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Pandit S, Biswas TK, Bera S, Saha S, Jana U, Sur TK. Efficacy of Heart Revival, an Ayurvedic formulation, in hypertension and related risks - An exploratory single arm open label trial. J Ayurveda Integr Med 2024; 15:100975. [PMID: 39047600 PMCID: PMC11321376 DOI: 10.1016/j.jaim.2024.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/07/2022] [Accepted: 05/14/2024] [Indexed: 07/27/2024] Open
Affiliation(s)
- Srikanta Pandit
- Department of Kayachikitsha, J.B. Roy State Ayurvedic Medical College & Hospital, Kolkata, West Bengal, 700 004, India
| | - Tuhin Kanti Biswas
- Department of Kayachikitsha, J.B. Roy State Ayurvedic Medical College & Hospital, Kolkata, West Bengal, 700 004, India
| | - Sayantan Bera
- Department of Kayachikitsha, J.B. Roy State Ayurvedic Medical College & Hospital, Kolkata, West Bengal, 700 004, India
| | - Sumana Saha
- Department of Kayachikitsha, J.B. Roy State Ayurvedic Medical College & Hospital, Kolkata, West Bengal, 700 004, India
| | - Utpalenedu Jana
- Department of Kayachikitsha, J.B. Roy State Ayurvedic Medical College & Hospital, Kolkata, West Bengal, 700 004, India
| | - Tapas Kumar Sur
- Multidisciplinary Research Unit (ICMR), R.G. Kar Medical College & Hospital, Kolkata, West Bengal, 700 004, India.
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Yeh JJ, Lai MC, Yang YC, Hsu CY, Kao CH. Relationships Between Bronchodilators, Steroids, Antiarrhythmic Drugs, Antidepressants, and Benzodiazepines and Heart Disease and Ischemic Stroke in Patients With Predominant Bronchiectasis and Asthma. Front Cardiovasc Med 2022; 9:797623. [PMID: 35252385 PMCID: PMC8893278 DOI: 10.3389/fcvm.2022.797623] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/17/2022] [Indexed: 01/09/2023] Open
Abstract
ObjectiveWe investigated the effects of medication on heart disease and ischemic stroke (HDS) risk in patients with predominant bronchiectasis-asthma combination (BCAS).MethodsBCAS and non-BCAS cohorts (N = 588 and 1,118, respectively) were retrospectively enrolled. The cumulative incidence of HDS was analyzed using Cox proportional regression; propensity scores were estimated using non-parsimonious multivariable logistic regression. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for HDS were calculated, adjusting for sex, age, comorbidities, and medication {long- and short-acting β2 agonists and muscarinic antagonists (LABAs/SABAs and LAMAs/SAMAs), steroids [inhaled corticosteroid steroids (ICSs), oral steroids (OSs)], antiarrhythmics, antidepressants (fluoxetine), benzodiazepines (alprazolam, fludiazepam), statins and antihypertensive drugs (diuretics, cardioselective beta blockers, calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEi), angiotensin II blockers)}.ResultsCompared with the non-BCAS cohort, the BCAS cohort taking LABAs, SABAs, SAMAs, ICSs, OSs, antiarrhythmics, and alprazolam had an elevated HDS risk [aHRs (95% CIs): 2.36 (1.25–4.33), 2.65 (1.87–3.75), 2.66 (1.74–4.05), 2.53 (1.61–3.99), 1.76 (1.43–2.18), 9.88 (3.27–30.5), and 1.73 (1.15–2.58), respectively except fludiazepam 1.33 (0.73–2.40)]. The aHRs (95% CIs) for LABAs ≤ 30 days, DDDs <415, ICSs ≤ 30 days were 1.10 (0.38–3.15), 2.95 (0.22–38.8), 1.45 (0.76–2.77). The aHRs (95% CIs) for current and recent alprazolam were 1.78 (1.09–2.93) and 777.8 (1.34–451590.0); for current and past fludiazepam were 1.39 (0.75–2.59) and 1.29 (0.42–4.01) and for past alprazolam was 1.57 (0.55–4.46); respectively. The aHRs (95% CIs) for alprazolam >30 DDDs, fludiazepam >20 DDDs, ICSs ≦415 DDDs, and OSs DDDs ≦15 were 1.60 (0.78–3.29), 2.43 (0.90–6.55), 5.02 (1.76–14.3), and 2.28 (1.43–3.62), respectively.ConclusionThe bronchodilators, steroids, and antiarrhythmics were associated with higher risk of HDS, even low dose use of steroids. However, the current use of LABAs/ICSs were not associated with HDS. Benzodiazepines were relatively safe, except for current or recent alprazolam use. Notably, taking confounders into account is crucial in observational studies.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Chest Medicine, Geriatric Medicine and Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Mei-Chu Lai
