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Hu F, Wang Z, Liu Y, Gao Y, Liu S, Xu C, Wang Y, Cai Y. Association between total cholesterol and all-cause mortality in oldest old: a national longitudinal study. Front Endocrinol (Lausanne) 2024; 15:1405283. [PMID: 38938514 PMCID: PMC11208679 DOI: 10.3389/fendo.2024.1405283] [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: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Background A common sense is that lower serum cholesterol levels are better. However, a growing number of researches have questioned this especially for the oldest old. The current study was to assess the association between total cholesterol and all-cause mortality in a group of people aged 85 years old and over. Methods We selected 903 Chinese old participants who aged ≥85 years from the Chinese Longitudinal Healthy Longevity Survey(CLHLS) at baseline in 2012. The participants were followed up until death or until December 31, 2014. The outcome was all-cause mortality. The univariate and multivariate Cox regression analyses were used to estimate risk levels of all-cause mortality. We stratified the participants into three groups (<3.40, 3.40-4.39, ≥4.39 mmol/L) based on the restricted cubic splines methods. The survival probability according to total cholesterol category was calculated using the Kaplan-Meier curves, and the log-rank test was performed to analyze differences between the groups. Results During the follow-up of three years, 282 participants died, 497 survived and 124 lost to follow-up. There was significant relationship between the total cholesterol and lower risk of all-cause mortality in the multivariable Cox regression analysis (HR=0.88, 95% CI: 0.78-1.00). Based on the restricted cubic splines methods, the total cholesterol was converted from a continuous variable to a categorical variable. The populations were divided into three groups (<3.40, 3.40-4.39, ≥4.39 mmol/L) according to the total cholesterol categorized by cutoff values. Compared to the total cholesterol level of <3.40 mmol/L, populations in the total cholesterol level of 3.40-4.39 mmol/L (HR = 0.72, 95% CI: 0.53-0.97) and ≥4.39 mmol/L (HR = 0.71, 95% CI: 0.52-0.96) groups had lower all-cause mortality in multivariate Cox regression analysis and higher survival probability in survival analysis. When two groups were divided, similar results were found among the populations in the total cholesterol level of ≥3.40 mmol/L compared to the populations in the total cholesterol level of <3.40 mmol/L groups. Conclusion In oldest old aged 85 and older, serum total cholesterol levels are inversely associated with all-cause mortality. This study suggested that total cholesterol should be maintained to acceptable levels (≥ 3.40 mmol/L) in oldest old to achieve longevity.
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Affiliation(s)
| | | | | | | | | | | | - Ying Wang
- Public Health Department, International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- Public Health Department, International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kim YS, Jeong HG, Chang JY, Kim JY, Kim BJ, Bae HJ, Han MK. Effect of Statin Therapy on Cardiovascular Outcome in Stroke Patients with Low Baseline Low-Density Lipoprotein Cholesterol. Ann Neurol 2024; 95:876-885. [PMID: 38400785 DOI: 10.1002/ana.26895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To investigate whether post-stroke statin therapy reduces subsequent major vascular events in statin-naïve patients with pretreatment low-density lipoprotein cholesterol (LDL-C) below the recommended target (≤70 mg/dL for atherosclerotic stroke and ≤100 mg/dL for non-atherosclerotic stroke) at stroke onset. METHODS Patients from an ongoing stroke registry who had an ischemic stroke between 2011 and 2020 were screened. Statin naïve patients with baseline LDL-C below the target were assessed. The effect of post-stroke statin therapy on major vascular events (composite of recurrent stroke, myocardial infarction, and death) was investigated using weighted Cox regression analyses using stabilized inverse probability treatment weighting. RESULTS The baseline LDL-C level of the 1,858 patients (mean age 67.9 ± 15.3 years, 61.4% men, 13.2% atherosclerotic stroke) included in the study was 75.7 ± 17.0 mg/dL. Statins were prescribed to 1,256 (67.7%) patients (low-to-moderate intensity, 23.5%; high intensity, 44.1%). Post-stroke statin therapy was associated with a lower risk of major vascular events during 1-year follow-up (weighted hazard ratio 0.55, 95% confidence interval 0.42-0.71). In a subgroup of patients who were at very high risk of atherosclerotic cardiovascular disease with LDL-C <55 mg/dL or patients who were not at very high risk of atherosclerotic cardiovascular disease with LDL-C <70 mg/dL, post-stroke statin therapy was also associated with a reduction in major vascular events (weighted hazard ratio 0.45, 95% confidence interval 0.29-0.70). The intensity of the most beneficial statin varied by subtype of stroke. INTERPRETATION Statin therapy may improve vascular outcomes after ischemic stroke, even in cases of LDL-C below the target without pre-stroke lipid-lowering therapy. ANN NEUROL 2024;95:876-885.
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Affiliation(s)
- Yong Soo Kim
- Department of Neurology, Nowon Eulji Medical Center, Seoul, Korea
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han-Gil Jeong
- Division of Neurocritical Care, Department of Neurosurgery and Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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Lu L, Jing W, Qian W, Fan L, Cheng J. Association between dietary patterns and cardiovascular diseases: A review. Curr Probl Cardiol 2024; 49:102412. [PMID: 38278463 DOI: 10.1016/j.cpcardiol.2024.102412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
Cardiovascular disease (CVD), especially atherosclerosis, is the primary cause of global deaths. It accounts for millions of deaths annually. Even a small reduction in CVD through preventive treatment can have a substantial impact. Dietary patterns and substances are strongly linked to chronic diseases such as atherosclerosis, hypertension, heart failure, and type 2 diabetes. An unhealthy diet could lead to traditional risk factors such as LDL levels, TG levels, diabetes, and high blood pressure while accelerating atherosclerosis progression. Recent research has shown the potential of dietary interventions to prevent and treat cardiovascular disease, particularly through healthy dietary patterns such as the Mediterranean diet or DASH. In 2016, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) launched a new initiative aimed at enhancing the prevention and control of cardiovascular disease (CVD) by improving the management of CVD in primary care, including the optimization of dietary patterns. Here, this review summarizes several large cohort researches about the effects of dietary patterns on atherosclerosis, refines dietary components, and outlines some typical anti-atherosclerosis dietary agents. Finally, this review discusses recent mechanisms by which dietary interventions affect atherosclerosis progression.
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Affiliation(s)
- Lijun Lu
- Central Sterile Supply Department, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Wangwei Jing
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, China
| | - Weiming Qian
- Department of Operating Room, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Lin Fan
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China.
| | - Jifang Cheng
- Department of Cardiovascular Intervention, The Second Affiliated Hospital, School of Medicine, Zhejiang University, China.
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Fakhry B, Peterson L, Comhair SA, Sharp J, Park MM, Tang WW, Neumann DR, DiFilippo FP, Farha S, Erzurum SC, Mulya A. Blood Cholesterol and Triglycerides Associate with Right Ventricular Function in Pulmonary Hypertension. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.20.24301498. [PMID: 38343848 PMCID: PMC10854346 DOI: 10.1101/2024.01.20.24301498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Background Blood lipids are dysregulated in pulmonary hypertension (PH). Lower high-density lipoproteins cholesterol (HDL-C) and low-density lipoproteins cholesterol (LDL-C) are associated with disease severity and death in PH. Right ventricle (RV) dysfunction and failure are the major determinants of morbidity and mortality in PH. This study aims to test the hypothesis that dyslipidemia is associated with RV dysfunction in PH. Methods We enrolled healthy control subjects (n=12) and individuals with PH (n=30) (age: 18-65 years old). Clinical characteristics, echocardiogram, 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (PET) scan, blood lipids, including total cholesterol (TC), triglycerides (TG), lipoproteins (LDL-C and HDL-C), and N-terminal pro-B type Natriuretic Peptide (NT-proBNP) were determined. Results Individuals with PH had lower HDL-C [PH, 41±12; control, 56±16 mg/dL, p<0.01] and higher TG to HDL-C ratio [PH, 3.6±3.1; control, 2.2±2.2, p<0.01] as compared to controls. TC, TG, and LDL-C were similar between PH and controls. Lower TC and TG were associated with worse RV function measured by RV strain (R=-0.43, p=0.02 and R=-0.37, p=0.05 respectively), RV fractional area change (R=0.51, p<0.01 and R=0.48, p<0.01 respectively), RV end-systolic area (R=-0.63, p<0.001 and R=-0.48, p<0.01 respectively), RV end-diastolic area: R=-0.58, p<0.001 and R=-0.41, p=0.03 respectively), and RV glucose uptake by PET (R=-0.46, p=0.01 and R=-0.30, p=0.10 respectively). NT-proBNP was negatively correlated with TC (R=-0.61, p=0.01) and TG (R=-0.62, p<0.02) in PH. Conclusion These findings confirm dyslipidemia is associated with worse right ventricular function in PH.
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Affiliation(s)
- Battoul Fakhry
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Laura Peterson
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suzy A.A. Comhair
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jacqueline Sharp
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Margaret M. Park
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - W.H. Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | | | - Samar Farha
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Serpil C. Erzurum
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Anny Mulya
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
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Oh MJ, Han K, Kim B, Lim JH, Kim B, Kim SG, Cho SJ. Risk of gastric cancer in relation with serum cholesterol profiles: A nationwide population-based cohort study. Medicine (Baltimore) 2023; 102:e36260. [PMID: 38050195 PMCID: PMC10695609 DOI: 10.1097/md.0000000000036260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
Obesity is a known risk factor for gastric cancer. However, the relationship between serum lipids and gastric cancer risk has not been fully established. We investigated the relationship between serum cholesterol levels and gastric cancer risk using a nationwide population cohort. Adults who received health care screening in 2009 from the Korean National Health Insurance Service were enrolled. Gastric cancer risk in relation to quartiles of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were compared according to sex, using adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Among 9690,168 subjects enrolled, 92,403 gastric cancer cases were diagnosed. Higher HDL-C levels were associated with lower gastric cancer risk in the total population, men, and women (aHR [for the highest quartile] = 0.98 [0.96-0.99, P < .0001], aHR = 0.98 [0.96-1.004, P = .0004], and aHR = 0.91 [0.88-0.94, P < .0001], respectively). HDL-C showed consistent trends regardless of age or statin use. Higher LDL-C levels were also associated with lower gastric cancer risk in the total population (aHR = 0.92 [0.91-0.94], P < .0001) and men (aHR = 0.94 [0.91-0.96], P < .0001), but not in women (P = .4073). A subgroup analysis of LDL-C showed significant interactions with age and statin use (Pinteraction < .0001 and Pinteraction = .0497, respectively). The risk of gastric cancer was higher in subjects with elevated LDL-C levels in the younger group (age < 55, HR [for the highest quartile] = 1.02 [0.99-1.04] in the total population; HR = 1.03 [1.003-1.06] in men), the risk was lower in subjects with elevated LDL-C in the elderly (age ≥ 55, HR = 0.93 [0.91-0.95] in the total population; HR = 0.94 [0.92-0.96] in men). Elevated TC was associated with lower gastric cancer risk in the total population (aHR = 0.95 [0.94-0.97], P < .0001), but not in each sex separately (P = .3922 in men; P = .1046 in women). Overall, higher HDL-C levels may play a protective role in gastric cancer pathogenesis. The association between LDL-C/TC and gastric cancer seems to vary according to sex, age, and statin use. Especially in young males under age 55, high LDL-C and TC levels were associated with higher risk of gastric cancer.
