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Patel RJ, Willie-Permor D, Fan A, Zarrintan S, Malas MB. 30-Day Risk Score for Mortality and Stroke in Patients with Carotid Artery Stenosis Using Artificial Intelligence Based Carotid Plaque Morphology. Ann Vasc Surg 2024:S0890-5096(24)00397-2. [PMID: 39009122 DOI: 10.1016/j.avsg.2024.05.016] [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: 01/27/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES The gold standard for determining carotid artery stenosis intervention is based on a combination of percent stenosis and symptomatic status. Few studies have assessed plaque morphology as an additive tool for stroke prediction. Our goal was to create a predictive model and risk score for 30-day stroke and death inclusive of plaque morphology. METHODS Patients with a CT angiography head/neck between 2010-2021 at a single institution and a diagnosis of carotid artery stenosis were included in our analysis. Each CT was used to create a 3D image of carotid plaque based off image recognition software. A stepwise backward regression was used to select variables for inclusion in our prediction models. Model discrimination was assessed with receiver operating characteristic curves (AUC). Additionally, calibration was performed and the model with the least Akaike Information Criterion (AIC) was selected. The risk score was modeled from the Framingham Study. Primary outcome was mortality/stroke. RESULTS We created three models to predict mortality/stroke from 366 patients: model A using only clinical variables, model B using only plaque morphology and model C using both clinical and plaque morphology variables. Model A used age, sex, PAD, hyperlipidemia, BMI, COPD, and history of TIA/stroke and had an AUC of 0.737 and AIC of 285.4. Model B used perivascular adipose tissue volume, lumen area, calcified volume, and target lesion length and had an AUC of 0.644 and AIC of 304.8. Finally, model C combined both clinical and software variables of age, sex, matrix volume, history of TIA/stroke, BMI, perivascular adipose tissue, lipid rich necrotic core, COPD and hyperlipidemia and had an AUC of 0.759 and an AIC of 277.6. Model C was the most predictive because it had the highest AUC and lowest AIC. CONCLUSION Our study demonstrates that combining both clinical factors and plaque morphology creates the best predication of a patient's risk for all-cause mortality or stroke from carotid artery stenosis. Additionally, we found that for patients with even 3 points in our risk score model have a 20% chance of stroke/death. Further prospective studies are needed to validate our findings.
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Affiliation(s)
- Rohini J Patel
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Daniel Willie-Permor
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Austin Fan
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Sina Zarrintan
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Mahmoud B Malas
- Center for Learning and Excellence in Vascular & Endovascular Research (CLEVER), Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego, San Diego, CA.
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Son HM, Lee H. Association Between Nurse-Led Multidisciplinary Education and Cardiac Events in Patients With Heart Failure: A Retrospective Chart Review. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:60-67. [PMID: 38311228 DOI: 10.1016/j.anr.2024.01.009] [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: 08/31/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE This study examined the modifiable factors, including nurse-led multidisciplinary education and in/out-of-hospital rehabilitation, to predict cardiac events in patients with heart failure (HF) in South Korea. METHODS A retrospective review of the medical records was conducted using data of patients admitted for HF between June 2021 and April 2022. A total of 342 patients were included in this study. Information related to HF education, cardiac rehabilitation, and demographic and clinical characteristics were collected. Cardiac events, including emergency department visits, readmissions, and deaths, were defined as a composite of events. After adjusting for covariates, a multivariate Cox proportional hazard regression model was used to explore the association between modifiable factors and cardiac events in patients with HF. RESULTS During the follow-up period (median, 823 days), 123 patients (36.0%) experienced at least one cardiac event. In the Cox regression model, patients who received nurse-led multidisciplinary HF education during hospitalization were less likely to experience cardiac events (hazard ratio: 0.487; 95% confidence interval [CI]:0.239-0.993). Additionally, high NT-pro BNP levels were associated with an increased risk of cardiac events. CONCLUSIONS The education led by nurses on HF was a factor that reduced adverse prognoses in patients with HF. Our results highlight the importance of a nurse-led multidisciplinary approach during hospitalization.
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Affiliation(s)
- Haeng-Mi Son
- Department of Nursing, University of Ulsan, Ulsan, Republic of Korea.
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea.
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Poloczková H, Krejčí J. Heart Failure Treatment in 2023: Is There a Place for Lipid Lowering Therapy? Curr Atheroscler Rep 2023; 25:957-964. [PMID: 38048006 DOI: 10.1007/s11883-023-01166-3] [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] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE OF REVIEW An evidence for lipid lowering therapy in heart failure is briefly summarized in this review. RECENT FINDINGS Heart failure therapy is based on recent guidelines for diagnosis and treatment of acute and chronic heart failure. The question of the importance of hypolipidemic treatment in heart failure remains insufficiently answered. We still rely only on results of two randomized controlled trials that did not show significant benefit of statins on mortality in these patients. In contrast, some meta-analysis, prospective or retrospective cohorts, found some positive effects of this therapy. Recently, the role of inflammation and the possibility of its influence by hypolipidemics have been discussed. PCSK9 inhibitors, new lipid lowering drugs, are very effective in LDL-cholesterol lowering and atherosclerotic cardiovascular diseases prevention. The role of PCSK9 inhibitors in heart failure treatment is investigated. Based on current knowledge, hypolipidemics are not generally recommended in heart failure therapy, unless there is another indication for their use.
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Affiliation(s)
- Hana Poloczková
- Department of Cardiovascular Diseases, St Anne's University Hospital and Masaryk, University Brno, Brno, Czech Republic
| | - Jan Krejčí
- Department of Cardiovascular Diseases, St Anne's University Hospital and Masaryk, University Brno, Brno, Czech Republic.
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Charach L, Grosskopf I, Galin L, Guterman I, Karniel E, Charach G. Low Cholesterol Levels in Younger Heart Failure Patients May Predict Unfavorable Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1314. [PMID: 37512127 PMCID: PMC10384220 DOI: 10.3390/medicina59071314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Hypercholesterolemia is a main risk-factor leading to ischemic heart disease (IHD). However, among patients with heart failure, the use of lipid lowering drugs in the presence of low cholesterol might be dangerous. This 18-year longitudinal study of patients ≤51 years old investigated the relationship between baseline total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triglyceride levels, and survival among patients with severe HF. Materials and Methods: The average NYHA score of 82 patients ≤51 years old with heart failure was 2.61. They were followed for a mean of 11.3 years (15 months-20 years). Total mortality was 22%. Patients were divided into three groups. Group 1 had plasma LDL-c levels ≤ 80 mg/dl, Group 2, 80-115 mg/dl and Group 3 > 115 mg/dl. Results: Patients with the highest baseline total cholesterol, triglyceride and LDL-c levels > 115 mg/dl had a better survival rate (83%) compared to those with LDL-c < 80 mg/dl (50% survival, p = 0.043). The association between higher LDL-c levels and lower mortality was most noticeable among patients with heart failure. Conclusion: Longitudinal follow-up found that low LDL-c levels may indicate poorer prognosis among patient with heart failure who are ≤51 years old, similar to elderly heart failure patients. Cholesterol lowering drugs in younger patients with heart failure may increase mortality.
