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Comparison of Carotid Intima-Media Thickness in Children and Adults With and Without Obesity: A Hysteresis Model. Endocr Pract 2021; 28:315-320. [PMID: 34890785 DOI: 10.1016/j.eprac.2021.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe a third-degree polynomial function (hysteresis) of the effect size of age, obesity, and insulin sensitivity over the carotid intima-media thickness (c-IMT), in the pediatric and adult groups. METHODS A quasi-experimental study with fixed factor analysis of age (children aged 8-12 years, n = 73; adults aged 21-45 years, n = 82) and obesity (yes, n = 76; no, n = 79) was conducted to analyze the effect on the c-IMT and Matsuda insulin sensitivity index values. This quasi-experimental design was analyzed with robust regression modeling. RESULTS The additive effect of obesity, independent of age, was evident in the case of the c-IMT values. There was no interaction effect, but a significant difference between participants with normal weight and those with obesity was found (P < .0001). The difference between adults and children was also significant, but the effect size was smaller. A model was created based on age, Tanner stage, and obesity using the c-IMT and Matsuda insulin sensitivity index values. A linear function fit as R2, and the cubic function estimated parameters like a polynomial model. CONCLUSION This practical study design showed that children with obesity displayed the same levels of carotid intima-media abnormalities as adults with obesity. The polynomial shape of the model suggests potentially poor outcomes that resemble the hysteresis process and may predict chronic cardiometabolic events during early adulthood.
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Armstrong MK, Fraser BJ, Hartiala O, Buscot MJ, Juonala M, Wu F, Koskinen J, Hutri-Kähönen N, Kähönen M, Laitinen TP, Lehtimäki T, Viikari JSA, Raitakari OT, Magnussen CG. Association of Non-High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood. JAMA Cardiol 2021; 6:661-668. [PMID: 33502454 PMCID: PMC7841578 DOI: 10.1001/jamacardio.2020.7238] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
Importance Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non-HDL-C levels at specific life stages for CAC remains unclear. Objective To identify the relative association of non-HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood. Design, Setting, and Participants The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020. Exposures Non-HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years). Main Outcomes and Measures In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non-HDL-C at each life stage and the presence of CAC in mid-adulthood. Results Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non-HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non-HDL-C was associated with CAC and exposure to non-HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34). Conclusions and Relevance These data suggest that elevated non-HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non-HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non-HDL-C in adolescence is needed.
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Affiliation(s)
- Matthew K. Armstrong
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Brooklyn J. Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Olli Hartiala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Juha Koskinen
- Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
| | - Nina Hutri-Kähönen
- Tampere University Hospital, Department of Pediatrics, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Tampere University Hospital, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tomi P. Laitinen
- Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center–Tampere, Tampere University, Tampere, Finland
| | - Jorma S. A. Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
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Global Cardiovascular Risk Profile of Italian Medical Students Assessed by a QR Code Survey. Data from UNIMI HEART SURVEY: Does Studying Medicine Hurt? J Clin Med 2021; 10:jcm10071343. [PMID: 33805103 PMCID: PMC8037873 DOI: 10.3390/jcm10071343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Few studies to date have addressed global cardiovascular (CV) risk profile in a “protected” young population as that of medical school students. Objective: to assess CV traditional risk factors and global CV risk profile of Italian medical students throughout the six years of university. Methods: A cross-sectional survey accessible online via quick response (QR) code was conducted among 2700 medical students at the University of Milan, Italy. Data on baseline characteristics, traditional CV risk factors, diet, lifestyle habits, and perceived lifestyle variations were evaluated across different years of school. Results: Overall, 1183 students (mean age, 22.05 years; 729 women (61.6%)) out of 2700 completed the questionnaire (43.8% rate response). More than 16% of the students had at least 3 out of 12 CV risk factors and only 4.6% had ideal cardiovascular health as defined by the American Heart Association. Overweight, underweight, physical inactivity, sub-optimal diet, smoke history, and elevated stress were commonly reported. Awareness of own blood pressure and lipid profile increased over the academic years as well as the number of high-blood-pressure subjects, alcohol abusers, and students constantly stressed for university reasons. Moreover, a reduction in physical-activity levels over the years was reported by half of the students. Conclusion and Relevance: This study demonstrates that a “protected” population as that of young medical students can show an unsatisfactory cardiovascular risk profile and suggests that medical school itself, being demanding and stressful, may have a role in worsening of the lifestyle.
