1
|
Temtem M, Mendonça MI, Santos M, Sá D, Sousa F, Freitas S, Borges S, Henriques E, Rodrigues M, Soares C, Rodrigues R, Serrão M, Drumond A, Sousa AC, Palma Reis R. Validation of the SCORE2 risk prediction algorithm in a Portuguese population: A new model to estimate 10-year cardiovascular disease incidence in Europe. Rev Port Cardiol 2024; 43:437-444. [PMID: 38395299 DOI: 10.1016/j.repc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/05/2023] [Accepted: 10/15/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Subjects without cardiovascular (CV) disease (CVD) may suffer from subclinical atherosclerosis, and are at increased risk for atherosclerotic CV events (ASCVE). The ESC/EAS risk SCORE was updated by SCORE2, which estimates 10-year risk of fatal and non-fatal CVD in European populations aged 40-69 years without established CVD or diabetes. Our aim was to compare the two ESC/EAS risk scores and to validate SCORE2 in our population. METHODS A total of 1071 individuals (age 57.2±6.1 years; 75.2% male) without CVD or diabetes, from GENEMACOR study controls, were analyzed over 5.4±3.9 years. The population was stratified into risk categories according to the two scores, and the area under the ROC curve (AUC) and Harrell's C-index assessed the scores' performance. Calibration was performed using the goodness-of-fit test, and occurrence of the first event assessed by Cox regression. Kaplan-Meier analysis estimated SCORE2 survival. RESULTS SCORE stratified subjects into four risk categories: low (7.4%), moderate (46.5%), high (25.3%) and very high (20.8%), and SCORE2 into three: low-to-moderate (24.7%), high (59.0%) and very high (16.2%). SCORE presented good discrimination for CV mortality (AUC=0.838; C-index=0.834, 95% CI: 0.728-0.940), as did SCORE2 for total CV events (AUC=0.744; C-index=0.728, 95% CI: 0.648-0.808). Calibration did not show a disparity between observed and expected ASCVE. The probability of ASCVE was eight times higher in very-high-risk SCORE2 (p=0.001), and three times in the high-risk group (p=0.049). Event-free survival was 99%, 90% and 72% in the low-to-moderate, high and very-high-risk categories, respectively (p<0.0001). CONCLUSIONS SCORE2 improved population stratification by identifying higher-risk patients, enabling early preventive measures. It showed good discriminative ability for all ASCVE.
Collapse
Affiliation(s)
- Margarida Temtem
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal.
| | - Maria Isabel Mendonça
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Marina Santos
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Débora Sá
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Francisco Sousa
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Sónia Freitas
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Sofia Borges
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Eva Henriques
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Mariana Rodrigues
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Carolina Soares
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Ricardo Rodrigues
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Marco Serrão
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - António Drumond
- Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | - Ana Célia Sousa
- Centro de Investigação Dra. Maria Isabel Mendonça, Hospital Dr. Nélio Mendonça, SESARAM EPERAM, Funchal, Portugal
| | | |
Collapse
|
2
|
Pereira Santos S, Guedes S, Pesqueira R, Stuart J, Carvalho AM, Correia P, Lourenço Ribeiro I, Teixeira ÂM. Cardiovascular risk assessment using SCORE2 in a population with hypertension - The reality at a primary health care unit. Rev Port Cardiol 2024:S0870-2551(24)00223-3. [PMID: 39004141 DOI: 10.1016/j.repc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/11/2024] [Accepted: 03/08/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal, thus it is important to identify individuals at risk. Patients with hypertension have an increased risk of adverse cardiovascular (CV) events. The role of LDL cholesterol (LDL-C) in atherosclerotic CVD is well-established. SCORE2, a new CV risk calculation tool, is used to predict the 10-year risk of fatal or non-fatal CVD. The aim of this study was to understand the impact of SCORE2 on CV risk assessment in a population with hypertension from a moderate risk country, compared to the previously used SCORE. METHODS This observational cross-sectional study analyzed a population census of 3146 patients diagnosed with hypertension without complications (K86). After applying inclusion and exclusion criteria, 654 patients were included. Data from medical records were collected to calculate and compare SCORE and SCORE2 categories and LDL-C targets. RESULTS Patients were classified into SCORE categories: 188 (28.75%) low, 448 (68.5%) moderate, 17 (2.6%) high and 1 (0.15%) very high risk. Using SCORE2, individuals in the SCORE low risk category were reclassified, requiring new targets: 149 individuals (80%) as low to moderate and 39 (20%) as high risk. These differences became more evident when considering SCORE moderate and high-risk categories, where 358 patients (77%) received a higher CV risk categorization, and therefore a lower LDL-C target. There was a significant increase in individuals failing to meet the target when using SCORE2, compared to SCORE (p<0.001). CONCLUSION These findings support the importance of CV risk assessment using SCORE2 algorithm in patients with hypertension.