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Affiliation(s)
- Mi Jin Oh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Joo Hyun Lim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Bokyung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chou KR, Huang MS, Chiu WC, Chen YH, Chen YY, Xiao Q, Yang SC. A comprehensive assessment of oral health, swallowing difficulty, and nutritional status in older nursing home residents. Sci Rep 2023; 13:19914. [PMID: 37964096 PMCID: PMC10645724 DOI: 10.1038/s41598-023-47336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/12/2023] [Indexed: 11/16/2023] Open
Abstract
Declines in oral consumption and swallowing function are common reasons which may elevate the risk of malnutrition in the older adults. This study aimed to provide valuable information and contribute to the existing body of knowledge in this field as well as highlight the importance of a comprehensive assessment of oral health, swallowing function, and nutritional status in long-term care residents. This was a cross-sectional study. Thirty-nine participants were recruited from a nursing home. The comprehensive assessment was evaluated in participants, including oral health (Oral Health Assessment Tool (OHAT)), swallowing function (Functional Oral Intake Scale (FOIS) and Eating Assessment Tool (EAT)-10), and nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF). The average age of participants was 80.4 ± 11.7 years, and 46% of these older adults were found to be at the risk of malnutrition. There was a negative correlation between the OHAT and MNA-SF scores. In addition, subjects with poor oral health (OHAT score = 5~8), oral consumption of a modified diet (FOIS score = 4~6), and reduced swallowing function (EAT-10 score ≥ 3) were more likely to be at risk of malnutrition. A comprehensive evaluation of oral health and swallowing function was closely connected with the nutritional status of older nursing home dwellers.
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Affiliation(s)
- Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Mao-Suan Huang
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wan-Chun Chiu
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
- Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan
- Department of Nutrition, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsiu Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Yu-Yoh Chen
- Graduate Institute of Health and Biotechnology Law, Taipei Medical University, Taipei, Taiwan
| | - Qian Xiao
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Suh-Ching Yang
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan.
- Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
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Nguyen XT, Ho Y, Li Y, Song RJ, Leung KH, Rahman SU, Orkaby AR, Vassy JL, Gagnon DR, Cho K, Gaziano JM, Wilson PWF. Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans. J Am Heart Assoc 2023; 12:e030496. [PMID: 37889207 PMCID: PMC10727410 DOI: 10.1161/jaha.123.030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
Background The lipid hypothesis postulates that lower blood cholesterol is associated with reduced coronary heart disease (CHD) risk, which has been challenged by reports of a U-shaped relation between cholesterol and death in recent studies. We sought to examine whether the U-shaped relationship is true and to assess the impact of age on this association. Method and Results We conducted a prospective cohort study of 4 467 942 veterans aged >18 years, with baseline outpatient visits from 2002 to 2007 and follow-up to December 30, 2018, in the Veterans Health Administration electronic health record system. We observed a J-shaped relation between total cholesterol (TC) and CHD mortality after a comprehensive adjustment of confounding factors: flat for TC <180 mg/dL, and greater risk was present at higher cholesterol levels. Compared with veterans with TC between 180 and 199 mg/dL, the multiadjusted hazard ratios (HRs) for CHD death were 1.03 (95% CI, 1.02-1.04), 1.07 (95% CI, 1.06-1.09), 1.15 (95% CI, 1.13-1.18), 1.25 (95% CI, 1.22-1.28), and 1.45 (95% CI, 1.42-1.49) times greater among veterans with TC (mg/dL) of 200 to 219, 220 to 239, 140 to 259, 260 to 279 and ≥280, respectively. Similar J-shaped TC-CHD mortality patterns were observed among veterans with and without statin use at or before baseline. Conclusions The cholesterol paradox, for example, higher CHD death in patients with a low cholesterol level, was a reflection of reverse causality, especially among older participants. Our results support the lipid hypothesis that lower blood cholesterol is associated with reduced CHD. Furthermore, the hypothesis remained true when TC was low due to use of statins or other lipid-lowering medication.
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Affiliation(s)
- Xuan‐Mai T. Nguyen
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Yuk‐Lam Ho
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
| | - Yanping Li
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
| | | | - Kenneth H. Leung
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Saad Ur Rahman
- Carle Illinois College of MedicineUniversity of Illinois Urbana ChampaignChampaignILUSA
| | - Ariela R. Orkaby
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Jason L. Vassy
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division of General Internal MedicineBrigham and Women’s HospitalBostonMAUSA
| | - David R. Gagnon
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Boston University School of Public HealthBostonMAUSA
| | - Kelly Cho
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - J. Michael Gaziano
- MAVERIC VA Boston Healthcare SystemBostonMAUSA
- Division on Aging, Department of MedicineBrigham and Women’s HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Peter W. F. Wilson
- Atlanta VA Medical CenterDecaturGAUSA
- Emory University Schools of Medicine and Public HealthAtlantaGAUSA
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Sanaie S, Dolati S, Montazer M, Ranjbari S, Fathalizadeh A, Shadvar K, Faramarzi E, Mahmoodpoor A. Lipid Profile as a Predictive Marker for Organ Dysfunction after Thoracoabdominal Surgery: A Cross-sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:465-473. [PMID: 37786464 PMCID: PMC10541545 DOI: 10.30476/ijms.2022.95364.2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 09/24/2022] [Indexed: 10/04/2023]
Abstract
Background Plasma total cholesterol is considered a negative acute phase reactant. In various pathological conditions, such as trauma, sepsis, burns, and liver dysfunction, as well as post-surgery, serum cholesterol level decreases. This study aimed to investigate the role of lipid profiles in determining the probability of organ dysfunction after surgery. Methods This cross-sectional study included patients who underwent thoracoabdominal surgery and were admitted to the intensive care unit of Imam Reza Hospital in Tabriz, Iran, between October 2016 and September 2018. During the first two days of admission, blood samples were taken, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and albumin were measured. The relation between the changes in these laboratory markers and six organ functions including cardiovascular, respiratory, renal, central nervous system, hepatic, and hematologic, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use were investigated. The independent t test was used to compare continuous variables. The association between different variables and organ dysfunction and mortality was evaluated by using logistic regression. Results The serum TC increased the risk of mortality (OR=1.09, 95%CI=1.06-1.11, P<0.001), renal dysfunction (OR=1.09, 95%CI=1.06-1.12; P<0.001), liver dysfunction (OR=1.07, 95%CI=1.03-1.10; P<0.001), respiratory dysfunction (OR=1.08, 95%CI=1.05-1.13; P<0.001). Moreover, LDL, HDL, and TG were found to be inversely related to mortality, organ dysfunction, length of stay in the hospital and intensive care unit, mechanical ventilation duration, and vasopressor use. Conclusion TC could be considered a risk factor for mortality, organ dysfunction, and clinical outcomes. On the other hand, LDL, HDL, and TG played a protective role in the patients' mortality, organ dysfunction, and clinical outcomes.
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Affiliation(s)
- Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Montazer
- Department of Cardiothoracic Surgeries, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarina Ranjbari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezoo Fathalizadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Shadvar
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Thong EHE, Quek EJW, Loo JH, Yun CY, Teo YN, Teo YH, Leow AST, Li TYW, Sharma VK, Tan BYQ, Yeo LLL, Chong YF, Chan MY, Sia CH. Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review. BIOLOGY 2023; 12:1154. [PMID: 37627038 PMCID: PMC10452707 DOI: 10.3390/biology12081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer's Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.
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Affiliation(s)
- Elizabeth Hui En Thong
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Ethan J. W. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Jing Hong Loo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Choi-Ying Yun
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Yao Hao Teo
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Aloysius S. T. Leow
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Tony Y. W. Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Benjamin Y. Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Leonard L. L. Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Mark Y. Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
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10
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Vainshelboim B, Myers J. Dyslipidemia paradox: Analysis from the veterans exercise testing study. PLoS One 2023; 18:e0287923. [PMID: 37467298 DOI: 10.1371/journal.pone.0287923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Dyslipidemia is a well-established cardiovascular disease (CVD) risk factor, although its association with mortality is less clear. This study aimed to assess the association between established dyslipidemia criteria [National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel (ATP) III] and all-cause mortality in men. METHODS Prospective cohort study of 1,479 men aged 59.7±10.7 years was conducted between 1987 and 2012. At baseline, dyslipidemia markers of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were assessed as an exposure. Cox proportional hazard models were analyzed adjusting for conventional health risk factors using all-cause mortality as an outcome. RESULTS Mean and standard deviations of TC, LDL-C and HDL-C were 199.5±45.2, 149.4±47.4 and 44.3±12.2 mg/dL, respectively. During 8.9±4.5 years follow-up, 284 participants died. Compared to TC <200 mg/dL, levels of 200-239 mg/dL and ≥240 mg/dL were associated with 13% [hazard ratio (HR) = 0.87, 95% confidence intervals (CI) (0.66-1.1)] and 37% [HR = 0.63, 95% CI (0.44-0.92)] lower risks of mortality (p trend = 0.048), respectively. Compared to LDL-C <130 mg/dL, levels of 130-189 mg/dL and ≥190 mg/dL were associated with 26% [HR = 0.74, 95% CI (0.57-0.97)] and 32% [HR = 0.68, 95% CI (0.48-0.98)] lower risks of mortality (p trend = 0.044), respectively. Mean survival time was 0.9 to 1.9 years longer with higher TC and LDL-C categories (both p = 0.001). HDL-C was not associated with mortality. CONCLUSION In reference to established dyslipidemia criteria, this study showed that higher TC and LDL-C were independently and paradoxically associated with lower risk of all-cause mortality and longer survival time in men. Along with previous reports, these novel findings support a rigorous reevaluation of evidence on dyslipidemia and health risks. Systematic review and meta-analysis are warranted for evidence-based recommendations on dyslipidemia for primary and secondary prevention of CVD.
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Affiliation(s)
- Baruch Vainshelboim
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, the Ohio State University, Columbus, OH, United States of America
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, CA, United States of America
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11
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Charach L, Grosskopf I, Galin L, Guterman I, Karniel E, Charach G. Low Cholesterol Levels in Younger Heart Failure Patients May Predict Unfavorable Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1314. [PMID: 37512127 PMCID: PMC10384220 DOI: 10.3390/medicina59071314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hypercholesterolemia is a main risk-factor leading to ischemic heart disease (IHD). However, among patients with heart failure, the use of lipid lowering drugs in the presence of low cholesterol might be dangerous. This 18-year longitudinal study of patients ≤51 years old investigated the relationship between baseline total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride levels, and survival among patients with severe HF. Materials and Methods: The average NYHA score of 82 patients ≤51 years old with heart failure was 2.61. They were followed for a mean of 11.3 years (15 months-20 years). Total mortality was 22%. Patients were divided into three groups. Group 1 had plasma LDL-c levels ≤ 80 mg/dl, Group 2, 80-115 mg/dl and Group 3 > 115 mg/dl. Results: Patients with the highest baseline total cholesterol, triglyceride and LDL-c levels > 115 mg/dl had a better survival rate (83%) compared to those with LDL-c < 80 mg/dl (50% survival, p = 0.043). The association between higher LDL-c levels and lower mortality was most noticeable among patients with heart failure. Conclusion: Longitudinal follow-up found that low LDL-c levels may indicate poorer prognosis among patient with heart failure who are ≤51 years old, similar to elderly heart failure patients. Cholesterol lowering drugs in younger patients with heart failure may increase mortality.