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Affiliation(s)
- Lior Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Leonid Galin
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Irit Guterman
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eli Karniel
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gideon Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Matsiras D, Bezati S, Ventoulis I, Verras C, Parissis J, Polyzogopoulou E. Gut Failure: A Review of the Pathophysiology and Therapeutic Potentials in the Gut-Heart Axis. J Clin Med 2023; 12:2567. [PMID: 37048650 PMCID: PMC10095379 DOI: 10.3390/jcm12072567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Despite considerable advances in the field, heart failure (HF) still poses a significant disease burden among affected individuals since it continues to cause high morbidity and mortality rates. Inflammation is considered to play a key role in disease progression, but the exact underlying pathophysiological mechanisms involved have not yet been fully elucidated. The gut, as a potential source of inflammation, could feasibly explain the state of low-grade inflammation seen in patients with chronic HF. Several derangements in the composition of the microbiota population, coupled with an imbalance between favorable and harmful metabolites and followed by gut barrier disruption and eventually bacterial translocation, could contribute to cardiac dysfunction and aggravate HF. On the other hand, HF-associated congestion and hypoperfusion alters intestinal function, thereby creating a vicious cycle. Based on this evidence, novel pharmaceutical agents have been developed and their potential therapeutic use has been tested in both animal and human subjects. The ultimate goal in these efforts is to reverse the aforementioned intestinal derangements and block the inflammation cascade. This review summarizes the gut-related causative pathways implicated in HF pathophysiology, as well as the associated therapeutic interventions described in the literature.
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Affiliation(s)
- Dionysis Matsiras
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
- Emergency Medicine Department, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, 12462 Athens, Greece
- Emergency Medicine Department, National and Kapodistrian University of Athens, 15772 Athens, Greece
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Teis A, Castelblanco E, Cediel G, Amigó N, Julve J, Ribalta J, Guardiola M, Franch J, Bermúdez-López M, Codina P, Lupón J, Mauricio D, Alonso N, Bayés-Genís A. 1H-magnetic resonance spectroscopy lipoprotein profile in patients with chronic heart failure versus matched controls. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:864-873. [PMID: 34716123 DOI: 10.1016/j.rec.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Advanced lipoprotein phenotyping is a better predictor of atherosclerotic cardiovascular risk than cholesterol concentration alone. Lipoprotein profiling in heart failure (HF) is incompletely characterized. We aimed to describe the lipoprotein profile in patients with chronic HF compared with a matched control population. METHODS This cross-sectional study was performed from May 2006 to April 2014 and included ambulatory patients with chronic HF. Lipid concentrations and the size of main lipoprotein fractions (high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very low-density lipoprotein) and the particle concentration of their 3 subfractions (large, medium and small) were assessed using 1H magnetic resonance spectroscopy. RESULTS The 429 included patients with chronic HF were compared with 428 matched controls. Patients with chronic HF had lower total cholesterol and lower mean LDL (1115 vs 1352 nmol/L; P<.001) and HDL (25.7 vs 27.9μmol/L; P <.001) particle concentrations, with this last difference being mediated by a significantly lower concentration of the small subfraction of HDL (15.2 vs 18.6μmol/L; P <.001). Mean very low-density lipoprotein, LDL, and HDL particle size was significantly higher in patients with HF vs controls. All HDL-related differences from controls persisted after adjustment for New York Heart Association functional class or body mass index. We found strong negative correlations of known cardiac biomarkers (N-terminal pro-brain natriuretic peptide and interleukin-1 receptor-like 1) with total and small LDL and HDL fractions and HDL particle size. CONCLUSIONS Patients with chronic HF significantly differ in their lipoprotein profile compared with unaffected controls. Further research is needed to better understand the pathogenic relevance of this difference.
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Affiliation(s)
- Albert Teis
- Institut del Cor, Departament de Cardiologia, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esmeralda Castelblanco
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Institut de Recerca i d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Departament d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Germán Cediel
- Institut del Cor, Departament de Cardiologia, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut del Cor, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain
| | - Nuria Amigó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Biosfer Teslab SL, Reus, Tarragona, Spain; Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Josep Julve
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Institut de Recerca i d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Josep Ribalta
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Unitat de Recerca en Lípids i Aterosclerosi, Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Montse Guardiola
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Unitat de Recerca en Lípids i Aterosclerosi, Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Tarragona, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Josep Franch
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; DAP-Cat Group, Unitat de Suport a la Recerca, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi i Gurina (IDIAPJGol), Barcelona, Spain
| | - Marcelino Bermúdez-López
- Grupo Investigación Translacional Vascular y Renal, IRBLleida, Red de Investigación Renal (RedInRen-ISCIII), Lleida, Spain
| | - Pau Codina
- Institut del Cor, Departament de Cardiologia, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Institut del Cor, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain
| | - Josep Lupón
- Institut del Cor, Departament de Cardiologia, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Institut del Cor, Unitat d'Insuficiència Cardiaca, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Dídac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Institut de Recerca i d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; Institut de Recerca Biomèdica de Lleida Dr. Pifarré (IRB Lleida), Universitat de Lleida, Lleida, Spain
| | - Nuria Alonso
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain; Departament d'Endocrinologia i Nutrició, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain.
| | - Antoni Bayés-Genís
- Institut del Cor, Departament de Cardiologia, Hospital Universitari Germans Trias, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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The prognostic impact of magnesium in acute heart failure is different according to the presence of diabetes mellitus. Porto Biomed J 2022; 7:e197. [PMID: 37152077 PMCID: PMC10158881 DOI: 10.1097/j.pbj.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Hypermagnesemia predicts mortality in chronic heart failure (HF); however, in acute HF, magnesium does not seem to be outcome-associated. Diabetes mellitus (DM) frequently associates with altered magnesium status. We hypothesized that DM might influence the prognostic impact of magnesium in acute HF. Methods This is a retrospective cohort study of hospitalized patients with acute HF. Patients without data on admission serum magnesium were excluded. Follow-up: 1 year from hospital admission. Primary end point: all-cause mortality. Patients were divided according to median serum magnesium (1.64 mEq/L). The Kaplan-Meier survival method was used to determine survival curves according to magnesium levels. The analysis was stratified according to the presence of DM. A multivariable Cox regression analysis was used to study the prognostic impact of magnesium. Results We studied 606 patients. The mean age was 76 ± 12 years, 44.1% were male, 50.7% had DM, and 232 (38.3%) died during follow-up. Median magnesium was 1.64 (1.48-1.79) mEq/L. Patients with magnesium ≥1.64 mEq/L had higher 1-year mortality [141 (46.4%) vs 91 (30.1%), P < .001]. After adjustments for age, sex, history of atrial fibrillation, systolic blood pressure, heart rate, ischemic etiology, B-type natriuretic peptide, estimated glomerular filtration rate, alcohol consumption, antihyperglycaemic agents or glycated hemoglobin, admission glycemia, New York Heart Association class IV, and severe left ventricle systolic dysfunction, serum magnesium ≥1.64 mEq/L was associated with higher mortality only in patients with DM: HR 1.89 (95% confidence interval: 1.19-3.00), P = .007, and 1.27 (95% confidence interval: 0.83-1.94) and P = .26 for non-DM patients. The results were similar if magnesium was analyzed as a continuous variable. Per 0.1 mEq/L increase in magnesium levels, patients with DM had 13% increased risk of 1-year mortality. Conclusions Higher magnesium levels were associated with worse prognosis only in HF patients with DM.
