1
|
Liu Y, Lyu K, Liu S, You J, Wang X, Wang M, Zhang D, Bai Y, Yin C, Jiang M, Zheng S. Predictive value of total cholesterol to high-density lipoprotein cholesterol ratio for chronic kidney disease among adult male and female in Northwest China. Chronic Dis Transl Med 2024; 10:216-226. [PMID: 39027193 PMCID: PMC11252436 DOI: 10.1002/cdt3.122] [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: 01/03/2024] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 07/20/2024] Open
Abstract
Background Studies have found that the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females. Methods Based on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL-C, TC/HDL-C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve. Results During a mean follow-up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL-C and TC/HDL-C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05-1.31), 0.84 (0.71-0.99), and 1.15 (1.06-1.25) for males, 0.94 (0.78-1.13), 0.58 (0.35-0.95), and 1.19 (1.01-1.40) for females, respectively. The results also showed that TC, HDL-C, and TC/HDL-C were associated with CKD in a linear dose-response relationship. The TC/HDL-C had the largest area under the curve (AUC) compared to TC and HDL-C, and the AUC among the females was larger than that among males. Conclusions The TC/HDL-C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL-C, especially in females.
Collapse
Affiliation(s)
- Yanli Liu
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Kang Lyu
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Shaodong Liu
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Jinlong You
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Xue Wang
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Minzhen Wang
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Desheng Zhang
- Workers' Hospital of Jinchuan Group Co. Ltd.JinchangGansuChina
| | - Yana Bai
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| | - Chun Yin
- Workers' Hospital of Jinchuan Group Co. Ltd.JinchangGansuChina
| | - Min Jiang
- Wuwei People's HospitalWuweiGansuChina
| | - Shan Zheng
- School of Public Health, Institute of Epidemiology and StatisticsLanzhou UniversityLanzhouGansuChina
| |
Collapse
|
2
|
Lan Y, Shang J, Ma Y, Zhen Y, Dang Y, Ren D, Liu T, Ju R, Guo N, Wang X, Hou Y. A new predictor of coronary artery disease in acute ischemic stroke or transient ischemic attack patients: pericarotid fat density. Eur Radiol 2024; 34:1667-1676. [PMID: 37672057 DOI: 10.1007/s00330-023-10046-y] [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: 01/09/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES The study aims to evaluate the incremental predictive value of pericarotid fat density (PFD) on head and neck computed tomography angiography (CTA) for the obstructive coronary artery disease (CAD) (≥ 50% stenosis) relative to a clinical risk model (Framingham risk score (FRS)) and the degree of carotid artery stenosis and plaque type in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients without a known history of CAD. METHODS In a cohort of 134 consecutive stable patients diagnosed with AIS or TIA undergoing head and neck CTA between January 2010 and December 2021, pericarotid adipose tissue density (PFD) was quantified using a dedicated software. We collected demographic and clinical data, assessed the risk of CAD using the FRS, and analyzed coronary and carotid artery CTA images. Univariate and multivariate logistic regression analyses were performed to assess associations between FRS, PFD, CTA variables, and obstructive CAD risk. Four prediction models were established to evaluate the incremental predictive value of PFD relative to FRS, stenosis degree, and plaque types. Receiver operating characteristic (ROC) curves were generated, and the areas under the curves (AUC) were compared. RESULTS Increasing FRS, stenosis degree, and PFD values were positively correlated with obstructive CAD (all p < 0.05). In the predictive models for obstructive CAD, the model incorporating carotid stenosis exhibited superior predictive performance compared to FRS alone (p < 0.05). Moreover, the predictive model integrating PFD demonstrated enhanced performance and yielded the highest AUC of the receiver operator characteristic curve (AUC = 0.783), with sensitivity and specificity values of 86.89% and 65.75%, respectively. CONCLUSION CTA-derived PFD measurements offer supplementary predictive value for obstructive CAD beyond FRS and stenosis, thereby facilitating improved risk stratification of TIA or stroke patients without a history of CAD history. CLINICAL RELEVANCE STATEMENT CTA-derived PFD provides incremental predictive value for obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients without CAD history, beyond Framingham risk score and carotid artery stenosis degree, improving risk stratification. KEY POINTS • Pericarotid fat density is associated with obstructive coronary artery disease in acute ischemic stroke or transient ischemic attack patients. • Higher pericarotid fat density corresponds to an increased risk of obstructive coronary artery disease. • Estimation of pericarotid fat density using computed tomography angiography imparts additional predictive value for obstructive CAD in risk stratification of acute ischemic stroke or transient ischemic attack patients.
Collapse
Affiliation(s)
- Yu Lan
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yanhua Zhen
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Dongqing Ren
- Department of Radiology, The People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenyang, 110004, Liaoning Province, China
| | - Ting Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Ronghui Ju
- Department of Radiology, The People's Hospital of Liaoning Province, No. 33, Wenyi Road, Shenyang, 110004, Liaoning Province, China
| | - Ning Guo
- Clinical Research, Philips Healthcare, No. 1 Jiuxianqiao East Road, Chaoyang District, Beijing, 100021, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, No. 324, Jingwu Road, Jinan City, 250000, Shandong Province, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, Liaoning Province, China.
| |
Collapse
|
3
|
Udell JA, Brickman AR, Chu A, Ferreira-Legere LE, Sheth MS, Ko DT, Austin PC, Abdel-Qadir H, Ivers NM, Bhatia RS, Farkouh ME, Stukel TA, Tu JV. Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes. Can J Cardiol 2023; 39:340-349. [PMID: 36574928 DOI: 10.1016/j.cjca.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND It is unknown whether the annual number of primary care physician (PCP) unique outpatient assessments, which we refer to as clinical volume, translates into better cardiovascular preventive care. We examined the relationship between PCP outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline-recommended eligible patients. METHODS This was a retrospective cohort study conducted as part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a population-based cohort of almost all adult residents of Ontario, Canada, followed from 2008 to 2012. For each clinical volume quintile, we compared cholesterol testing and major adverse cardiovascular events, defined as time to first event of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS The 10,037 PCPs evaluated had an annualized median volume of 2303 clinical encounters (IQR 1292-3680). Among 4,740,380 patients, 84% underwent guideline-concordant cholesterol testing at least once over 5 years, ranging from 73% with the lowest clinical volume quintile physicians to 86% with the highest. After multivariable adjustment, there was a 10.5% relative increase in the probability of cholesterol testing for every doubling of clinical volumes (95% CI 9.7-11.4; P < 0.001). Patients treated by the lowest volume quintile physicians had the highest rate of major adverse cardiovascular outcomes (compared with the highest volume quintile physicians: adjusted HR 1.15, 95% CI 1.10-1.21; P < 0.001). CONCLUSIONS Patients of physicians with the lowest clinical volumes received less frequent cholesterol testing and had the highest rate of incident cardiovascular events. Further research investigating the drivers of this relationship is warranted.
Collapse
Affiliation(s)
- Jacob A Udell
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Arielle R Brickman
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | | | | | - Maya S Sheth
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Husam Abdel-Qadir
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Cardiovascular Division, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Thérèse A Stukel
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jack V Tu
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Gill H, Rodrigues NB, Mansur RB, Marks CA, DiVincenzo JD, Ceban F, Rosenblat JD, Cao B, Lieberman JM, Ho R, McIntyre RS. The effect of adjunctive infliximab treatment on future cardiovascular disease risk in patients with bipolar disorder. J Affect Disord 2022; 316:273-279. [PMID: 35878838 DOI: 10.1016/j.jad.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 07/17/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bipolar disorder (BD) is characterized by a pro-inflammatory biotype, and is a major cause of cardiovascular disease (CVD), consequently causing elevated rates of morbidity and mortality among individuals with BD. METHODS The present study is based on a 12-week clinical trial assessing the antidepressant effects of adjunctive infliximab treatment in BD. Generalized estimating equation (GEE) models were used to evaluate CVD risk in people with BD following adjunctive infliximab treatment at baseline and week 12. Participants (baseline: n = 40; endpoint: 33) were randomized for an infliximab-treatment or placebo group. CVD-risk was calculated using Framingham risk scores (FRS), mean arterial blood pressure (MAP) and total cholesterol (TC). RESULTS There was no main effect of treatment on FRS in infliximab-treated participants compared to controls (p = 0.408). Similarly, there were no significant differences in MAP between the infliximab-treated and control group (p = 0.796). The effect of treatment on TC was not significant (p = 0.130), however, an evaluation across time suggested the main effect of the group was significant at week 0 (p = 0.01), but not week 12 (p = 0.219). LIMITATIONS Cardiovascular disease was not an outcome of the original clinical trial, and our participant group did not have a high CVD-risk at baseline. CONCLUSION There were no significant treatment effects of infliximab on FRS, MAP and TC. The current study highlights the complexity of immune-system targets that influence CVD in psychiatric populations. Future studies should include a large scale, combinatorial omnibus biomarker approach to evaluate the immune and vascular link in BD.