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Affiliation(s)
- Lior Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leonid Galin
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Guterman
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eli Karniel
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gideon Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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12
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Zoungas S, Curtis A, Spark S, Wolfe R, McNeil JJ, Beilin L, Chong TTJ, Cloud G, Hopper I, Kost A, Nelson M, Nicholls SJ, Reid CM, Ryan J, Tonkin A, Ward SA, Wierzbicki A. Statins for extension of disability-free survival and primary prevention of cardiovascular events among older people: protocol for a randomised controlled trial in primary care (STAREE trial). BMJ Open 2023; 13:e069915. [PMID: 37012015 PMCID: PMC10083753 DOI: 10.1136/bmjopen-2022-069915] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION The world is undergoing a demographic transition to an older population. Preventive healthcare has reduced the burden of chronic illness at younger ages but there is limited evidence that these advances can improve health at older ages. Statins are one class of drug with the potential to prevent or delay the onset of several causes of incapacity in older age, particularly major cardiovascular disease (CVD). This paper presents the protocol for the STAtins in Reducing Events in the Elderly (STAREE) trial, a randomised double-blind placebo-controlled trial examining the effects of statins in community dwelling older people without CVD, diabetes or dementia. METHODS AND ANALYSIS We will conduct a double-blind, randomised placebo-controlled trial among people aged 70 years and over, recruited through Australian general practice and with no history of clinical CVD, diabetes or dementia. Participants will be randomly assigned to oral atorvastatin (40 mg daily) or matching placebo (1:1 ratio). The co-primary endpoints are disability-free survival defined as survival-free of dementia and persistent physical disability, and major cardiovascular events (cardiovascular death or non-fatal myocardial infarction or stroke). Secondary endpoints are all-cause death, dementia and other cognitive decline, persistent physical disability, fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, heart failure, atrial fibrillation, fatal and non-fatal cancer, all-cause hospitalisation, need for permanent residential care and quality of life. Comparisons between assigned treatment arms will be on an intention-to-treat basis with each of the co-primary endpoints analysed separately in time-to-first-event analyses using Cox proportional hazards regression models. ETHICS AND DISSEMINATION STAREE will address uncertainties about the preventive effects of statins on a range of clinical outcomes important to older people. Institutional ethics approval has been obtained. All research outputs will be disseminated to general practitioner co-investigators and participants, published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02099123.
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Affiliation(s)
- Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simone Spark
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence Beilin
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Geoffrey Cloud
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Alissia Kost
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Nelson
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
| | - Stephen J Nicholls
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Wierzbicki
- Metabolic Medicine/Chemical Pathology, Guy's and St Thomas' Hospitals, London, UK
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13
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Li S, Zhang W, Liu H. Association between lipid levels and all-cause and cause-specific mortality in critically ill patients. Sci Rep 2023; 13:5109. [PMID: 36991035 PMCID: PMC10060260 DOI: 10.1038/s41598-023-32209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Extremely low lipid levels are considered a sign of debilitation and illness. The association between lipid levels and the risk of mortality in critically ill patients has not been well investigated. This study was designed to evaluate the association between lipid levels and all-cause and cause-specific mortality in critically ill patients using a large collaborative research database known as the eICU database. In total, 27,316 individuals with low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglyceride (TG) measurements were analyzed. A J-shaped association was observed between LDL-C, HDL-C, and TC levels and all-cause and noncardiovascular mortality, with low concentrations associated with higher risk. LDL-C, HDL-C and TC levels in the first quintile were associated with higher all-cause and noncardiovascular mortality but not with cardiovascular mortality compared to the reference quintile. There was a marked synergistic effect between low LDL-C combined with low HDL-C on the risk of mortality. Individuals with LDL-C ≤ 96 mg/dL and HDL-C ≤ 27 mg/dL had an increased risk of all-cause mortality (OR 1.52, 95% CI: 1.26-1.82), cardiovascular mortality (OR 1.07, 95% CI: 1.37-1.76) and noncardiovascular mortality (OR 1.82, 95% CI: 1.37-2.43). The results of this observational cohort showed that low LDL-C, HDL-C and TC levels were independently associated with higher all-cause and noncardiovascular mortality in critically ill patients.
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Affiliation(s)
- Shan Li
- Department of Cardiology, The Second Medical Center, Chinese People Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Wei Zhang
- Department of Cardiology, The Second Medical Center, Chinese People Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center, Chinese People Liberation Army General Hospital, Beijing, China.
- National Clinical Research Center for Geriatric Disease, Beijing, China.
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14
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Edes AN, Brown JL, Edwards KL. Evaluating individual biomarkers for predicting health risks in zoo-housed chimpanzees (Pan troglodytes) and bonobos (Pan paniscus). Am J Primatol 2023; 85:e23457. [PMID: 36537335 DOI: 10.1002/ajp.23457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Although biomarkers are often used for predicting morbidity and mortality in humans, similar data are lacking in our closest relatives. This study analyzed 16 biomarkers in zoo-housed chimpanzees and bonobos from serum samples collected during both routine and nonroutine veterinary immobilizations. Generalized linear and generalized linear mixed models were used to determine the efficacy of each biomarker to predict all-cause morbidity, defined as the presence of at least one chronic condition, or cardiac disease as a subset of all-cause morbidity. Cox proportional hazards models were used to examine associations between biomarkers and mortality risk from any cause. Analyses were conducted using two data sets for each species, one with all values retained (chimpanzees: n = 148; bonobos: n = 33) and the other from samples collected during routine immobilizations only (chimpanzees: n = 95; bonobos: n = 23). Consistent results across both data sets in chimpanzees included associations of higher cortisol with all-cause morbidity risk, lower creatinine with cardiac disease risk, and higher creatinine with mortality risk, and in bonobos were increased cardiac disease risk with higher cortisol and lower dehydroepiandrosterone-sulfate, fructosamine, and triglycerides. However, there were some inconsistencies between data sets, such as tumor necrosis factor-α predicting mortality risk positively in chimpanzees when all values were retained, but negatively for routine values only. Despite the close evolutionary relationships between chimpanzees and bonobos, the only result observed in both species was a negative association between albumin and mortality risk in the all values retained data sets. Thus, data suggest some biomarkers may be useful predictors of future health outcomes, although a better understanding of both individual and species variation in biomarkers and their contribution to health risks is needed.
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Affiliation(s)
- Ashley N Edes
- Department of Reproductive and Behavioral Sciences, Saint Louis Zoo, Saint Louis, Missouri, USA.,Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, Virginia, USA.,Conservation Science and Policy, North of England Zoological Society, Chester Zoo, Upton by Chester, UK
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15
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Lee WJ, Peng LN, Lin MH, Loh CH, Hsiao FY, Chen LK. Intrinsic capacity differs from functional ability in predicting 10-year mortality and biological features in healthy aging: results from the I-Lan longitudinal aging study. Aging (Albany NY) 2023; 15:748-764. [PMID: 36750172 PMCID: PMC9970311 DOI: 10.18632/aging.204508] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
This study aimed to explore the biological features and mortality risk of intrinsic capacity (IC) and functional ability (FA). Based on data from 1839 participants from the I-Lan Longitudinal Aging Study, multivariable Cox proportional hazard models were used to evaluate the predictive ability of IC (range 0-100) and FA (range 0-100) on 10-year mortality. Of 2038 repeated measurements for IC within a 7-year observational period, multivariable logistic regression was used to compare biological features of participants with maintained, improved and rapidly deteriorated IC. A 1-point increased IC value was associated with a 5% (HR 0.95, 95% CI 0.93-0.97, p < 0.001) decrease in mortality risk. Low IC (HR 1.94, 95% CI 1.39-2.70, p < 0.001) was associated with higher mortality risk. Hyperglycemia (OR 1.40, 95% CI 1.09-1.81, p = 0.010), low serum levels of DHEA-S (OR 3.33, 95% CI 1.32-8.41, p = 0.011), and high serum levels of C-reactive protein (OR 1.45, 95% CI 1.05-2.00, p = 0.023) were associated with low IC at baseline. Low serum levels of DHEA-S (middle tertile OR 1.84, 95% CI 1.15-2.95, p = 0.012; lowest tertile OR 2.25, 95% CI 1.34-3.77, p = 0.002) and vitamin D deficiency (OR 1.82, 95% CI 1.02-3.27, p = 0.044) were associated with rapid deterioration of IC. IC and FA predicted 10-year mortality, whereas chronic inflammation, hyperglycemia, and low DHEA-S were associated with low IC status. Low DHEA-S and vitamin D deficiency may be considered as potential biomarkers of rapid IC declines, which implies underlying biological mechanisms of healthy aging.
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Affiliation(s)
- Wei-Ju Lee
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan,Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan
| | - Li-Ning Peng
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan,Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan,Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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16
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Chang CH, Yeh ST, Ooi SW, Li CY, Chen HF. The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study. PeerJ 2023; 11:e14609. [PMID: 36643628 PMCID: PMC9835695 DOI: 10.7717/peerj.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Background The optimal levels of low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes (T2D) are not currently clear. In this study, we determined the relationship between various mean LDL-C and all-cause or cardiovascular mortality risks in patients with T2D, stratifying by albumin level, age, sex, and antilipid medication use. We also evaluated the association of LDL-C standard deviation (LDL-C-SD) and all-cause and cardiovascular mortality by type of antilipid medication use. Methods A total of 46,675 T2D patients with a prescription for antidiabetic agents >6 months from outpatient visits (2003-2018) were linked to Taiwan's National Death Registry to identify all-cause and cardiovascular mortality. The Poisson assumption was used to estimate mortality rates, and the Cox proportional hazard regression model was used to assess the relative hazards of respective mortality in relation to mean LDL-C in patient cohorts by albumin level, age, sex, and antilipid use adjusting for medications, comorbidities, and laboratory results. We also determined the overall, and anti-lipid-specific mortality rates and relative hazards of all-cause and cardiovascular mortality associated with LDL-C-SD using the Poisson assumption and Cox proportional hazard regression model, respectively. Results All-cause and cardiovascular mortality rates were the lowest in T2D patients with a mean LDL-C > 90-103.59 mg/dL in the normal albumin group (≥ 3.5 g/dL). Compared to T2D patients with a mean LDL-C > 90-103.59 mg/dL, those with a mean LDL-C ≤ 77 mg/dL had an elevated risk of all-cause mortality in both the normal and lower albumin groups. T2D patients with a mean LDL-C ≤ 90 and > 103.59-119 mg/dL had relatively higher risk of cardiovascular mortality in the normal albumin group, but in the lower albumin group (<3.5 g/dL), any level of mean LDL-C ≤ 119 mg/dL was not significantly associated with cardiovascular mortality. Increased risks of all-cause and cardiovascular mortality were observed in patients with a mean LDL-C ≤ 77 mg/dL in both sexes and in all age groups except in those aged <50 years, a lower mean LDL-C was not associated with cardiovascular mortality. Similarly, patients with an LDL-C-SD <10th and > 90th percentiles were associated with significant risks of all-cause and cardiovascular mortality. In statin users, but not fibrate users, lower and higher levels of mean LDL-C and LDL-C-SD were both associated with elevated risks of all-cause and cardiovascular mortality. Conclusions The optimal level of LDL-C was found to be >90-103.59 mg/dL in T2D patients. Lower and higher levels of mean LDL-C and LDL-C-SD were associated with all-cause and cardiovascular mortality, revealing U-shaped associations. Further studies are necessary to validate the relationship between optimal LDL-C levels and all-cause and cardiovascular mortality in patients with diabetes.
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Affiliation(s)
- Chin-Huan Chang
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Tin Yeh
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Seng-Wei Ooi
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan,Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung City, Taiwan
| | - Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan
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17
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Lee YB, Koo M, Noh E, Hwang SY, Kim JA, Roh E, Hong SH, Choi KM, Baik SH, Cho GJ, Yoo HJ. Myocardial Infarction, Stroke, and All-Cause Mortality according to Low-Density Lipoprotein Cholesterol Level in the Elderly, a Nationwide Study. Diabetes Metab J 2022; 46:722-732. [PMID: 35255552 PMCID: PMC9532170 DOI: 10.4093/dmj.2021.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We assessed the myocardial infarction (MI), stroke, and all-cause death risks during follow-up according to the low-density lipoprotein cholesterol (LDL-C) levels among older adults. METHODS The Korean National Health Insurance Service datasets (2002 to 2020) were used for this population-based cohort study. The hazards of MI, stroke, and all-cause mortality during follow-up were analyzed according to LDL-C level in individuals aged ≥65 years without baseline cardiovascular diseases (n=1,391,616). RESULTS During a mean 7.55 years, 52,753 MIs developed; 84,224 strokes occurred over a mean 7.47 years. After a mean 8.50 years, 233,963 died. A decrease in LDL-C was associated with lower hazards of MI and stroke. The decreased hazard of stroke in lower LDL-C was more pronounced in statin users, and individuals with diabetes or obesity. The hazard of all-cause death during follow-up showed an inverted J-shaped pattern according to the LDL-C levels. However, the paradoxically increased hazard of mortality during follow-up in lower LDL-C was attenuated in statin users and individuals with diabetes, hypertension, or obesity. In statin users, lower LDL-C was associated with a decreased hazard of mortality during follow-up. CONCLUSION Among the elderly, lower LDL-C was associated with decreased risks of MI and stroke. Lower LDL-C achieved by statins in the elderly was associated with a decreased risk of all-cause death during follow-up, suggesting that LDL-C paradox for the premature death risk in the elderly should not be applied to statin users. Intensive statin therapy should not be hesitated for older adults with cardiovascular risk factors including diabetes.