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Chung SM, Lee JI, Han E, Seo HA, Jeon E, Kim HS, Yoon JS. Association between the Diabetes Drug Cost and Cardiovascular Events and Death in Korea: A National Health Insurance Service Database Analysis. Endocrinol Metab (Seoul) 2022; 37:759-769. [PMID: 36195551 PMCID: PMC9633219 DOI: 10.3803/enm.2022.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGRUOUND This study aimed to investigate the long-term effects of diabetes drug costs on cardiovascular (CV) events and death. METHODS This retrospective observational study used data from 2009 to 2018 from the National Health Insurance in Korea. Among the patients with type 2 diabetes, those taking antidiabetic drugs and who did not have CV events until 2009 were included. Patients were divided into quartiles (Q1 [lowest]-4 [highest]) according to the 2009 diabetes drug cost. In addition, the 10-year incidences of CV events (non-fatal myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization) and CV death (death due to CV events) were analyzed. RESULTS A total of 441,914 participants were enrolled (median age, 60 years; men, 57%). CV events and death occurred in 28.1% and 8.36% of the patients, respectively. The 10-year incidences of CV events and deaths increased from Q1 to 4. After adjusting for sex, age, income, type of diabetes drugs, comorbidities, and smoking and drinking status, the risk of CV events significantly increased according to the sequential order of the cost quartiles. In contrast, the risk of CV death showed a U-shaped pattern, which was the lowest in Q3 (hazard ratio [HR], 0.953; 95% confidence interval [CI], 0.913 to 0.995) and the highest in Q4 (HR, 1.266; 95% CI, 1.213 to 1.321). CONCLUSION Diabetes drug expenditure affects 10-year CV events and mortality. Therefore, affording an appropriate diabetes drug cost at a similar risk of CV is an independent protective factor against CV death.
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Affiliation(s)
- Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji-In Lee
- Research Institute of The Way Healthcare, Seoul, Korea
| | - Eugene Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun-Ae Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Eonju Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hye Soon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Ji Sung Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- Corresponding author: Ji Sung Yoon. Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4049, Fax: +82-53-654-8386, E-mail:
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Yu W, Dujiang X, Yi W, Guanwen D, Mengyu Z, Chang P, Aikai Z, Juan Z, Linlin Z, Hang Z. Apolipoprotein A1 is associated with pulmonary vascular resistance and adverse clinical outcomes in patients with pulmonary hypertension secondary to heart failure. Pulm Circ 2022; 12:e12096. [PMID: 35911182 PMCID: PMC9326519 DOI: 10.1002/pul2.12096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary hypertension secondary to heart failure (HF-PH) combined with pulmonary vascular remodeling has a high mortality rate. Apolipoprotein A1 (ApoA1) has been shown to adversely affect outcomes in patients with HF. A prospective follow-up study was performed on 239 consecutive patients with HF-PH who underwent right heart catheterization. Proteomics technology was used to analyze different proteins in plasma between post- and precapillary pulmonary hypertension (CpcPH) and isolated postcapillary pulmonary hypertension (IpcPH) filtered by propensity score matching. Ultimately, 175 patients were enrolled and followed for an average of 4.4 years. Lipoprotein components in plasma were measured, and the following clinical events were tracked. Proteomics data showed that lipid metabolism and inflammation were different between CpcPH and IpcPH. ApoA1 levels in HF-PH patients with CpcPH were lower than those in HF-PH patients with IpcPH. The patients with lower ApoA1 levels (≤1.025 g/L) were in a higher New York Heart Association class and had high levels of NT-proBNP, mean pulmonary artery pressure, PVR, and diastolic pressure gradient. Besides, HF-PH patients with lower ApoA1 levels had a 2.836-fold higher relative risk of comorbid CpcPH compared with patients with higher ApoA1 levels. Moreover, patients with lower ApoA1 levels had a lower survival rate after adjusting for CpcPH. In conclusion, ApoA1 levels were negatively correlated with PVR levels. Lower ApoA1 levels were an independent risk factor for pulmonary vascular remodeling in HF-PH patients. The survival of HF-PH patients with lower ApoA1 levels was reduced.
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Affiliation(s)
- Wande Yu
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Xie Dujiang
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Wang Yi
- Division of CardiologyNanjing Medical UniversityNanjingChina
| | - Ding Guanwen
- Department of BiologyNanjing Foreign Language SchoolNanjingChina
| | - Zhang Mengyu
- Division of CardiologyNanjing Medical UniversityNanjingChina
| | - Pan Chang
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zhang Aikai
- Division of CardiologyNanjing Medical UniversityNanjingChina
| | - Zhang Juan
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zhu Linlin
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zhang Hang
- Division of Cardiology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
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Perfil lipoproteico por espectroscopia nuclear magnética en pacientes con insuficiencia cardiaca crónica comparado con controles apareados. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Teis A, Cediel G, Amigó N, Julve J, Aranyó J, Andrés-Cordón J, Puig-Jové C, Castelblanco E, Gual-Capllonch F, Ferrer-Sistach E, Vallejo N, Juncà G, López-Ayerbe J, De Antonio M, Domingo M, Santiago-Vacas E, Codina P, Mauricio D, Lupón J, Alonso N, Bayes-Genis A. Particle size and cholesterol content of circulating HDL correlate with cardiovascular death in chronic heart failure. Sci Rep 2021; 11:3141. [PMID: 33542459 PMCID: PMC7862293 DOI: 10.1038/s41598-021-82861-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Evidence regarding any association of HDL-particle (HDL-P) derangements and HDL-cholesterol content with cardiovascular (CV) death in chronic heart failure (HF) is lacking. To investigate the prognostic value of HDL-P size (HDL-Sz) and the number of cholesterol molecules per HDL-P for CV death in HF patients. Outpatient chronic HF patients were enrolled. Baseline HDL-P number, subfractions and HDL-Sz were measured using 1H-NMR spectroscopy. The HDL-C/P ratio was calculated as HDL-cholesterol over HDL-P. Endpoint was CV death, with non-CV death as the competing event. 422 patients were included and followed-up during a median of 4.1 (0–8) years. CV death occurred in 120 (30.5%) patients. Mean HDL-Sz was higher in CV dead as compared with survivors (8.39 nm vs. 8.31 nm, p < 0.001). This change in size was due to a reduction in the percentage of small HDL-P (54.6% vs. 60% for CV-death vs. alive; p < 0.001). HDL-C/P ratio was higher in the CV-death group (51.0 vs. 48.3, p < 0.001). HDL-Sz and HDL-C/P ratio were significantly associated with CV death after multivariable regression analysis (HR 1.22 [95% CI 1.01–1.47], p = 0.041 and HR 1.04 [95% CI 1.01–1.07], p = 0.008 respectively). HDL-Sz and HDL-C/P ratio are independent predictors of CV death in chronic HF patients.