- Department of Laboratory Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Yu-Cih Yang
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Y. Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- *Correspondence: Chia-Hung Kao ;
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Mirsafaei L, Reiner Ž, Shafabakhsh R, Asemi Z. Molecular and Biological Functions of Quercetin as a Natural Solution for Cardiovascular Disease Prevention and Treatment. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2020; 75:307-315. [PMID: 32588290 DOI: 10.1007/s11130-020-00832-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cardiovascular disease (CVD) is a worldwide health problem with growing up rates of mortality and morbidity. Many risk factors, including high blood pressure, cigarette smoking, diabetes, obesity, and dyslipidemia are responsible for CVD. CVD can be prevented by some simple and cost-effective steps such as smoking cessation, normalizing body weight, regular physical activity, and dietary changes, including decreasing saturated fats, increasing the intake of vegetables and fruits, and reducing sugar intake. In the last decades, growing up number of studies were performed to explain the possible function of non-nutrient substances from the diet which might prevent CVD. One of these natural compounds is quercetin which is widely present in vegetables, tea, fruits and wine. Many in vitro, in vivo and clinical studies have indicated the cardioprotective functions of quercetin. They can be explained by quercetin's reducing blood pressure, antioxidant potential and some other activities. This review evaluates the experimental and clinical studies that have studied the effect of quercetin in CVD and summarizes the molecular mechanisms of action as well as clinical effects of quercetin in CVD.
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Affiliation(s)
- Liaosadat Mirsafaei
- Department of Cardiology, Ramsar Campus, Mazandaran University of Medical Sciences, Sari, Iran
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Rana Shafabakhsh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran.
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran.
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Jusufovic M, Skagen K, Krohg-Sørensen K, Skjelland M. Current Medical and Surgical Stroke Prevention Therapies for Patients with Carotid Artery Stenosis. Curr Neurovasc Res 2019; 16:96-103. [PMID: 30706783 DOI: 10.2174/1567202616666190131162811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 01/22/2023]
Abstract
Carotid Artery Stenosis (CAS) is a marker of systemic atherosclerosis and patients with CAS are at high risk of vascular events in multiple vascular locations, including ipsilateral ischemic stroke. Both medical and surgical therapies have been demonstrated effective in reducing this risk. The optimal management for patients with asymptomatic carotid artery stenosis remains controversial. In patients with symptomatic CAS ≥70%, CEA has been demonstrated to reduce the risk of stroke. With the risk of recurrent stroke being particularly high in the first 2 weeks after the first event, Carotid Endarterectomy (CEA) or carotid angioplasty with stenting provides maximal benefits to patients with symptomatic CAS ≥70% if performed within this «2-week» target. Several large ongoing trials are currently comparing the risks and benefits of carotid revascularization versus medical therapy alone.