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Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Minji Koo
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eunjin Noh
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - So-hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
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Cho KH, Kim MC, Choo EH, Choi IJ, Lee SN, Park MW, Park CS, Kim HY, Kim CJ, Sim DS, Kim JH, Hong YJ, Jeong MH, Chang K, Ahn Y. Impact of Low Baseline Low-Density Lipoprotein Cholesterol on Long-Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e025958. [PMID: 36000434 PMCID: PMC9496430 DOI: 10.1161/jaha.122.025958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (<70, 70–99, and ≥100 mg/dL), as LDL‐C levels decreased, clinical outcomes worsened (237/3759 [6.3%] in LDL‐C ≥100 mg/dL versus 123/1291 [9.5%] in LDL‐C 70–99 mg/dL versus 86/482 [17.8%] in LDL‐C <70 mg/dL for cardiovascular death; P‐trend<0.001; and 417/3759 [11.1%] in LDL‐C ≥100 mg/dL versus 172/1291 [13.3%] in LDL‐C 70–99 mg/dL versus 106/482 [22.2%] in LDL‐C <70 mg/dL for 3‐point major adverse cardiovascular event; P‐trend<0.001). In a Cox time‐to‐event multivariable model with LDL‐C levels ≥100 mg/dL as the reference, the baseline LDL‐C level <70 mg/dL was independently associated with an increased incidence of cardiovascular death (adjusted hazard ratio, 1.68 [95% CI, 1.30–2.17]) and 3‐point major adverse cardiovascular event (adjusted hazard ratio, 1.37 [95% CI, 1.10–1.71]). Conclusions In this Korean acute myocardial infarction registry, the baseline LDL‐C level <70 mg/dL was significantly associated with an increased incidence of long‐term cardiovascular events after discharge. (COREA [Cardiovascular Risk and Identification of Potential High‐Risk Population]‐Acute Myocardial Infarction Registry; NCT02806102). Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02806102.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea
| | - Min Chul Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Eun Ho Choo
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Ik Jun Choi
- Department of Cardiology Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of Korea
| | - Su Nam Lee
- Department of Cardiology St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea
| | - Mahn-Won Park
- Department of Cardiology Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea
| | - Chul Soo Park
- Department of Cardiology Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Hee-Yeol Kim
- Department of Cardiology Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Bucheon Republic of Korea
| | - Chan Joon Kim
- Department of Cardiology Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Ju Han Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Young Joon Hong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Kiyuk Chang
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
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19
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Nilsson G, Leppert J, Ohrvik J. Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case-control study with controls from the patients' recruitment area. BMJ Open 2022; 12:e057562. [PMID: 35896296 PMCID: PMC9335044 DOI: 10.1136/bmjopen-2021-057562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the impact of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) on long-term all-cause mortality (ACM) in patients with acute myocardial infarction (AMI) and controls. DESIGN Matched case-control study with 8-year follow-up. SETTING Vastmanland County Hospital, Vasteras, Sweden. PARTICIPANTS Consecutive patients with AMI admitted to the coronary care unit from March 2005 to May 2010 and age-matched and sex-matched controls from the general population. OUTCOME MEASURES ACM. RESULTS Person-year at risk among patients with AMI and controls was 11 667 (cases: 5780 and controls: 5887). During follow-up, 199 patients and 84 controls died, implying 3.4 deaths among patients and 1.4 among controls per 100 person-years at risk. Unadjusted Cox analyses showed significantly increasing mortality by decreasing TC and LDL-C levels in both patients (HR=0.70, 95% CI 0.62 to 0.79, p<0.001, and HR=0.64, 95% CI 0.56 to 0.74, p<0.001) and controls (HR=0.73, 95% CI 0.60 to 0.89, p=0.002, and HR=0.74, 95% CI 0.59 to 0.93, p=0.010). After adjusting for clinical variables, the results for the patients remained significant. Cox analyses of the relations between mortality and TC and LDL-C below and above their respective medians revealed the following pattern. PATIENTS below medians were TC and LDL-C levels significantly inversely related to mortality; above medians there were no relations with mortality. CONTROLS below medians were TC and LDL-C levels significantly inversely related to mortality; above medians were LDL-C levels significantly positively related to mortality. Mean LDL-C level in patients with blood sampled >12 hours after symptom onset was 0.41 mmol/L lower than that in patients with blood sampled ≤12 hours (p=0.030). This LDL-C decrease was reasonably caused by ongoing AMI and reflects the difference in LDL-C levels between patients and controls. CONCLUSIONS In patients with AMI, lower TC and LDL-C levels independently predict higher ACM. In their controls, LDL-C levels above the median independently predict higher ACM. This study adds to the body of evidence supporting the existence of a cholesterol paradox.
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Affiliation(s)
- Göran Nilsson
- Center for Clinical Research, Vasteras, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Jerzy Leppert
- Center for Clinical Research, Vasteras, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - John Ohrvik
- Center for Clinical Research, Vasteras, Faculty of Medicine, Uppsala University, Uppsala, Sweden
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20
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Wen CP, Lee YC, Sun YT, Huang CY, Tsai CH, Chen PL, Chang WL, Yeh PY, Wei CY, Tsai MJ, Sun Y, Lin CH, Lee JT, Lai TC, Lien LM, Lin MC, Lin CL, Lee JH, Wang HK, Hsu CY. Low-Density Lipoprotein Cholesterol and Mortality in Patients With Intracerebral Hemorrhage in Taiwan. Front Neurol 2022; 12:793471. [PMID: 35113980 PMCID: PMC8802633 DOI: 10.3389/fneur.2021.793471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts. Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality. Results: Low cholesterol (LDL-C <100 mg/dL), found in 1/4 of the MJ cohort, was highly prevalent (36%) among young adults (age 20–39). There was a graded relationship between cholesterol and mortality for ICH [Hazard ratio, 1.56; 95% confidence interval (CI), 1.13–2.16]. Compared with patients with an LDL-C of 110–129 mg/dL in TSR, the risk for mortality was 1.84 (95% CI, 1.28–2.63) with an LDL-C of <100 mg/dL. Conclusion: Lower serum LDL-C level independently predicts higher mortality after acute ICH. While its causative role may vary, low cholesterol may pose potential harms in Taiwan.
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Affiliation(s)
- Chi-Pang Wen
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Yi-Che Lee
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Yuan Huang
- Department of Surgery, Faculty of Neurosurgical Service, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chon-Haw Tsai
- Division of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Po-Lin Chen
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Lun Chang
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Yen Yeh
- Department of Neurology, St. Martin De Porres Hospital, Chiayi, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ming-Jun Tsai
- Department of Neurology, Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chih-Hao Lin
- Department of Neurology, Lin Shin Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, New Taipei City, Taiwan
| | - Ta-Chang Lai
- Department of Neurology, Cheng Hsin General Hospital, New Taipei City, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho Su Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - June-Han Lee
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chung Y Hsu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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21
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Yang JK, Kim YJ, Jeong J, Kim J, Park JH, Ro YS, Shin SD. Low serum cholesterol level as a risk factor for out-of-hospital cardiac arrest: a case-control study. Clin Exp Emerg Med 2022; 8:296-306. [PMID: 35000357 PMCID: PMC8743677 DOI: 10.15441/ceem.20.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We aimed to identify the association between low serum total cholesterol levels and the risk of out-of-hospital cardiac arrest (OHCA). METHODS This case-control study was performed using datasets from the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES) project and the Korea National Health and Nutrition Examination Survey (KNHANES). Cases were defined as emergency medical service-treated adult patients who experienced OHCA with a presumed cardiac etiology from the CAPTURES project dataset. Four controls from the KNHANES dataset were matched to each case based on age, sex, and county. Multivariable conditional logistic regression analysis was conducted to evaluate the effect of total cholesterol levels on OHCA. RESULTS A total of 607 matched case-control pairs were analyzed. We classified total cholesterol levels into six categories (<148, 148-166.9, 167-189.9, 190-215.9, 216-237.9, and ≥238 mg/dL) according to the distribution of total cholesterol levels in the KNHANES dataset. Subjects with a total cholesterol level of 167-189.9 mg/dL (25th-49th percentile of the KNHANES dataset) were used as the reference group. In both the adjusted models and sensitivity analysis, a total cholesterol level of <148 mg/dL was significantly associated with OHCA (adjusted odds ratio [95% confidence interval], 6.53 [4.47-9.56]). CONCLUSION We identified an association between very-low total cholesterol levels and an increased risk of OHCA in a large, community-based population. Future prospective studies are needed to better understand how a low lipid profile is associated with OHCA.
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Affiliation(s)
- Jae Kwang Yang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jungeun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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22
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Ding M, Wennberg A, Ek S, Santoni G, Gigante B, Walldius G, Hammar N, Modig K. The association of apolipoproteins with later-life all-cause and cardiovascular mortality: a population-based study stratified by age. Sci Rep 2021; 11:24440. [PMID: 34952923 PMCID: PMC8709841 DOI: 10.1038/s41598-021-03959-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Midlife lipid levels are important predictors of cardiovascular diseases, yet their association with mortality in older adults is less clear. We aimed to (1) identify lipid profiles based on cholesterol, triglycerides, and apolipoproteins using cluster analysis, and (2) investigate how lipid profiles and lipid levels at different ages are associated with later-life all-cause and cardiovascular mortality. We used data from 98,270 individuals in the Swedish AMORIS cohort who had blood measurements between 1985-1996 and were followed until 2012. Over the follow-up (mean 18.0 years), 30,730 (31.3%) individuals died. Three lipid profiles were identified. Compared with reference profile, a high lipid profile (low ApoA-I and high total cholesterol (TC), triglycerides, ApoB, and ApoB/ApoA-I ratio) at ages 39-59 or 60-79 was associated with higher all-cause mortality. A high lipid profile at ≥ 80 years, however, did not confer higher mortality. For the specific markers, high TC (≥ 7.25 mmol/L) was associated with higher all-cause mortality in ages 39-59 but lower mortality in ages 60-79 and ≥ 80. Low ApoA-I (< 1.28 g/L) and high ApoB/ApoA-I ratio (≥ 1.18), on the other hand, were associated with higher cardiovascular mortality regardless of age at lipid measurement, highlighting their potential relevance for survival in both young and older individuals.
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Affiliation(s)
- Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden.
| | - Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
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23
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Andrade NVDSS, Noronha IMD, Almeida LX, Siqueira F, Onofre T. Cardiovascular risk in primary care: comparison between Framingham Score and waist circumference. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i4.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: To estimate and compare the cardiovascular risk using the Framingham risk score (FRS) and waist circumference (WC) in primary care individuals and, secondarily, determine the main factors associated with these scores. Methods: Cross-sectional study involving individuals of both sexes attended in a primary health unit and aging between 30 and 74 years. The cardiovascular risks (FRS and WC) were stratified as low, intermediate, and high. The weighted Kappa coefficient was used to assess agreements between scores. Results: Fifty-five individuals (52.8 ± 9.4 years, 70.9% women) were evaluated. Using the FRS, 40.0% of the sample presented a low risk, 45.5% intermediate risk, and 14.5% high risk of cardiovascular disease. Conversely, when analyzed using the WC score, the highest frequency (71%) was observed in the high-risk category. Also, no agreement (K= 0.36; p= 0.55) was found between scores. FRS was associated with hypertension (p<0.01), diabetes (p=0.01), and stress in women (p=0.01), while the WC score was associated with hypertension (p=0.02), obesity (p<0.01), and high-density lipoprotein cholesterol HDL-c (p=0.03). Conclusions: Primary care individuals presented intermediate cardiovascular risk in the FRS and high risk in the WC, with no agreement between scores. Hypertension, diabetes, stress, obesity, and HDL-c represented the factors that were most associated with these scores.