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Affiliation(s)
- Albert Teis
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain. .,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
| | - G Cediel
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - N Amigó
- Biosfer Teslab, SL, Reus, Spain.,Metabolomics Platform, Rovira i Virgili University (URV), Instituto de Investigación Sanitaria Pere Virigili (IISPV), Tarragona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
| | - J Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - J Aranyó
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - J Andrés-Cordón
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - C Puig-Jové
- Endocrinology and Nutrition Department, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - E Castelblanco
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - F Gual-Capllonch
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - E Ferrer-Sistach
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - N Vallejo
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - G Juncà
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - J López-Ayerbe
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - M De Antonio
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - M Domingo
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - E Santiago-Vacas
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - P Codina
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - D Mauricio
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau i Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.,Endocrinology and Nutrition Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Lleida Biomedical Research Institute's Dr. Pifarré Foundation (IRBLleida), University of Lleida, Lleida, Spain
| | - J Lupón
- Heart Institute, Heart Failure Unit, Germans Trias University Hospital, Badalona, Barcelona, Spain
| | - Nuria Alonso
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. .,Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain. .,Endocrinology and Nutrition Department, Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - A Bayes-Genis
- Heart Institute, Cardiology Department, Germans Trias University Hospital, Carretera de Canyet s/n, 08916, Badalona, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,Centre for Biomedical Research on cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, Barcelona, Spain
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12
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Jędrychowska M, Januszek R, Wańha W, Malinowski KP, Kunik P, Trznadel A, Bartuś J, Staszczak B, Januszek SM, Kameczura T, Wojakowski W, Surdacki A, Bartuś S. Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E432. [PMID: 32867290 PMCID: PMC7557849 DOI: 10.3390/medicina56090432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives: A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). Thus, the aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis. Materials and Methods: We selected 337 consecutive patients admitted to hospital with a working diagnosis of MINOCA. The patients were divided in three groups according to the extent of hs-TnI increase during hospitalization (increase ≤5-times above the limit of the upper norm, >5 and ≤20-times, and >20-times). The study endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; cerebral stroke and transient ischemic attacks, MI, coronary artery revascularization, either percutaneous coronary intervention or coronary artery bypass grafting and all-cause mortality). Results: During the mean follow-up period of 516.1 ± 239.8 days, using Kaplan-Meier survival curve analysis, significantly higher mortality rates were demonstrated among patients from the group with the greatest hs-TnI increase compared to the remaining groups (p = 0.01) and borderline values for MACCE (p = 0.053). Multivariable cox regression analysis did not confirm hs-TnI among factors related to increased MACCE or all-cause mortality rates. Conclusion: While a relationship between clinical outcomes and the extent of the hs-TnI increase among patients with a MINOCA working diagnosis remains, it does not seem to be not as strong as it is in patients with obstructive coronary atherosclerosis.
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Affiliation(s)
- Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland;
| | - Rafał Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland;
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Kraków, Poland;
| | - Piotr Kunik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Agata Trznadel
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Joanna Bartuś
- Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland;
| | | | | | - Tomasz Kameczura
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, 35-310 Rzeszow, Poland;
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland; (W.W.); (P.K.); (A.T.); (W.W.)
| | - Andrzej Surdacki
- Department of Cardiology, Jagiellonian University Medical College, 40-055 Kraków, Poland; (A.S.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 40-055 Kraków, Poland
| | - Stanisław Bartuś
- Department of Cardiology, Jagiellonian University Medical College, 40-055 Kraków, Poland; (A.S.); (S.B.)
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 40-055 Kraków, Poland
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13
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Sia CH, Zheng H, Ho AFW, Bulluck H, Chong J, Foo D, Foo LL, Lim PZY, Liew BW, Tan HC, Yeo TC, Chua TSJ, Chan MYY, Hausenloy DJ. The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients: Insights from the Singapore Myocardial Infarction Registry. Sci Rep 2020; 10:6799. [PMID: 32321961 PMCID: PMC7176706 DOI: 10.1038/s41598-020-63825-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/06/2020] [Indexed: 12/12/2022] Open
Abstract
Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the 'lipid paradox'. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008-2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huili Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | | | - Jun Chong
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - David Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling-Li Foo
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | | | | | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Derek J Hausenloy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Cardiovascular & Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore.
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom.
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan.
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14
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Sharma V, Sharma V, Khan A, Wassmer DJ, Schoenholtz MD, Hontecillas R, Bassaganya-Riera J, Zand R, Abedi V. Malnutrition, Health and the Role of Machine Learning in Clinical Setting. Front Nutr 2020; 7:44. [PMID: 32351968 PMCID: PMC7174626 DOI: 10.3389/fnut.2020.00044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Nutrition plays a vital role in health and the recovery process. Deficiencies in macronutrients and micronutrients can impact the development and progression of various disorders. However, malnutrition screening tools and their utility in the clinical setting remain largely understudied. In this study, we summarize the importance of nutritional adequacy and its association with neurological, cardiovascular, and immune-related disorders. We also examine general and specific malnutrition assessment tools utilized in healthcare settings. Since the implementation of the screening process in 2016, malnutrition data from hospitalized patients in the Geisinger Health System is presented and discussed as a case study. Clinical data from five Geisinger hospitals shows that ~10% of all admitted patients are acknowledged for having some form of nutritional deficiency, from which about 60-80% of the patients are targeted for a more comprehensive assessment. Finally, we conclude that with a reflection on how technological advances, specifically machine learning-based algorithms, can be integrated into electronic health records to provide decision support system to care providers in the identification and management of patients at higher risk of malnutrition.