Collapse
Affiliation(s)
- Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - CéAnn A Marks
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D DiVincenzo
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China
| | - Jonathan M Lieberman
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (IHealthtech), National University of Singapore, Singapore, Singapore
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| |
Collapse
|
5
|
Wang J, Wang L, Tang X, Wang F, Liu S, Wu X, Dong R, Lin X, Wang B, Bi Y. The Relationship Between Cardiovascular Disease Risk Score and Postoperative Delirium: The PNDABLE Study. Front Aging Neurosci 2022; 14:851372. [PMID: 35800979 PMCID: PMC9252852 DOI: 10.3389/fnagi.2022.851372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/19/2022] [Indexed: 12/27/2022] Open
Abstract
ObjectiveWe aimed to investigate the relationship between Framingham Heart Study general cardiovascular disease risk score (FHS–CVD risk score) and postoperative delirium (POD) among patients who had unilateral total knee arthroplasty performed under epidural anesthesia. Furthermore, we examined whether such a hypothesized relationship was mediated by the cerebrospinal fluid (CSF) biomarkers.MethodsA total of 750 participants were included in the current study. And the data were drawn from the database obtained from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE) study. The preoperative cognitive function of participants was measured by using Mini-Mental State Examination (MMSE). The incidence of POD was assessed using the Confusion Assessment Method (CAM). The POD severity was measured using the Memorial Delirium Assessment Scale (MDAS). The POD CSF biomarkers included in the current study were: Aβ42, T-tau, P-tau, Aβ42/T-tau, and Aβ42/P-tau. The level of the CSF biomarkers was measured using the enzyme-linked immune-sorbent assay (ELISA) in the PNDABLE study. Linear regression analysis was performed to examine the relationship between the FHS–CVD risk score and the POD CSF biomarkers. Logistic regression was used to analyze the relationship between FHS–CVD risk score, POD CSF biomarkers, and POD incidence. The proposed mediating effect of CSF biomarkers was evaluated using Mediation Analysis with 10,000 bootstrapped iterations. The receiver operating characteristic (ROC) curve is chosen as the evaluation metric for assessing the efficacy of the FHS–CVD risk score in predicting POD.ResultsIn the PNDABLE study, the overall incidence of POD was 22.9% with 37.2% in the higher vascular risk group and 7.9% in the lower vascular risk group. Multiple linear regression models showed that a higher preoperative FHS–CVD risk score was positively correlated with CSF T-tau (β = 0.218, P = 0.015) and P-tau level (β = 0.309, P < 0.001) in the higher vascular risk group. After adjusting for age (40–90 years), gender, education, MMSE, smoking history, drinking history, hypertension, diabetes, and the presence of CHD (cardiovascular heart disease), the results of the logistic regression analysis demonstrated the effect of Aβ42 (OR = 0.994, 95% CI 0.992–0.996, P < 0.001), Aβ42/T-tau (OR = 0.353, 95% CI 0.254–0.491, P < 0.001), and Aβ42/P-tau (OR = 0.744, 95% CI 0.684–0.809, P < 0.001) in protecting patients against POD. However, the FHS–CVD risk score (OR = 1.142, 95% CI 1.017–1.282, P = 0.025) and the remaining two biomarkers: T-tau (OR = 1.005, 95% CI 1.004–1.007, P < 0.001) and P-tau (OR = 1.045, 95%CI 1.029–1.062, P < 0.001) were identified as the risk factors. Mediation analyses revealed that the association between FHS–CVD risk score and POD was partially mediated by T-tau (proportion: 31.6%) and P-tau (proportion: 23.6%). The predictive power of the FHS–CVD risk score was validated by the ROC curve with an AUC of 0.7364.ConclusionHigher vascular risk score is one of the preoperative risk factors for POD, which is partly mediated by CSF biomarker tau protein.Clinical Trial Registration[www.clinicaltrials.gov], identifier [ChiCTR2000033439].
Collapse
Affiliation(s)
- Jiahan Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Li Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xinhui Tang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Fei Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Siyv Liu
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xiaoyue Wu
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Rui Dong
- Department of Anesthesiology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Xu Lin
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
- Xu Lin,
| | - Bin Wang
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
- *Correspondence: Bin Wang,
| | - Yanlin Bi
- Department of Anesthesiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
- Yanlin Bi,
| |
Collapse
|
6
|
Effect of sleep surgery on lipid profiles in adults with obstructive sleep apnea: a meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3811-3820. [DOI: 10.1007/s00405-022-07382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
|
7
|
Mohammadi K, Alizadeh Sani M, Nattagh‐Eshtivani E, Yaribash S, Rahmani J, Shokrollahi Yancheshmeh B, Julian McClements D. A systematic review and meta-analysis of the impact of cornelian cherry consumption on blood lipid profiles. Food Sci Nutr 2021; 9:4629-4638. [PMID: 34401109 PMCID: PMC8358377 DOI: 10.1002/fsn3.2416] [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: 04/15/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 01/13/2023] Open
Abstract
Polyphenolic and flavonoid compounds are claimed to improve blood lipid profiles and to provide protective effects against cardiovascular disease. For this reason, we conducted a systematic review and meta-analysis of studies that comprehensively investigated the effects of cornelian cherry supplementation on lipid profiles in rat models. Up to December 2020, 855 articles were screened, and finally, seven articles were selected as eligible for the meta-analysis. This meta-analysis revealed that cornelian cherry supplementation significantly decreased low-density lipoprotein (LDL) (WMD = -6.38 mg/dl; 95% CI, -9.93 to-2.84; p < .001), triglyceride (TG) (WMD = -52.36 mg/dl; 95% CI, -80.50 to -24.22; p < .005), and cholesterol level (WMD = -37.16 mg/dl; 95% CI, -51.19 to -23.13; p < .005) in treated rats compared with control groups. A nonsignificant increase in high-density lipoprotein (HDL) level was observed (WMD = 4.21 mg/dl; 95% CI, -3.25 to 11.66; p = .268). These results suggest that cherry supplementation may have health effects by modifying lipid profiles. However, there is a need for more well-controlled human clinical trials to make more definitive conclusions about the potential health benefits of cherry supplementation.
Collapse
Affiliation(s)
- Keyhan Mohammadi
- Department of Clinical PharmacyFaculty of PharmacyTehran University of Medical SciencesTehranIran
| | - Mahmood Alizadeh Sani
- Division of Food Safety and HygieneSchool of Public HealthTehran University of Medical SciencesTehranIran
| | | | - Shakila Yaribash
- Faculty of PharmacyTehran University of Medical SciencesTehranIran
| | - Jamal Rahmani
- Student Research CommitteeDepartment of Clinical Nutrition and DieteticsFaculty of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | | | | |
Collapse
|
8
|
Franco BB, Hopman WM, Lamarche MC, Holden RM. Protein energy wasting and long-term outcomes in nondialysis dependent chronic kidney disease. J Ren Care 2021; 48:14-23. [PMID: 34053197 DOI: 10.1111/jorc.12378] [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: 12/04/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined. OBJECTIVES To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure. DESIGN Prospective cohort design. PARTICIPANTS One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5. MEASUREMENTS The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes. RESULTS PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake. CONCLUSIONS PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.
Collapse
Affiliation(s)
- Bryan B Franco
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
9
|
Identification of the Framingham Risk Score by an Entropy-Based Rule Model for Cardiovascular Disease. ENTROPY 2020; 22:e22121406. [PMID: 33322122 PMCID: PMC7764435 DOI: 10.3390/e22121406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/12/2022]
Abstract
Since 2001, cardiovascular disease (CVD) has had the second-highest mortality rate, about 15,700 people per year, in Taiwan. It has thus imposed a substantial burden on medical resources. This study was triggered by the following three factors. First, the CVD problem reflects an urgent issue. A high priority has been placed on long-term therapy and prevention to reduce the wastage of medical resources, particularly in developed countries. Second, from the perspective of preventive medicine, popular data-mining methods have been well learned and studied, with excellent performance in medical fields. Thus, identification of the risk factors of CVD using these popular techniques is a prime concern. Third, the Framingham risk score is a core indicator that can be used to establish an effective prediction model to accurately diagnose CVD. Thus, this study proposes an integrated predictive model to organize five notable classifiers: the rough set (RS), decision tree (DT), random forest (RF), multilayer perceptron (MLP), and support vector machine (SVM), with a novel use of the Framingham risk score for attribute selection (i.e., F-attributes first identified in this study) to determine the key features for identifying CVD. Verification experiments were conducted with three evaluation criteria-accuracy, sensitivity, and specificity-based on 1190 instances of a CVD dataset available from a Taiwan teaching hospital and 2019 examples from a public Framingham dataset. Given the empirical results, the SVM showed the best performance in terms of accuracy (99.67%), sensitivity (99.93%), and specificity (99.71%) in all F-attributes in the CVD dataset compared to the other listed classifiers. The RS showed the highest performance in terms of accuracy (85.11%), sensitivity (86.06%), and specificity (85.19%) in most of the F-attributes in the Framingham dataset. The above study results support novel evidence that no classifier or model is suitable for all practical datasets of medical applications. Thus, identifying an appropriate classifier to address specific medical data is important. Significantly, this study is novel in its calculation and identification of the use of key Framingham risk attributes integrated with the DT technique to produce entropy-based decision rules of knowledge sets, which has not been undertaken in previous research. This study conclusively yielded meaningful entropy-based knowledgeable rules in tree structures and contributed to the differentiation of classifiers from the two datasets with three useful research findings and three helpful management implications for subsequent medical research. In particular, these rules provide reasonable solutions to simplify processes of preventive medicine by standardizing the formats and codes used in medical data to address CVD problems. The specificity of these rules is thus significant compared to those of past research.
Collapse
|
10
|
Zhao C, Li S, Zhang J, Huang Y, Zhang L, Zhao F, Du X, Hou J, Zhang T, Shi C, Wang P, Huo R, Woodman OL, Qin CX, Xu H, Huang L. Current state and future perspective of cardiovascular medicines derived from natural products. Pharmacol Ther 2020; 216:107698. [PMID: 33039419 DOI: 10.1016/j.pharmthera.2020.107698] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
The contribution of natural products (NPs) to cardiovascular medicine has been extensively documented, and many have been used for centuries. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Over the past 40 years, approximately 50% of newly developed cardiovascular drugs were based on NPs, suggesting that NPs provide essential skeletal structures for the discovery of novel medicines. After a period of lower productivity since the 1990s, NPs have recently regained scientific and commercial attention, leveraging the wealth of knowledge provided by multi-omics, combinatorial biosynthesis, synthetic biology, integrative pharmacology, analytical and computational technologies. In addition, as a crucial part of complementary and alternative medicine, Traditional Chinese Medicine has increasingly drawn attention as an important source of NPs for cardiovascular drug discovery. Given their structural diversity and biological activity NPs are one of the most valuable sources of drugs and drug leads. In this review, we briefly described the characteristics and classification of NPs in CVDs. Then, we provide an up to date summary on the therapeutic potential and the underlying mechanisms of action of NPs in CVDs, and the current view and future prospect of developing safer and more effective cardiovascular drugs based on NPs.