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24
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Cobos-Palacios L, Sanz-Cánovas J, Muñoz-Ubeda M, Lopez-Carmona MD, Perez-Belmonte LM, Lopez-Sampalo A, Gomez-Huelgas R, Bernal-Lopez MR. Statin Therapy in Very Old Patients: Lights and Shadows. Front Cardiovasc Med 2021; 8:779044. [PMID: 34912868 PMCID: PMC8667269 DOI: 10.3389/fcvm.2021.779044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of death worldwide. High levels of total cholesterol—and of low-density lipoprotein cholesterol in particular—are one of the main risk factors associated with ASCVD. Statins are first-line treatment for hypercholesterolemia and have been proven to reduce major vascular events in adults with and without underlying ASCVD. Findings in the literature show that statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged people, but their benefits in older adults are not as well-established, especially in primary prevention. Furthermore, many particularities must be considered regarding their use in old subjects, such as age-related changes in pharmacokinetics and pharmacodynamics, comorbidities, polypharmacy, and frailty, which decrease the safety and efficacy of statins in this population. Myopathy and a possible higher risk of falling along with cognitive decline are classic concerns for physicians when considering statin use in the very old. Additionally, some studies suggest that the relative risk for coronary events and cardiovascular mortality associated with high levels of cholesterol decreases after age 70, making the role of statins unclear. On the other hand, ASCVD are one of the most important causes of disability in old subjects, so cardiovascular prevention is of particular interest in this population in order to preserve functional status. This review aims to gather the current available evidence on the efficacy and safety of statin use in very old patients in both primary and secondary prevention.
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Affiliation(s)
- Lidia Cobos-Palacios
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Jaime Sanz-Cánovas
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Mónica Muñoz-Ubeda
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - María Dolores Lopez-Carmona
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Luis Miguel Perez-Belmonte
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Almudena Lopez-Sampalo
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Ricardo Gomez-Huelgas
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición, Carlos III Health Institute, Madrid, Spain
| | - Maria Rosa Bernal-Lopez
- Department of Internal Medicine, Regional University Hospital of Málaga-Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain.,CIBER Fisiopatología de la Obesidad y la Nutrición, Carlos III Health Institute, Madrid, Spain
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Aldana-Bitar J, Moore J, Budoff MJ. LDL receptor and pathogen processes: Functions beyond normal lipids. J Clin Lipidol 2021; 15:773-781. [PMID: 34645587 DOI: 10.1016/j.jacl.2021.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Although the role of the LDL receptor concerning lipids is well known, its role in various viral and parasitic infections, and in regulating the inflammatory response is poorly understood. Several infectious agents use the LDL receptor as a port of entry, and others depend on it for their cycle of infection. In this review, we focus on the discovery, structure, and normal function of the LDL receptor, as well as its role in a selection of infections. The LDL receptor plays an important role in certain infections and is a potential target for treatment deserving further research.
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Affiliation(s)
- Jairo Aldana-Bitar
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
| | - Jeff Moore
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
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Miyagawa N, Ohkubo T, Fujiyoshi A, Shiino A, Chen R, Ross GW, Willcox B, Miura K, Ueshima H, Masaki K. Factors Associated with Lower Cognitive Performance Scores Among Older Japanese Men in Hawaii and Japan. J Alzheimers Dis 2021; 81:403-412. [PMID: 33814425 DOI: 10.3233/jad-201084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have compared factors related to cognitive function among people with similar genetic backgrounds but different lifestyles. OBJECTIVE We aimed to identify factors related to lower cognitive scores among older Japanese men in two genetically similar cohorts exposed to different lifestyle factors. METHODS This cross-sectional study of community-dwelling Japanese men aged 71-81 years included 2,628 men enrolled in the Kuakini Honolulu-Asia Aging Study based in Hawaii and 349 men in the Shiga Epidemiological Study of Subclinical Atherosclerosis based in Japan. We compared participant performance through Cognitive Abilities Screening Instrument (CASI) assessment in Hawaii (1991-1993) and Japan (2009-2014). Factors related to low cognitive scores (history of cardiovascular disease, cardiometabolic factors, and lifestyle factors) were identified with questionnaires and measurements. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (ORs) of a low (< 82) CASI score based on different factors. RESULTS CASI scores were lower in Hawaii than in Japan [21.2%(n = 556) versus 12.3%(n = 43), p < 0.001], though this was not significant when adjusted for age and educational attainment (Hawaii 20.3%versus Japan 17.9%, p = 0.328). History of stroke (OR = 1.65, 95%confidence interval = 1.19-2.29) was positively associated with low cognitive scores in Hawaii. Body mass index ≥25 kg/m2 tended to be associated with low cognitive scores in Japan; there was a significant interaction between the cohorts. CONCLUSION Cognitive scores differences between cohorts were mostly explained by differences in educational attainment. Conversely, cardiovascular diseases and cardiometabolic factors differentially impacted cognitive scores among genetically similar older men exposed to different lifestyle factors.
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Affiliation(s)
- Naoko Miyagawa
- International Center for Nutrition and Information, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Hygiene, School of Medicine, Wakayama Medical University; Wakayama, Japan
| | - Akihiko Shiino
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Randi Chen
- Kuakini Medical Center, Honolulu, HI, USA
| | - George Webster Ross
- Veterans Affairs Pacific Islands Health Care System, Honolulu, HI, USA.,Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Bradley Willcox
- Kuakini Medical Center, Honolulu, HI, USA.,Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Kamal Masaki
- Kuakini Medical Center, Honolulu, HI, USA.,Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Tsai SP, Wen CP, Tsai MK, Lu PJ, Wai JPM, Wen C, Gao W, Wu X. Converting health risks into loss of life years - a paradigm shift in clinical risk communication. Aging (Albany NY) 2021; 13:21513-21525. [PMID: 34491905 PMCID: PMC8457574 DOI: 10.18632/aging.203491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
For facilitating risk communication in clinical management, such a ratio-based measure becomes easier to understand if expressed as a loss of life expectancy. The cohort, consisting of 543,410 adults in Taiwan, was recruited between 1994 and 2008. Health risks included lifestyle, biomarkers, and chronic diseases. A total of 18,747 deaths were identified. The Chiang's life table method was used to estimate a loss of life expectancy. We used Cox regression to calculate hazard ratios (HRs) for health risks. The increased mortality from cardio-metabolic risks such as high cholesterol (HR=1.10), hypertension (HR=1.48) or diabetes (HR=2.02) can be converted into a loss of 1.0, 4.4, and 8.9 years in life expectancy, respectively. The top 20 of the 30 risks were associated with a loss of 4 to 10 years of life expectancy, with 70% of the cohort having at least two such risk factors. Smoking, drinking, and physical inactivity each had 5-7 years loss. Individuals with diabetes or an elevated white count had a loss of 7-10 years, while prolonged sitting, the most prevalent risk factor, had a loss of 2-4 years. Those with diabetes (8.9 years) and proteinuria (9.1 years) present at the same time showed a loss of 16.2 years, a number close to the sum of each risk. Health risks, expressed as life expectancy loss, could facilitate risk communication. The paradigm shift in expressing risk intensity can help set public health priorities scientifically to promote a focus on the most important ones in primary care.
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Affiliation(s)
| | - Chi Pang Wen
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - Min Kuang Tsai
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Po Jung Lu
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Jackson Pui Man Wai
- Institute of Sport Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Christopher Wen
- Long Beach VAMC Hospital, University of Irvine Medical Center, Irvine, CA 92868, USA
| | - Wayne Gao
- Taipei Medical University, Taipei, Taiwan
| | - Xifeng Wu
- Center for Biostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
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Postoperative controlling nutritional status score is an independent risk factor of survival for patients with small hepatocellular carcinoma: a retrospective study. BMC Surg 2021; 21:338. [PMID: 34493254 PMCID: PMC8422699 DOI: 10.1186/s12893-021-01334-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The controlling nutritional status (CONUT) score has been widely used to evaluate the nutritional and immunological status. Clinical value of postoperative CONUT (PoCONUT) score in hepatocellular carcinoma (HCC) remains unknown. This study assessed whether PoCONUT score could serve as a useful predictor of survival for patients with small HCC. METHODS 547 consecutive patients with small HCC who underwent liver resection between February 2007 and December 2015 were included in this retrospective case-control study. Patients were categorized into two groups: low PoCONUT group (PoCONUT score ≤ 2, n = 382) and high PoCONUT group (PoCONUT score ≥ 3, n = 165). Propensity score matching (PSM) analysis was applied to balance the bias in baseline characteristics. A cumulative survival curve was established by the Kaplan-Meier method, and differences in OS and RFS among CONUT score groups were determined by the log rank test. Cox proportional hazard regression analysis was used to evaluate the association of PoCONUT score and overall survival (OS) and recurrence-free survival (RFS), with calculation of hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). RESULTS Cox proportional hazard regression analysis suggested that the PoCONUT score was an independent risk factor for both OS and RFS in patients with small HCC before and after PSM. CONCLUSIONS High PoCONUT score helps to predict worse OS and RFS in patients with small HCC who underwent liver resection.
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Impact of initial very low-level low-density lipoprotein cholesterol on the prognosis of acute myocardial infarction patients. Coron Artery Dis 2021; 31:e44-e50. [PMID: 34347637 DOI: 10.1097/mca.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cholesterol control with statins has been shown to have beneficial effects in coronary artery disease. However, the relationship between initial very low low-density lipoprotein (LDL) cholesterol levels and long-term clinical outcomes in patients with acute myocardial infarction (AMI) remains unclear. METHODS A total of 8741 (mean age: 64.6 ± 12.7 years, men) consecutive AMI patients treated with drug-eluting stents were entered into the Korea Acute Myocardial Infarction Registry from November 2011 to December 2015. Patients were divided into six groups according to whether they were taking statins (on-statin group) or not (statin naive group) and depending on their LDL cholesterol level at admission (<70, 70-99, 100-129, 130-159, >160 mg/dl). Clinical outcomes at 24 months in patients with AMI were examined. RESULTS The incidence of risk factors including hypertension, diabetes, coronary artery disease and heart failure was lower as LDL cholesterol increased, except in the on-statin group. Clinical outcomes, including total mortality at 24 months, showed better outcomes in those with high LDL cholesterol than those with low LDL cholesterol, except in the statin group. In the statin-naïve group, the higher the LDL cholesterol level, the higher the rate of 24-month survival. In a Cox regression model, initial low LDL cholesterol was an independent predictor of mortality at 24 months after adjusting for baseline confounding factors. CONCLUSIONS At admission, a very low LDL cholesterol level (<70 mg/dL) in statin-naïve AMI patients undergoing percutaneous coronary intervention was independently associated with higher mortality at 24 months.
