI] of 31.7 kg/m2) randomized into two groups, one participating in DE only (n = 12) and the other participating in DE plus RT (DERT) (n = 15). The intervention involved all subjects participating in 30 minutes of DE per week for 10 weeks. Subjects in the DERT group participated in an additional 40 minutes of RT three times per week for 10 weeks. Measurements taken were anthropometric (height, weight, waist circumference, and body composition using the BOD POD® [Body Composition System, v 2.14; Life Measurement Instruments, Concord, CA]), clinical (blood pressure), and biochemical (lipid profile and apoB and apoA-I concentrations), and the DASH Diet Index was used to measure diet quality. Results 27 subjects (11 males, 16 females), with a mean age of 66.6 ± 4.3 years, were included in analyses. The DERT subjects had significantly better triacylglycerol and apoB concentrations and DASH Diet Index scores than the DE subjects post-intervention. Improvements were seen within the DE group in energy intake, fat-free mass, and systolic blood pressure and within the DERT group in body weight, percentage of body fat, BMI, diastolic blood pressure, and oxidized low-density lipoprotein (all P < 0.05). Conclusion The addition of RT effectively reduced CHD risk factors, body composition, and diet quality in overweight and obese older adults; DERT was more effective than DE alone in improving DASH Diet Index scores and lowering apoB concentrations but was not more effective in increasing apoA-I concentrations. Future research is needed to determine if apolipoproteins are superior to lipoprotein cholesterol concentrations in predicting CHD risk.
Collapse
Affiliation(s)
- Elizabeth A Valente
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
Correction of diabetic dyslipidaemia in diabetic patients is the most important factor in reducing cardiac risk. Diabetic dyslipidaemia is characterized by elevated triglycerides, low total high-density lipoprotein (HDL) and small dense low-density lipoprotein (LDL) particles. The most important therapeutic goal in diabetic dyslipidaemia is correction of the non-HDL-cholesterol (HDL-C) level. Glycaemic control with particular attention to postprandial glucose control plays a role not only in improving dyslipidaemia but also in lowering cardiac events. Pioglitazone is particularly effective for improving the manifestations of diabetic dyslipidaemia, in addition to its favorable effects on systemic inflammation and hyperglycaemia. Use of statins in addition to lifestyle change is recommended in most if not all type 2 diabetic patients and the goal should be to lower the LDL to a level recommended for the patient with existing cardiovascular disease (CVD) (non-HDL-C level <100 mg/dl). In addition, therapies for normalization of HDL and triglyceride levels should be deployed. Most patients with type 2 diabetes (T2D) will require combining a lipid-lowering therapy with therapeutic lifestyle changes to achieve optimal lipid levels. Combinations usually include two or more of the following: a statin, nicotinic acid, omega-3 fats and bile acid sequestrants (BASs). Fibrates may also be of use in diabetic patients with persistently elevated triglycerides and depressed HDL-C levels, although their role in lowering adverse CV events is questionable.
Collapse
Affiliation(s)
- D S H Bell
- Department of Endocrinology, University of Alabama, Birmingham, AL 35205, USA.