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Santos-Neto PJ, Sena-Santos EH, Meireles DP, Bittencourt MS, Santos IS, Bensenor IM, Lotufo PA. Association of Carotid Plaques and Common Carotid Intima-media Thickness with Modifiable Cardiovascular Risk Factors. J Stroke Cerebrovasc Dis 2021; 30:105671. [PMID: 33631475 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/09/2020] [Accepted: 02/05/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To assess the association of carotid plaques and common carotid artery intima-media thickness with traditional modifiable cardiovascular risk factors. METHODS We examined 4,266 participants aged 35-74years in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. The presence of plaques at all carotid arteries sites was evaluated. The mean far wall common carotid artery intima-media thickness was measured. To evaluate the association of cardiovascular risk factors with plaques and plaque burden, we applied logistic regression models presented as crude, adjusted by sociodemographic variables, along with multivariate further adjustment for hypertension, diabetes, hypercholesterolemia, and smoking. For the association of cardiovascular risk factors and common carotid artery intima-media thickness, linear regression models were used with the same adjustments. RESULTS Median age was 51 years (interquartile range: 45-58 years; 54.5% of females). Plaque prevalence in at least one segment of the carotid arteries was 35.9%. Mean common carotid artery intima-media thickness of the far walls was 0.609 ± 0.133 mm. In the multivariate model for plaque presence, the odds ratios were:1.39 (1.19-1.63) for hypertension;1.58 (1.36-1.82) for hypercholesterolemia; 2.00 (1.65-2.43),1.19 (1.02-1.40) for current and past smoking, and 1.13 (0.95-1.35) for diabetes. In the multivariate linear regression models, common carotid artery intima-media thickness beta-coefficients were: 0.035 mm (0.027-0.043) for hypertension; 0.020 mm (0.013-0.027) for hypercholesterolemia; 0.020 mm (0.010-0.029), 0.012 mm (0.004-0.020) for current and past smoking, and 0.024 mm (0.015-0.033) for diabetes. CONCLUSION Cardiovascular risk factors were independently associated with increasing common carotid artery intima-media thickness, plaque prevalence, and plaque scores. Diabetes did not show an independent association with plaques in the multivariate model.
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Affiliation(s)
| | | | - Danilo P Meireles
- Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | | | - Itamar S Santos
- Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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5
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Karnebeek K, Thapar S, Willeboordse M, van Schayck OCP, Vreugdenhil ACE. Comorbidities in primary versus secondary school children with obesity and responsiveness to lifestyle intervention. J Clin Endocrinol Metab 2019; 104:3803-3811. [PMID: 30776292 DOI: 10.1210/jc.2018-02318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 02/13/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Childhood obesity increases the risk of diseases as diabetes, cardiovascular disease and non-alcoholic fatty liver disease. OBJECTIVE To evaluate the prevalence of comorbidities in school-age children with obesity and to compare its prevalence and the effect of a lifestyle intervention between children in primary and secondary school and between boys and girls. DESIGN Cross-sectional analysis and lifestyle intervention. SETTING Centre for Overweight Adolescent and Children's Healthcare. PATIENTS Comorbidities were evaluated in 149 primary and 150 secondary school children with (morbid) obesity (162 girls). The effect of lifestyle intervention was studied in 82 primary and 75 secondary school children. INTERVENTION One-year interdisciplinary lifestyle intervention. RESULTS Insulin resistance (37%), impaired glucose tolerance (IGT) (3%), dyslipidemia (48%), hypertension (7%) and elevated liver transaminase levels (54%) were already common in primary school children. Glomerular hyperfiltration and insulin resistance were more prevalent in secondary school children. IGT was more prevalent in girls.The change in BMI z-score after intervention was greater in primary school children (primary vs. secondary: -0.25±0.32 vs. -0.11±0.47), even as the change in LDL cholesterol concentrations (primary vs. secondary: -0.30(-0.70;0.10) vs. -0.10(-0.40;0.30)) and systolic blood pressure z-score (primary vs. secondary: -0.32±1.27 vs. 0.24±1.3). The change in BMI z-score, but not in comorbidities, was greater in boys (boys vs. girls: -0.33±0.45 vs. -0.05±0.31). CONCLUSIONS The presence of comorbidities is already evident in primary school children with obesity. The effect of a lifestyle intervention on these comorbidities is greater in primary compared to secondary school children, stressing the need for early interventions.