Collapse
Affiliation(s)
| | - Sara Guedes
- Unidade de Saúde Familiar Nova Via, Portugal
| | | | - João Stuart
- Unidade de Saúde Familiar Nova Via, Portugal
| | | | | | | | | |
Collapse
|
3
|
Gavina C, Seabra Carvalho D, Afonso-Silva M, Brandão Abreu D, Canelas-Pais M, Taveira-Gomes T, Araújo F. Long-term cardiovascular outcomes in a population-based multicentric cohort of northern Portugal: Validation of the ESC/EAS prognostic risk classification. J Clin Lipidol 2024; 18:e562-e571. [PMID: 38908967 DOI: 10.1016/j.jacl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Cardiovascular (CV) risk scores identify individuals at higher long-term risk of CV events that may benefit from more aggressive preventive interventions. OBJECTIVE To assess the association of CV-risk categories and criteria with long-term CV events. METHODS Observational cohort study between 2000-2019 on patients aged 40-80 years, followed by 14 primary care centers assisted by 1 hospital in Portugal. Follow-up began when electronic health records data allowed for CV-risk classification and dynamic reassessment per 2019 ESC/EAS Guidelines. Inclusion criteria required at least one appointment with a primary care physician within three years before follow-up initiation. We assessed the 10-year adjusted hazard-ratio of combined CV death and non-fatal atherosclerotic cardiovascular disease (ASCVD) hospitalization, across SCORE risk categories and criteria, using Cox proportional hazards models adjusted for sex, age, competing comorbidities, and medication. RESULTS The study included 161 681 observations from 87 035 unique patients. During the observation period, 71 787 patients were classified as low/moderate, 51 476 as high and 38 418 as very-high CV-risk categories. In the very-high group, prevalent comorbidities were hypertension (69%), hypercholesterolemia (69%) and type 2 diabetes (61%), and 13% were hospitalized for ASCVD. The adjusted 10-year hazard ratio of the composite of CV death or ASCVD hospitalization was 2.10 (95% CI: 1.91-2.32) for high-risk and 3.56 (95% CI: 3.21-3.96) for very-high-risk patients (low-risk as reference). CONCLUSION Our study reinforces the prognostic relevance of CV-risk stratification for long-term prediction of CV death and ASCVD hospitalization in an unselected cohort, independently of sex, age, competing comorbidities and medication.