| | | | | |
Collapse
|
37
|
Nash MS, Lewis JE, Dyson-Hudson TA, Szlachcic Y, Yee F, Mendez AJ, Spungen AM, Bauman WA. Safety, tolerance, and efficacy of extended-release niacin monotherapy for treating dyslipidemia risks in persons with chronic tetraplegia: a randomized multicenter controlled trial. Arch Phys Med Rehabil 2011; 92:399-410. [PMID: 21276961 DOI: 10.1016/j.apmr.2010.06.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/07/2010] [Accepted: 06/23/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To test the safety, tolerance, and efficacy of extended-release niacin monotherapy on dyslipidemia in persons with chronic tetraplegia. DESIGN Placebo-controlled, blinded, multicenter, randomized controlled trial. SETTING Three spinal cord injury research/rehabilitation centers. PARTICIPANTS Persons with chronic tetraplegia (N=54) and low plasma high-density lipoprotein cholesterol (HDL-C) levels. INTERVENTION Extended-release niacin monotherapy (48 weeks; n=31) on a dose-titration schedule versus matched placebo (n=23). MAIN OUTCOME MEASURES Safety was assessed by using percentages of treatment-emergent adverse events and increased levels of hepatic transaminases, uric acid, glycosylated hemoglobin, and fasting glucose. Tolerance was assessed by using participant reports for frequency and intensity of adverse effects of extended-release niacin. Primary effectiveness outcomes were fasting HDL-C level and plasma total cholesterol (TC)/HDL-C ratio. Secondary outcomes included plasma low-density lipoprotein cholesterol (LDL-C) and TC levels and LDL-C/HDL-C ratio. RESULTS Significant increases in fasting HDL-C levels (24.5%) were accompanied by decreases in TC/HDL-C and LDL-C/HDL-C ratios, LDL-C levels, and TC levels (all P<.05). No evidence of sustained hepatotoxicity or hyperglycemia was observed. Treatment-emergent withdrawals (12.9%) accompanied flushing (n=1), hypotension/presyncope (n=1), and diarrhea (n=2). One subject experienced transient hyperuricemia. Other drug-reported symptoms did not differ from those for placebo. CONCLUSIONS Extended-release niacin monotherapy is safe, tolerated, and effective for most persons with chronic tetraplegia. Special precautions for changes in bowel habits and postadministration hypotension should be observed.
Collapse
Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Libby A, Meier J, Lopez J, Swislocki ALM, Siegel D. The effect of body mass index on fasting blood glucose and development of diabetes mellitus after initiation of extended-release niacin. Metab Syndr Relat Disord 2010; 8:79-84. [PMID: 19943800 DOI: 10.1089/met.2009.0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Niacin increases blood glucose, but whether the degree of increase is associated with increasing body mass index (BMI) is unknown. We evaluated the effect of extended-release niacin initiation on fasting plasma glucose (FPG) and the development of new-onset diabetes mellitus (DM) in relation to body mass index (kg/m(2)) in nondiabetic patients. METHODS This retrospective observational study used data from six facilities within a geographical region of the Department of Veterans Affairs (VA). Patients included were 18 years of age or older and on a stable extended-release niacin dose (minimum 100 days) of at least 250 mg/day between January, 2001, and April, 2007. Patients were excluded if they were new to the VA, on corticosteroids or insulin, if medication adherence was <80%, or if they met criteria for DM. RESULTS A total of 811 nondiabetic patients taking extended-release niacin initiation were studied. FPG after niacin initiation was stastically significantly correlated with increasing BMI (P < 0.001, R = 0.144 Pearson correlation coefficient). Factors independently associated with change in FPG using multiple linear regression were BMI (P = 0.043), baseline average glucose (P < 0.001), and baseline average triglycerides (P = 0.037). Of all patients started on niacin, 220 (27.1%) patients developed DM after niacin initiation. BMI, (P = 0.002) and baseline average glucose (P < 0.001) were independent predictors of the development of new-onset DM (logistic regression analysis). CONCLUSIONS We found an association between increasing BMI and increasing FPG and diagnosis of new-onset DM after initiation of extended-release niacin initiation. This suggests that extended-release niacin may increase FPG into the diabetic range, especially for obese patients.