Collapse
Affiliation(s)
- Chunhui Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Sen Li
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, China
| | - Junhong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuanyun Huang
- Biology Department, Cornell University, Ithaca, NY 14850, United States of America
| | - Luoqi Zhang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, China
| | - Feng Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xia Du
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710003, China
| | - Jinli Hou
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Tong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Chenjing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ping Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ruili Huo
- China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Owen L Woodman
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3800, Australia
| | - Cheng Xue Qin
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3800, Australia; School of Pharmaceutical Science, Shandong University, Shandong 250100, China; Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong 250100, China.
| | - Haiyu Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Luqi Huang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China; China Academy of Chinese Medical Sciences, Beijing 100700, China.
| |
Collapse
|
11
|
Sahebkar A, Cicero AF, Di Giosia P, Pomilio I, Stamerra CA, Giorgini P, Ferri C, von Haehling S, Banach M, Jamialahmadi T. Pathophysiological mechanisms of statin-associated myopathies: possible role of the ubiquitin-proteasome system. J Cachexia Sarcopenia Muscle 2020; 11:1177-1186. [PMID: 32743965 PMCID: PMC7567138 DOI: 10.1002/jcsm.12579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/24/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Statins are the cornerstone of pharmacotherapy for atherosclerotic cardiovascular disease. While these drugs are generally safe, treatment adherence is not optimal in a considerable proportion of patients because of the adverse effects on skeletal muscles in the forms of myopathy, myalgia, muscular pain, nocturnal muscle cramping, weakness, and rare rhabdomyolysis. METHODS For the purpose of this narrative review, we searched for the literature suggesting the involvement of the ubiquitin-proteasome system in the development of statin-induced myopathy. RESULTS Statins have been shown to up-regulate the expression of the muscle-specific ubiquitin-proteasome system as the major non-lysosomal intracellular protein degradation system. It has been postulated that statins may provoke instability in the myocyte cell membrane when subjected to eccentric exercise stress, triggering activation of intracellular proteolytic cascades and changes in protein degradation machinery. This is accompanied by the up-regulation of a series of genes implicated in protein catabolism, in addition to those of the ubiquitin-proteasome system. CONCLUSIONS Based on the available literature, it seems that the involvement of ubiquitin-proteasome system is potentially implicated in the pathophysiology of statin-induced myopathy.
Collapse
Affiliation(s)
- Amirhossein Sahebkar
- Halal Research Center of IRIFDATehranIran
- Biotechnology Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran
- Neurogenic Inflammation Research CenterMashhad University of Medical SciencesMashhadIran
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)LodzPoland
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical SciencesAlma Mater Studiorum—Università di BolognaBolognaItaly
| | - Paolo Di Giosia
- Department of life, health and environmental sciences San Salvatore HospitalUniversity of L'AquilaL'AquilaItaly
| | - Irene Pomilio
- Faculty of PharmacyUniversity of CamerinoCamerinoItaly
| | | | - Paolo Giorgini
- Department of life, health and environmental sciences San Salvatore HospitalUniversity of L'AquilaL'AquilaItaly
| | - Claudio Ferri
- Department of life, health and environmental sciences San Salvatore HospitalUniversity of L'AquilaL'AquilaItaly
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), Partner Site GöttingenGöttingenGermany
| | - Maciej Banach
- Department of HypertensionWAM University Hospital in Lodz, Medical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)LodzPoland
| | - Tannaz Jamialahmadi
- Biotechnology Research Center, Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran
- Department of Food Science and Technology, Quchan BranchIslamic Azad UniversityQuchanIran
- Department of Nutrition, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| |
Collapse
|
12
|
Lamarche MC, Hopman WM, Garland JS, White CA, Holden RM. Relationship of coronary artery calcification with renal function decline and mortality in predialysis chronic kidney disease patients. Nephrol Dial Transplant 2020; 34:1715-1722. [PMID: 30010904 DOI: 10.1093/ndt/gfy183] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/11/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) have higher levels of coronary artery calcification (CAC) compared with the general population. The role of CAC in renal function decline is not well understood. METHODS In this prospective cohort study of Stages 3-5 CKD patients with CAC scores kidney function decline, development of end-stage kidney disease (ESKD) and all-cause mortality were determined at 5 and 10 years. Baseline variables included markers of CKD and chronic kidney disease mineral and bone disorder (CKD-MBD), demographics and comorbidities. Multivariable analyses identified predictors of outcomes, and survival curves demonstrated the association of CAC score with ESKD and mortality. RESULTS One hundred and seventy-eight patients were enrolled between 2005 and 2007. Independent predictors of ESKD at 5 years were estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR); at 10 years, eGFR was no longer a predictor, but CAC was now significant. Those who developed ESKD at the fastest rate either had the highest CAC score (≥400 AU) or were youngest and had the lowest calcidiol, and highest serum phosphate, UACR and percentage change in CAC per year. Predictors of eGFR decline over 5 years were UACR, parathyroid hormone and CAC score. Predictors of mortality at 5 years were age, diabetes and eGFR and at 10 years also included CAC score. CONCLUSIONS In Stages 3-5 CKD patients, CAC is an independent predictor of both ESKD and mortality at 10 years. Those who developed ESKD at the fastest rate either had the highest CAC score or the worst CKD-MBD derangements.
Collapse
Affiliation(s)
| | - Wilma M Hopman
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | | | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
13
|
Alwhaibi M, Altoaimi M, AlRuthia Y, Meraya AM, Balkhi B, Aldemerdash A, Alkofide H, Alhawassi TM, Alqasoumi A, Kamal KM. Adherence to Statin Therapy and Attainment of LDL Cholesterol Goal Among Patients with Type 2 Diabetes and Dyslipidemia. Patient Prefer Adherence 2019; 13:2111-2118. [PMID: 31853174 PMCID: PMC6916674 DOI: 10.2147/ppa.s231873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Statins are widely utilized antidyslipidemics with a proven track record of safety and efficacy. However, the efficacy of these therapeutic agents hinges on patients' adherence to their prescribed statins. OBJECTIVE The primary objectives of this study were to examine the relationship between adherence to prescribed statins and its impact on the low-density lipoprotein (LDL) level, and to explore the factors that influence patient adherence to statins among patients with diabetes and dyslipidemia. METHODS This was a retrospective, cross-sectional study using the electronic health records data of adults (≥18 years) with type 2 diabetes and dyslipidemia visiting outpatient clinics at a university-affiliated tertiary care center. Adherence to statin therapy was estimated using the proportion of days covered (PDC). Patients with diabetes were considered adherent to statins if they had a PDC of ≥80%. Treatment success was considered if the LDL level of < 2.6 mmol/L. RESULTS Out of 10,226 of patients with diabetes, 1532 met the inclusion criteria and were included in the study. Seventy-nine percent of the patients with diabetes were on atorvastatin and 21% were on simvastatin. The vast majority of the patients with diabetes (77%) were considered adherent and about 42% achieved LDL-cholesterol goal < 2.6 mmol/L. No association between adherence to statin therapy and LDL goal attainment was observed. Women had lower odds of being adherent to statin therapy (AOR=0.66, 95% CI: 0.49-0.87) compared to men. Further, young adults (18-44 years) had lower odds of being adherent to statin therapy (AOR=0.58, 95% CI: 0.32-0.97) compared to older adults (age>65 years). CONCLUSION The findings of this study highlight the need to examine the impact of adherence to statins on healthcare services utilization due to different complications of uncontrolled dyslipidemia.
Collapse
Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Maha Altoaimi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim M Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Alqasoumi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Khalid M Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
| |
Collapse
|
14
|
Ko DT, Khan AM, Kotrri G, Austin PC, Wijeysundera HC, Koh M, Chu A, Jackevicius CA, Lawler PR, Tu JV. Eligibility, Clinical Outcomes, and Budget Impact of PCSK9 Inhibitor Adoption: The CANHEART PCSK9 Study. J Am Heart Assoc 2019; 7:e010007. [PMID: 30571382 PMCID: PMC6404170 DOI: 10.1161/jaha.118.010007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The FOURIER (Further Cardiovascular Outcomes Research With PCSK9i [Proprotein Convertase Subtilisin‐Kexin Type 9 Inhibitors] in Subjects With Elevated Risk) trial found a reduction in cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). Our objective was to estimate the eligibility, clinical outcomes, and budget impact of adopting PCSK9i in a large healthcare system. Methods and Results Ontario, Canada, residents alive in 2011, aged 40 to 85 years, were eligible for inclusion. PCSK9i eligibility was determined on the basis of FOURIER trial definition. Hazard ratios observed in the FOURIER trial were applied to assess the number of events that could be avoided. Budget impact was calculated as the difference between projected costs of treatment adoption and events avoided if PCSK9i were used. Of the 2.4 million included individuals, 5.3% had a history of ASCVD. We estimated that 2.7% of the general population and 51.9% of the patients with ASCVD would be eligible for PCSK9i. Adoption of PCSK9i in all eligible patients with ASCVD was projected to reduce primary events rates by 1.8% after 3 years. Despite cost reduction of $44 million in events, PCSK9i adoption would have a net budget impact of $1.5 billion over 3 years. Potential benefits of PCSK9i varied widely across subgroups, with the largest absolute risk reduction estimated to be 4.3% at 3 years in peripheral artery disease. In this subgroup of 5601 patients, the budget impact of treatment adoption was $116 million. Conclusions We estimated that ≈1 in 2 patients with ASCVD would be eligible for PCSK9i. The budget impact of adopting PCSK9i for all patients with ASCVD is substantial. Selective adoption to high‐risk patients will lessen the overall budgetary impact of PCSK9i treatment. See Editorial by Nasir
Collapse
Affiliation(s)
- Dennis T Ko
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Anam M Khan
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Gynter Kotrri
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Peter C Austin
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Maria Koh
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Anna Chu
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Cynthia A Jackevicius
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada.,4 University Health Network Toronto Ontario Canada.,5 Western University of Health Sciences Pomona CA
| | - Patrick R Lawler
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,4 University Health Network Toronto Ontario Canada
| | - Jack V Tu
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| |
Collapse
|
15
|
Moon J, Yoo S, Koh G, Min KW, Shin HH. Efficacy and Safety of High-Dose Atorvastatin in Moderate-to-High Cardiovascular Risk Postmenopausal Korean Women with Dyslipidemia. J Lipid Atheroscler 2019; 9:162-171. [PMID: 32821729 PMCID: PMC7379073 DOI: 10.12997/jla.2020.9.1.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/14/2019] [Accepted: 10/14/2019] [Indexed: 12/12/2022] Open
Abstract
Objective Postmenopausal women show a more atherogenic lipid profile and elevated cardiovascular risk compared to premenopausal women. The aim of this study was to investigate the efficacy and safety of high-dose atorvastatin on the improvement of the blood lipid profile of postmenopausal women in Korea. Methods This study is a prospective, open-label, single-arm clinical trial that was conducted in 3 teaching hospitals. Postmenopausal women with a moderate-to-high cardiovascular risk, according to guidelines from the Korean Society of Lipid & Atherosclerosis, were enrolled. Participants were administered 20 mg of atorvastatin daily for the first 8 weeks, and if the targeted low-density lipoprotein cholesterol (LDL-C) level was not achieved, the dose was increased to 40 mg for the second 8 weeks. The primary endpoint was percentage change of LDL-C from baseline after 16 weeks of drug administration. Results Forty-four women were enrolled, 28 of whom (75.6%) had diabetes mellitus. By the end of treatment period (16 weeks) all patients had achieved LDL-C target levels, with 33 (94.2%) of the participants achieving it after only 8 weeks of administration. After 16 weeks, LDL-C decreased by 45.8±16.7% (p<0.001) from the baseline, and total cholesterol (33.2±10.9%; p<0.001), triglyceride (24.2±37.5%; p=0.001), and apolipoprotein B (34.9±15.6%; p<0.001) also significantly decreased. Blood glucose and liver enzyme levels slightly increased, but none of the participants developed serious adverse events that would cause them to prematurely withdraw from the clinical trial. Conclusion 20 and 40 mg atorvastatin was effective and safe for treating dyslipidemia in postmenopausal Korean women with moderate-to-high cardiovascular risk.