Collapse
Affiliation(s)
- Cristina Gavina
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | | | - Marta Afonso-Silva
- Health Economics & Outcomes Research / Real-world evidence, Novartis Farma - Produtos Farmacêuticos SA, Porto Salvo, Portugal
| | - Daniela Brandão Abreu
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal; MTG Research and Development Lab, Porto, Portugal
| | - Mariana Canelas-Pais
- MTG Research and Development Lab, Porto, Portugal; Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Taveira-Gomes
- MTG Research and Development Lab, Porto, Portugal; Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal; Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal.
| | - Francisco Araújo
- Departamento de Medicina Interna, Hospital Lusíadas, Lisboa, Portugal
| |
Collapse
|
4
|
Araújo F, Caldeira D, Aguiar C, Antunes JP, Cardim N, Cunha V, Fonseca L, Moura JP, Paixão-Dias VM, Ribeiro H, Tedim Cruz V, Gavina C. Polypill use for the prevention of cardiovascular disease: A position paper. Rev Port Cardiol 2023; 42:861-872. [PMID: 37172761 DOI: 10.1016/j.repc.2023.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/08/2023] [Accepted: 02/12/2023] [Indexed: 05/15/2023] Open
Abstract
Cardiovascular (CV) guidelines stress the need for global intervention to manage risk factors and reduce the risk of major vascular events. Growing evidence supports the use of polypill as a strategy to prevent cerebral and cardiovascular disease, however it is still underused in clinical practice. This paper presents an expert consensus aimed to summarize the data regarding polypill use. The authors consider the benefits of polypill and the significant claims for clinical applicability. Potential advantages and disadvantages, data regarding several populations in primary and secondary prevention, and pharmacoeconomic data are also addressed.
Collapse
Affiliation(s)
- Francisco Araújo
- Departamento Medicina Interna, Hospital dos Lusíadas, Lisboa, Portugal.
| | - Daniel Caldeira
- Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria - CHULN, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Carlos Aguiar
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Portugal
| | - José Pedro Antunes
- Unidade de Saúde Familiar Arte Nova, Agrupamento Centros de Saúde Baixo Vouga, Aveiro, Portugal
| | - Nuno Cardim
- Cardiology Department, Hospital da CUF, Lisboa, Portugal
| | | | - Luísa Fonseca
- Stroke Unit, Internal Medicine Department, Centro Hospitalar Universitário S. João, Faculty of Medicine of the University of Porto, Portugal
| | - José P Moura
- Department of Internal Medicine, University Hospital of Coimbra, Coimbra, Portugal
| | - Vitor M Paixão-Dias
- ESH Hypertension Excellence Center of the Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, EPE, Portugal
| | - Hugo Ribeiro
- Palliative Care Unit of ACES Gaia and Faculty of Medicine of Universidade do Porto, Porto, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR) - Group of Environment Genetics and Oncobiology (CIMAGO), FMUC, Coimbra, Portugal
| | - Vitor Tedim Cruz
- EPIUnit - Instituto de Saúde Pública, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Serviço de Neurologia, Departamento de Medicina, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Cristina Gavina
- Serviço de Cardiologia, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal; Departamento de Medicina, Faculdade de Medicina da Universidade do Porto, UnIC, Cardiovascular Research Center, Portugal
| |
Collapse
|
5
|
In silico and in vitro analysis of microRNAs with therapeutic potential in atherosclerosis. Sci Rep 2022; 12:20334. [PMID: 36433987 PMCID: PMC9700707 DOI: 10.1038/s41598-022-24260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease in which aberrant lipid metabolism plays a key role. MicroRNAs (miRNAs), micro-coordinators of gene expression, have been recently proposed as novel clinical biomarkers and potential therapeutic tools for a broad spectrum of diseases. This study aimed to identify miRNAs with therapeutic potential in atherosclerosis. Bioinformatic databases, including experimentally validated and computational prediction tools as well as a novel combination method, were used to identify miRNAs that are able to simultaneously inhibit key genes related to the pathogenesis of atherosclerosis. Further validation of genes and miRNAs was conducted using the STRING online tool, KEGG pathway analysis and DIANA-miRPath. The inhibitory effects of the identified miRNAs in HepG2 and Huh7 cells were verified by real-time PCR. The MTT assay was utilized to evaluate cell cytotoxicity effects of miRNAs. Atherosclerotic drug-targeted genes were selected as key genes. Strong interactions between genes were confirmed using STRING. These genes were shown to be integral to critical pathological processes involved in atherosclerosis. A novel combined method of validated and predicted tools for the identification of effective miRNAs was defined as the combination score (C-Score). Bioinformatic analysis showed that hsa-miR-124-3p and hsa-miR-16-5p possessed the best C-Score (0.68 and 0.62, respectively). KEGG and DIANA-miRPath analysis showed that selected genes and identified miRNAs were involved in atherosclerosis-related pathways. Compared with the controls in both HepG2 and Huh7 cell lines, miR-124 significantly reduced the expression of CETP, PCSK9, MTTP, and APOB, and miR-16 significantly reduced the expression of APOCIII, CETP, HMGCR, PCSK9, MTTP, and APOB, respectively. The cytotoxicity assay showed that miR-124 reduced cell viability, especially after 72 h; however, miR-16 did not show any significant cytotoxicity in either cell line. Our findings indicate that hsa-miR-124 and miR-16 have potential for use as therapeutic candidates in the treatment of atherosclerosis.