Collapse
Affiliation(s)
- Ardelle Libby
- Pharmacy Service, Department of Veterans Affairs, Northern California Health Care System, Martinez, California 95655, USA
| | | | | | | | | |
Collapse
|
39
|
Mangravite LM, Medina MW, Cui J, Pressman S, Smith JD, Rieder MJ, Guo X, Nickerson DA, Rotter JI, Krauss RM. Combined influence of LDLR and HMGCR sequence variation on lipid-lowering response to simvastatin. Arterioscler Thromb Vasc Biol 2010; 30:1485-92. [PMID: 20413733 DOI: 10.1161/atvbaha.110.203273] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although statins are efficacious for lowering low-density lipoprotein cholesterol, there is wide interindividual variation in response. We tested the extent to which combined effects of common alleles of LDLR and HMGCR can contribute to this variability. METHODS AND RESULTS Haplotypes in the LDLR 3'-untranslated region (3-UTR) were tested for association with lipid-lowering response to simvastatin treatment in the Cholesterol and Pharmacogenetics trial (335 blacks and 609 whites). LDLR haplotype 5 (LDLR L5) was associated with smaller simvastatin-induced reductions in low-density lipoprotein cholesterol, total cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B (P=0.0002 to 0.03) in blacks but not whites. The combined presence of LDLR L5 and previously described HMGCR haplotypes in blacks was associated with significantly attenuated apolipoprotein B reduction (-22.4+/-1.5%, N=89) compared with both noncarriers (-30.6+/-1.5%, N=78, P=0.0001) and carriers of either individual haplotype (-28.2+/-1.1%, N=158, P=0.001). We observed similar differences when measuring simvastatin-mediated induction of low-density lipoprotein receptor surface expression using lymphoblast cell lines (P=0.03). CONCLUSIONS We have identified a common LDLR 3-UTR haplotype that is associated with attenuated lipid-lowering response to simvastatin treatment. Response was further reduced in individuals with both LDLR and previously described HMGCR haplotypes. Previously identified racial differences in statin efficacy were partially explained by the greater prevalence of these combined haplotypes in blacks.
Collapse
Affiliation(s)
- Lara M Mangravite
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr. Way, Oakland, CA 94609, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Barber MJ, Mangravite LM, Hyde CL, Chasman DI, Smith JD, McCarty CA, Li X, Wilke RA, Rieder MJ, Williams PT, Ridker PM, Chatterjee A, Rotter JI, Nickerson DA, Stephens M, Krauss RM. Genome-wide association of lipid-lowering response to statins in combined study populations. PLoS One 2010; 5:e9763. [PMID: 20339536 PMCID: PMC2842298 DOI: 10.1371/journal.pone.0009763] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 02/22/2010] [Indexed: 11/18/2022] Open
Abstract
Background Statins effectively lower total and plasma LDL-cholesterol, but the magnitude of decrease varies among individuals. To identify single nucleotide polymorphisms (SNPs) contributing to this variation, we performed a combined analysis of genome-wide association (GWA) results from three trials of statin efficacy. Methods and Principal Findings Bayesian and standard frequentist association analyses were performed on untreated and statin-mediated changes in LDL-cholesterol, total cholesterol, HDL-cholesterol, and triglyceride on a total of 3932 subjects using data from three studies: Cholesterol and Pharmacogenetics (40 mg/day simvastatin, 6 weeks), Pravastatin/Inflammation CRP Evaluation (40 mg/day pravastatin, 24 weeks), and Treating to New Targets (10 mg/day atorvastatin, 8 weeks). Genotype imputation was used to maximize genomic coverage and to combine information across studies. Phenotypes were normalized within each study to account for systematic differences among studies, and fixed-effects combined analysis of the combined sample were performed to detect consistent effects across studies. Two SNP associations were assessed as having posterior probability greater than 50%, indicating that they were more likely than not to be genuinely associated with statin-mediated lipid response. SNP rs8014194, located within the CLMN gene on chromosome 14, was strongly associated with statin-mediated change in total cholesterol with an 84% probability by Bayesian analysis, and a p-value exceeding conventional levels of genome-wide significance by frequentist analysis (P = 1.8×10−8). This SNP was less significantly associated with change in LDL-cholesterol (posterior probability = 0.16, P = 4.0×10−6). Bayesian analysis also assigned a 51% probability that rs4420638, located in APOC1 and near APOE, was associated with change in LDL-cholesterol. Conclusions and Significance Using combined GWA analysis from three clinical trials involving nearly 4,000 individuals treated with simvastatin, pravastatin, or atorvastatin, we have identified SNPs that may be associated with variation in the magnitude of statin-mediated reduction in total and LDL-cholesterol, including one in the CLMN gene for which statistical evidence for association exceeds conventional levels of genome-wide significance. Trial Registration PRINCE and TNT are not registered. CAP is registered at Clinicaltrials.gov NCT00451828