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Jin J, Shi Z, Pang X. Association between low-density lipoprotein cholesterol level and mortality in patients with cardiogenic shock: a retrospective cohort study. BMJ Open 2021; 11:e044668. [PMID: 34215599 PMCID: PMC8256757 DOI: 10.1136/bmjopen-2020-044668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Inflammation plays a key role in the pathophysiology of cardiogenic shock (CS). Low-density lipoprotein cholesterol (LDL-C) is a biomarker of inflammation and is used to predict prognostic outcomes of several diseases. The primary purpose of this study was to evaluate if LDL-C can be used as a biomarker to predict the mortality of CS. METHODS AND RESULTS Records of critically ill patients with CS were identified from the Medical Information Mart for Intensive Care III database. A multivariate Cox regression model was employed to adjust for imbalances by incorporating parameters and potential confounders.A total of 551 critically ill patients with CS were enrolled for this analysis, including 207 with LDL-C <1.8 mmol/L and 344 with LDL-C ≥1.8 mmol/L. Results of multivariate Cox regression models found that higher concentration of LDL-C (LDL-C ≥1.8mmol/L) was associated with a reduced risk of in-hospital mortality (HR 0.66, 95% CI 0.50 to 0.87; p=0.003) and 28-day mortality (HR 0.61, 95% CI 0.46 to 0.80; p=0.002) LDL-C in patients with CS. Patients with LDL-C ≥1.8 mmol/L were independently associated with improved in-hospital survival (HR 0.32, 95% CI 0.20 to 0.52, p<0.001) and 28-day survival (HR 0.51, 95% CI 0.33 to 0.73, p=0.002) compared with patients with LDL-C <1.8 mmol/L. The impact of LDL-C on in-hospital mortality and 28-day mortality persisted in patients with acute coronary syndrome (ACS) and was not statistically significant in the non-ACS subgroup. CONCLUSIONS Our study observed that increased LDL-C level was related with improved survival in patients with CS, but not with improved outcomes in patients with uncomplicated ACS. The results need to be verified in randomised controlled trials.
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Affiliation(s)
- Jiali Jin
- Department of Cardiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Zhewei Shi
- Department of Cardiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
| | - Xiaomin Pang
- Department of Emergency, People's Hospital of Tiantai County, Taizhou, Zhejiang, China
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Cho Y, Jeong Y, Seo DH, Ahn SH, Hong S, Suh YJ, Kim SH. Use of statin for the primary prevention of cardiovascular outcomes in elderly patients: A propensity-matched cohort study. Atherosclerosis 2021; 328:92-99. [PMID: 34126505 DOI: 10.1016/j.atherosclerosis.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/30/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Herein, we investigate whether statin treatment as primary prevention reduces cardiovascular outcomes in elderly Asian patients. METHODS Data were obtained from the Korean National Health Insurance Service-Senior Cohort database (n = 558,147). A total of 81,729 elderly patients (≥75 years) without clinically recognized atherosclerotic cardiovascular disease (CVD) were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to the end of 2012. New statin users (n = 3670) were matched on the basis of the propensity score in a 1:2 ratio with non-users. Incidences of myocardial infarction, ischemic stroke, and death from CVD were compared using the Cox proportional hazards model. RESULTS The risk of cardiovascular death was significantly reduced in the statin treatment group compared with the non-user group (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.29 to 0.40; p < 0.001). This effect was observed in both patient groups with and without diabetes. In patients with diabetes, the HR for statin use was 0.85 (95% CI 0.55 to 1.33) for myocardial infarction and 0.75 (95% CI 0.60 to 0.93) for ischemic stroke. In participants without diabetes, the HR of statin use was 0.95 (95% CI 0.73 to 1.24) for myocardial infarction and 1.13 (95% CI 1.01 to 1.26) for ischemic stroke. The presence of hypertension was also a significant factor in the prevention of ischemic stroke by statin treatment. CONCLUSIONS In elderly patients without clinically recognized atherosclerotic CVD, the risk of cardiovascular mortality was significantly reduced with statin treatment than with non-users. In participants with type 2 diabetes, statin treatment was associated with a reduction in ischemic stroke.
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Affiliation(s)
- Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, South Korea.
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
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Lawrence GD. Perspective: The Saturated Fat-Unsaturated Oil Dilemma: Relations of Dietary Fatty Acids and Serum Cholesterol, Atherosclerosis, Inflammation, Cancer, and All-Cause Mortality. Adv Nutr 2021; 12:647-656. [PMID: 33693484 PMCID: PMC8166560 DOI: 10.1093/advances/nmab013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 12/27/2022] Open
Abstract
PUFAs are known to regulate cholesterol synthesis and cellular uptake by multiple mechanisms that do not involve SFAs. Polymorphisms in any of the numerous proteins involved in cholesterol homeostasis, as a result of genetic variation, could lead to higher or lower serum cholesterol. PUFAs are susceptible to lipid peroxidation, which can lead to oxidative stress, inflammation, atherosclerosis, cancer, and disorders associated with inflammation, such as insulin resistance, arthritis, and numerous inflammatory syndromes. Eicosanoids from arachidonic acid are among the most powerful mediators that initiate an immune response, and a wide range of PUFA metabolites regulate numerous physiological processes. There is a misconception that dietary SFAs can cause inflammation, although endogenous palmitic acid is converted to ceramides and other cell constituents involved in an inflammatory response after it is initiated by lipid mediators derived from PUFAs. This article will discuss the many misconceptions regarding how dietary lipids regulate serum cholesterol, the fact that all-cause death rate is higher in humans with low compared with normal or moderately elevated serum total cholesterol, the numerous adverse effects of increasing dietary PUFAs or carbohydrate relative to SFAs, as well as metabolic conversion of PUFAs to SFAs and MUFAs as a protective mechanism. Consequently, dietary saturated fats seem to be less harmful than the proposed alternatives.
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Affiliation(s)
- Glen D Lawrence
- Department of Chemistry and Biochemistry, Long Island University, Brooklyn, NY, USA
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He GD, Liu XC, Liu L, Yu YL, Chen CL, Huang JY, Lo K, Huang YQ, Feng YQ. A nonlinear association of total cholesterol with all-cause and cause-specific mortality. Nutr Metab (Lond) 2021; 18:25. [PMID: 33691735 PMCID: PMC7945313 DOI: 10.1186/s12986-021-00548-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/27/2021] [Indexed: 01/14/2023] Open
Abstract
Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999–2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression models and Cox models with penalized splines were applied to explore nonlinear and irregular shape relationships. Kaplan–Meier survival curve and subgroup analyses were conducted. Results The sample studied comprised 14,662 men and 16,025 women, categorized as 25,429 adults aged 18–65 and 5,258 adults over 65 years old. A total of 2,570 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause and cancer mortality were particularly negatively related to TC levels in the lower range < 200 mg/dL, especially in the range < 120 mg/dL (HR 1.97; 95% CI 1.38, 2.83, HR 2.39; 95% CI 1.21, 4.71, respectively). However, the HRs of cardiovascular disease mortality in the range < 120 mg/dL were the lowest (HR 0.60; 95% CI 0.15, 2.42). In the upper range, a TC range of ≥ 280 mg/dL was correlated with mortality as a result of CVD and cancer (HR 1.31; 95% CI 0.87, 1.97 and HR 1.22; 95% CI 0.82, 1.79). The lowest cumulative survival rate of all-cause mortality was recorded in the lowest TC-level group, while the lowest cumulative survival rate of CVD mortality was recorded in the highest TC-level group. Conclusions A nonlinear association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00548-1.
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Affiliation(s)
- Guo-Dong He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Kenneth Lo
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, USA
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
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Rivera-Chávez JG, Torres-Gutiérrez JL, Regalado-Villalobos A, Moreno-Cervantes CA, Luna-Torres S. Association between falls and cardiovascular diseases in the geriatric population. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:66-72. [PMID: 33661879 PMCID: PMC8258912 DOI: 10.24875/acm.20000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the association of cardiovascular diseases with falls in the geriatric population. Methods Original, Transversal and analytical study. Elderly patients who attend the external consultation of the Geriatrics service, older than 65 years, with falls history, perform comprehensive geriatric assessment to indentify causes of falls in the period from March 2018 to June 2019. We perform measures of central tendency, chi-square test X2 for qualitative variables, we performed linear regression model. Results A total of 669 patients were included, the analysis shows association with frailty [OR 1.65 (95% CI 1.37-3.77), p <0.05], Heart Failure [OR 1.02, (95% CI, 0.68 - 1.54), p < 0.05 ], the logistic regression analysis with the variables (Fragility, SAH, es: DM2, AMI, Stroke, AF, postural hypotensive syncope, Hypothyroidism, Dyslipidemia, and HF) shows that the probability of falling is 57%. Conclusion Cardiovascular diseases have a high prevalence in the population studied and increase the risk of falls. Individually analyzed cardiovascular diseases do not show an association with the syndrome of falls in the elderly, except for frailty, which proved to be an independent factor that increases the risk of falls with an OR 1.65. When analyzing them together, the risk of falling increases up to 57%. It is necessary to correctly identify and treat cardiovascular diseases in the elderly.
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Affiliation(s)
- José G. Rivera-Chávez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Jorge L. Torres-Gutiérrez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Alejandra Regalado-Villalobos
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - César A. Moreno-Cervantes
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Sara Luna-Torres
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Paradoxical association between atrial fibrillation/flutter and high cholesterol over age 75 years: The Kuakini Honolulu Heart Program and Honolulu-Asia Aging Study. J Electrocardiol 2020; 65:37-44. [PMID: 33482619 DOI: 10.1016/j.jelectrocard.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation/flutter (AF). However, the etiology is uncertain. One potential explanation might be the confounding effect of age exemplifying prevalence-incidence (Neyman's) bias. However, this bias has not often been discussed in depth in the literature. Therefore, we conducted a cross-sectional analysis to test the hypothesis that there is a paradoxical association between lipid profile and AF prevalence. METHODS This is a cross-sectional study design, using data from the Kuakini Honolulu Heart Program. Participants were 3741 Japanese-American men between 71 and 93 years old living in Hawaii. Serum total cholesterol (TC) level was measured and categorized into quartiles. AF was diagnosed by 12‑lead Electrocardiogram. We categorized age into quartiles (71-74, 75-77, 78-80 and 81+ years). RESULTS We observed opposite associations between AF and TC among different age groups. For participants age ≥75, higher TC levels were paradoxically associated with lower prevalence of AF after multivariable adjustment, i.e. the odds ratios of AF comparing the highest TC quartile with the lowest TC quartile for age 75-77, 78-80 and 81+ years were 0.17 (95% confidence interval [CI], 0.06-0.52), 0.28 (95% CI, 0.07-1.09) and 0.14 (95% CI, 0.03-0.62), respectively. Conversely, for those who were 71-74 years old, the odds ratio of AF was 2.09 (95% CI, 0.76-5.75) between the highest and the lowest TC quartiles. CONCLUSIONS There is a paradoxical association of TC with AF in Japanese-American men age ≥75, but not <75 years. The paradox might be explained by Neyman's bias.
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Affiliation(s)
- Tagayasu Anzai
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Andrew Grandinetti
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Alan R Katz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Yan Yan Wu
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 347 N Kuakini St, Honolulu, HI, USA; Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA.
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Edes A, Brown J, Edwards K. Testing lipid markers as predictors of all-cause morbidity, cardiac disease, and mortality risk in captive western lowland gorillas ( Gorilla gorilla gorilla). Primate Biol 2020; 7:41-59. [PMID: 33553576 PMCID: PMC7852406 DOI: 10.5194/pb-7-41-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
Great apes and humans develop many of the same health conditions, including cardiac disease as a leading cause of death. In humans, lipid markers are strong predictors of morbidity and mortality risk. To determine if they similarly predict risk in gorillas, we measured five serum lipid markers and calculated three lipoprotein ratios from zoo-housed western lowland gorillas (aged 6-52 years, n = 61 , subset with routine immobilizations only: n = 47 ): total cholesterol (TC), triglycerides (TGs), high-density lipoprotein (HDL), low-density lipoprotein (LDL), apolipoprotein A1 (apoA1), TC / HDL , LDL / HDL , and TG / HDL . We examined each in relation to age and sex, then analyzed whether they predicted all-cause morbidity, cardiac disease, and mortality using generalized linear models (GLMs). Older age was significantly associated with higher TG, TC / HDL , LDL / HDL , and TG / HDL , and lower HDL and apoA1. With all ages combined, compared to females, males had significantly lower TG, TC / HDL , LDL / HDL , and TG / HDL , and higher HDL. Using GLMs, age, sex, and lower LDL / HDL were significant predictors of all-cause morbidity; this is consistent with research demonstrating lower LDL in humans with arthritis, which was the second most prevalent condition in this sample. In contrast to humans, lipid markers were not better predictors of cardiac disease and mortality risk in gorillas, with cardiac disease best predicted by age and sex alone, and mortality risk only by age. Similar results were observed when multimodel inference was used as an alternative analysis strategy, suggesting it can be used in place of or in addition to traditional methods for predicting risk.