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Affiliation(s)
- Vaibhav Sharma
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Vishakha Sharma
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Ayesha Khan
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - David J. Wassmer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | | | | | | | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States
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15
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Cunha FM, Pereira J, Ribeiro A, Silva S, Araújo JP, Leite-Moreira A, Bettencourt P, Lourenço P. The cholesterol paradox may be attenuated in heart failure patients with diabetes. Minerva Med 2019; 110:507-514. [PMID: 31638359 DOI: 10.23736/s0026-4806.19.06067-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In heart failure (HF) patients, a lower total cholesterol (TC) appears to portend an ominous prognosis. We studied if the prognostic impact of TC was different according to diabetes mellitus (DM) status in a chronic HF population. METHODS Patients with systolic HF under optimized and stable evidence-based therapy were prospectively recruited from our HF clinic. We excluded patients on renal replacement therapy and those hospitalized in the previous 2 months. A venous blood sample was collected. Patients were followed for up to 5 years and all-cause mortality was the endpoint under analysis. The prognostic impact of TC was analyzed using a Cox-regression analysis. Analysis was stratified according to coexistence of DM. RESULTS We studied 262 chronic HF patients, 182 males, mean age 69 years, 98 (37.4%) diabetic and 62.2% with severe left ventricular systolic dysfunction. Median B-type natriuretic peptide: 237.8 pg/mL; median TC: 169 mg/dL. During follow-up 121 (46.2%) patients died. Patients with TC>200 mg/dL had better survival than those with lower TC; however, this protective effect was mostly observed in non-diabetic HF patients. In non-diabetics the multivariate adjusted 5-year mortality hazard ratio (HR) was 0.36 (95% CI: 0.16-0.79) for those with TC>200 mg/dL. In diabetic HF patients, there was a non-significant survival benefit of TC>200 mg/dL; HR 0.51 (95% CI: 0.20-1.30). CONCLUSIONS Non-diabetic chronic HF patients with TC>200 mg/dL have a 64% lower risk of 5-year death. In diabetics, there is a non-significant 49% protective effect of elevated TC. The cholesterol paradox may be attenuated in diabetic HF patients.
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Affiliation(s)
- Filipe M Cunha
- Department of Endocrinology, Tâmega e Sousa Hospital, Penafiel, Portugal -
| | - Joana Pereira
- Department of Internal Medicine, São João Hospital, Porto, Portugal
| | - Ana Ribeiro
- Department of Internal Medicine, São João Hospital, Porto, Portugal
| | - Sérgio Silva
- Department of Internal Medicine, Trofa Saúde Hospital, Gaia, Portugal
| | - José P Araújo
- Department of Internal Medicine, São João Hospital, Porto, Portugal.,Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Heart Failure Clinic, São João Hospital, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, São João Hospital, Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Service of Internal Medicine, CUF Porto Hospital, Porto, Portugal
| | - Patrícia Lourenço
- Department of Internal Medicine, São João Hospital, Porto, Portugal.,Cardiovascular R&D Center (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal.,Internal Medicine Heart Failure Clinic, São João Hospital, Porto, Portugal
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16
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Radulović B, Potočnjak I, Dokoza Terešak S, Trbušić M, Vrkić N, Huršidić Radulović A, Starčević N, Milošević M, Degoricija V, Frank S. CHOLESTEROL AND CHLORIDE IN ACUTE HEART FAILURE. Acta Clin Croat 2019; 58:195-201. [PMID: 31819314 PMCID: PMC6884370 DOI: 10.20471/acc.2019.58.02.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/20/2018] [Indexed: 01/10/2023] Open
Abstract
Detecting predictors of poor outcome is crucial for understanding the underlying pathophysiology of heart failure (HF) and thus creating new therapeutic concepts. It is well established that low serum lipid levels are associated with unfavorable outcomes in HF patients. Several studies examined the association between serum lipids and established predictors of mortality in HF patients. The aim of the present study was to examine the association of serum lipid and chloride concentrations, as well as their impact on survival in acute heart failure (AHF). The present study was performed as a prospective, single-centre, observational research. The study included 152 patients with AHF. Spearman's correlation coefficient revealed a significant positive correlation of serum chloride levels with serum levels of total cholesterol (ρ 0.221, p=0.006), low-density lipoprotein cholesterol (LDL-c) (ρ 0.187, p=0.015) and high-density lipoprotein-cholesterol (HDL-c) (ρ 0.169, p=0.038). Binary logistic regression revealed a significant association of chloride, total cholesterol and LDL-c serum levels measured at admission with hospital survival (OR 1.077, CI 1.01-1.154, p=0.034), (OR 1.731, CI 1.090-2.748, p=0.020) and (OR 1.839, CI 1.033-3.274, p=0.038), respectively, as well as with 3-month survival (OR 1.065, CI 1.002-1.131, p=0.042), (OR 1.625, CI 1.147-2.303, p=0.006) and (OR 1.711, CI 1.117-2.622, p=0.014), respectively. In conclusion, positive statistical association between serum cholesterol (total cholesterol, LDL-c and HDL-c) and chloride levels may suggest their similar modulation by AHF pathophysiology. Serum levels of total cholesterol, LDL-c and chloride contribute to patient survival.
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17
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Cheng PC, Hsu SR, Li JC, Chen CP, Chien SC, Tu ST, Cheng YC, Liu YH, Kuo JF. Plasma Low-Density Lipoprotein Cholesterol Correlates With Heart Function in Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2019; 10:234. [PMID: 31031709 PMCID: PMC6470411 DOI: 10.3389/fendo.2019.00234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Heart failure is a frequent complication of type 2 diabetes mellitus (T2DM). Plasma cholesterol, particularly the proatherogenic low-density lipoprotein (LDL) cholesterol, impairs heart function by promoting atheroma formation and ventricular dysfunction. Considering the established effect of cholesterol on the cardiovascular system, we hypothesized that plasma LDL cholesterol may influence left ventricular function in individuals with T2DM. Methods: This cross-sectional study was conducted at a tertiary care hospital in Taiwan. Enrollment criteria were patients exceeding 21 years of age with T2DM who received antidiabetic and cholesterol-lowering medications. Candidates were excluded if they had heart failure, acute cardiovascular events, or familial hypercholesterolemia. Participants received blood sampling for plasma lipids after a 12-h fast, followed by transthoracic echocardiography in the cardiology clinic. Results: The study enrolled 118 participants who were divided into two groups according to their plasma LDL cholesterol levels. Demographic characteristics including age (69.7 vs. 66.9 years, P = 0.159), body mass index (26.2 vs. 25.9 kg/m2, P = 0.66), diabetes duration (5.4 vs. 5.1 years, P = 0.48), hemoglobin A1c (7.2 vs. 7.5%, P = 0.225), and systolic blood pressure (129 vs. 130 mm Hg, P = 0.735) were similar between these groups. Moreover, all participants received similar antihypertensive medications. Participants with lower plasma LDL cholesterol levels had better heart function, as measured by the left ventricular ejection fraction (LVEF), than patients with higher LDL cholesterol levels (58.0 vs. 50.5%, P = 0.022). Multivariate regression analysis also showed an inverse correlation between plasma LDL cholesterol and left ventricular function (β coefficient: -0.110, P = 0.024). Conclusion: This study observed an inverse correlation between plasma LDL cholesterol and heart function in individuals with T2DM. Patients with higher levels of plasma LDL cholesterol had worse left ventricular function. Therefore, plasma LDL cholesterol may be a modifiable risk factor of heart failure in diabetes, but prospective studies are necessary to confirm this finding.