Collapse
Affiliation(s)
- Mathew J. Barber
- Department of Human Genetics, University of Chicago, Chicago, Illinois, United States of America
| | - Lara M. Mangravite
- Children's Hospital Oakland Research Institute, Oakland, California, United States of America
| | - Craig L. Hyde
- Statistical Application, Pfizer Global Research and Development, Groton, Connecticut, United States of America
| | - Daniel I. Chasman
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joshua D. Smith
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Catherine A. McCarty
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - Xiaohui Li
- Medical Genetics Institute, Cedars-Sinai Medical Center, West Los Angeles, California, United States of America
| | - Russell A. Wilke
- Department of Pharmacology and Toxicology and Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Mark J. Rieder
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Paul T. Williams
- Life Sciences Division, Ernest Orlando Lawrence Berkeley National Laboratory, Berkeley, California, United States of America
| | - Paul M. Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aurobindo Chatterjee
- Statistical Application, Pfizer Global Research and Development, Groton, Connecticut, United States of America
| | - Jerome I. Rotter
- Medical Genetics Institute, Cedars-Sinai Medical Center, West Los Angeles, California, United States of America
| | - Deborah A. Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington, United States of America
| | - Matthew Stephens
- Department of Human Genetics, University of Chicago, Chicago, Illinois, United States of America
- Department of Statistics, University of Chicago, Chicago, Illinois, United States of America
| | - Ronald M. Krauss
- Children's Hospital Oakland Research Institute, Oakland, California, United States of America
- * E-mail:
| |
Collapse
|
41
|
Sager HB, Linsel-Nitschke P, Mayer B, Lieb W, Franzel B, Elsasser U, Schunkert H. Physicians' perception of guideline-recommended low-density lipoprotein target values: characteristics of misclassified patients. Eur Heart J 2010; 31:1266-73. [PMID: 20219745 DOI: 10.1093/eurheartj/ehq026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The present study investigated the awareness of primary care physicians for patient characteristics relevant for designation of low-density lipoprotein (LDL) target values. METHODS AND RESULTS Physicians (n = 907) were asked to estimate guideline-recommended LDL target value for 30 of their patients with hyperlipidaemia. In total, 25 250 patients were allocated on that basis in three different groups (LDL target <100, <130, and <160 mg/dL), in which by guideline criteria 68.0, 21.9, and 10.1% of patients, respectively, were allocated. We analysed (by logistic regression) whether physicians utilized risk factors and co-morbidities appropriately for assignment of correct LDL target values. Overall, physicians estimated recommended LDL target values correctly in 55.1% of male vs. 49.1% of female patients (P < 0.001). In the group with LDL targets of <100 mg/dL, correct assignment was most often given to male patients with a history of myocardial infarction (MI; 77.1%). In comparison with this group, increasing probabilities for incorrect assignment were found in patients with documented coronary artery disease (CAD) without a history of MI [odds ratio (OR): 2.08, 95% confidence intervals (95% CI): 1.87-2.33], CAD-equivalent conditions (OR: 2.30, 95% CI: 2.08-2.55), and a 10-year risk >20% based on calculated risk scores (OR: 2.69, 95% CI: 2.40-3.02). Next, physicians were grouped, based on the number of correct assignments they gave to their patients, in quartiles of guideline knowledge. In patients from physicians of the top performing quartile (>90% of correct assignments), LDL levels were significantly lower than in the second, third, and fourth quartiles (LDL 134.3, 138.8, 145.5, 151.4 mg/dL, P < 0.001 between all groups). CONCLUSION In primary care, about half of high-risk patients receive correct assignment of guideline-recommended LDL targets by their physicians. Perception of correct LDL target values varied largely depending on patients' gender and co-morbid conditions. Poor perception of risk resulted in lower rates of objective LDL target achievement.