Collapse
Affiliation(s)
- Jaecheol Moon
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea
| | - Soyeon Yoo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.,Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Gwanpyo Koh
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.,Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Kyung-Wan Min
- Department of Internal Medicine, Eulji Hospital, Seoul, Korea
| | - Hyun Ho Shin
- Department of Medicine/Cardiology, Cheil General Hospital, Seoul, Korea
| |
Collapse
|
16
|
Xia Y, Zou J, Xu H, Yi H, Guan J, Yin S. Effect modification by gender of the influence of obstructive sleep apnoea characteristics on dyslipidaemia in China: a cross-sectional study. BMJ Open 2019; 9:e028509. [PMID: 31488475 PMCID: PMC6731808 DOI: 10.1136/bmjopen-2018-028509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Obstructive sleep apnoea (OSA) characteristics differ by gender, possibly affecting any association between OSA and dyslipidaemia. We explored whether gender influenced any association between OSA characteristics and dyslipidaemia. METHODS/DESIGN This was a cross-sectional, large-scale hospital-based study. Male and female risks of dyslipidaemia by OSA characteristics were assessed with logistic regression. Additive interactions were measured using three indices: the relative excess risk due to interaction, the attributable proportion due to interaction and the synergy index. Multiplicative interaction was evaluated via logistic regression. SETTING A single secondary-care setting in China. PARTICIPANTS 3760 patients with OSA. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were male and female risks of dyslipidaemia, and the associated additive and multiplicative interactions between the apnoea-hypopnea index (AHI), the oxygen-desaturation index (ODI), the microarousal index (MAI), and gender. RESULTS After controlling for confounding factors, males (but not females) with AHIs>30 were at higher risk of hyper-total cholesterol (TC), hypo-high-density lipoprotein cholesterol (HDL-C) status and a hyper-TC/HDL-C ratio than males with AHIs≤30. Positive additive interactions were evident between the male gender and AHI on a hyper-TC/HDL-C ratio and hypo-HDL-C status. Males with ODIs>40.1 were at higher risk of hypo-HDL-C status and a hyper-TC/HDL-C ratio than males with ODIs≤40.1. Positive additive and multiplicative interactions were evident between male gender and ODI on hyper-TC/HDL-C ratio. Males with MAIs>28.6 were at higher risk of hyper-TC and hyper-low-density lipoprotein cholesterol status than males with MAIs≤28.6, but no statistically significant interactions were apparent between gender and MAI. CONCLUSIONS Males (but not females) with higher AHIs, ODIs or MAIs were at higher risks of some measures of dyslipidaemia. Positive interactions between male and severe OSA or intermittent hypoxia on some measures of dyslipidaemia were apparent. Thus, dyslipidaemia should be evaluated in patients with OSA, especially males with severe OSA or intermittent hypoxia.
Collapse
Affiliation(s)
- Yunyan Xia
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nangchang, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Juanjuan Zou
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huajun Xu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hongliang Yi
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian Guan
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| |
Collapse
|
17
|
Daily date vinegar consumption improves hyperlipidemia, β-carotenoid and inflammatory biomarkers in mildly hypercholesterolemic adults. J Herb Med 2019. [DOI: 10.1016/j.hermed.2019.100265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
18
|
Sperlongano S, Gragnano F, Natale F, D'Erasmo L, Concilio C, Cesaro A, Golia E, Crisci M, Sperlongano R, Fimiani F, Russo M, Arca M, Limongelli G, Calabrò P. Lomitapide in homozygous familial hypercholesterolemia: cardiology perspective from a single-center experience. J Cardiovasc Med (Hagerstown) 2018; 19:83-90. [PMID: 29389816 DOI: 10.2459/jcm.0000000000000620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIMS Homozygous familial hypercholesterolemia (HoFH) is a genetic dyslipidemia characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerosis. Frequently, traditional lipid-lowering therapy is ineffective in these patients, and lipoprotein apheresis is required. Lomitapide has been recently approved for HoFH. We reported our experience in HoFH patients treated with lomitapide, evaluating its efficacy and safety profile. METHODS Probands suspected for familial hypercholesterolemia were extrapolated from the registry of patients admitted to our cardiology department. Dutch Lipid Clinic Network (DLCN) criteria were adopted to diagnose familial hypercholesterolemia clinically. Individuals receiving a definite or probable diagnosis of familial hypercholesterolemia underwent family cascade screening and genetic test. Patients with a genetic diagnosis of HoFH were treated with lomitapide and monitored with serial follow-up visits. RESULTS Within 1 year of screening, from a population of 3250 patients admitted to our cardiology department, seven probands were selected with a DLCN score greater than 5. A total of two patients resulted genetically homozygotes for familial hypercholesterolemia and started lomitapide. A marked reduction in LDL-C occurred in both patients on lomitapide (78% reduction in patient 1 and 86% in patient 2 already on lipoprotein apheresis, compared with baseline LDL-C), allowing the apheresis treatment to be stopped in the second case. Lomitapide was well tolerated, and both patients experienced only mild gastrointestinal events. CONCLUSION Lomitapide is an effective and well tolerated cholesterol-lowering drug approved for the treatment of HoFH patients. It would be useful to administer it early in these patients to reduce LDL-C and avoid the development of fatal cardiovascular complications.
Collapse
Affiliation(s)
- Simona Sperlongano
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Felice Gragnano
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Francesco Natale
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Laura D'Erasmo
- Department of Internal Medicine and Clinical Specialties, Policlinico Umberto 1, 'Sapienza' University of Rome, Rome
| | - Claudia Concilio
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Arturo Cesaro
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Enrica Golia
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Mario Crisci
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Rossella Sperlongano
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Fabio Fimiani
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Mariagiovanna Russo
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Marcello Arca
- Department of Internal Medicine and Clinical Specialties, Policlinico Umberto 1, 'Sapienza' University of Rome, Rome
| | - Giuseppe Limongelli
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| | - Paolo Calabrò
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', A.O. dei Colli Monaldi Hospital, Naples
| |
Collapse
|
19
|
The effect of chronic kidney disease on lipid metabolism. Int Urol Nephrol 2018; 51:265-277. [DOI: 10.1007/s11255-018-2047-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022]
|
20
|
Cai H, Guo Y, Zhao Z, Chen Y, Zhao S, Chen B. Banxia Baizhu Tianma decoction for hyperlipidemia: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13067. [PMID: 30383686 PMCID: PMC6221624 DOI: 10.1097/md.0000000000013067] [Citation(s) in RCA: 5] [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: 11/25/2022] Open
Abstract
BACKGROUND Hyperlipidemia is one of the most common metabolic diseases worldwide, as well as a leading risk factor for cardio-cerebrovascular diseases. Banxia Baizhu Tianma decoction (BBTD) is widely used for the treatment of hyperlipidemia in China, however, systematic review and meta-analysis regarding its efficacy and safety is lacking. The aim of this protocol of systematic review is to evaluate the effectiveness and safety of BBTD in the treatment of hyperlipidemia. METHODS We will include the randomized controlled trials estimating the effectiveness and safety of BBTD in the treatment of hyperlipidemia. Data sources will include 5 English databases (PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL) and 4 Chinese databases (CMB, CNKI, VIP, Wanfang database). The literature to be collected will be from the time when databases were established to September 2018. Efficacy will be accepted as the primary outcome, while blood lipid levels and adverse reactions as the secondary outcome. Study selection, data collection, risk of bias assessment, and evaluation of the quality of the evidence will be conducted by 2 × 2 different reviewers. Statistical syntheses will be conducted by using RevMan software V.5.3. RESULTS This study will provide a high-quality evidence for BBTD on the treatment of hyperlipidemia from efficacy, serum lipid levels, and adverse reactions. CONCLUSION The result will provide a basis for judging whether BBTD is an effective intervention for the treatment of hyperlipidemia. PROSPERO REGISTRATION NUMBER PROSPERO CRD 42018081359.
Collapse
Affiliation(s)
- Hairong Cai
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
- Department of Emergency, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yongning Guo
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
| | - Zicong Zhao
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
| | - Yanhong Chen
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
| | - Shuai Zhao
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
- Department of Emergency, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Bojun Chen
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine
| |
Collapse
|
21
|
Taghizadeh M, Hamedifard Z, Jafarnejad S. Effect of garlic supplementation on serum C-reactive protein level: A systematic review and meta-analysis of randomized controlled trials. Phytother Res 2018; 33:243-252. [PMID: 30370629 DOI: 10.1002/ptr.6225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 01/28/2023]
Abstract
The present study was designed to systematically review randomized controlled trials (RCTs) that report on the effects of garlic supplementation on serum C-reactive protein (CRP) levels. We conducted a literature search of Scopus, PubMed, Cochrane Library, and Google Scholar up to January 2018. Weighted mean differences (WMD) were estimated for net change in serum CRP. Subgroup analyses were also performed by duration of study, dose of supplementation, baseline CRP level, and the quality of studies. From 438 articles found and screened in our initial search, nine RCTs with the sum of total sample size of 363 were included in the meta-analysis. Compared with the controls, garlic intake significantly reduced the concentrations of serum CRP by 0.8 mg/L (95% CI [-1.5, -0.1], p = 0.02) with the evidence of heterogeneity among studies. Subgroup analyses showed that garlic significantly lowered CRP by 0.82 mg/L (95% CI [-1.02, -0.62], p < 0.001) among studies with a daily garlic dose ≥1,200 mg/day and by 2.44 mg/L (95% CI [-4.02, -0.87], p = 0.002) among studies with baseline CRP ≥2 mg/L. Current data confirmed that garlic supplementation would reduce serum CRP levels. However, the changes were related to the supplemental doses and baseline levels of serum CRP.
