Gallstone disease is associated with arterial stiffness progression

Causal effect of gallstone disease on the risk of coronary heart disease or acute myocardial infarction: a Mendelian randomization study

Gallstone disease (GSD) is thought to be associated with the risk of coronary heart disease (CHD) or acute myocardial infarction (AMI), which may be due to abnormal cholesterol metabolism. We used multiple Mendelian randomization (MR) methods based on publicly available genome-wide association study data to assess whether this association is genetically causal and to search for loci driving causality. Pooled data for GSD were obtained from FinnGen Biobank and Biobank Japan, while CHD and AMI were obtained as pooled data from the CARDIoGRAMplusC4D consortium. In this MR study, we found a significant negative causal effect of genetic susceptibility to GSD on AMI in the Finnish population, but no causal effect was found on CHD. This causal effect was not confounded by reverse causality and the same findings were obtained in the Japanese population. Furthermore, the negative causal effect of GSD on AMI risk may be driven by the rs4245791-regulated ABCG5/8 protein. In conclusion, the results of this MR study support a negative causal effect of GSD on AMI and suggest that rs4245791 is the causal driver locus of this effect, which provides new ideas and evidence for the prevention and etiologic study of AMI in patients with GSD.

Risk of acute atherosclerotic cardiovascular disease in patients with acute and chronic pancreatitis

The association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

Use of lipid parameters to identify apparently healthy men at high risk of arterial stiffness progression

Background

Dyslipidemia contributes to the development and progression of arterial stiffness. We aimed to identify the most informative measures of serum lipids and their calculated ratios in terms of arterial stiffness progression risk.

Methods

Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and brachial-ankle pulse wave velocity (baPWV) of 659 healthy males (47.4 ± 10.7 years) were measured at baseline. Values for non-HDL-C, TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, and non-HDL-C/HDL-C were calculated. BaPWV was re-performed after 4.1 years follow-up. Elevated baPWV was defined as baPWV ≥ 1400 cm/s.

Results

Over the follow-up period, the mean baPWV value increased from 1340 cm/s to 1410 cm/s, and 331 individuals increased/persisted with high baPWV (outcome 1). Among the 448 subjects who had normal baseline baPWV, 100 incident elevated baPWV occurred (outcome 2). Only baseline logTG (OR 1.64 [95% CI: 1.14–2.37] for outcome 1; 1.89 [1.14–3.17] for outcome 2) and logTG/HDL-C (1.54 [1.15–2.10] for outcome 1; 1.60 [1.05–2.45] for outcome 2) were significantly associated with arterial stiffness progression after adjusting for confounding factors. Adding logTG or logTG/HDL-C to age and blood pressure improved the accuracy of risk predictions for arterial stiffness progression. These associations remained significant when lipids were analyzed as categorical variables.

Conclusions

Baseline serum TG and TG/HDL-C were independently associated with increases in/persistently high baPWV and incident elevated baPWV, and they performed more effectively than other lipid variables in identifying healthy men at high risk of arterial stiffness progression.

Systolic Blood Pressure and Longitudinal Progression of Arterial Stiffness: A Quantitative Meta-Analysis

Background

Arterial stiffness predicts the risk of cardiovascular events and all‐cause mortality and is associated with age and hypertension. However, the magnitude of the relationship between blood pressure (BP) and progression of arterial stiffness is unclear, limiting our understanding of how arterial stiffness mediates clinical effects of hypertension and planning of clinical trials.

Methods and Results

Medline and EMBASE were searched for prospective studies reporting linear models between baseline BP and progression of arterial stiffness, with and without adjustment for demographic characteristics and baseline stiffness. Standardized and unstandardized β coefficients for pulse wave velocity were combined by fixed and random effects meta‐analysis, weighted by the inverse variance. Of 566 fully reviewed articles from 30, 524 titles, 22 populations from 21 reports were included. In 9 cohorts, there were consistent, adjusted associations between baseline systolic BP and progression of arterial stiffness (11 781 patients; standardized β=0.041; 95% CI, 0.026–0.055; P<0.001; P value for heterogeneity=0.70), equivalent to a 1.14‐m/s increase in standard carotid‐femoral pulse wave velocity per decade per 20–mm Hg systolic BP, independent of age. Unstandardized, adjusted associations were similar (1762 patients; β=0.0047; 95% CI, 0.004–0.006; P<0.001; P value for heterogeneity=0.64), equivalent to a 0.94‐m/s increase per decade per 20–mm Hg systolic BP. In limited studies, standardized associations between mean BP and arterial stiffness progression were not significant and heterogeneous (913 patients; β=0.039; 95% CI, −0.008 to 0.086; P=0.11; P value for heterogeneity=0.03).

Conclusions

Baseline systolic BP was associated with a clinically important progression of arterial stiffness, independent of age, providing a reference for the potential effect of arterial stiffness in mediating changes in clinical outcomes associated with hypertension and providing a reference value to aid clinical trial design.