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Affiliation(s)
- Kylie Karnebeek
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Supriya Thapar
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Maartje Willeboordse
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Anita C E Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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6
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Sood T, Roy S, Pathak M. Effect of pulse rate variation on blood flow through axisymmetric and asymmetric stenotic artery models. Math Biosci 2018; 298:1-18. [DOI: 10.1016/j.mbs.2018.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 11/28/2022]
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7
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Cimmino G, Loffredo FS, Morello A, D'Elia S, De Palma R, Cirillo P, Golino P. Immune-Inflammatory Activation in Acute Coronary Syndromes: A Look into the Heart of Unstable Coronary Plaque. Curr Cardiol Rev 2017; 13:110-117. [PMID: 27758696 PMCID: PMC5452145 DOI: 10.2174/1573403x12666161014093812] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/24/2016] [Accepted: 10/06/2016] [Indexed: 12/21/2022] Open
Abstract
In the last twenty years, our comprehension of the molecular mechanisms involved in the formation, progression and complication of atherosclerotic plaque has advanced significantly and the main role of inflammation and immunity in this phenomenon is now largely accepted. Accumulating evidence highlight the crucial role of different inflammatory and immune cells, such as monocytes and T-lymphocytes, in the pathophysiology of atherosclerotic lesion, particularly in contributing to its com-plications, such as rupture or ulceration. According to the new terminology, “vulnerable plaque” identi-fies an inflamed atherosclerotic lesion that is particularly prone to rupture. Once disrupted, prothrom-botic material is exposed to the flowing blood, thus activating coagulation cascade and platelet aggrega-tion, ultimately leading to acute thrombus formation within the coronary vessel. To date this is the key event underlying the clinical manifestations of acute coronary syndromes (ACS). The degree of vessel occlusion (complete vs. incomplete) and the time of blood flow cessation will define the severity of clinical picture. This phenomenon seems to be the final effect of a complex inter-action between different local and systemic factors, involving the degree of inflammation, type of cells infiltration and the rheological characteristics of blood flow at the site of plaque rupture, thrombogenic substrates within the atherosclerotic lesion and different soluble mediators, already present or acutely released in the circulating blood. This article will review currently available data on the pathophysiology of ACS, emphasizing the immunological and inflammatory aspects of vulnerable plaque. We may pos-tulate that intraplaque antigens and local microenvironment will define the immune-inflammatory re-sponse and cells phenotype, thus determining the severity of clinical manifestations.