Collapse
Affiliation(s)
- Mohsen Taghizadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Hamedifard
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Sadegh Jafarnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| |
Collapse
|
22
|
A Simple Modified Framingham Scoring System to Predict Obstructive Coronary Artery Disease. J Cardiovasc Transl Res 2018; 11:495-502. [PMID: 30315503 DOI: 10.1007/s12265-018-9837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
Development of simple non-invasive risk prediction model would help in early prediction of coronary artery disease (CAD) reducing the burden on public health. This paper demonstrates a risk prediction scoring system to predict obstructive coronary artery disease (OCAD) in CAD patients. A total of 13,082 patients, referred for coronary angiography (CAG) in TRUST trial, were included in the development of a multivariable diagnostic prediction model. External validation of the model used 1009 patients from PRECOMIN study. The occurrence of OCAD was observed in 73.1% and 75.1% patients in TRUST (development) and PRECOMIN study (validation) cohorts, respectively. Good discrimination and calibration were obtained in both development and validation datasets (C-statistics 0.686 and 0.677; Hosmer-Lemeshow χ2 = 5.19, p = 0.74 and χ2 = 8.60, p = 0.38, respectively). The simple risk prediction model and risk scoring system developed on the basis of routine clinical variables showed good performance for estimation of OCAD in relative high-risk patients with suspected CAD.
Collapse
|
23
|
Liu F, Li J, Chen J, Hu D, Li Y, Huang J, Liu X, Yang X, Cao J, Shen C, Yu L, Liu Z, Wu X, Zhao L, Wu X, Gu D, Lu X. Predicting lifetime risk for developing atherosclerotic cardiovascular disease in Chinese population: the China-PAR project. Sci Bull (Beijing) 2018; 63:779-787. [PMID: 36658952 DOI: 10.1016/j.scib.2018.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/19/2018] [Accepted: 05/05/2018] [Indexed: 01/21/2023]
Abstract
Evidence on the lifetime risk for atherosclerotic cardiovascular disease (ASCVD) is insufficient; yet, estimating an individual's lifetime risk allows for a comprehensive assessment of ASCVD burden. We developed and validated lifetime risk prediction equations for ASCVD using four large and ongoing prospective cohorts of Chinese, the China-PAR project (Prediction for ASCVD Risk in China). Sex-specific equations were developed using two cohorts (as the derivation cohort) of 21,320 participants. Two other independent cohorts with 14,123 and 70,838 participants were used for their external validation, respectively. We evaluated both calibration and discrimination measures for model performance. Furthermore, we estimated ASCVD-free years lost or excess absolute risk attributable to high 10-year risk (≥10.0%) and/or high lifetime risk (≥32.8%). After 12.3 years' follow-up of the derivation cohort, 1048 ASCVD events and 1304 non-ASCVD deaths were identified. Our sex-specific equations had good internal validation, with discriminant C statistics of 0.776 (95% confidence interval [CI]: 0.757-0.794) and 0.801 (95% CI: 0.778-0.825), and calibration χ2 of 9.2 (P = 0.418) and 5.6 (P = 0.777) for men and women, respectively. Good external validation was also demonstrated with predicted rates closely matched to the observed ones. Compared with men having both low 10-year and low lifetime risk, men would develop ASCVD 3.0, 4.6 and 8.6 years earlier if they had high 10-year risk alone, high lifetime risk alone, or both high 10-year and high lifetime risk at the index age of 35 years, respectively. We developed well-performed lifetime risk prediction equations that will help to identify those with the greatest potential to avert ASCVD burden after implementation of innovative clinical and public health interventions in China.
Collapse
Affiliation(s)
- Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518001, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongsheng Hu
- Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen 518060, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China
| | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou 350014, China
| | - Zhendong Liu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xigui Wu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Xiangfeng Lu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; The 3rd Affiliated Hospital of Shenzhen University, Shenzhen 518001, China.
| |
Collapse
|
24
|
Žitňanová I, Šiarnik P, Füllöp M, Oravec S, Penesová A, Ďuračková Z, Vaská E, Turčáni P, Kollár B. Gender differences in LDL- and HDL-cholesterol subfractions in patients after the acute ischemic stroke and their association with oxidative stress markers. J Clin Biochem Nutr 2018; 63:144-148. [PMID: 30279626 PMCID: PMC6160728 DOI: 10.3164/jcbn.17-105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/17/2017] [Indexed: 01/20/2023] Open
Abstract
The aim of our study was to examine gender differences of LDL- and HDL-cholesterol subfractions in patients after the acute ischemic stroke with focus on small LDL and HDL subfractions, and their association with oxidative stress markers. In addition, we have monitored the 7-day effect of cholesterol-lowering drugs administered to patients after the acute ischemic stroke, on these subfractions. Eighty two stroke patients and 81 age matched controls were included in this study. Blood was collected from patients within 24 h after the stroke (group A) and re-examined at the 7-day follow-up (group B). We have found gender differences in LDL- and HDL-subfractions in stroke patients, lipid-lowering drugs administered to acute ischemic stroke patients significantly reduced all measured parameters of lipoprotein profile. In the group A LDL1 subfraction positively correlated with activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase) indicating a protective role of this subfraction. On the contrary, small HDL subfractions positively correlated with lipoperoxide levels and negatively with trolox equivalent antioxidant capacity in plasma suggesting a negative role of these subfractions. In this work we have confirmed the hypothesis of atherogenic properties of small HDL subfractions and anti-atherogenic properties of large LDL1-subfractions.
Collapse
Affiliation(s)
- Ingrid Žitňanová
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinskova 2, 81108 Bratislava, Slovakia
| | - Pavel Šiarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Mickiewiczova 13, 81369 Bratislava, Slovakia
| | - Matej Füllöp
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinskova 2, 81108 Bratislava, Slovakia
| | - Stanislav Oravec
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Mickiewiczova 13, 81369 Bratislava, Slovakia
| | - Adela Penesová
- Institute for Clinical and Translational Research, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Zdenka Ďuračková
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, Sasinskova 2, 81108 Bratislava, Slovakia
| | - Eva Vaská
- Institute of Physiotherapy, Balneology and Medical Rehabilitation - Piešťany, University of SS. Cyril and Methodius, Trnava, Slovakia.,Department of Physical Medicine and Rehabilitation, University Hospital Staré Mesto in Bratislava, Slovakia
| | - Peter Turčáni
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Mickiewiczova 13, 81369 Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University, Mickiewiczova 13, 81369 Bratislava, Slovakia
| |
Collapse
|
25
|
Wijeysundera HC, Koh M, Alter DA, Austin PC, Jackevicius CA, Tu JV, Ko DT. Association of high-density lipoprotein cholesterol with non-fatal cardiac and non-cardiac events: a CANHEART substudy. Open Heart 2017; 4:e000731. [PMID: 29344372 PMCID: PMC5761297 DOI: 10.1136/openhrt-2017-000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 11/04/2022] Open
Abstract
Background Emerging evidence has questioned the role of high-density lipoprotein cholesterol (HDL-C) as an independent and modifiable risk factor for cardiovascular disease. We sought to understand the relationship between HDL-C levels and subsequent non-fatal clinical events. Methods Individuals without prior cardiovascular disease or cancer were identified. Outcomes of interest were classified as non-fatal cardiovascular, cancer and infectious. Sex-stratified, multivariable, cause-specific Cox proportional hazards models were created. The reference level HDL-C for both women and men was 51-60 mg/dL. Results Our cohort consisted of 631 762 individuals. For cardiovascular events, there was a consistent inverse relationship, with higher adjusted HRs for the lower HDL-C strata in both men and women. This relationship was also seen in the composite of non-cardiovascular outcomes. In women, the HR in the <30 mg/dL HDL-C category was 2.10 (95% CI 1.66 to 2.57) and 1.86 (95% CI 1.27 to 2.72) for cardiovascular and non-cardiovascular outcomes, respectively; in contrast, in the >90 mg/dL group, it was 0.87 (95% CI 0.74 to 1.02) and 0.81 (95% CI 0.63 to 1.06). For men, HRs were 2.02 (95% CI 1.79 to 2.28) and 1.84 (95% CI 1.47 to 2.31) in the <30 mg/dL HDL-C category for cardiovascular and non-cardiovascular outcomes, respectively, compared with 0.73 (95% CI 0.53 to 1.00) and 1.07 (95% CI 0.67 to 1.70) in the >90 mg/dL group. Conclusions We found an inverse relationship between HDL-C and a wide spectrum of non-fatal outcomes, suggesting that HDL-C is a heavily confounded factor that may be a marker of poor overall health, rather than an independent and modifiable risk factor.
Collapse
Affiliation(s)
- Harindra C Wijeysundera
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Maria Koh
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - David A Alter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Cynthia A Jackevicius
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,College of Pharmacy, Western University of Health Sciences, Pomona, California, USA
| | - Jack V Tu
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Dennis T Ko
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| |
Collapse
|
26
|
Zhang QH, Yin RX, Huang F, Yang DZ, Lin WX, Pan SL. Association between the PINX1 and NAT2 polymorphisms and serum lipid levels. Oncotarget 2017; 8:114081-114094. [PMID: 29371971 PMCID: PMC5768388 DOI: 10.18632/oncotarget.23123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023] Open
Abstract
Jing nationality is a relatively conservative and isolated minority in China. Little is known about the association of the PIN2/TERF1-interacting telomerase inhibitor 1 (PINX1) and N-acetyltransferase 2 (NAT2) single nucleotide polymorphisms (SNPs) and serum lipid levels in the Chinese populations. This study aimed to clarify the association of 6 SNPs of the PINX1 and NAT2 and serum lipid levels in two Chinese populations. Genotyping of the SNPs was performed in 1236 Han subjects and 1248 Jing participants. Allelic and genotypic frequencies of these variants (except NAT2 rs1799931) were different between the two ethnic groups. The minor allele carriers had higher triglyceride (TG, rs11776767, rs1495743 and rs1799930), low-density lipoprotein cholesterol (rs6601530) levels and the apolipoprotein (Apo)A1/ApoB ratio (rs1495743) in Han nationality; and higher total cholesterol (rs1961456), TG (rs11776767, rs6601530 and rs1495743) and lower ApoA1 (rs6601530 and rs1799931) levels in Jing minority than the minor allele non-carriers. The SNPs were not statistically independent by the multiple-locus linkage disequilibrium analyses. The integrative haplotypes and gene-by-gene (G × G) interactions on serum lipid traits were also observed in the two populations. Association analysis based on haplotypes and G × G interactions might be powerful than single-locus tests. Differences in serum lipid profiles between the two populations might partially be attributed to these SNPs, their haplotypes and G × G interactions.