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Affiliation(s)
- Mirza Jusufovic
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kirsten Krohg-Sørensen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Nezu T, Hosomi N, Aoki S, Suzuki N, Teshima T, Sugii H, Nagahama S, Kurose Y, Maruyama H, Matsumoto M. Effects of Cilnidipine, an L/N-Type Calcium Channel Blocker, on Carotid Atherosclerosis in Japanese Post-Stroke Hypertensive Patients: Results from the CA-ATTEND Study. J Atheroscler Thromb 2018; 25:490-504. [PMID: 29225324 PMCID: PMC6005225 DOI: 10.5551/jat.42101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims: Although several antihypertensive agents reduced the carotid intima-media thickness (IMT), it remains unclear whether those agents affect the interadventitial diameter (IAD). We aimed to examine whether cilnidipine, an L/N-type calcium channel blocker, reduced the common carotid IMT or IAD in post-stroke hypertensive patients. Methods: The common carotid IMT and IAD were measured at the start of cilnidipine treatment and 12 months from that. The changes in the mean max-IMT or IAD between baseline and the 12-month follow-up were evaluated and compared between the thick group (max-IMT ≥ 1.1 mm) and the normal group (max-IMT < 1.1 mm). Results: A total of 603 post-stroke hypertensive subjects (mean age = 69.3 yr, 378 males) were included in the analysis. At baseline, IAD was increased stepwise according to the value of max-IMT (p for trend < 0.001). Among them, 326 subjects were followed up for 12 months. The mean max-IMT from baseline to 12 months did not change in the normal group (−0.01 mm, 95% confidence interval [CI] −0.03 to 0.01, n = 170), whereas a significant reduction was observed in the thick group (−0.09 mm, 95% CI −0.13 to −0.05, n = 156). The mean IAD was significantly reduced during the study period in the normal group (−0.14 mm, 95% CI −0.22 to −0.05) as well as in the thick group (−0.12 mm, 95% CI −0.21 to −0.03). Conclusions: Cilnidipine promoted the regression of common carotid IMT in post-stroke hypertensive patients, especially in the thick group. Cilnidipine also reduced the IAD in both normal and thick groups.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | | | - Tsukasa Teshima
- Post-Marketing Surveillance, Mochida Pharmaceutical Co., Ltd
| | - Hitoshi Sugii
- Post-Marketing Surveillance, Mochida Pharmaceutical Co., Ltd
| | | | - Yoshiki Kurose
- Post-Marketing Medical Research Department, EA Pharma Co., Ltd
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences.,Hoshigaoka Medical Center, Japan Community Healthcare Organization (JCHO)
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Tsioufis C, Andrikou I, Siasos G, Filis K, Tousoulis D. Anti-hypertensive treatment in peripheral artery disease. Curr Opin Pharmacol 2018; 39:35-42. [DOI: 10.1016/j.coph.2018.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/22/2018] [Accepted: 01/31/2018] [Indexed: 12/30/2022]
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Cuspidi C, Sala C, Tadic M, Grassi G, Mancia G. Carotid intima-media thickness and anti-hypertensive treatment: Focus on angiotensin II receptor blockers. Pharmacol Res 2018; 129:20-26. [DOI: 10.1016/j.phrs.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
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Kim KH, Song IG, Kwon TG, Park JB, Kim KS, Kim WS, Bae JH. Impact of different antihypertensives on carotid arterial wall thickness. J Clin Hypertens (Greenwich) 2018; 20:248-254. [DOI: 10.1111/jch.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ki-Hong Kim
- Department of Cardiology; Konyang University Hospital; Daejeon Korea
| | - In Geol Song
- Department of Cardiology; Konyang University Hospital; Daejeon Korea
| | - Taek-Geun Kwon
- Department of Cardiology; Konyang University Hospital; Daejeon Korea
| | - Jeong Bae Park
- Department of Cardiology; Cheil General Hospital; Dankook University; Seoul Korea
| | - Kee-Sik Kim
- Department of Cardiology; Daegu Catholic University Medical Center; Daegu Korea
| | - Wuon-Shik Kim
- Korea Research Institute of Standards and Science; Daejeon Korea
| | - Jang-Ho Bae
- Department of Cardiology; Konyang University Hospital; Daejeon Korea
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Stavropoulos K, Imprialos KP, Doumas M, Athyros VG. Carotid intima-media thickness as a target-organ damage and treatment-target: Need for a major revision? J Clin Hypertens (Greenwich) 2018; 20:255-257. [DOI: 10.1111/jch.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Konstantinos P. Imprialos
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Vasilios G. Athyros
- 2nd Propedeutic Department of Internal Medicine; Aristotle University of Thessaloniki; Thessaloniki Greece