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Affiliation(s)
- Giovanni Cimmino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | - Francesco S Loffredo
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Alberto Morello
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | - Saverio D'Elia
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
| | - Raffaele De Palma
- Department of Clinical and Experimental Medicine, Section of Immunology, Second University of Naples, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Paolo Golino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Naples, Italy
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8
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Novak SP, Kroutil LA, Williams RL, Van Brunt DL. The nonmedical use of prescription ADHD medications: results from a national Internet panel. Subst Abuse Treat Prev Policy 2007; 2:32. [PMID: 17974020 PMCID: PMC2211747 DOI: 10.1186/1747-597x-2-32] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 10/31/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Emerging evidence suggests that nonmedical use (NMU) of prescription attention deficit/hyperactivity disorder (ADHD) medications is rising, but many previous investigations have used clinical or regionally based samples or limited their investigations to stimulants rather than to medications specifically used to treat ADHD. Using an Internet-based epidemiological survey, this paper advances understanding of the prevalence and correlates of NMU of medications used to treat ADHD, sources of diverted medications, motivations for use, and consumption patterns. METHODS The study used a self-administered Internet survey of civilian, noninstitutionalized adults (N = 4,297) aged 18 to 49 in the United States. National-level estimates were created using propensity scoring methods and weighting procedures using data from three nationally representative probability surveys: a random-digit dialed telephone survey, the current U.S. Census, and the National Survey on Drug Use and Health (NSDUH). RESULTS Past-year prevalence of NMU of ADHD medications was approximately 2%, with 4.3% reported among those aged 18 to 25 and 1.3% among those aged 26 to 49. Most respondents reporting NMU used on multiple occasions. Receipt of medications for ADHD was a significant correlate of past-year NMU, though most nonmedical users never had a prescription. Among persons who had never been prescribed medication to treat ADHD, friends or family members were the most common source. Productivity was the most frequently endorsed reason for NMU. Alcohol was the substance most commonly used in combination with ADHD drugs. CONCLUSION Because most prescription ADHD medications currently are highly regulated, policy options for supply-side reduction of nonmedical use may include identifying those medications with lower abuse liability for inclusion on insurance formularies. Patient and physician education programs also may be useful tools to heighten awareness of intentional and unintentional diversion of ADHD medications for nonmedical purposes.
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Affiliation(s)
- Scott P Novak
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Larry A Kroutil
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Rick L Williams
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - David L Van Brunt
- Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN 46285, USA
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Bansal D, Eigenbrodt M, Gupta E, Mehta JL. Traditional risk factors and acute myocardial infarction in patients hospitalized with cocaine-associated chest pain. Clin Cardiol 2007; 30:290-4. [PMID: 17551964 PMCID: PMC6653705 DOI: 10.1002/clc.20079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cocaine causes coronary artery constriction and may cause acute myocardial infarction (AMI). The role of traditional coronary risk factors in cocaine-associated myocardial infarction is unclear. HYPOTHESIS We hypothesized that traditional risk factors play a major role in predicting AMI in patients admitted with cocaine-associated chest pain METHODS After reviewing 165 admissions for chest pain in patients with a history of recent cocaine use and/or a positive drug screen from January 2001 to December 2004, we identified 151 patients with information available on at least 6 of the following 7 risk factors: gender, hypertension, hyperlipidemia, diabetes, smoking, family history of coronary artery disease (CAD) and known CAD. AMI was diagnosed using WHO criteria. A risk score was calculated on the basis of the number of risk factors, gender and age. Association of AMI was evaluated with the individual risk factors and with the risk score. RESULTS AMI was identified in 21 patients (14%). All patients diagnosed with AMI were smokers. Continuous risk score (p < 0.0001), highest vs. lowest quartile of risk score (p = 0.007), known CAD, age, hyperlipidemia and family history of CAD were individually associated with the diagnosis of AMI (p>or=0.05). Each quartile of risk score was associated with increased odds of the diagnosis of AMI and score of 8 or higher was statistically significant. CONCLUSION Several traditional risk factors are associated with the diagnosis of AMI among patients hospitalized with cocaine-associated chest pain and increasing risk factor score was associated with increasing odds of AMI diagnosis.