Collapse
Affiliation(s)
- Qing-Hui Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| | - De-Zhai Yang
- Department of Molecular Genetics, Medical Scientific Research Center, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| | - Wei-Xiong Lin
- Department of Molecular Genetics, Medical Scientific Research Center, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| | - Shang-Ling Pan
- Department of Pathophysiology, School of Premedical Sciences, Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China
| |
Collapse
|
27
|
Skeldon SC, Cheng L, Morgan SG, Detsky AS, Goldenberg SL, Law MR. Erectile Dysfunction Medications and Treatment for Cardiometabolic Risk Factors: A Pharmacoepidemiologic Study. J Sex Med 2017; 14:1597-1605. [DOI: 10.1016/j.jsxm.2017.10.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/07/2017] [Accepted: 10/14/2017] [Indexed: 02/04/2023]
|
28
|
Glaser E, Richard C, Lussier MT. The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2017; 100:2062-2070. [PMID: 28535926 DOI: 10.1016/j.pec.2017.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care. METHODS Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia. INTERVENTIONS (1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care. OUTCOME Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for. RESULTS Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up. CONCLUSIONS Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients. PRACTICE IMPLICATIONS Web communication interventions are an effective tool that can be used in primary care.
Collapse
Affiliation(s)
- Emma Glaser
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Faculty of Medicine, Université de Montréal, Canada.
| | - Claude Richard
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada
| | - Marie-Thérèse Lussier
- Primary Care Research Team: Centre Intégré de Santé et des Services Sociaux de Laval, Canada; Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Canada
| |
Collapse
|
29
|
Brown F, Singer A, Katz A, Konrad G. Statin-prescribing trends for primary and secondary prevention of cardiovascular disease. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e495-e503. [PMID: 29138175 PMCID: PMC5685466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the proportion of patients receiving statins for primary or secondary prevention of cardiovascular disease (CVD), as well as to describe lipid-screening trends. DESIGN Retrospective chart review using the Manitoba Primary Care Research Network repository. SETTING Manitoba. PARTICIPANTS A total of 149 262 patients. MAIN OUTCOME MEASURES Proportion of patients who were taking statins for primary or secondary prevention of cardiovascular disease (CVD), who did not have evidence of CVD recorded in their charts, and who underwent lipid screening; distribution of statins among age groups; and the proportion of patients eligible for lipid screening when the age cutoffs of the 2012 and 2016 Canadian Cardiovascular Society guidelines were applied. RESULTS Of the 149 262 patients, 139 025 (93%) did not have CVD recorded in their electronic medical records and made up the primary prevention group; of these 139 025 patients, 5955 (4%) were taking statins. Also in the primary prevention group, 14 814 (11%) patients were 75 years of age and older; of these patients, 1374 (9%) were taking statins. A total of 10 237 of the 149 262 (7%) patients had CVD recorded in their charts (secondary prevention group); 3013 (29%) of these patients were taking statins. When the 2016 Canadian Cardiovascular Society guidelines age cutoffs were applied, 56% of patients (83 119 of 149 262) were eligible for lipid screening, and 31% (26 024 of 83 119) of them had evidence of screening in the past 5 years. Of the total population of those aged 75 and older, 28% (5597 of 20 188) had undergone lipid screening. Of the total population taking statins, 28% (2481 of 8968) had undergone lipid testing while taking statins. CONCLUSION In Manitoba, less than 5% of the primary prevention population and less than 30% of the secondary prevention population had received repeat statin prescriptions from their primary care providers. This represents a possible practice gap that warrants future research, as statins offer considerable morbidity and mortality benefits in these patients.
Collapse
Affiliation(s)
- Felicity Brown
- Practising physician at Seven Oaks Emergency Department in Winnipeg, Man.
| | - Alexander Singer
- Director of the Manitoba Primary Care Research Network and Assistant Professor in the Department of Family Medicine at the University of Manitoba
| | - Alan Katz
- Director of the Manitoba Centre for Health Policy and Professor in the Department of Community Health Sciences and the Department of Family Medicine at the University of Manitoba
| | - Gerald Konrad
- Unit Director at the Family Medical Centre Teaching Unit and Associate Professor in the Department of Family Medicine at the University of Manitoba
| |
Collapse
|
30
|
Richard C, Glaser E, Lussier M. Communication and patient participation influencing patient recall of treatment discussions. Health Expect 2017; 20:760-770. [PMID: 27868327 PMCID: PMC5513012 DOI: 10.1111/hex.12515] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. OBJECTIVES To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. DESIGN Observational study within a RCT. SETTING & PARTICIPANTS Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. MAIN VARIABLES Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. MAIN OUTCOME MEASURES Recall of CD, lifestyle treatment and medication information. RESULTS Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. DISCUSSION Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. CONCLUSION Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.
Collapse
Affiliation(s)
- Claude Richard
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
| | - Emma Glaser
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Marie‐Thérèse Lussier
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Family Medicine and Emergency Medicine DepartmentFaculty of MedicineUniversité de MontréalMontréalQCCanada
| |
Collapse
|
31
|
Nayak SB, Mohammed SB, Nayak AS. Controlling Lipids AIDS in the Prevention of Type 2 Diabetes, Hypertension, and Cardiovascular Diseases. Int J Prev Med 2017; 8:39. [PMID: 28656095 PMCID: PMC5474908 DOI: 10.4103/ijpvm.ijpvm_184_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 03/18/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Abnormal lipid profiles are a characteristic feature of persons with chronic conditions in which the diabetic populations are recognized as the dominant group, regardless of gender and ethnicity worldwide. This study was conducted to identify and evaluate the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. METHODS This study was a case-control investigation conducted between 2013 and 2015. The study enrolled 266 patients from the North Central and South West Regional Health Authorities of Trinidad. Of the 266 patients recruited, 126 were diabetic and 140 were nondiabetic. RESULTS Our study observed that dyslipidemia was present among the nondiabetic populations as the nondiabetics had 55 women and 20 men with high cholesterol, 22 women and 14 men with high triglyceride (TG), 30 women and 25 men with low high-density lipoprotein cholesterol (HDL-C), 42 women and 21 men with high low-density level-cholesterol (LDL-C), 13 women and 8 men with high very low-density lipoprotein (VLDL), and also 30 women and 11 men with body mass index (BMI) over 30 kg/m2. We also observed that diabetic women had significantly lower TGs (P = 0.019) and higher HDL-C (P = 0.001) and LDL (P = 0.003) when compared with the diabetic men. In addition, the nondiabetic females also had higher HDL-C (P = 0.045) when compared to their male counterparts. Both diabetic and nondiabetic women exhibited significantly higher BMI of P = 0.000. A negative correlation was obtained among TGs and HDL (r = -0.356, n = 83, P = 0.001) and a positive correlation was observed among LDL and HDL (r = 0.230, n = 86, P = 0.035). CONCLUSIONS This study observed the incidences in the abnormalities of serum lipid profiles in both nondiabetic and diabetic persons. It also presents the high occurrence of nondiabetic women with dyslipidemia as they presented with high cholesterol, high TG, low HDL-C, and high VLD-L with BMI over 30 kg/m2.
Collapse
Affiliation(s)
- Shivananda B Nayak
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Stephanie B Mohammed
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | | |
Collapse
|
32
|
Albai O, Roman D, Frandes M. Hypertriglyceridemia, an important and independent risk factor for acute pancreatitis in patients with type 2 diabetes mellitus. Ther Clin Risk Manag 2017; 13:515-522. [PMID: 28450786 PMCID: PMC5399973 DOI: 10.2147/tcrm.s134560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Acute pancreatitis (AP) is a frequent inflammatory disease of the pancreas with multiple causes, among which high triglyceride (TG) level is the most common. The main purpose of this study has been to research the prevalence of AP in patients with diabetes mellitus (DM) and to underline the importance of hypertriglyceridemia (HTG) as a risk factor in triggering AP. The possible link between AP and glycemic control has been studied also, alongside some cardiovascular risk factors and long-term diabetes complications. PATIENTS AND METHODS The patient cohort comprised 1,586 patients with DM, admitted to the Internal Medicine Clinic of Diabetes, Nutrition and Metabolic Disease within the Emergency Hospital in Timisoara between January and August 2016. Following a series of clinical and biological investigations, these patients were diagnosed with AP. The patients' antidiabetic treatment and chronic diabetes-related complications have also been recorded. RESULTS The prevalence of pancreatitis in this group of patients was 3.7%. The presence of pancreatitis was associated with a higher HbA1c (8.5% vs 7.7%; P<0.001), fasting glycemia (167.5 vs 95 mg/dL; P<0.001), postprandial glycemia (244.5 vs 118 mg/dL; P<0.001), total cholesterol (256.5 vs 189.5 mg/dL; P<0.001), low-density lipoprotein cholesterol (LDLc) (208.7 vs 112.8 mg/dL; P<0.001), and TGs (495 vs 161 mg/dL; P<0.001). HDL cholesterol (HDLc) was found to be a significant protective factor against the risk of pancreatitis. On the contrary, high LDLc values were a significant risk factor for pancreatitis along with high non-HDLc and high TG values, respectively. CONCLUSION The development of AP events in patients with DM is associated with unsatisfactory glycemic control, HTG, hypertension, and the presence and severity of DM chronic complications. In this study, the prevalence of AP events in patients with DM was 3.7%.
Collapse
Affiliation(s)
| | - Deiana Roman
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mirela Frandes
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| |
Collapse
|
33
|
Kaysen GA. Lipid-Lowering Therapy in CKD: Should We Use It and in Which Patients. Blood Purif 2017; 43:196-199. [PMID: 28114129 DOI: 10.1159/000452727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic kidney disease is associated with a 15-fold increase in the risk of death and a 30-fold increase in the risk of cardiovascular events even prior to dialysis initiation, and this situation remains unchanged following the initiation of the dialysis procedure. Lipoprotein structure and function, especially the anti-oxidative properties of high-density lipoprotein, are altered. In this study, the effectiveness of lipid-lowering therapy on mortality and cardiovascular outcomes is explored. SUMMARY Mortality is inversely associated with the cholesterol level. The degree of inflammation and wasting is a stronger predictor of mortality than are cholesterol levels. Treatment with statins reduces the risk of death and cardiovascular outcomes among patients not yet requiring renal replacement therapy, but is not effective once dialysis is initiated, most likely because other processes, such as inflammation, not affected by lipid-lowering therapy, dominate in the causal pathway leading to adverse outcomes. Fenofibrate is also useful in reducing cardiovascular outcomes and the progression of renal disease among patients with type 2 diabetes not yet requiring dialysis. While the lipid-lowering therapy is effective in patients with the nephrotic syndrome, no long-term outcome studies regarding hard outcomes are available. KEY POINTS The great increase in cardiovascular outcomes in patients with kidney disease is likely due to a consequence of properties that are unresponsive to the lipid-lowering therapy, most likely inflammation. The lipid-lowering therapy is useful in patients who are not yet in need of dialysis but does not reduce mortality in dialysis patients.