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Baroncini LAV, de Castro Sylvestre L, Filho RP. Carotid intima-media thickness and carotid plaque represent different adaptive responses to traditional cardiovascular risk factors. IJC HEART & VASCULATURE 2015; 9:48-51. [PMID: 28785705 PMCID: PMC5497319 DOI: 10.1016/j.ijcha.2015.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 11/26/2022]
Abstract
Aim To assess the effects of each traditional cardiovascular risk factor (hypertension, diabetes mellitus, dyslipidemia, and smoking), including the presence of coronary artery disease (CAD), on carotid intima-media thickness (CIMT) and to assess the degree of carotid plaque occurrence. Methods A total of 553 outpatients (216 men and 337 women; mean age 67.06 ± 12.44 years) who underwent a carotid artery ultrasound were screened for carotid plaque and CIMT measurements. Results The CIMT medians were higher in males (P < .001) and in patients with hypertension (P < .001). A linear increase occurred in mean CIMT of 0.0059 mm for each year of increase in age. The presence of plaque indicated a tendency to correlate with CIMT (P = .067). The presence of hypertension associated with diabetes (P = .0061; estimated difference 0.0494 mm) or dyslipidemia (P = .0016; estimated difference 0.0472 mm) or CAD (P = .0043; estimated difference 0.0527 mm) increased the mean CIMT measurements. The probability of plaque occurrence in carotid arteries is influenced by the age (P < .001) and is higher in patients with dyslipidemia (P = .008) and CAD (P < .001). Conclusions Hypertension is the strongest cardiovascular risk factor that increases CIMT, followed by age and male sex. Age and dyslipidemia increase the probability of carotid plaque. Increased CIMT and plaque could be present in the same patient caused by different risk factors and with independent effects on the artery wall and different clinical prognoses. Hypertension alone or with diabetes, dyslipidemia or CAD increases CIMT, but not the probability of carotid plaque. There is no current evidence to suggest that CIMT may progress to atherosclerotic plaque. Increased CIMT and plaque have different clinical prognoses in the same patient.
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Affiliation(s)
- Liz Andréa Villela Baroncini
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
| | - Lucimary de Castro Sylvestre
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
| | - Roberto Pecoits Filho
- Pontifícia Universidade Católica do Paraná, Medical School, Health Sciences Postgraduate Program, Rua Imaculada Conceição 1155 - Bloco CCBS, CEP: 80215-901 Curitiba, Brazil
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Bahls M, Friedrich N, Atzler D, Felix SB, Nauck MA, Böger RH, Völzke H, Schwedhelm E, Dörr M. L-Arginine and SDMA Serum Concentrations Are Associated with Subclinical Atherosclerosis in the Study of Health in Pomerania (SHIP). PLoS One 2015; 10:e0131293. [PMID: 26098562 PMCID: PMC4476678 DOI: 10.1371/journal.pone.0131293] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/01/2015] [Indexed: 02/02/2023] Open
Abstract
Objective Even though ˪-arginine (ARG) derivatives can predict cardiovascular mortality, their role as atherosclerotic biomarkers is unclear. We tested the hypothesis if asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and the sum of both (DMA) are positively, while ARG and ARG/ADMA ratio are inversely associated with carotid intima-media thickness (cIMT) and atherosclerotic plaque in the carotid artery. Approach and Results Cross-sectional data of 1999 subjects (age: 45–81 years; 48.2% ♀) from the population-based Study of Health in Pomerania (SHIP-0) was used. Analysis of variance and logistic regression models were calculated and all adjusted models were corrected for sex, age, smoking status, waist-to-hip ratio and estimated glomerular filtration rate. Increased cIMT (>75th age-sex specific percentile) was found in 517 subjects (25.7%), while atherosclerotic plaque was detected in 1413 subjects (70.4%). SDMA tertiles were significantly positively associated with larger cIMT among subjects with high SDMA levels [>66th: 0.82 (95%-CI 0.80; 0.85) mm]. High SDMA levels were related to a higher odds ratio (OR) of increased cIMT [OR 1.39 (95%-CI 1.08; 1.79)]. Furthermore, ARG was positively associated with atherosclerotic plaques [OR 1.41 (95%-CI 1.07; 1.85)]. No relation was found for ADMA and atherosclerosis. Conclusions In conclusion, the hypothesis of a positive association between SDMA with an increased cIMT was confirmed. Unexpectedly, ARG was positively related to atherosclerotic plaque. In view of these inconsistent findings, the impact of ARG derivatives as atherosclerotic biomarkers deserves further research.