Collapse
Affiliation(s)
- Hendrik B Sager
- Medizinische Klinik II, Universitätsklinik Schleswig Holstein, Campus Lübeck, Ratzeburger Allee, Lübeck, Germany
| | | | | | | | | | | | | |
Collapse
|
42
|
Aucella F, Maas R, Vigilante M, Tripepi G, Schwedhelm E, Margaglione M, Gesualdo L, Boeger R, Zoccali C. Methylarginines and mortality in patients with end stage renal disease: A prospective cohort study. Atherosclerosis 2009; 207:541-5. [DOI: 10.1016/j.atherosclerosis.2009.05.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/30/2022]
|
43
|
Michos ED, Blumenthal RS. Prevalence of Low Low-Density Lipoprotein Cholesterol With Elevated High Sensitivity C-Reactive Protein in the U.S. J Am Coll Cardiol 2009; 53:931-5. [PMID: 19281922 DOI: 10.1016/j.jacc.2008.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 12/03/2008] [Accepted: 12/08/2008] [Indexed: 12/01/2022]
Affiliation(s)
- Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | | |
Collapse
|
44
|
Best LG, Ferrell RE, Decroo S, North KE, Maccluer JW, Zhang Y, Lee ET, Howard BV, Umans J, Palmieri V, Garred P. Genetic and other factors determining mannose-binding lectin levels in American Indians: the Strong Heart Study. BMC MEDICAL GENETICS 2009; 10:5. [PMID: 19161617 PMCID: PMC2637849 DOI: 10.1186/1471-2350-10-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 01/22/2009] [Indexed: 01/30/2023]
Abstract
Background Mannose-binding lectin (MBL) forms an integral part of the innate immune system. Persistent, subclinical infections and chronic inflammatory states are hypothesized to contribute to the pathogenesis of atherosclerosis. MBL gene (MBL2) variants with between 12 to 25% allele frequency in Caucasian and other populations, result in markedly reduced expression of functional protein. Prospective epidemiologic studies, including a nested, case-control study from the present population, have demonstrated the ability of MBL2 genotypes to predict complications of atherosclerosis,. The genetic control of MBL2 expression is complex and genetic background effects in specific populations are largely unknown. Methods The Strong Heart Study is a longitudinal, cohort study of cardiovascular disease among American Indians. A subset of individuals genotyped for the above mentioned case-control study were selected for analysis of circulating MBL levels by double sandwich ELISA method. Mean MBL levels were compared between genotypic groups and multivariate regression was used to determine other independent factors influencing MBL2 expression. Results Our results confirm the effects of variant structural (B, C, and D) and promoter (H and Y) alleles that have been seen in other populations. In addition, MBL levels were found to be positively associated with male gender and hemoglobin A1c levels, but inversely related to triglyceride levels. Correlation was not found between MBL and other markers of inflammation. Conclusion New data is presented concerning the effects of known genetic variants on MBL levels in an American Indian population, as well as the relationship of MBL2 expression to clinical and environmental factors, including inflammatory markers.