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Affiliation(s)
- Po-Chung Cheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shang-Ren Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jung-Chi Li
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Pei Chen
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Szu-Chi Chien
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shih-Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsiu Liu
- Department of Accounting and Information Systems, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Jeng-Fu Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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18
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The "cholesterol paradox" among inpatients - retrospective analysis of medical documentation. ACTA ACUST UNITED AC 2018; 3:e46-e57. [PMID: 30775589 PMCID: PMC6374572 DOI: 10.5114/amsad.2018.74736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/11/2018] [Indexed: 12/03/2022]
Abstract
Introduction There is evidence of positive relationships between cholesterol concentration and risk of cardiovascular diseases. However, higher mortality in patients with a low cholesterol level has been reported (the “cholesterol paradox”). Material and methods Medical records of 34 191 inpatients between 2014 and 2016 were reviewed and the relationships between total (TC), low-density lipoprotein (LDL-C) and high-density lipoprotein (HDL-C) cholesterol and triglyceride blood concentrations and all-cause in-hospital death and readmission within 14 and 30 days and 1 year were determined in univariate and multivariate analyses. Results Patients with TC in the lower quartile and LDL-C < 70 mg/dl had greater risk of the outcomes measured than individuals with a TC level in the remaining quartiles and LDL-C ≥ 70 mg/dl. Moreover, patients with TC in the highest quartile, OR (95% CI): 0.36 (0.13–0.99), p < 0.05, and LDL-C ≥ 115 mg/dl, OR (95% CI): 0.53 (0.37–0.77), p < 0.05, had the lowest all-cause in-hospital mortality. However, multivariate analysis using logistic regression and a Cox proportional hazard model showed no significant influence of blood lipid levels on the occurrence of the outcomes measured. Conclusions A significant effect of a “cholesterol paradox” linking better prognosis with higher blood lipid concentration was found only in univariate analysis but, after adjustment for clinical characteristics in multivariate analysis, the plasma lipid level had a neutral influence on the occurrence of the measured outcomes. This suggests that a low cholesterol level should be interpreted as a biomarker of illness severity.
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Konishi M, von Haehling S. The need for re-defining cut-off values in heart failure: From obesity to iron deficiency. Exp Gerontol 2017; 87:1-7. [DOI: 10.1016/j.exger.2016.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 10/15/2016] [Accepted: 10/26/2016] [Indexed: 01/09/2023]
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Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence. J Cardiol 2016; 69:719-730. [PMID: 27520756 DOI: 10.1016/j.jjcc.2016.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a well-known atherosclerosis risk factor; however, its role and the importance of undernutrition in atrial fibrillation (AF) pathogenesis are still not well understood. The aim of this study was to present the current state of knowledge on this issue in different groups of patients. METHODS Systematic review of papers published between 1980 and 2016. RESULTS The literature shows contradicting views regarding the impact of nutritional status on the risk, course, and complications of AF. On the one hand, it has been revealed that overweight, obesity, and high birth mass increase the risk of AF, and that their reduction is linked to an improved course of AF and reduced all-cause and cardiovascular mortality. On the other hand, a so-called obesity paradox has been found, which shows lower all-cause mortality in overweight patients with AF compared to those of normal weight or who are underweight. It has also been shown, although based on a small number of studies, that the relationship between nutritional status and risk of AF and its complication may be U-shaped, which means that not only patients with obesity, but also individuals with underweight, cachexia, and low birth weight may have an increased risk and poor outcome of AF. CONCLUSIONS The relationship between patients' nutritional status and the course of AF has become clearer but it requires further studies examining the importance of weight reduction on AF course.
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Gombos T, Förhécz Z, Pozsonyi Z, Jánoskuti L, Prohászka Z, Karádi I. Long-Term Survival and Apolipoprotein A1 Level in Chronic Heart Failure: Interaction With Tumor Necrosis Factor α -308 G/A Polymorphism. J Card Fail 2016; 23:113-120. [PMID: 27317841 DOI: 10.1016/j.cardfail.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Apolipoprotein A1 (ApoA1), a major constituent of high-density lipoprotein (HDL), has antiinflammatory and antioxidative properties and plays a prognostic role in chronic heart failure (CHF). Despite increased tumor necrosis factor α (TNFα) levels being linked to worse outcome of HF, the results are ambiguous about the association of functionally active 308 promoter polymorphism of the TNFα gene. The aims of our study were to investigate the association of ApoA1 and TNFα levels with mortality and to evaluate potential interaction between these factors and TNFα -308 polymorphism. METHODS Together with several parameters ApoA1, TNFα levels and TNFα-308 polymorphism were determined in a cohort of 195 patients with CHF who were followed for 5 years. RESULTS Low ApoA1 and high TNFα levels were associated with more severe disease, and ApoA1 showed the strongest relationship with HDL, total cholesterol, C-reactive protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). TNFα -308 A carriers had significantly higher ApoA1 levels than wild-type (GG) patients (1.41 ± 0.268 vs 1.29 ± 0.324 g/L; P = .007), whereas levels of TNFα were the same in these groups. Decreased ApoA1 levels were significant predictors of 5-year mortality (NT-proBNP-adjusted HR for 1 decile decrease in ApoA1 level was 1.10 (P = .011). Interaction was found between the ApoA1 level and TNFα -308 polymorphism, because in patients with GG haplotype the adverse effect of low ApoA1 level on survival was more prevalent. CONCLUSIONS Lower ApoA1 levels were strongly associated with adverse outcome in CHF patients in a TNFα -308 polymorphism dependent manner. These observations support the complex involvement of malnutrition and inflammation in the pathogenesis of CHF.
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Affiliation(s)
- Tímea Gombos
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
| | - Zsolt Förhécz
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Pozsonyi
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Lívia Jánoskuti
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Prohászka
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - István Karádi
- IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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O'Brien EC, Thomas LE. Untangling the paradox: Obesity as prognostic marker in prevalent cardiovascular disease. Am Heart J 2016; 172:170-2. [PMID: 26856229 DOI: 10.1016/j.ahj.2015.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/21/2022]
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Zhang J, Chen L, Delzell E, Muntner P, Hillegass WB, Safford MM, Millan IYN, Crowson CS, Curtis JR. Republished: The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Postgrad Med J 2015; 90:722-9. [PMID: 25431465 DOI: 10.1136/postgradmedj-2013-204715rep] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. METHODS We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. RESULTS We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. CONCLUSIONS This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.
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Affiliation(s)
- Jie Zhang
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lang Chen
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William B Hillegass
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Iris Yolanda Navarro Millan
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ribeiro A, Lourenço P, Silva S, Cunha F, Vilaça J, Gomes F, Araújo JP, Bettencourt P. Predictors of natriuretic peptide non-response in patients hospitalized with acute heart failure. Am J Cardiol 2015; 115:69-74. [PMID: 25456879 DOI: 10.1016/j.amjcard.2014.09.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/20/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
Increasing natriuretic peptide (NP) levels are associated with worse heart failure (HF) outcomes. Predictors of NP nonresponse have not been studied. The aim of this study was to identify predictors of nondecreasing NP levels during episodes of acute HF. A retrospective analysis was conducted in patients prospectively included in a registry of acute HF, with the primary diagnosis of acute HF. The objective under analysis was B-type NP (BNP) response, defined as a >30% decrease in BNP during hospitalization. Percentage of BNP variation was calculated as: % BNP variation = [(admission BNP - discharge BNP)/admission BNP] × 100. A logistic regression analysis was performed to study potential predictors of NP nonresponse. A multivariate model was built. A total of 496 patients were studied: 28.2% were considered nonresponders to the implemented HF treatment strategy. Identified predictors of nonresponse were older age, chronic HF, lower admission systolic blood pressure, anemia, renal dysfunction, and lower sodium on admission, as well as lower admission albumin and lower admission total cholesterol. Admission BNP was not a predictor of response. The only identified independent predictor of nonresponse was a low admission total cholesterol level (cutoff 125 mg/dl), with an odds ratio of 2.55 (95% confidence interval 1.59 to 4.11). This remained valid when the analysis was stratified according to admission BNP (cutoff 2,000 pg/ml) and according to statin use. In conclusion, a low admission total cholesterol level was a strong and independent predictor of BNP nonresponse in patients admitted with acute HF. The ability of cholesterol to predict BNP nonresponse was valid for patients with intrinsically low cholesterol and in those with statin-induced low cholesterol.