Collapse
|
6
|
Gavina C, Carvalho DS, Pardal M, Afonso-Silva M, Grangeia D, Dinis-Oliveira RJ, Araújo F, Taveira-Gomes T. Cardiovascular Risk Profile and Lipid Management in the Population-Based Cohort Study LATINO: 20 Years of Real-World Data. J Clin Med 2022; 11:jcm11226825. [PMID: 36431309 PMCID: PMC9692709 DOI: 10.3390/jcm11226825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
The rising prevalence of cardiovascular (CV) risk factors in Portugal has translated into more than 35,000 annual deaths due to CV diseases. We performed a multicenter observational cohort study encompassing clinical activities performed between 2000 and 2019 to characterize the CV risk profile and LDL-C management of patients in every CV risk category using electronic health records of a regional population in Portugal. We analyzed data from 14 health centers and 1 central hospital in the north of Portugal of patients between 40 and 80 years that had at least 1 family medicine appointment at these institutions. Living patients were characterized on 31 December 2019. CV risk assessment was computed according to the 2019 ESC/EAS Guidelines. Lipid-lowering therapy (LLT) and achievement of LDL-C targets were assessed. In total, the analysis included 78,459 patients. Patient proportions were 33%, 29%, 22%, and 17% for low, intermediate, high, and very high CV risk, respectively. Moderate-intensity statins were the most frequently used medication across all CV risk categories. High-intensity statins were used in 5% and 10% of high and very high CV risk patients, respectively. Ezetimibe was used in 6% and 10% of high and very high CV risk patients, respectively. LDL-C targets were achieved in 44%, 27%, 7%, and 3% of low, intermediate, high, and very high CV risk patients, respectively. For uncontrolled patients in the high and very high CV risk categories, a median LDL-C reduction of 44% and 53%, respectively, would be required to meet LDL-C targets. There are clear opportunities to optimize LDL-C management in routine clinical practice. The prescription of LLT according to CV risk represents an important missed treatment opportunity.