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Affiliation(s)
- Martin Bahls
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- * E-mail:
| | - Nele Friedrich
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - Dorothee Atzler
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Hamburg/Kiel/Lübeck, Germany
| | - Stephan B. Felix
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Matthias A. Nauck
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - Rainer H. Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Hamburg/Kiel/Lübeck, Germany
| | - Henry Völzke
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Hamburg/Kiel/Lübeck, Germany
| | - Marcus Dörr
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany
- DZHK—German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
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12
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Long-term effects of ACE inhibitor on vascular remodelling. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe long-term pathomorphological changes of the injured vessels under angiotensin-converting-enzyme (ACE) inhibitor are still not known. Therefore, we assessed the alternations of vascular architecture after three-month therapy with ACE inhibitor and identified new target cells for this medication. Carotid arteries of spontaneously hypertensive rats underwent balloon angioplasty. 14 days prior intervention, half of the animals was treated with ACE inhibitor. After three months of vascular trauma, the injured vessels were explored by histomorphology and immunohistochemistry for angiotensin-II receptor (AT1R), dendritic and HSP47+ cells. The neointimal growth decreased significantly only up to 28 days under ACE inhibitor. In contrast, the reductive effect of ACE inhibitor on media area persisted up to three months after intervention. A significant fraction of early neointimal cells was of a dendritic cell type. The relevant portion of these cells showed an expression of AT1R and HSP47. AT1R was present in 70% and HSP47 in 18% of all early neointimal cells in both groups. ACE inhibitor may at least temporarily diminish remodelling processes in injured vessels. The detection of AT1R on dendritic cells identifies these cells as important targets for therapeutic strategies involving modulation of the renin-angiotensin system.
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Milane A, Abdallah J, Kanbar R, Khazen G, Ghassibe-Sabbagh M, Salloum AK, Youhanna S, Saad A, El Bayeh H, Chammas E, Platt DE, Hager J, Gauguier D, Zalloua P, Abchee A. Association of hypertension with coronary artery disease onset in the Lebanese population. SPRINGERPLUS 2014; 3:533. [PMID: 25279324 PMCID: PMC4176843 DOI: 10.1186/2193-1801-3-533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/09/2014] [Indexed: 12/22/2022]
Abstract
The onset of coronary artery disease (CAD) is influenced by cardiovascular risk factors that often occur in clusters and may build on one another. The objective of this study is to examine the relationship between hypertension and CAD age of onset in the Lebanese population. This retrospective analysis was performed on data extracted from Lebanese patients (n = 3,753). Logistic regression examined the association of hypertension with the age at CAD diagnosis after controlling for other traditional risk factors. The effect of antihypertensive drugs and lifestyle changes on the onset of CAD was also investigated. Results showed that hypertension is associated with late onset CAD (OR=0.656, 95% CI=0.504-0.853, p=0.001). Use of antihypertensive drugs showed a similar association with delayed CAD onset. When comparing age of onset in CAD patients with traditional risk factors such as hypertension, diabetes, hyperlipidemia, obesity, smoking and family history of CAD, the age of onset was significantly higher for patients with hypertension compared to those with any of the other risk factors studied (p < 0.001). In conclusion, hypertension and its treatment are associated with late coronary atherosclerotic manifestations in Lebanese population. This observation is currently under investigation to clarify its genetic and/or environmental mechanisms.