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Affiliation(s)
- Darpan Bansal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Little Rock, Arkansas, USA
| | - Marsha Eigenbrodt
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ekta Gupta
- Division of Cardiovascular Medicine, Department of Internal Medicine, Little Rock, Arkansas, USA
| | - J. L. Mehta
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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10
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Pozner CN, Levine M, Zane R. The cardiovascular effects of cocaine. J Emerg Med 2005; 29:173-8. [PMID: 16029829 DOI: 10.1016/j.jemermed.2005.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 11/25/2004] [Accepted: 01/26/2005] [Indexed: 10/25/2022]
Abstract
Cocaine use continues to be prevalent among all races and socioeconomic groups in the United States. Patients presenting to emergency departments after cocaine ingestion frequently present with a chief complaint of chest pain. Although acute myocardial infarction is perhaps the most concerning diagnosis in this setting, there are many other potential causes of chest pain after cocaine ingestion. This article reviews the pharmacology of cocaine, as well as the etiologies and treatment of cocaine-associated chest pain, with an emphasis on this drug's range of cardiovascular effects.
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Affiliation(s)
- Charles N Pozner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, 75 Francis Street, Boston, MA 02115, USA
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11
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Abstract
UNLABELLED Although clinical manifestations of atherosclerotic coronary heart disease occur in adult life, the initial stages of its development commence in childhood. Therefore, elucidating the pathogenesis of early atherosclerosis and identifying the network of risk factors have become fundamental priorities for both cardiovascular healthcare providers and scientists. There is mounting evidence from both human studies and animal experiments that infectious pathogens could be implicated in atherosclerosis development. The vulnerability of the arterial wall to the adverse effects of infection is probably augmented when additional risk factors and/or certain proatherogenic genetic profiles are also present. The precise mechanisms whereby infection, alone or in synergy with conventional cardiovascular risk factors, could contribute to atherosclerosis are not fully understood. CONCLUSION Injury to the vascular endothelium, which could be elicited by infection through inflammatory, metabolic, autoimmune, and pathogen-related mechanisms, might be a central link between infection and early atherosclerosis.
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Affiliation(s)
- Petru Liuba
- Division of Paediatric Cardiology, Children's Hospital, University Hospital Lund, Lund, Sweden.
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12
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Charakida M, Donald AE, Terese M, Leary S, Halcox JP, Ness A, Davey Smith G, Golding J, Friberg P, Klein NJ, Deanfield JE. Endothelial Dysfunction in Childhood Infection. Circulation 2005; 111:1660-5. [PMID: 15795332 DOI: 10.1161/01.cir.0000160365.18879.1c] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atherosclerosis begins in early life, and endothelial dysfunction is recognized as a key initiating event in the development of atherosclerosis. Although infection has been implicated in endothelial dysfunction and atherogenesis, the impact of acute common childhood infections on the vascular endothelium is unknown.
Methods and Results—
We studied 600 children aged 10 years drawn from the Avon Longitudinal Study of Parents and Children. The children were divided into 3 groups: those with current acute infection (AI; n=135; 73 boys and 62 girls); a convalescent group with infection in the past 2 weeks (n=166; 78 boys and 88 girls), and a healthy control group (n=299; 131 boys and 168 girls). Endothelial function was determined in all subjects by high-resolution ultrasound to measure brachial artery flow-mediated dilation (FMD) and was expressed as the percentage change in diameter from baseline after reactive hyperemia. FMD was repeated in 40 children in the AI group and 50 in the control group after a mean interval of 1 year. FMD was lower in both the AI group (6.3±2.7%, mean±SD) and the convalescent group (8.1±3.1%) than in the control group (9.7±2.5%;
P
<0.001 for both). The observed differences in FMD remained after adjustment for potential confounding variables. At the repeat visit, FMD was unchanged in controls (
P
=0.85) but improved in the AI group (
P
<0.001).
Conclusions—
Acute infection in childhood is associated with impaired endothelium-dependent vasodilation. These findings support a potential role for previously unsuspected extrinsic inflammatory stimuli in the pathogenesis of early atherosclerosis.