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Relationship between lipids levels and right ventricular volume overload in congestive heart failure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:192-9. [PMID: 25278966 PMCID: PMC4178509 DOI: 10.11909/j.issn.1671-5411.2014.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/14/2014] [Accepted: 08/20/2014] [Indexed: 11/21/2022]
Abstract
Background The relationship between lipids and coronary artery disease has been well established. However, this is not the case between lipids and heart failure. Ironically, high lipid levels are associated with better outcomes in heart failure, but the mechanisms underlying the phenomenon are not fully understood. This study was performed to test the hypothesis that reduced intestinal lipid absorption due to venous congestion may lead to low lipid levels. Methods We collected data of clinical characteristics, echocardiograph, and lipid profile in 442 unselected patients with congestive heart failure. Correlations between lipid levels [including total cholesterol (TCL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG)] and right ventricle end diastolic diameter (RVEDD), left ventricle end diastolic diameter (LVEDD), right atrium diameter (RA), left atrium diameter (LA), or left ventricle ejection fraction (LVEF) were analyzed using Pearson correlation and partial correlation. RVEDD, LVEDD, RA, and LA were indexed to the body surface area. Results There was a significantly inverse correlation between TCL levels and RVEDD (r = −0.34, P < 0.001) and RA (r = −0.36, P < 0.001). Other lipids such as LDL-C, HDL-C, and TG had a similar inverse correlation with RVEDD and RA. All these correlations remained unchanged after adjusting for age, gender, smoking status, physical activity levels, comorbidities, and medication use. Conclusions Lipid levels were inversely correlated to RVEDD in patients with congestive heart failure; however, because this was an observational study, further investigation is needed to verify our results as well as identify a causal relationship, if any.
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Zhang J, Chen L, Delzell E, Muntner P, Hillegass WB, Safford MM, Millan IYN, Crowson CS, Curtis JR. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis 2014; 73:1301-8. [PMID: 24796336 DOI: 10.1136/annrheumdis-2013-204715] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. METHODS We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. RESULTS We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. CONCLUSIONS This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.
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Affiliation(s)
- Jie Zhang
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lang Chen
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Delzell
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William B Hillegass
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Monika M Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Iris Yolanda Navarro Millan
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Inglis SC, McMurray JJ, Böhm M, Schaufelberger M, van Veldhuisen DJ, Lindberg M, Dunselman P, Hjalmarson Å, Kjekshus J, Waagstein F, Wedel H, Wikstrand J. Intermittent claudication as a predictor of outcome in patients with ischaemic systolic heart failure: analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). Eur J Heart Fail 2014; 12:698-705. [DOI: 10.1093/eurjhf/hfq070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sally C. Inglis
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; 126 University Place Glasgow G12 8TA UK
- Preventative Health; Baker IDI Heart and Diabetes Institute; Melbourne Australia
| | - John J.V. McMurray
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; 126 University Place Glasgow G12 8TA UK
| | - Michael Böhm
- Department of Internal Medicine, Faculty of Medicine; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Maria Schaufelberger
- Sahlgrenska University Hospital/Östra, Institute of Medicine, Department of Emergency and Cardiovascular medicine, Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | | | | | - Peter Dunselman
- Amphia Hospital; Breda The Netherlands
- Department of Cardiology, Thoraxcenter; University Medical Center; Groningen The Netherlands
| | - Åke Hjalmarson
- Wallenberg Laboratory for Cardiovascular Research; Sahlgrenska Academy, Gothenburg University; Gothenburg Sweden
| | - John Kjekshus
- Department of Cardiology, Rikshospitalet University Hospital; University of Oslo; Norway
| | - Finn Waagstein
- Wallenberg Laboratory for Cardiovascular Research; Sahlgrenska Academy, Gothenburg University; Gothenburg Sweden
| | - Hans Wedel
- Nordic School of Public Health; Göteborg Sweden
| | - John Wikstrand
- Wallenberg Laboratory for Cardiovascular Research; Sahlgrenska Academy, Gothenburg University; Gothenburg Sweden
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Jeong HC, Ahn Y, Park KH, Sim DS, Hong YJ, Kim JH, Jeong MH, Kim YJ, Chae SC, Cho MC, Chae JK, Kim CJ, Rha SW, Jang YS, Oh SK, Seong IW, Cha KS. Effect of Statin Treatment in Patients With Acute Myocardial Infarction and Left Ventricular Systolic Dysfunction According to the Level of High-Sensitivity C-Reactive Protein. Int Heart J 2014; 55:106-12. [DOI: 10.1536/ihj.13-223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sidorov AV, Fateev MM. Changes in lipid spectrum in rats with chronic heart failure of different severity on the background of angiotensin-converting enzyme inhibitors and beta-adrenoblockers. J EVOL BIOCHEM PHYS+ 2013. [DOI: 10.1134/s002209301304004x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Erbano BO, De Souza DC, Koga FB, Guarita-Souza LC, Olandoski M, Faria-Neto JR. Lipid profile and mortality after discharge of patients admitted with decompensated heart failure. Int J Cardiol 2013; 167:1066-8. [DOI: 10.1016/j.ijcard.2012.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 10/28/2012] [Indexed: 11/27/2022]
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Doi T, Nakata T, Hashimoto A, Yuda S, Wakabayashi T, Kouzu H, Kaneko N, Hase M, Tsuchihashi K, Miura T. Cardiac Mortality Assessment Improved by Evaluation of Cardiac Sympathetic Nerve Activity in Combination with Hemoglobin and Kidney Function in Chronic Heart Failure Patients. J Nucl Med 2012; 53:731-40. [DOI: 10.2967/jnumed.111.095786] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Herrmann R, Sandek A, von Haehling S, Doehner W, Schmidt HB, Anker SD, Rauchhaus M. Risk stratification in patients with chronic heart failure based on metabolic-immunological, functional and haemodynamic parameters. Int J Cardiol 2012; 156:62-8. [DOI: 10.1016/j.ijcard.2010.10.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 10/18/2010] [Accepted: 10/23/2010] [Indexed: 11/25/2022]
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Abate E, Sartor R, Ceconi C, Boffa GM. Pharmacological treatment of chronic systolic heart failure: are we scraping the bottom of the barrel? J Cardiovasc Med (Hagerstown) 2011; 11:893-905. [PMID: 20414119 DOI: 10.2459/jcm.0b013e328339d884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Heart failure is a major health problem and its prevalence is growing, primarily as a consequence of the aging of the population. Recently, we have witnessed significant progress in reducing the mortality associated with chronic heart failure due to the introduction of renin-angiotensin-aldosterone system inhibitors, beta-blocking agents and the use of electrical devices. However, the prognosis of heart failure is still so disappointing that it remains the leading cause of death in developed countries. This grim record impels the search for new therapeutic strategies. The objective of this paper is to briefly review the results of some recent trials that have been put in place to test the effects of drugs that are deemed to be potentially capable of improving the prognosis of chronic systolic heart failure patients. Despite compelling theoretical premises, the results to date appear to be weak or even disappointing.