Collapse
Affiliation(s)
- Cristina Gavina
- Cardiology Department, Pedro Hispano Hospital, Senhora da Hora, 4464-513 Matosinhos, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Daniel Seabra Carvalho
- Cardiology Department, Pedro Hispano Hospital, Senhora da Hora, 4464-513 Matosinhos, Portugal
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - Marisa Pardal
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Marta Afonso-Silva
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Diana Grangeia
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- MTG Research and Development Lab, 4200-604 Porto, Portugal
- TOXRUN–Toxicology Research Unit, Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, 4585-116 Gandra, Portugal
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | | | - Tiago Taveira-Gomes
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- MTG Research and Development Lab, 4200-604 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa (FCS-UFP), 4249-004 Porto, Portugal
- Correspondence:
| |
Collapse
|
7
|
Kotlyarov S, Kotlyarova A. Clinical significance of polyunsaturated fatty acids in the prevention of cardiovascular diseases. Front Nutr 2022; 9:998291. [PMID: 36276836 PMCID: PMC9582942 DOI: 10.3389/fnut.2022.998291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular diseases are one of the most important problems of modern medicine. They are associated with a large number of health care visits, hospitalizations and mortality. Prevention of atherosclerosis is one of the most effective strategies and should start as early as possible. Correction of lipid metabolism disorders is associated with definite clinical successes, both in primary prevention and in the prevention of complications of many cardiovascular diseases. A growing body of evidence suggests a multifaceted role for polyunsaturated fatty acids. They demonstrate a variety of functions in inflammation, both participating directly in a number of cellular processes and acting as a precursor for subsequent biosynthesis of lipid mediators. Extensive clinical data also support the importance of polyunsaturated fatty acids, but all questions have not been answered to date, indicating the need for further research.
Collapse
Affiliation(s)
| | - Anna Kotlyarova
- Department of Pharmacy Management and Economics, Ryazan State Medical University, Ryazan, Russia
| |
Collapse
|
8
|
Aguiar C. Low-density lipoprotein cholesterol lowering in the comfort zone and the benefits of stepping out. Rev Port Cardiol 2022; 41:689-691. [DOI: 10.1016/j.repc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
9
|
Mello e Silva A. Management of dyslipidemia in diabetic patients: More than atheroma – The key things to understand in order to avoid a bittersweet taste. Rev Port Cardiol 2021; 41:131-133. [DOI: 10.1016/j.repc.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
10
|
Kotlyarov S. Diversity of Lipid Function in Atherogenesis: A Focus on Endothelial Mechanobiology. Int J Mol Sci 2021; 22:11545. [PMID: 34768974 PMCID: PMC8584259 DOI: 10.3390/ijms222111545] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
Atherosclerosis is one of the most important problems in modern medicine. Its high prevalence and social significance determine the need for a better understanding of the mechanisms of the disease's development and progression. Lipid metabolism and its disorders are one of the key links in the pathogenesis of atherosclerosis. Lipids are involved in many processes, including those related to the mechanoreception of endothelial cells. The multifaceted role of lipids in endothelial mechanobiology and mechanisms of atherogenesis are discussed in this review. Endothelium is involved in ensuring adequate vascular hemodynamics, and changes in blood flow characteristics are detected by endothelial cells and affect their structure and function.
Collapse
Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
| |
Collapse
|
11
|
Abrantes AM, Nogueira-Garcia B, Alves M, Teixeira Passos D, Brito D, Pinto FJ, Caldeira D. Low-Dose Colchicine in Coronary Artery Disease - Systematic Review and Meta-Analysis. Circ Rep 2021; 3:457-464. [PMID: 34414335 PMCID: PMC8338916 DOI: 10.1253/circrep.cr-21-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Recent studies have revealed the benefits of using colchicine, a drug with anti-inflammatory properties, in coronary artery disease (CAD). This study systematically reviewed the benefits and risks of low-dose colchicine in patients with CAD. Methods and Results: We searched for randomized controlled trials (RCTs) in MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases (March 2020). Efficacy and safety outcomes were evaluated. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with I2 test. Confidence in the pooled evidence was appraised using the GRADE framework. Colchicine reduced the rate of major adverse cardiovascular events (RR 0.65; 95% CI 0.49-0.86; 6 RCTs; I2=50%; 11,718 patients; GRADE, moderate confidence), acute coronary syndrome (RR 0.64; 95% CI 0.46-0.90; I2=47%; 7 RCTs; 11,955 patients; GRADE, very low confidence), stroke (RR 0.49; 95% CI 0.30-0.78; I2=0%; 6 RCTs; 11,896 patients; GRADE, moderate confidence), and cardiovascular interventions (RR 0.61; 95% CI 0.42-0.89; I2=40%; 4 RCTs; 11,284 patients; GRADE, high confidence). Colchicine did not increase the risk of adverse events, except for gastrointestinal events (RR 1.54; 95% CI 1.11-2.13; I2=72%; 9 RCTs; 12,374 patients; GRADE, very low confidence). Conclusions: Low-dose colchicine in patients with CAD is associated with beneficial effects on prognosis, although an increased risk of gastrointestinal events was confirmed.