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Affiliation(s)
- Aline Milane
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Jad Abdallah
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Roy Kanbar
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Georges Khazen
- School of Arts and Sciences, Lebanese American University, Byblos 36, Lebanon
| | | | | | - Sonia Youhanna
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Aline Saad
- Lebanese American University, School of Pharmacy, Byblos 36, Lebanon
| | - Hamid El Bayeh
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Elie Chammas
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon
| | - Daniel E Platt
- Bioinformatics and Pattern Discovery, IBM T. J. Watson Research Centre, Yorktown Hgts, NY 10598 USA
| | - Jörg Hager
- CEA-Genomics Institute, Centre National de Génotypage, Evry, 91057 France
| | - Dominique Gauguier
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Headington, Oxford, OX3 7BN UK ; INSERM UMRS872, Centre de Recherche des Cordeliers, 15 Rue de l'école de Médecine, Paris, 75006 France
| | - Pierre Zalloua
- School of Medicine, Lebanese American University, Beirut, 1102 2801 Lebanon ; Harvard School of Public Health, Boston, MA 02215 USA
| | - Antoine Abchee
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Tattersall MC, Gassett A, Korcarz CE, Gepner AD, Kaufman JD, Liu KJ, Astor BC, Sheppard L, Kronmal RA, Stein JH. Predictors of carotid thickness and plaque progression during a decade: the Multi-Ethnic Study of Atherosclerosis. Stroke 2014; 45:3257-62. [PMID: 25213342 DOI: 10.1161/strokeaha.114.005669] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Carotid artery intima-media thickness (IMT) and plaque are noninvasive markers of subclinical arterial injury that predict incident cardiovascular disease. We evaluated predictors of longitudinal changes in IMT and new plaque during a decade in a longitudinal multiethnic cohort. METHODS Carotid IMT and plaque were evaluated in Multi-Ethnic Study of Atherosclerosis (MESA) participants at exams 1 and 5, a mean (standard deviation) of 9.4 (0.5) years later. Far wall carotid IMT was measured in both common and internal carotid arteries. A plaque score was calculated from all carotid segments. Mixed-effects longitudinal and multivariate regression models evaluated associations of baseline risk factors and time-updated medication use with IMT progression and plaque formation. RESULTS The 3441 MESA participants were aged 60.3 (9.4) years (53% women; 26% blacks, 22% Hispanic, 13% Chinese); 1620 (47%) had carotid plaque. Mean common carotid artery IMT progression was 11.8 (12.8) μm/year, and 1923 (56%) subjects developed new plaque. IMT progressed more slowly in Chinese (β=-2.89; P=0.001) and Hispanic participants (β=-1.81; P=0.02), and with higher baseline high-density lipoprotein cholesterol (per 5 mg/dL; β=-0.22; P=0.03), antihypertensive use (β=-2.06; P=0.0004), and time on antihypertensive medications (years; β=-0.29; P<0.0001). Traditional risk factors were associated with new plaque formation, with strong associations for cigarette use (odds ratio, 2.31; P<0.0001) and protection by black ethnicity (odds ratio, 0.68; P<0.0001). CONCLUSIONS In a large, multiethnic cohort with a decade of follow-up, ethnicity was a strong, independent predictor of carotid IMT and plaque progression. Antihypertensive medication use was associated with less subclinical disease progression.
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Affiliation(s)
- Matthew C Tattersall
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Amanda Gassett
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Claudia E Korcarz
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Adam D Gepner
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Joel D Kaufman
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Kiang J Liu
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Brad C Astor
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Lianne Sheppard
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - Richard A Kronmal
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle
| | - James H Stein
- From the Department of Medicine, Division of Cardiovascular Medicine (M.C.T., C.E.K., A.D.G., J.H.S.), and Department of Medicine, Division of Nephrology (B.C.A.), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Preventive Medicine Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); and Departments of Epidemiology (J.D.K.) and Biostatistics (A.G., L.S., R.A.K.), University of Washington School of Public Health, Seattle.