Collapse
Affiliation(s)
- Lyle G Best
- Missouri Breaks Industries Research Inc, Timber Lake, SD, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ezetimibe/simvastatin compared with atorvastatin or rosuvastatin in lowering to specified levels both LDL-C and each of five other emerging risk factors for coronary heart disease: Non-HDL-cholesterol, TC/HDL-C, apolipoprotein B, apo-B/apo-A-I, or C-reactive protein. J Clin Lipidol 2008; 2:436-46. [PMID: 21291777 DOI: 10.1016/j.jacl.2008.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 10/19/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent evidence suggests that in addition to low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo-B), non-high-density lipoprotein cholesterol (non-HDL-C), some lipoprotein ratios, and C-reactive protein (CRP) are predictive of coronary heart disease (CHD) risk. This post-hoc analysis of two trials comparing single-tablet ezetimibe/simvastatin (EZE/SIMVA) to atorvastatin (ATORVA) or rosuvastatin (ROSUVA) evaluates the proportion of patients attaining LDL-C <70 mg/dL and specific levels of these emerging risk factors. METHODS These were double-blind, 6-week, parallel group trials of hypercholesterolemic patients randomized to milligram equivalent doses of ATORVA versus EZE 10 mg/SIMVA, or to usual starting, next higher, and maximum doses of ROSUVA versus EZE/SIMVA. This analysis examined the percent of patients in prespecified dose comparisons and overall achievement of LDL-C <70 mg/dL and/or Apo-B <90 mg/dL, total cholesterol (TC)/HDL-C <4.0, or Apo-B/Apo-A-I <0.7 among all treated patients, non-HDL-C <100 mg/dL among patients with baseline triglycerides ≥200 mg/dL, or CRP <2.0 mg/L among patients with baseline CRP ≥2.0 mg/L. RESULTS Within each trial, baseline characteristics were similar among groups. At all dose comparisons, significantly more patients receiving EZE/SIMVA reached LDL-C <70 mg/dL and achieved both LDL-C <70 mg/dL and either Apo-B <90 mg/dL, TC/HDL-C <4.0, or Apo-B/Apo-A-I <0.7 (EZE/SIMVA versus ATORVA) compared to ATORVA and ROSUVA. For most dose comparisons, significantly more patients receiving EZE/SIMVA attained both LDL-C <70 mg/dL and either non-HDL-C <100 mg/dL or CRP <2 mg/L compared to ATORVA or ROSUVA. CONCLUSION The greater efficacy related to changes in blood lipids of EZE/SIMVA compared with both ATORVA and ROSUVA extends to changes in many emerging risk factors. Ultimate clinical implications of these findings still need to be defined.
Collapse
|
46
|
Prevention of premature mortality among patients with schizophrenia: the need for primary prevention efforts in cardiovascular disease. CNS Spectr 2008; 13:9-10. [PMID: 18567981 DOI: 10.1017/s1092852900003114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patients with schizophrenia have a markedly reduced lifespan compared with the general population. In the United States today, patients with schizophrenia have an average life expectancy of ∼61 years, about 20% lower than that of the general population, in which life expectancy is ∼76 years.
Collapse
|
47
|
Bingham A, Mamyrova G, Rother KI, Oral E, Cochran E, Premkumar A, Kleiner D, James-Newton L, Targoff IN, Pandey JP, Carrick DM, Sebring N, O’Hanlon TP, Ruiz-Hidalgo M, Turner M, Gordon LB, Laborda J, Bauer SR, Blackshear PJ, Imundo L, Miller FW, Rider LG. Predictors of acquired lipodystrophy in juvenile-onset dermatomyositis and a gradient of severity. Medicine (Baltimore) 2008; 87:70-86. [PMID: 18344805 PMCID: PMC2674585 DOI: 10.1097/md.0b013e31816bc604] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We describe the clinical features of 28 patients with juvenile dermatomyositis (JDM) and 1 patient with adult-onset dermatomyositis (DM), all of whom developed lipodystrophy (LD) that could be categorized into 1 of 3 phenotypes, generalized, partial, or focal, based on the pattern of fat loss distribution. LD onset was often delayed, beginning a median of 4.6 years after diagnosis of DM. Calcinosis, muscle atrophy, joint contractures, and facial rash were DM disease features found to be associated with LD. Panniculitis was associated with focal lipoatrophy while the anti-p155 autoantibody, a newly described myositis-associated autoantibody, was more associated with generalized LD. Specific LD features such as acanthosis nigricans, hirsutism, fat redistribution, and steatosis/nonalcoholic steatohepatitis were frequent in patients with LD, in a gradient of frequency and severity among the 3 sub-phenotypes. Metabolic studies frequently revealed insulin resistance and hypertriglyceridemia in patients with generalized and partial LD. Regional fat loss from the thighs, with relative sparing of fat loss from the medial thighs, was more frequent in generalized than in partial LD and absent from DM patients without LD. Cytokine polymorphisms, the C3 nephritic factor, insulin receptor antibodies, and lamin mutations did not appear to play a pathogenic role in the development of LD in our patients. LD is an under-recognized sequela of JDM, and certain DM patients with a severe, prolonged clinical course and a high frequency of calcinosis appear to be at greater risk for the development of this complication. High-risk JDM patients should be screened for metabolic abnormalities, which are common in generalized and partial LD and result in much of the LD-associated morbidity. Further study is warranted to investigate the pathogenesis of acquired LD in patients with DM.