Collapse
Affiliation(s)
- George A Kaysen
- Department of Medicine, Division of Nephrology, University of California Davis, Davis, CA, USA
| |
Collapse
|
34
|
Thaikruea L, Thammasarot J. Prevalence of normal weight central obesity among Thai healthcare providers and their association with CVD risk: a cross-sectional study. Sci Rep 2016; 6:37100. [PMID: 27848990 PMCID: PMC5111059 DOI: 10.1038/srep37100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022] Open
Abstract
This study aims to determine the prevalence of health personnel with normal weight central obesity and to investigate whether this group had higher cardiovascular disease (CVD) risk factors than those of the people with normal weight and without central obesity. A waist-to-height ratio was calculated as waist circumference (at umbilical level) in cm divided by height in cm. The central obesity cut-off level was 0.5. The body mass index was calculated as weight in kg divided by height in meters squared. The obesity cut-off level was 25 kg/m2. The prevalence of health personnel with normal weight central obesity was 15.4% (499 out of 3235). When compare this group to 1787 health personnel who had normal weight and without central obesity, they were 2.03 times (95% CI of adjusted OR; 1.62 to 2.54) more likely to have at least one CVD factor. The waist-to-height ratio cut-off value of 0.5 can be used as a self-assessment tool for central obesity without the need for a standard measuring tape. It is feasible to be implemented in screening or self-monitoring for the general population.
Collapse
Affiliation(s)
- Lakkana Thaikruea
- Community Medicine Department, Faculty of Medicine, Chiang Mai University, Thailand
| | - Jiraporn Thammasarot
- Health Promotion Center, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Thailand
| |
Collapse
|
35
|
The Effect of Serum 25-Hydroxyvitamin D Concentrations on Elevated Serum C-Reactive Protein Concentrations in Normal Weight, Overweight and Obese Participants of a Preventive Health Program. Nutrients 2016; 8:nu8110696. [PMID: 27827910 PMCID: PMC5133083 DOI: 10.3390/nu8110696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 01/05/2023] Open
Abstract
The hypothesized effect of vitamin D on C-reactive protein (CRP) has received substantial attention as a potential means to alleviate the risk for cardiovascular disease. However, observational studies have been inconsistent in their reporting of associations between serum 25-hydroxyvitamin D (25(OH)D) and CRP concentrations, and trials and meta analyses have been inconsistent in their conclusions regarding the effect of vitamin D supplementation on CRP concentrations. These supplementation trials were mostly conducted among patients with more or less inflammatory complications and did not consider potential distinctive effects by weight status. To further our understanding of the potential influences of vitamin D on CRP, we analyzed longitudinal observations of 6755 participants of a preventative health program. On average, serum 25(OH)D concentrations increased from 88.3 to 121.0 nmol/L and those of CRP decreased from 1.7 to 1.6 mg/L between baseline and follow up. Relative to obese participants without temporal increases in 25(OH)D, those who showed improvements of <25, 25-50, 50-75, and more than 75 nmol/L at follow up were 0.57 (95% confidence interval: 0.37-0.88), 0.54 (0.34-0.85), 0.49 (0.30-0.80), and 0.48 (0.29-0.78) times as likely to have elevated CRP concentrations (≥1 mg/L), respectively. These associations were less pronounced and not statistically significant for normal weight and overweight participants. Herewith, the findings suggest that promotion of adequate serum 25(OH)D concentrations among obese individuals along with healthy lifestyles may alleviate the public health burden associated with cardiovascular disease.
Collapse
|
36
|
Ko DT, Alter DA, Guo H, Koh M, Lau G, Austin PC, Booth GL, Hogg W, Jackevicius CA, Lee DS, Wijeysundera HC, Wilkins JT, Tu JV. High-Density Lipoprotein Cholesterol and Cause-Specific Mortality in Individuals Without Previous Cardiovascular Conditions. J Am Coll Cardiol 2016; 68:2073-2083. [DOI: 10.1016/j.jacc.2016.08.038] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/09/2016] [Indexed: 01/11/2023]
|
37
|
Kim JY, Kweon KH, Kim MJ, Park EC, Jang SY, Kim W, Han KT. Is nutritional labeling associated with individual health? The effects of labeling-based awareness on dyslipidemia risk in a South Korean population. Nutr J 2016; 15:81. [PMID: 27628312 PMCID: PMC5024492 DOI: 10.1186/s12937-016-0200-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/09/2016] [Indexed: 01/24/2023] Open
Abstract
Background In 1995, the South Korean government made nutrition labeling compulsory, which has positively impacted patients with certain chronic diseases, such as dyslipidemia. We investigated the association between nutrition labeling-based awareness and the risk of dyslipidemia among individuals not yet diagnosed. Methods Our study used data from the fifth Korea National Health and Nutrition Examination Surveys administered during 2010–2014 (n = 17,687). We performed multiple or logistic regression analysis to examine the association between nutritional analysis and various outcome variables. Results Approximately 70 % of the respondents (n = 11,513) were familiar with nutrition labeling, of which 20 % (n = 3172) decided what food to buy based on that information. This awareness yielded mostly positive results on outcome indicators, such as triglyceride and high-density lipoprotein cholesterol levels. In general, individuals who used nutritional labels to make decisions regarding food purchases had a lower risk of dyslipidemia than individuals who did not (OR: 0.806, 95 % CI: 0.709–0.917). Conclusion Utilizing nutrition labels for making food choices correlated with a lower risk of dyslipidemia in certain subgroups. Based on our findings, we recommend that health policymakers and medical professionals consider promoting nutrition labeling as an alternative method for managing certain chronic diseases in South Korean patients.
Collapse
Affiliation(s)
- Jong Yeob Kim
- Premedical Courses, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hong Kweon
- Premedical Courses, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Premedical Courses, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University Graduate School, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Preventive Medicine, Yonsei University Graduate School, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Woorim Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
38
|
|
39
|
Perez Fernandez GA. Prediction of cardiovascular disease from the early stages of life: A forgotten issue? Qatar Med J 2016; 2016:6. [PMID: 27413720 PMCID: PMC4928107 DOI: 10.5339/qmj.2016.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/19/2016] [Indexed: 11/25/2022] Open
|
40
|
Clinical phenotype in relation to the distance-to-index-patient in familial hypercholesterolemia. Atherosclerosis 2016; 246:1-6. [DOI: 10.1016/j.atherosclerosis.2015.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 12/22/2022]
|
41
|
Varshney R, Budoff MJ. Garlic and Heart Disease. J Nutr 2016; 146:416S-421S. [PMID: 26764327 DOI: 10.3945/jn.114.202333] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 05/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thousands of studies have been published based on animal and human studies evaluating garlic's effects and safety. OBJECTIVE We reviewed the available literature investigating the effects of garlic supplements on hypertension, hypercholesterolemia, C-reactive protein (CRP), pulse wave velocity (PWV), and coronary artery calcium (CAC), as well as available data on side effects. METHODS We searched PubMed for all human studies using medical subject heading words through 30 May 2013 and assessed relevant review articles and original studies. Only double-blind, randomized, controlled trials and meta-analyses of double-blind, randomized, controlled trials were included. The review of articles and data extraction were performed by 2 independent authors, with any disagreements resolved by consensus. RESULTS Garlic supplementation reduced blood pressure by 7-16 mm Hg (systolic) and 5-9 mm Hg (diastolic) (4 meta-analyses and 2 original studies). It reduced total cholesterol by 7.4-29.8 mg/dL (8 meta-analyses). The most consistent benefits were shown in studies that used aged garlic extract (AGE). A few small studies that used AGE also showed favorable effects on CAC, CRP, and PWV. Although garlic is generally safe, rare adverse reactions have been documented with limited causality established. CONCLUSION We conclude that garlic supplementation has the potential for cardiovascular protection based on risk factor reduction (hypertension and total cholesterol) and surrogate markers (CRP, PWV, and CAC) of atherosclerosis. Larger studies are warranted to evaluate these effects further.
Collapse
|
42
|
Guo T, Yin RX, Huang F, Yao LM, Lin WX, Pan SL. Association between the DOCK7, PCSK9 and GALNT2 Gene Polymorphisms and Serum Lipid levels. Sci Rep 2016; 6:19079. [PMID: 26744084 PMCID: PMC4705473 DOI: 10.1038/srep19079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/04/2015] [Indexed: 01/02/2023] Open
Abstract
This study was to determine the association between several single nucleotide polymorphisms (SNPs) in the dedicator of cytokinesis 7 (DOCK7), proprotein convertase subtilisin/kexin type 9 (PCSK9) and polypeptide N-acetylgalactosaminyltransferase 2 (GALNT2) and serum lipid levels. Genotyping of 9 SNPs was performed in 881 Jing subjects and 988 Han participants. Allele and genotype frequencies of the detected SNPs were different between the two populations. Several SNPs were associated with triglyceride (TG, rs10889332, rs615563, rs7552841, rs1997947, rs2760537, rs4846913 and rs11122316), high-density lipoprotein (HDL) cholesterol (rs1997947), low-density lipoprotein (LDL) cholesterol (rs1168013 and rs7552841), apolipoprotein (Apo) A1 (rs1997947), ApoB (rs10889332 and rs7552841), and ApoA1/ApoB ratio (rs7552841) in Jing minority; and with TG (rs10889332, rs615563, rs7552841, rs11206517, rs1997947, rs4846913 and rs11122316), HDL cholesterol (rs11206517 and rs4846913), LDL cholesterol (rs1168013), ApoA1 (rs11206517 and rs4846913), ApoB (rs7552841), and ApoA1/ApoB ratio (rs4846913) in Han nationality. Strong linkage disequilibria were noted among the SNPs. The commonest haplotype was G-C-G-C-T-G-C-C-G (>10%). The frequencies of C-C-G-C-T-G-T-C-G, G-C-A-C-T-G-C-C-G, G-C-G-C-T-A-C-C-A, G-C-G-C-T-G-C-C-A, G-C-G-C-T-G-T-C-A haplotypes were different between the two populations. Haplotypes could explain much more serum lipid variation than any single SNP alone especially for TG. Differences in lipid profiles between the two populations might partially attribute to these SNPs and their haplotypes.