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15
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Lundby-Christensen L, Tarnow L, Hansen DL, Worm D, Naver LS, Hvolris LE, Wiinberg N, Vaag A, Almdal TP. Carotid intima-media thickness is reduced 12 months after gastric bypass surgery in obese patients with type 2 diabetes or impaired glucose tolerance. J Diabetes Complications 2014; 28:517-22. [PMID: 24685364 DOI: 10.1016/j.jdiacomp.2014.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 01/06/2023]
Abstract
AIM To investigate whether Roux-en-Y gastric bypass surgery (RYGB) - an in vivo model for normalisation of hyperglycaemia - improves carotid intima-media thickness (IMT) in patients with type 2 diabetes (T2D)/impaired glucose tolerance (IGT) and normal glucose tolerance (NGT). METHODS Observational prospective study, 34 obese patients (T2D (n = 14)/IGT (n = 4), and NGT (n = 16)) were investigated before and six and 12months after RYGB. RESULTS Mean carotid IMT was significantly reduced 12months after RYGB in patients with T2D/IGT (-0.041 mm (95% CI -0.069; -0.012, p = 0.005)) but not in patients with NGT (-0.010 mm (-0.039; 0.020, p = 0.52)). The between-group difference was not significant (p=0.13). Twelve months after RYGB, patients with respectively T2D/IGT and NGT demonstrated changes in weight: -29.9 kg, p<0.001/-30.6 kg, p < 0.001, HbA1c: -0.7%, p < 0.001/-0.1%, p = 0.33, systolic blood pressure: -2 mmHg, p = 0.68/-10 mmHg, p = 0.01 and diastolic blood pressure: -8 mmHg, p = 0.003/-11 mmHg, p < 0.001. 80% of T2D patients terminated antihyperglycaemic medication. CONCLUSION Mean carotid IMT was significantly reduced 12months after RYGB in patients with T2D/IGT which provides evidence to support that the earliest atherosclerotic changes in the arterial wall are reversible. Although numerically different from the changes observed in patients with NGT, the between-group difference was not statistically significant.
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Affiliation(s)
- Louise Lundby-Christensen
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Department of Paediatrics, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Lise Tarnow
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Nordsjællands University Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Dorte L Hansen
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Dorte Worm
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Lars S Naver
- The Gastro Unit, Department of Surgery, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Lisbeth E Hvolris
- The Gastro Unit, Department of Surgery, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Niels Wiinberg
- Department of Physiology and Nuclear Medicine, Copenhagen University Hospital Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Allan Vaag
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Department of Endocrinology, University of Copenhagen Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas P Almdal
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Department of Medicine F, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
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16
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Pirro M, Vaudo G, Lupattelli G, Pasqualini L, Mannarino MR, Schillaci G, Alaeddin A, Paciullo F, Fallarino F, Bagaglia F, Mannarino E. On-treatment C-reactive protein and HDL cholesterol levels in patients at intermediate cardiovascular risk: Impact on carotid intima-media thickness. Life Sci 2013; 93:338-43. [DOI: 10.1016/j.lfs.2013.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 06/24/2013] [Accepted: 07/06/2013] [Indexed: 12/17/2022]
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17
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Hutton B, Tetzlaff J, Yazdi F, Thielman J, Kanji S, Fergusson D, Bjerre L, Mills E, Thorlund K, Tricco A, Straus S, Moher D, Leenen FHH. Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses. Syst Rev 2013; 2:44. [PMID: 23809864 PMCID: PMC3701495 DOI: 10.1186/2046-4053-2-44] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/01/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension has been cited as the most common attributable risk factor for death worldwide, and in Canada more than one of every five adults had this diagnosis in 2007. In addition to different lifestyle modifications, such as diet and exercise, there exist many pharmaco-therapies from different drug classes which can be used to lower blood pressure, thereby reducing the risk of serious clinical outcomes. In moderate and severe cases, more than one agent may be used. The optimal mono- and combination therapies for mild hypertension and moderate/severe hypertension are unclear, and clinical guidelines provide different recommendations for first line therapy. The objective of this review is to explore the relative benefits and safety of different pharmacotherapies for management of non-diabetic patients with hypertension, whether of a mild or moderate to severe nature. METHODS/DESIGN Searches involving MEDLINE and the Cochrane Database of Systematic Reviews will be used to identify related systematic reviews and relevant randomized trials. The outcomes of interest include myocardial infarction, stroke, incident diabetes, heart failure, overall and cardiovascular related death, and important side effects (cancers, depression, syncopal episodes/falls and sexual dysfunction). Randomized controlled trials will be sought. Two reviewers will independently screen relevant reviews, titles and abstracts resulting from the literature search, and also potentially relevant full-text articles in duplicate. Data will be abstracted and quality will be appraised by two team members independently. Conflicts at all levels of screening and abstraction will be resolved through team discussion. Random effect pairwise meta-analyses and network meta-analyses will be conducted where deemed appropriate. Analyses will be geared toward studying treatment of mild hypertension and moderate/severe hypertension separately. DISCUSSION Our systematic review results will assess the extent of currently available evidence for single agent and multi-agent pharmacotherapies in patients with mild, moderate and severe hypertension, and will provide a rigorous and updated synthesis of a range of important clinical outcomes for clinicians, decision makers and patients. TRIAL REGISTRATION PROSPERO Registration Number: CRD42013004459.