Collapse
|
48
|
Guyton JR, Goldberg RB, Mazzone T, Weinstock RS, Polis A, Rosenberg E, Tershakovec AM. Lipoprotein and apolipoprotein ratios in the VYTAL trial of ezetimibe/simvastatin compared with atorvastatin in type 2 diabetes. J Clin Lipidol 2008; 2:19-24. [DOI: 10.1016/j.jacl.2007.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 12/21/2007] [Accepted: 12/25/2007] [Indexed: 11/26/2022]
|
49
|
Brown LL, Lustria MLA, Rankins J. A review of web-assisted interventions for diabetes management: maximizing the potential for improving health outcomes. J Diabetes Sci Technol 2007; 1:892-902. [PMID: 19885163 PMCID: PMC2769687 DOI: 10.1177/193229680700100615] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes.This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.
Collapse
Affiliation(s)
- Linda Lockett Brown
- College of Human Sciences, Florida State University, Tallahassee, Florida 32306-2100, USA.
| | | | | |
Collapse
|
50
|
Sherwood A, Bower JK, McFetridge-Durdle J, Blumenthal JA, Newby LK, Hinderliter AL. Age moderates the short-term effects of transdermal 17beta-estradiol on endothelium-dependent vascular function in postmenopausal women. Arterioscler Thromb Vasc Biol 2007; 27:1782-7. [PMID: 17541023 DOI: 10.1161/atvbaha.107.145383] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We evaluated age and coronary heart disease (CHD) as potential moderators of the effects of 17beta-estradiol on vascular endothelial function in postmenopausal women. METHODS AND RESULTS In a double-blind crossover design, 100 postmenopausal women aged 50 to 80 years were randomized to each of 3 transdermal patches, releasing 17beta-estradiol (0.05 mg/d), 17beta-estradiol (0.05 mg/d) + norethindrone acetate (NETA, 0.14 mg/d), and placebo. Flow-mediated dilation (FMD) and response to 400 microg sublingual glyceryl trinitrate (GTN-D) were assessed approximately 18 hours after patch placement. Age, but not CHD, moderated the FMD response to treatment (P=0.01). For women in their fifties, the estradiol patch was associated with improved FMD (7.69+/-4.79%) compared with placebo (4.81+/-5.97%, P<0.05), but the estradiol+norethindrone patch response (5.81+/-4.85%) was not significantly different from placebo. Women in their sixties and seventies showed no alterations in FMD response to either active patch. GTN-D response declined with advancing age (P<0.01), with women in their seventies exhibiting blunted GTN-D response compared with younger women. CONCLUSIONS The cardiovascular benefits of natural estrogen supplementation on vascular endothelial function may be dependent on postmenopausal age, with improved vascular function evident only in the early postmenopausal years. Short-term FMD response to estradiol might help stratify individual differences in risks versus benefits of HRT.
Collapse
|