Erectile Dysfunction in Men With Gallbladder Stone Disease: A Nationwide Population-Based Study

We assessed the risk of erectile dysfunction after the diagnosis of gallbladder stone disease. We identified 9,362 men aged ≥20 years diagnosed with gallbladder stone disease between 2000 and 2011 from Taiwan’s National Health Insurance Research Database as the study cohort, and we randomly selected 9,362 men from the nongallbladder stone disease population by 1:1 frequency-matching with the case cohort based on age, the index date for the diagnosis of gallbladder stone disease, and comorbidities as the control cohort. All subjects were followed until December 31, 2011, for measuring the erectile dysfunction incidence. The risk of organic erectile dysfunction was higher in the gallbladder stone disease cohort than the nongallbladder stone disease cohort (4.01 vs. 2.69 per 1,000 person-years, adjusted hazard ratio = 1.41, 97.5% confidence interval [1.12, 1.78]), but the risk of psychogenic erectile dysfunction was comparable between the gallbladder stone disease cohort and the nongallbladder stone disease cohort (0.40 vs. 0.28 per 1,000 person-years, adjusted hazard ratio = 1.37, 97.5% confidence interval [0.67, 2.79]). Moreover, gallbladder stone disease men with cholecystectomy exhibited a lower risk of developing organic erectile dysfunction than gallbladder stone disease men without cholecystectomy (adjusted hazard ratio = 0.58, 97.5% confidence interval [0.41, 0.80]). The risk of organic erectile dysfunction contributed by gallbladder stone disease was only significantly higher in men aged ≥65 years (adjusted hazard ratio = 2.21, 97.5% confidence interval [1.34, 3.63]) and in men with comorbidities (adjusted hazard ratio = 1.42, 97.5% confidence interval [1.09, 1.85]). The risk of psychogenic erectile dysfunction contributed by gallbladder stone disease was nonsignificant in each age group and in men with or without comorbidities. Gallbladder stone disease is associated with an increased risk of organic erectile dysfunction, but it has no association with psychogenic erectile dysfunction. History of cholecystectomy for gallbladder stone disease may ameliorate the risk of organic erectile dysfunction; it requires more studies to ascertain the protective mechanism and to clarify whether the existence of gallbladder stone disease is an epiphenomenon or independent risk factor of erectile dysfunction.

Association of Cholecystectomy with the Risk of Prostate Cancer in Patients with Gallstones

Objectives: To assess the association of cholecystectomy with the risk of prostate cancer in patients with gallstones. Methods: This nationwide population-based cohort study was conducted by retrieving the Longitudinal Health Insurance Research Database (LHID2000) for inpatient claims in the Taiwan National Health Insurance (NHI) program. The study cohort consisted of 72,606 men aged ≥ 20 years with gallstones undergoing cholecystectomy between 2000 and 2010. The control cohort consisted of the men with gallstones, but without cholecystectomy, by 1:1 propensity score matching with the study cohort based on age, sex, urbanization, occupation, comorbidities, and the index date. We compared the hazard ratio of prostate cancer between both of the cohorts. Results: The incidence of prostate cancer was 0.76/1000 person-years for the non-cholecystectomy cohort and 1.28/1000 person-years for the cholecystectomy cohort [aHR (adjusted hazard ratio) = 1.67, 95% confidence interval (CI = 1.45–1.92), respectively (p < 0.001). When compared with the non-cholecystectomy cohort, the hazard ratio of prostate cancer for the cholecystectomy cohort was 1.49-fold greater (95% CI = 1.04–2.11) for follow-up ≤ 1 year, 1.52-fold greater (95% CI = 1.24–1.86) for follow-up 1–5 years, and 1.99-fold greater (95% CI = 1.56–2.53) for follow-up > 5 years, respectively. Conclusions: Cholecystectomy is associated with an increased hazard ratio of prostate cancer in gallstones patients, and the risk increases with an incremental period of follow-up. This observational study cannot ascertain the detrimental mechanisms of cholecystectomy for the development of prostate cancer, and cholecystectomy is not recommended for the prevention of prostate cancer based on our study.

Sex-specific association between serum immunoglobulin-M and brachial ankle pulse wave velocity in a Chinese population: Danyang Study

Emerging evidence supports a causal role for the immunoglobulin-M (IgM) as a protector of atherosclerosis. Since arterial stiffness is an index of subclinical atherosclerosis, we propose that IgM may play an important role in arterial stiffness. As the level of IgM differs between sexes, we investigate the sex-specific association of serum IgM with arterial stiffness in a Chinese population. The study subjects were recruited from Danyang in 2017. Using the Omron VP-1000 system, we measured brachial ankle pulse wave velocity (baPWV). Serum IgM concentration was measured by the immunoturbidimetry method. The 1030 study participants (mean age = 54.3 ± 9.0 years) included 407 men (39.5%), 428 hypertensive (41.6%), 80 diabetic (7.8%), and 512 arterial stiffness patients (49.7%). Serum IgM concentration was lower in men than women (0.97 vs. 1.26 μg/mL, P < 0.001) and negatively with alcohol intake (r = -0.11 in men and r = -0.07 in women, P ≤ 0.09). In multiple regression analyses, serum IgM concentration was negatively associated with baPWV in women (-0.82 m/s per 10-time increase in serum IgM concentration, P = 0.009) but not in men. In multivariable logistic regression analyses, elevated serum IgM concentration was associated with lower risks for arterial stiffness in women (OR = 0.26; 95% CI 0.08-0.82; P = 0.02) but not in men (OR = 0.66; 95% CI 0.17-2.62; P = 0.55). Categorical analyses produced similar results. Serum IgM is negatively associated with baPWV and accordingly associated with a lower risk of arterial stiffness in women.