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Affiliation(s)
- Brian Hutton
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Jennifer Tetzlaff
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Fatemeh Yazdi
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Justin Thielman
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Salmaan Kanji
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Dean Fergusson
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Lise Bjerre
- Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, ON, Canada K1N 5C8
- Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Edward Mills
- Department of Epidemiology and Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Kristian Thorlund
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4 K1
| | - Andrea Tricco
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON, Canada M5B 1T8
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON, Canada M5B 1T8
| | - David Moher
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada, Box 201 K1H 8L6
| | - Frans HH Leenen
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4W7
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18
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Ohta Y, Kawano Y, Iwashima Y, Hayashi S, Yoshihara F, Matayoshi T, Takiuchi S, Kamide K, Nakamura S, Horio T. Control of Home Blood Pressure with an Amlodipine- or Losartan-Based Regimen and Progression of Carotid Artery Intima-media Thickness in Hypertensive Patients: The HOSP Substudy. Clin Exp Hypertens 2013; 35:279-84. [DOI: 10.3109/10641963.2013.780074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Peters SAE, den Ruijter HM, Grobbee DE, Bots ML. Results From a Carotid Intima-Media Thickness Trial as a Decision Tool for Launching a Large-Scale Morbidity and Mortality Trial. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.112.978114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Trials with carotid intima-media thickness (CIMT) as primary end point may improve the efficiency of the evaluation of new therapies targeting atherosclerosis considerably, and the results of CIMT trials may be used as a decision tool to help in the choice to launch or not to launch a large-scale morbidity and mortality (M&M) trial. We evaluated the literature to provide evidence to support or refute this proposition.
Methods and Results—
PubMed Medline was systematically searched on May 1, 2012, for randomized double-blind controlled CIMT trials. The agreement between the results from CIMT and M&M trials was assessed, and positive and negative predictive values were calculated. Forty-eight CIMT trials were included. CIMT trials (n=20) on lipid-level modifying therapies are all, except one, in agreement with the M&M trial findings. For blood pressure-lowering trials (n=13), 3 were not congruent with the M&M trial. The positive and negative predictive value (95% confidence interval) of a CIMT trial to predict the outcome of a M&M trial are 96% (80–99%) and 83% (64–93%), respectively. The predictive values are higher for lipid-level modifying therapies than for other therapies.
Conclusions—
A CIMT trial positioned before an M&M trial may considerably improve the efficiency of the evaluation of new drug therapies on atherosclerosis and cardiovascular disease risk. Hence, the results of a CIMT trial should be seen as a decision tool to support or refute the start of a large-scale M&M trial on drugs targeting atherosclerosis.
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Affiliation(s)
- Sanne A. E. Peters
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Hester M. den Ruijter
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Diederick E. Grobbee
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
| | - Michiel L. Bots
- From the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P., H.M.D.R., D.E.G., M.L.B.); and The Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (H.M.D.R.)
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