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Affiliation(s)
- Marietta Charakida
- Vascular Physiology Unit, 30 Guilford St, London WC1N 1EH, United Kingdom.
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13
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Liuba P. Arterial endothelial injury due to infection in childhood: ticking bomb or innocent bystander? Acta Paediatr 2004; 93:55-62. [PMID: 15702671 DOI: 10.1111/j.1651-2227.2004.tb00240.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atherosclerosis is regarded as a chronic disease that begins in early life. While the main underlying mechanism of atherosclerosis is nowadays unequivocally attributed to a low-grade inflammatory reaction, the spectrum of aetiological conditions is far from being fully elucidated. Both viruses and bacteria have been suggested to intervene at various stages of atherosclerosis development, although a clear pathogenic link between infection and atherosclerosis remains debatable. As one key event in atherogenesis involves a perturbation of the protective mechanisms normally posed by the arterial endothelium, a number of studies have enquired into the possible detrimental effects of microbes and their components on the endothelial cells. This review aims to scrutinize the current literature in this regard, and to suggest several possible directions for future studies.
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Affiliation(s)
- P Liuba
- Division of Paediatric Cardiology, University Hospital Lund, Lund, Sweden.
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14
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Abstract
This review discusses the important consequences of dyslipidemia and arteriosclerosis in type 2 diabetes as documented in studies in adults. It then examines the relatively recent upsurge in type 2 diabetes in children and adolescents, its characteristics, and its importance in directing our attention to cardiovascular risk factors in this age group. The discussion concludes with an examination of the information available about arteriosclerosis in the young and about the treatment of hypercholesterolemia in children and adolescents.
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Affiliation(s)
- Kenneth Lee Jones
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Avenue, La Jolla, CA 92093-0831, USA.
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Cole JH, Miller JI, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003; 41:521-8. [PMID: 12598059 DOI: 10.1016/s0735-1097(02)02862-0] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study evaluated long-term survival and predictors of elevated risk for young adults diagnosed with coronary artery disease (CAD). BACKGROUND Coronary artery disease is rarely seen in young adults. Traditional cardiac risk factors have been studied in small series; however, many questions exist. METHODS We identified 843 patients under age 40 with CAD diagnosed by coronary angiography from 1975 to 1985. Death, hypertension, gender, family history, prior myocardial infarction (MI), diabetes, heart failure, angina class, number of diseased vessels, ejection fraction (EF), Q-wave infarction, in-hospital death, and initial therapy were studied. Patients were followed for 15 years. RESULTS The mean age was 35 for women (n = 94) and 36 for men (n = 729). The average EF was 55%. Fifty-eight percent of the subjects had single-vessel disease, and 10% were diabetic. The strongest predictors of long-term mortality were a prior MI (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.00 to 1.73), New York Heart Association class II heart failure (HR 1.75, 95% CI 1.03 to 2.97), and active tobacco use (HR 1.59, 95% CI 1.14 to 2.21). Revascularization, rather than medical therapy, was associated with lower mortality (coronary angioplasty: HR 0.51, 95% CI 0.32 to 0.81; coronary artery bypass graft: HR 0.68, 95% CI 0.50 to 0.94). Overall mortality was 30% at 15 years. Patients with diabetes had 15-year mortality of 65%. Those with prior MI had 15-year mortality of 45%, and patients with an EF <30% a mortality of 83% at 15 years. CONCLUSIONS Coronary disease in young adults can carry a poor long-term prognosis. A prior MI, diabetes, active tobacco abuse, and lower EF predict a significantly higher mortality.
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Affiliation(s)
- Jason H Cole
- Emory Center for Outcomes Research and Section of Preventive Cardiology, Division of Cardiology, Emory University School of Medicine, Emory University, 1525 Clifton Road, Atlanta, GA 30322, USA
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