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Affiliation(s)
- Ashley N. Edes
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
- currently at: Department of Reproductive and
Behavioral Sciences, Saint Louis Zoo, St. Louis, MO 63110, USA
| | - Janine L. Brown
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
| | - Katie L. Edwards
- Center for Species Survival, Smithsonian Conservation Biology
Institute, 1500 Remount Rd., Front Royal, VA 22630, USA
- North of England Zoological Society, Chester Zoo, Upton by Chester,
CH2 1LH, UK
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Prognostic value of non-alcoholic fatty liver disease in the elderly patients. Aging Clin Exp Res 2020; 32:2657-2665. [PMID: 32008226 DOI: 10.1007/s40520-020-01487-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the liver manifestation of metabolic syndrome, a risk factor for mortality and cardiovascular morbidity, but we ignore the role of steatosis per se in survival, and there is very little information about this condition in the geriatric patient. AIMS With the present study, we investigated the independent prognostic value of NAFLD on overall mortality in the elderly. METHODS Within the Pianoro Project, involving people ≥ 65 years, anamnestic, clinical and laboratoristic data related to NAFLD, insulin resistance, diabetes/hyperglycemia, hypertension, obesity and dyslipidemia were collected in 804 subjects (403 male, 401 female). These subjects were followed up for mortality for a median time of 12.6 years. A multivariate analysis was performed to evaluate the prognostic value of the covariates. RESULTS At Kaplan-Meier estimator the presence of NAFLD seems to be associated to a lower mortality, and survival tends to increase with the increasing of steatosis grade. Cox's analysis found that survival is increased for subjects having hypercholesterolemia (RR = 0.565), NAFLD (RR = 0.777), hypertension (RR = 0.711) and in female (RR = 0.741), while it is decreased for the older subjects (RR = 3.046), in patients with hypertriglyceridemia (RR = 1.699) and for diabetics (RR = 1.797). The variables BMI and HDL-cholesterol have no role. CONCLUSION The data obtained in our study show that NAFLD is not associated to overall mortality in the elderly population.
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Nozaka M, Yokoyama H, Kitayama K, Nagawa D, Hamadate M, Miura N, Kawamura Y, Nakata M, Nishizaki F, Hanada K, Yokota T, Yamada M, Tomita H. Clinical Outcomes of Acute Myocardial Infarction Patients With a History of Malignant Tumor. In Vivo 2020; 34:3589-3595. [PMID: 33144472 DOI: 10.21873/invivo.12203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the clinical outcomes of acute myocardial infarction (AMI) in patients with a history of malignant tumor (MT). PATIENTS AND METHODS We retrospectively studied 1,295 consecutive patients with AMI who underwent primary percutaneous coronary intervention within 24 hours of onset. The patients were divided into two groups: those with a history of MT (MT group, n=50) and those without (non-MT group, n=1,245). RESULTS The MT group was older, and had lower hemoglobin, total protein, and albumin levels. All-cause mortality and re-admission rates due to acute decompensated heart failure (ADHF) were significantly higher in the MT group. Multivariate analysis showed that a history of MT was an independent predictor for all-cause mortality and re-admission due to ADHF. CONCLUSION The clinical outcomes of patients with AMI with a history of MT are poor, and a history of MT is an independent predictor for all-cause mortality and re-admission due to ADHF. These patients may need careful risk management for heart failure to avoid re-admissions due to ADHF.
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Affiliation(s)
- Masashi Nozaka
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Kitayama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Nagawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Misato Hamadate
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naotake Miura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yosuke Kawamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masamichi Nakata
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenji Hanada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Yokota
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiro Yamada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Chen HC, Lee WC, Fang HY, Fang CY, Chen CJ, Yang CH, Wu CJ. Impact of high triglyceride/high-density lipoprotein cholesterol ratio (insulin resistance) in ST-segment elevation myocardial infarction. Medicine (Baltimore) 2020; 99:e22848. [PMID: 33120817 PMCID: PMC7581178 DOI: 10.1097/md.0000000000022848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) has been proposed as an easily obtainable atherogenic marker and high TG/HDL-C ratio is associated with insulin resistance. This study investigated the associated between a high TG/HDL-C ratio and cardiovascular mortality in patients with ST-segment elevation myocardial infarction (STEMI), with or without diabetes mellitus (DM).Between January 2005 and December 2014, 1661 patients with STEMI underwent primary percutaneous coronary intervention in our hospital. Of these, 289 were classified into group 1 (with both DM and a high TG/HDL-C ratio), 295 into group 2 (with DM, but without a high TG/HDL-C ratio), 501 into group 3 (without DM, but a high TG/HDL-C ratio), and 576 into group 4 (without DM or a high TG/HDL-C ratio).Older age, longer chest pain to reperfusion time, poor hemodynamic condition, and higher prevalence of multiple vessel coronary artery disease were noted in those with DM. Poor outcomes including higher 30-day and 1-year cardiovascular mortality and all-cause mortality rates were noted in those with DM but without a high TG/HDL-C ratio. Patients with DM but without a high TG/HDL-C ratio had a Hazard ratio of 3.637 for cardiovascular mortality relative to those without DM, but without a high TG/HDL-C ratio.Even though a high TG/HDL-C ratio is associated with insulin resistance, patients with or without DM, but with a high TG/HDL-C ratio had better 30-day and 1-year outcomes.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
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Turusheva A, Vaes B, Degryse JM, Frolova E. Low cholesterol levels are associated with a high mortality risk in older adults without statins therapy: An externally validated cohort study. Arch Gerontol Geriatr 2020; 90:104180. [DOI: 10.1016/j.archger.2020.104180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/23/2023]
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Bach RG, Cannon CP, Giugliano RP, White JA, Lokhnygina Y, Bohula EA, Califf RM, Braunwald E, Blazing MA. Effect of Simvastatin-Ezetimibe Compared With Simvastatin Monotherapy After Acute Coronary Syndrome Among Patients 75 Years or Older: A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2020; 4:846-854. [PMID: 31314050 DOI: 10.1001/jamacardio.2019.2306] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Limited evidence is available regarding the benefit and hazard of higher-intensity treatment to lower lipid levels among patients 75 years or older. As a result, guideline recommendations differ for this age group compared with younger patients. Objective To determine the effect on outcomes and risks of combination ezetimibe and simvastatin compared with simvastatin monotherapy to lower lipid levels among patients 75 years or older with stabilized acute coronary syndrome (ACS). Design, Setting, Participants In this prespecified secondary analysis of the global, multicenter, prospective clinical randomized Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and risks were compared by age among patients 50 years or older after a hospitalization for ACS. Data were collected from October 26, 2005, through July 8, 2010, with the database locked October 21, 2014. Data were analyzed May 29, 2015, through March 13, 2018, using Kaplan-Meier curves and Cox proportional hazards models. Interventions Double-blind randomized assignment to combined simvastatin and ezetimibe or simvastatin and placebo with follow-up for a median of 6 years (interquartile range, 4.3-7.1 years). Main Outcomes and Measures The primary composite end point consisted of death due to cardiovascular disease, myocardial infarction (MI), stroke, unstable angina requiring hospitalization, and coronary revascularization after 30 days. Individual adverse ischemic and safety end points and lipid variables were also analyzed. Results Of 18 144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8] years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75 years or older at randomization. Treatment with simvastatin-ezetimibe resulted in lower rates of the primary end point than simvastatin-placebo, including 0.9% for patients younger than 65 years (HR, 0.97; 95% CI, 0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR], 0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of 8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P = .02 for interaction). The rate of adverse events did not increase with simvastatin-ezetimibe vs simvastatin-placebo among younger or older patients. Conclusions and Relevance In IMPROVE-IT, patients hospitalized for ACS derived benefit from higher-intensity therapy to lower lipid levels with simvastatin-ezetimibe compared with simvastatin monotherapy, with the greatest absolute risk reduction among patients 75 years or older. Addition of ezetimibe to simvastatin was not associated with any significant increase in safety issues among older patients. These results may have implications for guideline recommendations regarding lowering of lipid levels in the elderly. Trial Registration ClinicalTrials.gov identifier: NCT00202878.
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Affiliation(s)
- Richard G Bach
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Christopher P Cannon
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer A White
- Duke Clinical Research Institute, Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert M Califf
- Duke Clinical Research Institute, Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael A Blazing
- Duke Clinical Research Institute, Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
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Vaes B, Indestege P, Serneels T, Hegendörfer E, van Peet PG, Poortvliet RKE, Wallemacq P, Gussekloo J, Degryse J. Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study. BMJ Open 2020; 10:e035809. [PMID: 32595156 PMCID: PMC7322328 DOI: 10.1136/bmjopen-2019-035809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers. DESIGN Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study. SETTING General practice, Belgium and The Netherlands. PARTICIPANTS The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD. OUTCOME MEASURES The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models. RESULTS Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI -0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)). CONCLUSIONS This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.
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Affiliation(s)
- Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Paulien Indestege
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Tinne Serneels
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Eralda Hegendörfer
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre Wallemacq
- Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Degryse
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Society, Université catholique de Louvain (UCL), Brussels, Belgium
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Edes AN, Edwards KL, Wolfe BA, Brown JL, Crews DE. Allostatic Load Indices With Cholesterol and Triglycerides Predict Disease and Mortality Risk in Zoo-Housed Western Lowland Gorillas ( Gorilla gorilla gorilla). Biomark Insights 2020; 15:1177271920914585. [PMID: 32425494 PMCID: PMC7218307 DOI: 10.1177/1177271920914585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Allostatic load, or the physiological dysregulation accumulated due to senescence and stress, is an established predictor of human morbidity and mortality and has been proposed as a tool for monitoring health and welfare in captive wildlife. It is estimated by combining biomarkers from multiple somatic systems into allostatic load indices (ALIs), providing a score representing overall physiological dysregulation. Such ALIs have been shown to predict disease and mortality risk in western lowland gorillas. In these prior analyses, we were unable to include lipid markers, a potential limitation as they are key biomarkers in human models. Recently, we were able to assay serum cholesterol and triglycerides and add them to our previous ALI. We then re-examined associations with health outcomes using binomial generalized linear models. We constructed ALIs using 2 pooling strategies and 2 methods. By itself, a 1-unit increase in allostatic load was associated with higher odds of all-cause morbidity and mortality, but results were mixed for cardiac disease. However, the best fit models for all-cause morbidity and cardiac disease included only age and sex. Allostatic load was retained alongside age in the best fit models for mortality, with a 1-unit increase associated with 23% to 45% higher odds of death. Compared with previous results, ALIs containing cholesterol and triglycerides better predict disease risk in zoo-housed western lowland gorillas, as evidenced by larger effect sizes for some models and better goodness of fit for all ALIs. Based on these results, we address methodology for future allostatic load research on wildlife.