Collapse
Affiliation(s)
- Ana Mafalda Abrantes
- Internal Medicine Department 2, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Beatriz Nogueira-Garcia
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Mariana Alves
- Internal Medicine Department 3, Pulido Valente Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Clinical and Therapeutic Pharmacology Laboratory, Faculty of Medicine, University of Lisbon Lisbon Portugal.,Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Dúlio Teixeira Passos
- Internal Medicine Department 2, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal
| | - Dulce Brito
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Fausto J Pinto
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
| | - Daniel Caldeira
- Cardiology Department, Santa Maria Hospital - Northern Lisbon University Hospital Center (CHULN) Lisbon Portugal.,Clinical and Therapeutic Pharmacology Laboratory, Faculty of Medicine, University of Lisbon Lisbon Portugal.,Cardiovascular Center, University of Lisbon Lisbon Portugal.,Academic Medical Center of Lisbon, Faculty of Medicine, University of Lisbon Lisbon Portugal
| |
Collapse
|
12
|
Teixeira H, Freitas A, Sarmento A, Nossa P, Gonçalves H, Pina MDF. Spatial Patterns in Hospital-Acquired Infections in Portugal (2014-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094703. [PMID: 33925064 PMCID: PMC8124660 DOI: 10.3390/ijerph18094703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospital-Acquired Infections (HAIs) represent the most frequent adverse event associated with healthcare delivery and result in prolonged hospital stays and deaths worldwide. AIM To analyze the spatial patterns of HAI incidence from 2014 to 2017 in Portugal. METHODS Data from the Portuguese Discharge Hospital Register were used. We selected episodes of patients with no infection on admission and with any of the following HAI diagnoses: catheter-related bloodstream infections, intestinal infections by Clostridium difficile, nosocomial pneumonia, surgical site infections, and urinary tract infections. We calculated age-standardized hospitalization rates (ASHR) by place of patient residence. We used empirical Bayes estimators to smooth the ASHR. The Moran Index and Local Index of Spatial Autocorrelation (LISA) were calculated to identify spatial clusters. RESULTS A total of 318,218 HAIs were registered, with men accounting for 49.8% cases. The median length of stay (LOS) was 9.0 days, and 15.7% of patients died during the hospitalization. The peak of HAIs (n = 81,690) occurred in 2015, representing 9.4% of the total hospital admissions. Substantial spatial inequalities were observed, with the center region presenting three times the ASHR of the north. A slight decrease in ASHR was observed after 2015. Pneumonia was the most frequent HAI in all age groups. CONCLUSION The incidence of HAI is not randomly distributed in the space; clusters of high risk in the central region were seen over the entire study period. These findings may be useful to support healthcare policymakers and to promote a revision of infection control policies, providing insights for improved implementation.
Collapse
Affiliation(s)
- Hugo Teixeira
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (A.F.); (H.G.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal; (A.S.); (M.d.F.P.)
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence: or
| | - Alberto Freitas
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (A.F.); (H.G.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - António Sarmento
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal; (A.S.); (M.d.F.P.)
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paulo Nossa
- CEGOT, Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal;
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Hernâni Gonçalves
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (A.F.); (H.G.)
- CINTESIS—Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Maria de Fátima Pina
- INEB—Instituto de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal; (A.S.); (M.d.F.P.)
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- ICICT/FIOCRUZ, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde/Fundação Oswaldo Cruz, 21040-900 Rio De Janeiro, Brazil
| |
Collapse
|