Collapse
Affiliation(s)
- Tao Guo
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Nanning 530021, Guangxi, China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Nanning 530021, Guangxi, China
| | - Feng Huang
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Nanning 530021, Guangxi, China
| | - Li-Mei Yao
- Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Nanning 530021, Guangxi, China
| | - Wei-Xiong Lin
- Department of Molecular Genetics, Medical Scientific Research Center, Nanning 530021, Guangxi, China
| | - Shang-Ling Pan
- Department of Pathophysiology, School of Premedical Sciences, Guangxi Medical University, Nanning 530021, Guangxi, China
| |
Collapse
|
43
|
Jonnagaddala J, Liaw ST, Ray P, Kumar M, Chang NW, Dai HJ. Coronary artery disease risk assessment from unstructured electronic health records using text mining. J Biomed Inform 2015; 58 Suppl:S203-S210. [PMID: 26319542 PMCID: PMC4985289 DOI: 10.1016/j.jbi.2015.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/30/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022]
Abstract
Coronary artery disease (CAD) often leads to myocardial infarction, which may be fatal. Risk factors can be used to predict CAD, which may subsequently lead to prevention or early intervention. Patient data such as co-morbidities, medication history, social history and family history are required to determine the risk factors for a disease. However, risk factor data are usually embedded in unstructured clinical narratives if the data is not collected specifically for risk assessment purposes. Clinical text mining can be used to extract data related to risk factors from unstructured clinical notes. This study presents methods to extract Framingham risk factors from unstructured electronic health records using clinical text mining and to calculate 10-year coronary artery disease risk scores in a cohort of diabetic patients. We developed a rule-based system to extract risk factors: age, gender, total cholesterol, HDL-C, blood pressure, diabetes history and smoking history. The results showed that the output from the text mining system was reliable, but there was a significant amount of missing data to calculate the Framingham risk score. A systematic approach for understanding missing data was followed by implementation of imputation strategies. An analysis of the 10-year Framingham risk scores for coronary artery disease in this cohort has shown that the majority of the diabetic patients are at moderate risk of CAD.
Collapse
Affiliation(s)
- Jitendra Jonnagaddala
- School of Public Health and Community Medicine, University of New South Wales, Australia; Asia-Pacific Ubiquitous Healthcare Research Centre, University of New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, University of New South Wales, Australia.
| | - Pradeep Ray
- Asia-Pacific Ubiquitous Healthcare Research Centre, University of New South Wales, Australia
| | - Manish Kumar
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Nai-Wen Chang
- Institution of Information Science, Academia Sinica, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan
| | - Hong-Jie Dai
- Department of Computer Science and Information Engineering, National Taitung University, Taiwan.
| |
Collapse
|
44
|
Poirier J, Kubow S, Noël M, Dupont C, Egeland GM. The hypertriglyceridemic-waist phenotype is associated with the Framingham risk score and subclinical atherosclerosis in Canadian Cree. Nutr Metab Cardiovasc Dis 2015; 25:1050-1055. [PMID: 26474723 DOI: 10.1016/j.numecd.2015.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS For primary prevention of cardiovascular disease (CVD), Canadian guidelines recommend that asymptomatic Canadians with abdominal obesity undergo Framingham risk score (FRS) assessment, and that in Indigenous Peoples, indicators of metabolic syndrome also be used to identify at-risk individuals. The hypertriglyceridemic-waist phenotype (HTGW) has been proposed to be a surrogate marker of visceral obesity and a simple proxy measure for metabolic syndrome. The primary aim of this study was to evaluate whether the HTGW and the FRS associated with sub-clinical atherosclerosis. METHODS AND RESULTS Asymptomatic Cree participants in a cross-sectional study conducted 2005-2009 (n = 446, 18-81 y) were assessed for the HTGW using NCEP-ATP-III gender-specific-cutoffs (waist circumference: for men, ≥102 cm; for women ≥88 cm) and fasting triglycerides ≥1.7 mmol/L. Sub-clinical atherosclerosis was defined by the presence of a high sex-specific common-carotid-intimal-medial-wall-thickness (≥75th percentile). HTGW was present in 26.7% and a 10-y FRS greater than 10% was present in 18.8% of participants. The multivariate adjusted OR (95% CI) for sub-clinical atherosclerosis associated with an FRS greater than 10% was 4.10 (2.20-7.50) while that associated with the HTGW phenotype was 1.74 (95% CI 1.61-1.88) from a model including age, body mass index, alcohol consumption, FRS and the HTGW. CONCLUSIONS The HTGW phenotype is prevalent in the Cree. Our findings support further study on the utility of combining the HTGW with the FRS in the prediction of cardiovascular disease outcomes and in health screening and intervention programs among indigenous peoples.
Collapse
Affiliation(s)
- J Poirier
- Center for Indigenous Peoples' Nutrition and Environment (CINE) & School of Dietetics and Human Nutrition, McGill University, 21,111 Lakeshore, St-Anne-de-Bellevue, Québec, H9X 3V9, Canada
| | - S Kubow
- Center for Indigenous Peoples' Nutrition and Environment (CINE) & School of Dietetics and Human Nutrition, McGill University, 21,111 Lakeshore, St-Anne-de-Bellevue, Québec, H9X 3V9, Canada
| | - M Noël
- University of Ottawa, 25 Université (Room 140), Ottawa, Ontario, K1N 7K4, Canada
| | - C Dupont
- Unité de recherche en santé publique, Université Laval, 2875 Boulevard Laurier, Édifice Delta 2, Bureau 600, Québec, Québec G1V 2M2, Canada
| | - G M Egeland
- Division of Epidemiology, Norwegian Institute of Public Health & Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
| |
Collapse
|
45
|
Influence of Abdominal Obesity on the Lipid-Lipoprotein Profile in Apoprotein E2/4 Carriers: The Effect of an Apparent Duality. J Lipids 2015; 2015:742408. [PMID: 26605088 PMCID: PMC4641183 DOI: 10.1155/2015/742408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022] Open
Abstract
Background. Apolipoprotein (Apo) E plays a key role in the handling of lipoprotein particles with ApoE2 and ApoE4 frequently having opposite effects compared to ApoE3. Some individuals simultaneously carry both E2 and E4 alleles. The impact of the ApoE2/4 genotype on lipid concentrations and its consequences on health remain poorly documented. Objective. This study compared the lipid profile between ApoE2/4 carriers and other ApoE genotypes in relation to the waist circumference. Methods. Cholesterol, triglyceride (TG), and ApoB concentrations were measured among 2,680 Caucasians. Multivariate logistic regression models were used to estimate the contribution of ApoE2/4 to various dyslipidemic profiles associated with abdominal obesity. Results. In presence of abdominal obesity, the lipid profile was as deteriorated in ApoE2/4 carriers as in carriers of other ApoE genotypes. There was a more pronounced effect on TG-rich lipoproteins, particularly in ApoE2/2 (a feature of type III dysbetalipoproteinemia), and non-high-density lipoprotein (HDL) cholesterol in ApoE4/4. Compared to ApoE2/2, ApoE2/4 carriers presented lower very-low-density lipoprotein (VLDL) cholesterol concentrations and VLDL-cholesterol/TG ratios, with or without obesity, and higher low-density lipoprotein (LDL) cholesterol concentrations. Conclusion. In presence of abdominal obesity, the influence of the ApoE2 allele could be less pronounced than that of ApoE4 among ApoE2/4 individuals.
Collapse
|
46
|
Bader MS, Kelly DV. Diagnosis and Management of Common Chronic Metabolic Complications in HIV-infected Patients. Postgrad Med 2015; 120:17-27. [DOI: 10.3810/pgm.2008.11.1930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
47
|
Abstract
An important strategy in primary prevention of cardiovascular diseases (CVD) is the early identification of high-risk individuals. Effective implementation of a strategy to identify these individuals in a clinical setting is reliant on the availability of appropriate CVD risk-assessment models and guideline recommendations. Several well-known models for CVD risk assessment have been developed and utilized in the USA and Europe, but might not be suitable for use in other regions or countries. Very few reports have discussed the development of risk-assessment models and recommendations from a global perspective. In this Review, we discuss why risk-assessment methods developed from studies in one geographical region or ethnic population might not be suitable for other regions or populations, and examine the availability and characteristics of predictive models in areas beyond the USA or Europe. In addition, we compare the differences in risk-assessment recommendations outlined in CVD clinical guidelines from developed and developing countries, and consider their potential effect on clinical practice. This overview of cardiovascular risk assessment from a global perspective can potentially guide low-to-middle-income countries in the development or validation of their own CVD risk-assessment models, and the formulation of recommendations in their own clinical guidelines according to local requirements.
Collapse
|
48
|
B�dard A, Corneau L, Vohl MC, Dodin S, Lemieux S. Effect of the Mediterranean Diet on the Lipid-Lipoprotein Profile: Is It Influenced by the Family History of Dyslipidemia? JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2015; 7:177-87. [DOI: 10.1159/000374116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
|
49
|
Huang CH, Chiu PC, Liu HC, Lu YH, Huang JK, Charng MJ, Niu DM. Clinical observations and treatment of pediatric homozygous familial hypercholesterolemia due to a low-density lipoprotein receptor defect. J Clin Lipidol 2015; 9:234-40. [DOI: 10.1016/j.jacl.2014.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
|
50
|
Magni P, Macchi C, Morlotti B, Sirtori CR, Ruscica M. Risk identification and possible countermeasures for muscle adverse effects during statin therapy. Eur J Intern Med 2015; 26:82-8. [PMID: 25640999 DOI: 10.1016/j.ejim.2015.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022]
Abstract
The use of statins for cardiovascular disease prevention is clearly supported by clinical evidence. However, in January 2014 the U.S. Food and Drug Administration released an advice on statin risk reporting that "statin benefit is indisputable, but they need to be taken with care and knowledge of their side effects". Among them the by far most common complication is myopathy, ranging from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. This class side effect appears to be dose dependent, with more lipophilic statin (i.e., simvastatin) carrying a higher overall risk. Hence, to minimize statin-associated myopathy, clinicians should take into consideration a series of factors that potentially increase this risk (i.e., drug-drug interactions, female gender, advanced age, diabetes mellitus, hypothyroidism and vitamin D deficiency). Whenever it is appropriate to stop statin treatment, the recommendations are to stay off statin until resolution of symptoms or normalization of creatine kinase values. Afterwards, clinicians have several options to treat dyslipidemia, including the use of a lower dose of the same statin, intermittent non-daily dosing of statin, initiation of a different statin, alone or in combination with nonstatin lipid-lowering agents, and substitution with red yeast rice.
Collapse
Affiliation(s)
- Paolo Magni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy.
| | - Chiara Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy
| | | | - Cesare R Sirtori
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Massimiliano Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy
| |
Collapse
|