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Affiliation(s)
- Ashley N Edes
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
| | - Katie L Edwards
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Barbara A Wolfe
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Janine L Brown
- Center for Species Survival, Smithsonian Conservation Biology Institute, Front Royal, VA, USA
| | - Douglas E Crews
- Department of Anthropology, The Ohio State University, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Cardiovascular risk profile and frailty in Japanese outpatients: the Nambu Cohort Study. Hypertens Res 2020; 43:817-823. [PMID: 32203449 DOI: 10.1038/s41440-020-0427-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 01/03/2023]
Abstract
Epidemiologic findings indicate that unfavorable cardiovascular (CV) risk profiles, such as elevated systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and overweight, decelerate with aging. Few studies, however, have evaluated the association between the CV risk profile and frailty. We performed a cross-sectional analysis using the baseline data of a prospective cohort study. A total of 599 subjects (age, 78 [range: 70-83] years; men, 50%) were analyzed in an outpatient setting. Frailty was diagnosed in 37% of the patients according to the Kihon Checklist score. An unfavorable CV risk profile was associated with a lower risk of frailty. The adjusted odds ratios (ORs; 95% confidence interval [CI]) of each CV risk factor for frailty were as follows: SBP (each 10 mmHg increase) 0.83 (0.72-0.95), LDL-C (each 10 mg/dl increase) 0.96 (0.86-1.05), and body mass index (each 1 kg/m2 increase) 1.03 (0.97-1.10). Moreover, the total number of CV risk factors within the optimal range was significantly associated with the risk of frailty with the following ORs (95% CI): 1, 2.30 (0.75-8.69); 2, 3.22 (1.07-11.97); and 3, 4.79 (1.56-18.05) compared with patients having no risk factors within optimal levels (p for trend 0.008). Abnormal homeostasis might lead to lower levels of CV risk factors, which together result in "reverse metabolic syndrome." Our findings indicate that a favorable CV risk profile is associated with frailty.
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Luotola K, Jyväkorpi S, Urtamo A, Pitkälä KH, Kivimäki M, Strandberg TE. Statin treatment, phenotypic frailty and mortality among community-dwelling octogenarian men: the HBS cohort. Age Ageing 2020; 49:258-263. [PMID: 31755909 DOI: 10.1093/ageing/afz138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/19/2019] [Accepted: 10/01/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND statin treatment has increased also among people aged 80 years and over, but adverse effects potentially promoting frailty and loss of resilience are frequent concerns. METHODS in the Helsinki Businessmen Study, men born in 1919-34 (original n = 3,490) have been followed up since the 1960s. In 2011, a random subcohort of home-living survivors (n = 525) was assessed using questionnaires and clinical (including identification of phenotypic frailty) and laboratory examinations. A 7-year mortality follow-up ensued. RESULTS we compared 259 current statin users (median age 82 years, interquartile range 80-85 years) with 266 non-users (83; 80-86 years). Statin users had significantly more multimorbidity than non-users (prevalencies 72.1% and 50.4%, respectively, P < 0.0001) and worse glucose status than non-users (prevalencies of diabetes 19.0% and 9.4%, respectively, P = 0.0008). However, there was no difference in phenotypic frailty (10.7% versus 11.2%, P = 0.27), and statin users had higher plasma prealbumin level than non-users (mean levels 257.9 and 246.3 mg/L, respectively, P = 0.034 adjusted for age, body mass index and C-reactive protein) implying better nutritional status. Despite morbidity difference, age-adjusted 7-year mortality was not different between the two groups (98 and 103 men among users and non-users of statins, respectively, hazard ratio 0.96, 95% confidence interval 0.72-1.30). CONCLUSIONS our study suggests that male octogenarian statin users preserved resilience and survival despite multimorbidity, and this may be associated with better nutritional status among statin users.
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Affiliation(s)
- Kari Luotola
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Satu Jyväkorpi
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Annele Urtamo
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
| | - Mika Kivimäki
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Timo E Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Helsinki, Finland
- University of Oulu, Center for Life Course Health Research, Oulu, Finland
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46
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Sittiwet C, Simonen P, Gylling H, Strandberg TE. Mortality and Cholesterol Metabolism in Subjects Aged 75 Years and Older: The Helsinki Businessmen Study. J Am Geriatr Soc 2020; 68:281-287. [PMID: 31930737 DOI: 10.1111/jgs.16305] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES In many studies, low serum cholesterol is paradoxically associated with a higher mortality risk among older adults. Therefore, we studied whole-body cholesterol metabolism and its role in all-cause mortality of older men in two subcohorts of different ages. DESIGN Prospective long-term cohort. SETTING Home-dwelling men of the Helsinki Businessmen Study. PARTICIPANTS Two partly overlapping subcohorts were recruited, in 2003 (n = 660; mean age = 76 years) and in 2011 (n = 398; mean age = 83 years). The younger subcohort was followed up after 3 and 11 years, and the older subcohort was followed up after 3 years. MEASUREMENTS Cholesterol metabolism was assessed via serum noncholesterol sterol-cholesterol ratios, and quantification was performed by gas-liquid chromatography with flame ionization detection. All statistical analyses were performed with age and statin treatment as covariates. RESULTS At the end of the 3-year follow-up, 10% of the younger and 13% of the older subcohort had died; and at the end of the 11-year follow-up, 40% of the younger subcohort had died. Serum total and low-density lipoprotein (LDL) cholesterol and cholesterol precursors reflecting cholesterol synthesis were lower in the older than in the younger subcohort (P < .001 for all). In the older subcohort, low serum campesterol and sitosterol, reflecting decreased cholesterol absorption efficiency, predicted all-cause mortality (P < .05). This was supported by a trend toward low serum campesterol and sitosterol predicting mortality (P = .088 and P = .079, respectively) in the younger subcohort after 11 years. Cholesterol synthesis did not predict mortality, but in the older subcohort, decreased cholesterol absorption was less efficiently compensated for by decreased cholesterol synthesis. CONCLUSIONS Low cholesterol absorption efficiency predicted all-cause mortality, especially in men aged 83 years on average, and cholesterol synthesis was lowered. These metabolic changes could contribute to the lowering of serum total and LDL-cholesterol in older men. J Am Geriatr Soc 68:281-287, 2020.
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Affiliation(s)
- Chaiyasit Sittiwet
- Faculty of Medicine, Mahasarakham University, Kantharawichai, Mahasarakham, Thailand
| | - Piia Simonen
- Heart and Lung Center, Cardiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Gylling
- Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Wang MC, Hu HY, Lin IF, Chuang JT. Plasma lipid concentrations and survival in geriatric population: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e18154. [PMID: 31804326 PMCID: PMC6919530 DOI: 10.1097/md.0000000000018154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Plasma lipids in mid-life are important predictors for cardiovascular events and deaths. However, the association between plasma lipid concentrations and mortality in late life is controversial. Recent studies showed that older people with extremely low total cholesterol (TC) have poor survival outcome, but this conclusion was drawn mostly from Western cohorts. Our study investigated association between plasma lipid concentrations and mortality in Taiwanese elderly population.A retrospective cohort study was conducted among the 69,824 elderly people who participated in the Taipei City Geriatric Health Examination between 2006 and 2010, with a mean follow-up of 3.6 years. The measurements of TC, high density lipoprotein (HDL) and triglycerides were obtained from the records of the participants. Low density lipoprotein (LDL) was calculated using Friedewald formula in 69,088 participants. All lipid components were categorized into quartiles. Males and females were analyzed separately using multivariate Cox proportional hazards models.The elderly with the lowest quartile of TC (<175 mg/dL), HDL cholesterol (<43 mg/dL) and LDL cholesterol (<100.4 mg/dL) were at higher risk of all-cause mortality. Older females with the lowest quartile of TC and LDL cholesterol had higher cardiovascular mortality. Older females with the lowest quartile of HDL had higher mortality from cardiovascular and cerebrovascular diseases.We concluded that TC, mostly attributed to LDL cholesterol, was inversely related to all-cause mortality. HDL remained to be protective against both cardiovascular and stroke mortality in older females. The target levels of plasma lipids in people older than 65 years should be different from that in younger adults.
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Affiliation(s)
- Mu-Cyun Wang
- From the Department of Family Medicine, China Medical University Hospital
- School of Medicine, College of Medicine, China Medical University, Taichung
- Institute of Public Health, National Yang-Ming University
| | - Hsiao-Yun Hu
- Institute of Public Health, National Yang-Ming University
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, National Yang-Ming University
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Zhu Y, Lu JM, Yu ZB, Li D, Wu MY, Shen P, Lin HB, Wang JB, Chen K. Intra-individual variability of total cholesterol is associated with cardiovascular disease mortality: A cohort study. Nutr Metab Cardiovasc Dis 2019; 29:1205-1213. [PMID: 31383502 DOI: 10.1016/j.numecd.2019.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/22/2019] [Accepted: 07/08/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The relationship between serum total cholesterol (TC) and mortality remains inconsistent. Additionally, intra-individual variability of cholesterol has been of increasing interest as a new indicator for health outcomes. We aimed to examine the association between TC and its variability and risk of mortality. METHODS AND RESULTS We performed a retrospective cohort study with 122,645 individuals aged over 40 years in Ningbo, China. The intra-individual variability was calculated using four metrics including standard deviation, coefficient variation, variation independent of mean and average successive variability. Hazard ratios and 95% confidence intervals were estimated for the associations of baseline and variability in TC with risk of mortality by Cox proportional hazards regression models. During 591,585.3 person-years of follow-up, 4563 deaths (including 1365 from cardiovascular disease, 788 from stroke and 1514 from cancer) occurred. A U-shaped association was observed for baseline TC level and risk of total, cardiovascular and cancer mortality, with lowest mortality at 5.46 mmol/L, 5.04 mmol/L and 5.51 mmol/L, respectively. As compared with subjects with TC variability in the lowest quartile, individuals in the highest quartile had 21% higher risk of all-cause mortality (HR = 1.21, 95% CI: 1.05 to 1.40), and 41% higher risk of CVD mortality (HR = 1.41, 95%CI: 1.10 to 1.81). CONCLUSION Both too low and too high baseline TC level were associated with higher risk of total, cardiovascular disease and cancer mortality. Variability of TC could be a risk factor of total and CVD mortality, independent of mean TC level. Future studies are needed to confirm these findings.
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Affiliation(s)
- Yao Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Jie-Ming Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Zhe-Bin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Die Li
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Meng-Yin Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hong-Bo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Jian-Bing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China; Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, China.
| | - Kun Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China; Research Center for Air Pollution and Health, Zhejiang University, Hangzhou, China; Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Gnanenthiran SR, Ng ACC, Cumming R, Brieger DB, Le Couteur D, Waite L, Handelsman D, Naganathan V, Kritharides L, Blyth F. Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins. Heart 2019; 106:698-705. [DOI: 10.1136/heartjnl-2019-315449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/13/2022] Open
Abstract
ObjectiveLow levels of total cholesterol (TC) are associated with adverse outcomes in older populations. Whether this phenomenon is independent of statin use is unknown. We investigated the association between low TC levels and long-term major adverse cardiovascular events (MACE) in a prospective study of men aged ≥70 years without ischaemic heart disease (IHD) and whether this was influenced by statin use.MethodsThe CHAMP (Concord Health and Ageing in Men Project) cohort is a prospective cohort study of community-dwelling men aged ≥70 years. The relationship between TC and long-term MACE was analysed using Cox-regression modelling adjusted for comorbidities and stratified by statin use.ResultsThe study cohort comprised 1289 men (mean (±SD) age, 77.0±5.5 years; mean follow-up, 6.4±2.7 years). Decreasing TC level was associated with increased comorbidity burden, frailty and MACE (linear trend p<0.001). In men not on statin therapy (n=731), each 1 mmol/L decrease in TC was associated with increased MACE (HR 1.27, 95% CI 1.10 to 1.45, p=0.001) and mortality (HR 1.22, 95% CI 1.03 to 1.44, p=0.02) adjusted for comorbidities. In contrast, low TC in men on statins (n=558) was not associated with MACE (HR 0.91, 95% CI 0.74 to 1.11) or mortality (HR 0.86, 95% CI 0.68 to 1.09).ConclusionLow TC is associated with increased risk of MACE in older men without IHD who are not taking statin therapy but not in those on statins.
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Hrabovsky V, Blaha V, Hyspler R, Ticha A, Skrobankova M, Svagera Z. Changes in cholesterol metabolism during acute upper gastrointestinal bleeding: liver cirrhosis and non cirrhosis compared. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 163:253-258. [DOI: 10.5507/bp.2018.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/13/2018] [Indexed: 11/23/2022] Open
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