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Affiliation(s)
- Elena Abate
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, via Giustiniani 2, Padua, Italy.
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Peters MJL, Voskuyl AE, Sattar N, Dijkmans BAC, Smulders YM, Nurmohamed MT. The interplay between inflammation, lipids and cardiovascular risk in rheumatoid arthritis: why ratios may be better. Int J Clin Pract 2010; 64:1440-3. [PMID: 20716150 DOI: 10.1111/j.1742-1241.2009.02220.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is abundant evidence that patients with rheumatoid arthritis (RA) are at elevated cardiovascular (CV) risk. The contribution of lipids in general is well recognised, but is as yet unclear in inflammatory diseases such as RA in part because inflammation appears inversely associated with lipid levels in RA. METHODS The CARRE study is a cohort study of 353 randomly selected RA outpatients followed since their enrollment in 2001-2002. We used data from this cohort to (i) evaluate the relationship at baseline between lipid levels [total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol and the TC:HDLc ratio] and inflammation [by means of C-reactive protein (CRP)]; and (ii) determine the association of baseline TC and TC:HDLc ratio with incident (fatal and non-fatal) CV events. RESULTS C-reactive protein correlated negatively with TC (r = -0.184, p = 0.002), more so with HDLc (r = -0.327, p = 0.001) and therefore positively with TC:HDLc ratio (r = 0.204, p = 0.001). These associations were most evident when CRP exceeded 10 mg/l. Furthermore, the TC:HDLc ratio, but not TC, was positively related to event risk, again most marked in those with elevated CRP. CONCLUSION Our observations support use of TC:HDLc ratio rather than TC alone in assessing cardiovascular risk in RA patients, especially in those with high inflammatory activity.
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Affiliation(s)
- M J L Peters
- Clinical Research Bureau of the JBI , The Netherlands
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Peters MJL, Nurmohamed MT, Kitas GD, Sattar N. Statin treatment of rheumatoid arthritis: Comment on the editorial by Ridker and Solomon. ACTA ACUST UNITED AC 2010; 62:302-3. [DOI: 10.1002/art.25054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McMurray JJV, Kjekshus J, Gullestad L, Dunselman P, Hjalmarson A, Wedel H, Lindberg M, Waagstein F, Grande P, Hradec J, Kamenský G, Korewicki J, Kuusi T, Mach F, Ranjith N, Wikstrand J. Effects of statin therapy according to plasma high-sensitivity C-reactive protein concentration in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA): a retrospective analysis. Circulation 2009; 120:2188-96. [PMID: 19917888 DOI: 10.1161/circulationaha.109.849117] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We examined whether the antiinflammatory action of statins may be of benefit in heart failure, a state characterized by inflammation in which low cholesterol is associated with worse outcomes. METHODS AND RESULTS We compared 10 mg rosuvastatin daily with placebo in patients with ischemic systolic heart failure according to baseline high sensitivity-C reactive protein (hs-CRP) <2.0 mg/L (placebo, n=779; rosuvastatin, n=777) or > or = 2.0 mg/L (placebo, n=1694; rosuvastatin, n=1711). The primary outcome was cardiovascular death, myocardial infarction, or stroke. Baseline low-density lipoprotein was the same, and rosuvastatin reduced low-density lipoprotein by 47% in both hs-CRP groups. Median hs-CRP was 1.10 mg/L in the lower and 5.60 mg/L in the higher hs-CRP group, with higher hs-CRP associated with worse outcomes. The change in hs-CRP with rosuvastatin from baseline to 3 months was -6% in the low hs-CRP group (27% with placebo) and -33.3% in the high hs-CRP group (-11.1% with placebo). In the high hs-CRP group, 548 placebo-treated (14.0 per 100 patient-years of follow-up) and 498 rosuvastatin-treated (12.2 per 100 patient-years of follow-up) patients had a primary end point (hazard ratio of placebo to rosuvastatin, 0.87; 95% confidence interval, 0.77 to 0.98; P=0.024). In the low hs-CRP group, 175 placebo-treated (8.9 per 100 patient-years of follow-up) and 188 rosuvastatin-treated (9.8 per 100 patient-years of follow-up) patients experienced this outcome (hazard ratio, 1.09; 95% confidence interval, 0.89 to 1.34; P>0.2; P for interaction=0.062). The numbers of deaths were as follows: 581 placebo-treated (14.1 per 100 patient-years of follow-up) and 532 rosuvastatin-treated (12.6 per 100 patient-years) patients in the high hs-CRP group (hazard ratio, 0.89; 95% confidence interval, 0.79 to 1.00; P=0.050) and 170 placebo-treated (8.3 per 100 patient-years) and 192 rosuvastatin-treated (9.7 per 100 patient-years) patients in the low hs-CRP group (hazard ratio, 1.17; 95% confidence interval, 0.95 to 1.43; P=0.14; P for interaction=0.026). CONCLUSIONS In this retrospective hypothesis-generating study, we found a significant interaction between hs-CRP and the effect of rosuvastatin for most end points whereby rosuvastatin treatment was associated with better outcomes in patients with hs-CRP > or = 2.0 mg/L. CLINICAL TRIAL REGISTRATION INFORMATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00206310.
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Affiliation(s)
- John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
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Affiliation(s)
- Bc Mathew
- Department of Medical Biochemistry, Faculty of Medicine, El Gabal El Gharby University, Gharyan, Libya
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Velavan P, Loh PH, Clark A, Cleland JGF. Is the Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA) the answer to the cholesterol paradox in heart failure? ACTA ACUST UNITED AC 2008; 14:55. [PMID: 18256572 DOI: 10.1111/j.1751-7133.2008.08188.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mathew B, Daniel R. Cholesterol: a Century of Research and Debate. Libyan J Med 2008. [DOI: 10.3402/ljm.v3i2.4757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B.C. Mathew
- Department of Medical Biochemistry, Faculty of Medicine, El Gabal El Gharby University, Gharyan, Libya
| | - R.S. Daniel
- Department of Medical Biochemistry, Faculty of Medicine, El Gabal El Gharby University, Gharyan, Libya
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